Nutrition Informatics – What is it? What does it mean to you? Elaine J. Ayres, MS, RD Deputy Chief, Laboratory for Informatics Development National Institutes of Health, Clinical Center February 23, 2009 University of Maryland 1
Key Topics • • • • •
What is nutrition informatics? Data and information Technology Where is the profession? What are competencies for the field of informatics? 2
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Informatics • Informatics includes the science of information, the practice of information processing, and the engineering of information systems. Informatics studies the structure, algorithms, behavior, and interactions of natural and artificial systems that store, process, access and communicate information. http://en.wikipedia.org/wiki/Informatics 4
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Nutrition Informatics “The effective retrieval, organization, storage and optimum use of information, data and knowledge for food and nutrition related problem solving and decision making. Informatics is supported by the use of information standards, information processes and information technology�. (ADA Nutrition Informatics Work Group, 2007) 6
Nutrition Informatics “The effective retrieval, organization, storage and optimum use of information, data and knowledge for food and nutrition related problem solving and decision making. Informatics is supported by the use of information standards, information processes and information technology�. (ADA Nutrition Informatics Work Group, 2007) 7
Data • Raw information that has not been analyzed or interpreted • Humans and/or computers can process data • Examples: – Weight – Brand of insulin – Grams of carbohydrate in rice 8
Information • Transforming data into information – Analysis – Interpretation – Comparison – Aggregation
• Can be displayed graphically • Humans and/or computers can turn data into information • Weight/insulin/CHO in rice = ? 9
Knowledge • • • • • •
Trends, patterns, context Outcomes Decision support Artificial intelligence Research Humans with computers can efficiently create knowledge 10
Data to Knowledge
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Sources of Data • • • • • •
Printed materials Electronic Verbal Databases Images Signals
How do you organize? The art of information processing… 12
Standards
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Standards • Term (a word) • Terminology (a set of terms) • Multiple terminologies developed to meet specific needs • Unified Medical Language System (UMLS) – SNOMED – LOINC – ICD-9
• Data transmission standards – HL7 14
Standard Hierarchy USDA Database Vegetables Tomato Tomatoes, red, ripe, raw Whole Cherry Italian Plum Other Nutrients 15
Knowledge-Based Terminologies • Defines the relationship between terms rather than just organizing into a hierarchy • Example – Lab test linked to chemical substance measured – Medication linked to chemical substance – Diseases linked to body location
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Knowledge-Based Hierarchy • Includes a traditional hierarchy • Adds concepts such as – Is a ….. – Attributes such as chemical composition – Synonyms
• Each item is a number not a word • Translation tables link numbers in a database 17
Knowledge-Based Hierarchy IS A - VEGETABLE
HAS CHEMICAL STRUCTURE LIKE:
HAS ALLERGAN PROFILE LIKE:
HAS NUTRIENT COMPOSITION LIKE: HAS GENETIC STRUCTURE LIKE:
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Nutrition Resources • Nutrient composition tables • Standardized languages – ADA Standardized language – SNOMED
• Proteomics and genomics data • Chemical composition tables – THINK BOTH WORDS AND NUMBERS!
• Career Tip: Many informaticists have training in information science! 19
Technology
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Hardware
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Look Familiar?
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Applications • Common tools – e-mail, browsers, office management • Query and reporting tools • Statistical analysis • Database management systems • Networking and interfaces • Electronic medical records • Nutrition management systems 23
The Future?
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Health Information Technology Health information technology (HIT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of health IT will: * Improve health care quality; * Prevent medical errors; * Reduce health care costs; * Increase administrative efficiencies; * Decrease paperwork; and * Expand access to affordable care. 1) http://www.dhhs.gov/healthit/ 25
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Interoperable Health IT Interoperable health IT will improve individual patient care, but it will also bring many public health benefits including: * Early detection of infectious disease outbreaks around the country; * Improved tracking of chronic disease management; and * Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared. 1) http://www.dhhs.gov/healthit/ 27
Electronic Health Record The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. The EHR has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface including evidence-based decision support, quality management, and outcomes reporting. 2) http://himss.org/ASP/topics_ehr.asp 28
Electronic Health Record “The Electronic Health Record is the
technology likely to have the most profound effect on the daily work of physicians and other health care providers�.
3) Blumenthal, D, Glaser, JP NEJM 2007 29
Consumer Health IT Health information technologies can be tools that help individuals maintain their health through better management of their health information. Health IT will help consumers gather all of their health information in one place so they can thoroughly understand it and share it securely with their health care providers so they get the care that best fits their individual needs. 1) http://www.dhhs.gov/healthit/ 30
Personal Health Record Personal Health Record (PHR) – a collection of information about an individual’s health and health care, stored in an electronic format. Personal Health Record System – a PHR with computerized tools that help an individual understand and manage the information contained in a PHR. 4) DHHS – Personal Health Records 2006 31
Personal Health Record “ Personal Health Records have the potential to affect the daily lives of patients by involving them more actively in managing their own health�.
3) Blumenthal, D, Glaser, JP NEJM 2007
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State of the Union
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Nutrition Informatics Survey • Electronic survey of all ADA members with valid e-mail (55,063) • Responses – 11,223 (20% response rate) • Included students, interns and retirees • 80% of respondents work in a dietetics related position • 35% work in clinical nutrition • .4% work in informatics 34
Survey continued • Access to a computer/internet – 97.3% have access to a computer at work – 91.5% have access to the internet at work – 1.3% had no access to a computer or the internet at work – 19% use a PDA
• Use of applications – – – –
93% use e-mail daily 86% use the internet daily 50% use clinical nutrition applications daily 45% use some form of electronic health record daily 35
ADA Standardized Language • 44% familiar with ADA standardized language • Using standardized language in practice – 16% using nutrition diagnostic terms – 13% using nutrition intervention terms – 11% using monitoring and evaluation terms
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Practitioner or Informaticist? •
Six areas of practice as defined by ADA: 1. 2. 3. 4. 5. 6.
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Community Nutrition Clinical Nutrition Consultation and Business Practice Food and Nutrition Management Education Research
Is #7 Informaticist? 38
Careers in Informatics
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Informatics Competencies •
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Dietetics – Nutrition science – Food composition – Food service management – Anatomy, physiology, microbiology Information Processing and Knowledge – Information science – Terminology – Evidence-based practice – Biostatistics – Evaluation methodologies Methods of Informatics – Software, hardware and networking – Database systems – Human/computer interactions – Project management Huang, QR Health Informatics J 2007; 13: 89-103
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Nutrition Informatics R.D.’s • • • • •
Learn from other professions Build our own expertise Develop our own programs Measure outcomes and value Do our own research
Be a NIRD !! 41
Rome was not built in a day‌.
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