Nutrition Bytes
June 2021
Christine Manta, MS, RD Sharon Solomon, MHA, RD
DATA
The COVID-19 pandemic has shifted how the health care system functions. To reduce exposure to the virus, there has been an increase in telehealth visits and remote monitoring to keep patients at home rather than coming in person to hospitals or outpatient clinics [1]. To monitor infection rates, there has been an increase in public health surveillance using contract tracing [2]. Any time data is transferred over the Internet, whether from a wearable, a smartphone app for access to electronic medical records, or a telehealth platform, there are cybersecurity risks. As dietitians are increasingly involved in remote patient care or solutions to reduce contact while treating patients, they need to be aware of cybersecurity considerations. Failure to safeguard against security threats poses unnecessary risks to patients, providers and health care systems. This article highlights four common questions about data security with the goal of arming dietitians with fundamental knowledge to be advocates for the safety of their patients, clients and themselves.
A Publication of the Nutrition Informatics Dietetics Practice Group
security in the era of COVID-19
Is there a difference between privacy and security?
Yes - data privacy and data security are different principles. Data privacy, also called data rights and governance, evaluates authorized uses of data [3]. Some systems may authorize data usages by third parties that are not welcomed or unsolicited by the stakeholder. For example, the Facebook and Cambridge Analytica scandal in 2018 was an issue of data rights --- the data sharing was a feature of the Facebook platform, not a hack by a bad actor [4]. Comparatively, security practices evaluate unauthorized uses of data. Cybersecurity involves protecting Internet-connected systems, data, and networks from unauthorized access and attacks [5]. A bad actor exploiting technical vulnerabilities in WiFi or Bluetooth connections or an accidental human error of clicking on malicious links in emails are examples of cybersecurity threats [6]. Information security refers to a discipline within cybersecurity that describes activities to protect systems (i.e. hardware plus an operating system and an application software) and the data stored within the systems [7]. The core risk mitigation principles of information security are Confidentiality, Integrity and Availability or CIA. Confidentiality: keeps data access limited to only authorized users [8]. Integrity: ensures data has not been tampered with so it can be trusted [8].
Availability: maintains networks, systems and applications appropriately for users to perform functions as intended [8]. Why would someone hack a medical device or medical records? There is no obvious financial gain like with credit cards. There are several types of hackers motivated by a variety of reasons. The term “black hat” refers to hackers who exploit security flaws for personal or financial gain, or just to create chaos [9]. The health care sector is certainly not immune to data breaches by bad actors. In 2019, there was a 49% increase in hacking across the health care industry and 41.4 million patient medical records compromised [10]. To date in 2021, the largest reported data breaches in health care include a Washington-based medical practice with more than 200,000 individuals potentially impacted and a Texas based home-health agency where more than 100,000 individuals were potentially impacted [11]. The term “white hat” refers to an ethical style of hacking on mission critical networks [9]. White hat hackers, also called security researchers, report vulnerabilities by following the appropriate policies and then often collaborate with product manufacturers to fix issues. Jay Radliffe is an example of a security researcher who discovered and reported a vulnerability in a medical device [12, 13]. Radcliffe, who has type 1 diabetes, found a flaw in his Johnson & Johnson insulin pump where unencrypted radio frequency communication could allow unauthorized access for an external party to alter insulin dosages with potentially life threatening consequences [14]. Johnson & Johnson was receptive to Radcliffe’s report and worked with him to conduct an investigation with regular updates to physicians, patients and FDA regulators throughout the process. Every year security researchers flock to DEFCON, one of the largest hacking conventions in the world [15]. At the Biohacking Village health care providers, regulators and security researchers converge to discuss the pressing need for cybersecurity considerations in medical products [16]. Through the #WeHeartHackers initiative, the FDA serves as an official partner and regularly attends the conference [17]. The 2020 talks from the Biohacking Village are on YouTube and a great resource for those looking to learn more [18]! Is there a platform or wearable that is “unhackable”? No - if it's connected to the Internet, it can be hacked. Despite best intentions, nothing is 100% protected. Someone can maliciously access the medical or personal data that is stored or transmitted via that product or platform. Health care systems can be vulnerable to three types of attacks: ransomware, phishing and cryptocurrency mining [19]. Ransomware allows hackers to take control of a device and prevent others from accessing or using it until demands are met. A well known example of ransomware is WannaCry, which hit the UK’s National Health Service especially hard in 2017 preventing hospital staff from accessing medical records [20, 21]. Phishing is when hackers use online communication to trick an individual into clicking a link or downloading a file. Unfortunately, the most common security threat is most often accidental human errors. A recent report found that 43% of employees have made a mistake at work, such as clicking on a link in an email, that compromised cybersecurity [22]. A study in JAMA evaluating health care employee susceptibility to phishing attacks, found that almost 1 in 7 simulated emails were clicked on [23]. If a hacker gains access to the email of a health care system employee, data from thousands of patients could be at risk. For example, in April 2020, 78,070 patients’ data was compromised from an email attack at the National Cardiovascular Partners [24]. Cryptocurrency mining is a way of generating cryptocurrency, such as bitcoin. The process requires a large power supply so hackers may gain control of a device and drain batteries, causing malfunction.
Use a password manager. Obtaining passwords is a common way for hackers to gain entry into a system and password managers offer opportunities for increased security [27]. Also don’t answer surveys, reply to Facebook or Instagram posts where the information collected is often the answers to your security questions on websites [28]. Update software regularly [19]. A recent report found that more than 35% of workstations used in health care are operating on unsupported versions of Windows, introducing unnecessary risk [29]. Software updates can correct and mitigate potential security and safety issues more effectively than replacing old hardware [3]. Additionally, ensure anti-malware software is installed and updated. Train staff to recognize phishing as a serious threat, the importance of two-factor authentication for login and to never transfer data to unknown sources [19,23,30] Test your network for vulnerabilities. In penetrating testing, which is required under the HIPAA Security Rule, health care systems can hire a security researcher to break into the network and expose vulnerabilities in a safe manner [19,31]. Partner with your IT department to ensure the following operations are in place to meet HIPAA guidelines: • Security and compliance oversight committee • Formal security assessment process • Security incident response plan • Ongoing user awareness and training • Information classification system • Security policies Take Home Messages There are risks, threats and vulnerabilities in every system. Users themselves are the most common source of risk. At any workspace domain, threats of viruses, malicious code, malware, unauthorized access to IP router, firewall or network appliance operating system can occur. Especially in the work from home lifestyle during the pandemic, remote access vulnerabilities exist from user id and password attacks, unauthorized access and more. Dietitians at any organization can strengthen the security shield by being aware of and avoiding apathy towards policies, monitoring personal devices, and minimizing downloading wrongful information. By being proactive and aware of cybersecurity data risks, dietitians can be leaders in implementing practices to avoid data breaches and protecting patients from unnecessary harm. References for this article are available on the NI DPG website.
Cybersecurity Security Tips and Best Practices
Before recommending a patient use a wearable or medical device, check if the product has a Coordinated Vulnerability Disclosure (CVD), also called a Responsible Disclosure Policy. A CVD, outlines the process, rules of engagement, and expectations for security researchers who find and report potential security issues in good faith [26]. Many consumer-facing companies, like Apple or Fitbit have bug bounty programs as a part of their CVDs that offer financial incentives for finding and reporting issues.
Annual Report
Operating Excess: $6,518 Investment Reserve: $6,627
Web site: ni.eatrightpro.org Twitter: @ni_dpg Instagram: @ni_dpg Facebook: https://www.facebook.com/NIDPG/ LinkedIn: https://www.linkedin.com/company/nutrition-informatics-dpg Email: nutritioninformatics@eatright.org FNCE® 2019 activities: Executive Committee Meeting: 1PM-3PM, Saturday, October 26, 2019 DPG Showcase 9AM-1PM, Monday October 28, 2019 Member Meet Up 5:30PM - 7:30PM, Monday October 28, 2019 Webinars: Nutrition Informatics 360: An Introduction to Nutrition and Health Informatics and Q&A Session with NI DPG Leaders (1 CEU) July 19, 2019 Presenters: Kathleen Pellechia, MS, RDN Ben Atkinson, MS, RD, CD Leslye Rauth, MPH, RDN, CDE, FAND Nutrition Documentation Under the Microscope. Documentation Challenges and ENCPRS (1 CEU) September 17, 2019 Presenters: Sharon Soloman, RD Donna Quirk, MBA, RD, LD Digital Medicine 101: Wearables, Apps, and Interoperability (1 CEU) Presenter: Christine Manta, RD Foodservice Efficiencies Using Informatics Solutions (1 CEU) Presenters: Amy Wootton, RD, LDN Marty Yadrick, MBI, MS, RDN, FAND
Revenue
Expenses
Budget
$5,250
$3,173
Actual
$8,340
$1,822
Financials:
Mission: Empowering members to adopt and embrace informatics, communications, and technology skills to improve patient care and enhance professional practice. Vision: Optimizing nutrition practice using informatics skills. Membership: 522 Active: 426 Students: 58 Associate: 2 International: 9 Life: 6 Retired: 12 Academy staff: 9 Executive Committee: Chair: Kathleen Pellechia, MS, RDN Secretary: Ben Atkinson, MS, RD, CD Treasurer: Leslye Rauth, MPH, RDN, CDE, FAND Nominating Committee Chair: Sue Evanchak, RD, LDN Committees: Advisory Awards Communication Professional Development Membership Executive Committee Meetings: Monthly calls plus 2-hour face to face meeting at FNCE® 2019.
June 1, 2019 - May 31, 2020
Career Corner: Advancing Your Nutrition and Health Informatics Education Moira Cain, RDN Moira Cain, RDN Are you looking to further your career in nutrition informatics? Have you considered completing an informatics degree? While there aren’t nutrition-specific informatics degrees, there are many options for health informatics. Below are several options of certificate and degree programs to grow your informatics skills. Like with accreditation through ACEND, many informatics programs are accredited through Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM), or American Medical Informatics Association (AMIA). There are 26 Masters degree programs that are accredited by CAHIIM which can be found here. Many of the programs are based online, and do not require you to be on campus. A few of the programs include Northeastern, University of Illinois at Chicago and Tufts. AMIA not only accredits programs, but also hosts their Academic and Training Programs - 10x10. These are formal training for biomedical, health and nursing informatics. There are 9 courses each year with five partner universities, which include Oregon Health Sciences University, University of Alabama at Birmingham and Case Western Reserve University. These are all Continuing Education classes and are all online. The Academy of Nutrition and Dietetics has a 5 module certificate on Informatics in Nutrition which can be found in the EatRight Store. Healthcare Information and Management Systems Society (HIMSS) is another society that offers certifications in either associates or professionals in Healthcare Information and Management Systems. The Associate program is for those earlier in their careers, while the Professional certificate is for those who have been working in the field longer. Both certifications require CEU credits before sitting for an exam. More information about each certification can be found at the links. These certification credentials need to be renewed every three years. HIMSS conference for 2020 is online only and can be viewed at any time. It is free if you are a member, but the collection is $199 to non members. The 2021 conference will be in Las Vegas, August 9-13. There are many great program options depending on what you are looking for. Getting started with the certificate from the Academy is a great place to start. You can also receive up to 10 CEU credits if you complete all five modules. Do you completed a program in health informatics that you thought was useful for RDs? Let us know and we can share! Graduate Programs: https://www.northeastern.edu/graduate/program/master-of-science-in-health-informatics-online-5248/ https://healthinformatics.uic.edu/ https://onlinepublichealth.tufts.edu/online-masters-health-informatics-analytics/ https://www.amia.org/education/programs-and-courses
Are you looking to further your career in nutrition informatics? Have you considered completing an informatics degree? While there aren’t nutrition-specific informatics degrees, there are many options for health informatics. Below are several options for certificate and degree programs to grow your informatics skills. Like with accreditation through ACEND, many informatics programs are accredited through the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM), or American Medical Informatics Association (AMIA). There are 9 Masters degree programs that are accredited by CAHIIM (including both Health Informatics and Health Information Management). Many of the programs are online, and do not require coming to campus. Example programs include Northeastern, University of Illinois at Chicago, and Tufts. AMIA not only accredits programs, but also offers a Health Informatics Certification and its 10x10 informatics education programs. These are formal trainings for biomedical, health and nursing informatics. There are 9 courses each year with five partner universities, which include Oregon Health Sciences University, University of Alabama at Birmingham and Case Western Reserve University. These are all considered continuing education classes and available online. Healthcare Information and Management Systems Society (HIMSS) is another society that offers certifications in Healthcare Information and Management Systems. The Associate program is for those earlier in their careers, while the Professional certificate is for those who have been working in the field longer. Both certifications require CEU credits before sitting for an exam. These certification credentials need to be renewed every three years. Have you completed a program in health informatics or other training that you thought was useful for RDNs? Let us know and we can share in our next Career Corner!
Body text
Member Perspective: Digital Nutrition Data in India
Priya Karkera Ph.D. Scholar, FCPN, PCCN, Fodmap Dietitian, Pediatric Nutritionist, with over 2 decades of practice. She specializes in Pediatric Nutrition and has developed digital Nutrition platforms with the Indian Food Database to assess the nutritional status of the Indian population. She is currently pursuing a PhD in Management to enhance her managerial skills. Priya is the Chief Nutrition Officer at Fitterfly Technologies in India. Digitization today has taken a big leap across the globe. Technology advancement especially under the umbrella of nutrition is expanding vividly. This article summarizes the growth of technology and nutrition data in India. The Indian National Family Health Survey, District Level Household Survey, Annual Health Survey, National Nutrition Monitoring Bureau Survey, Rapid Survey on Children and Comprehensive National Nutrition Survey are the various extensive national health and nutrition surveys providing information on different domains of health. These provide vital information and statistics for the country, and the data generated are used to identify the prevalence and risk factors for the diseases and health challenges faced by a country. Some of the types of nutrition data we look at are: Consumer Food Intake Data Food Label Data Food Frequency Data Behavioral Changes to Dietary Habits It is important to note linking data alone is not enough, however using data methodologies, we can ensure that digital health data produces reliable and unbiased evidence, and we can trigger changes in the Nutrition Care Process that ultimately enhances patient outcomes. Today, data-driven technologies are being used to improve nutrition and health outcomes at the individual level and on a global scale. For individuals, there are now hundreds of thousands of mobile health applications available related to diet and nutrition. The challenge lies in covering the wide diversity of food items, varied portion sizes, and innovations in recipes which may not be always standardized. India is well known for food diversity and cultural practices with the wide variety of millets, grains, legumes, etc. grown here. Appropriate dietary methods will have strengths and limitations and must be used to collect relevant data sets. New programs like Digital India and concerted efforts by previous governments to begin the process of data digitization are helping bring India to a globally acceptable standard, however large data points, especially at the rural level, are still collected using archaic tools and methods. This not only makes programs and initiatives harder to appraise and audit, but renders monitoring and evaluation relatively ineffective. In India, online conversations, like posts from social media and apps are now analyzed as complementary sources of data (and sometimes associated to clinical data) to identify and describe disease-related symptoms, and have shown potential in describing medication use and adverse events. Our current challenge is now to learn how to leverage this data to also characterize social media users’ diet and understand its potential in exploring dietary behaviors. We are now looking forward to addressing the current perspectives for the management of nutrition research studies within the Healthcare Data Institute and beyond. This is relatively important given India’s acceptance of the Sustainable Development Goals that it, with the world, hopes to achieve by 2030. It is furthermore crucially important for the goals set towards elimination of hunger and malnutrition.
"It is important to note linking data alone is not enough, however using data methodologies, we can ensure that digital health data produces reliable and unbiased evidence, and we can trigger changes in the Nutrition Care Process that ultimately enhances patient outcomes."
Member Perspective Continued Periodic data collection and hence, timely monitoring and evaluation is paramount to the creation of new responses or transforming old policies. It has the potential to identify outcomes of interventions and present new avenues of improving efficiency, effectiveness, and inclusivity of programs. The Indian government is working towards correcting these data gaps and challenges by implementing needed changes in: The way data is gathered, recorded, and presented Designing surveys such that they incorporate more indicators and the entire range of target populations, and In the way data is monitored and evaluated. Limitations of using digital nutrition apps for data collection Rely on patient information as entered on the app device Limited probing Missing entries Portion sizes Advantages of using digital nutrition tracking methods Sources such as the Global Nutrition Report, EAT-Lancet, Food and Agriculture Organization (FAO), World Health Organization (WHO), and peer-reviewed articles are the go-to sources for public health nutrition data. It is time we formulate nutrition data using technology platforms to enable better data collection. The Nutrition Informatics DPG provides great learning opportunities to better understand how digitization can be an integral part of nutrition data.
Hello from the NI DPG Student Liasions Sabrina Matlock & Sarah Bowers
I’m Sabrina - a first year graduate student in Health Informatics and Health Information Management at the University of Washington and a NDTR. I have been questioning my career path and where to focus my career as a direct result of COVID-19. I did some deep soul searching. For me, that also means some deep "Googling" to find where the intersection of my talents and passion could be deployed to make an impact. That’s how I decided to focus on informatics as a career change and found the NI DPG. I wasn’t aware of all the possibilities a career in nutrition and technology has to offer! I want to thank the NI DPG for seeking out student liaisons and lifting up our voice. I am excited about what this opportunity can offer to fellow students. ’m Sarah - a senior year Dietetics major at Miami University! As I’m planning for my future, I’ve been looking through all of the different dietetic internships available.n the fall. This past summer, while seaching online, I came across the topic of nutrition informatics and immediately wanted to learn more. From there, I joined the NI DPG and am really excited to have this opportunity to be a student liaison and learn from professionals in this field. I hope that bringing my student perspective to this DPG can help answer questions for other students who are also interested in nutrition informatics. As student liaisons to the NI DPG, we want to hear from you. We want to hear about your career, what you wish you knew about nutrition informatics as a student, and what opportunities and challenges you think students need to focus on to build solutions for the future. Are you a student looking for experience in nutrition informatics or do you have a project that could use a student intern or student research? We want to bring these opportunities to fellow students to help expand the nutrition informatics community. To learn more and to connect with Sabrina and I, reach out to: nutritioninformatics@eatright.org.
Student Corner
Tamara Melton, MS, RDN, CPHIMS Diversify Dietetics (Georgia) Co-founder and Executive DIrector
Margaret Dittloff, MS RDN Junum (Texas) Head of Product
Nicholas S. Groch, RDN, LDN Morrison Healthcare (Illinois) Director, Nutrition Systems and Chicago Area Regional Clinical Nutrition Manager
Member Spotlight: Let's Talk Data by Claudia Folette, MS, RDN
Sandra Miller, MS, RDN, CDES Marian Regional Medical Center (California) Dignity Health Manager Clinical Nutrition Patient Services
Please provide a brief description of your current position.
Kalli: I work for Mercy Health System in Chesterfield, MO, as the Director of Nutritional Programs for Quality and Safety. In this role, the team works in redesigning care for our patients throughout all settings. Creating pathways, order sets, clinical guidelines, and operational processes to deliver standardized evidence-based care across the continuum. Nicholas: I am the Director, Nutrition Systems and Chicago Area Regional Clinical Nutrition Manager with Morrison Healthcare at UChicago Medicine (this includes University of Chicago Medical Center and Ingalls Memorial). I have quite a unique position that is a blend of operations and clinical management. At the University of Chicago Medical Center, I support the clinical needs of our food and nutrition operation (2 patient kitchens) within an 800-bed academic adult and pediatric medical center. I directly oversee our room service call center operation, which includes 3 managers (2 RDNs) and ~20 hourly employees. My focus is on utilizing technology to optimize safe patient tray delivery and operational efficiency. Part of this includes tracking various data points to evaluate program effectiveness. I also work as a liaison between the clinical nutrition department and the food and nutrition team. At Ingalls Memorial, I directly manage the clinical program and 6 clinical RDNs. We also have a dietetic internship, which I work directly with the program director to manage their program needs. In addition, I support the technological needs of the food and nutrition department by managing our analyst who manages our CBORD database (this person also manages our Computrition database). Margaret: As Head of Product at Junum, a health care startup focused on delivering EHR-integrated nutrition technology solutions, I investigate the market and talk to hospital-based physicians, dietitians and administrators to identify the problems and challenges that impede their delivery of optimal nutrition care. Then, I work with our software team to design, develop and deploy technology solutions for those problems. The best part of working in product management is being involved in the creative design process and seeking out information to validate what works and what does not. I get to apply that knowledge to the next idea, enhancement or product that will help improve patient outcomes or enhance interdisciplinary care team communications, which is what informatics is all about. Tamara: Currently, I am the Co-Founder and Executive Director of Diversify Dietetics. Our mission is to increase the racial and ethnic diversity in the field of nutrition by empowering nutrition leaders of color. Prior to that I served as the Director of Nutrition and Sustainability for Chartwells K12, a sector of Compass Group. Sandra: I currently work for Dignity Health in the role of clinical nutrition manager for a 189 bed acute care hospital, Marian Regional Medical Center. In addition, I serve as a glycemic management quality and safety lead for my facility and two additional facilities within our region. Quality improvement process management, informatics, and data analytics is a key component of my management role. I have had the opportunities to design clinical nutrition workflows within our EMR, diet order sets, incorporation of nutrition screening and malnutrition identification and alert tools, insulin order sets, and serve as the content expert to ensure nutrition quality and evidenced-based standards represent our profession.
Kalli N. Castille, MS, RDN, LD, FAND Mercy Health System (Missouri) Director of Nutritional Programs for Quality and Safety.
Kalli: Data is a large part of how we measure our success as well as monitor progress, change, and sustainability. Nicholas: It impacts my job every day! From an operational standpoint, we use data to track numerous metrics around our meal delivery program. From a macro level we use this data to run the operation and track what is being done day in and day out, but from a micro level, we use this data to establish baselines and understand what we can do to improve. From a clinical standpoint, data is used to help manage my team's patient loads, success of our nutrition screening process, enteral nutrition infusion rates, and our malnutrition documentation and billing program.
How does data collection or use of data impact your work?
Without daily data being utilized, I would not be able to continually strive for operational improvements month after month. Margaret: Having the right information available when needed is one of the key goals of applied informatics. I personally rely on both qualitative (user interviews, satisfaction surveys) and quantitative data (product/marketing analytics and financials) to plan and prioritize new products and features. As an organization, we also collect, aggregate, and analyze patient care data to help our hospital customers measure their performance and track outcomes, so data integrity and security are imperative. Working with PHI datasets require access to separate, secure environments and constant vigilance that all security protocols are being followed. Tamara: At Chartwell, our team utilized data to determine what service programs are performing well, and which ones are not. I also used data heavily when I managed pilot projects. Proper data collection and analysis is crucial to determine if a pilot is a success and if the company should invest funds into developing the program further. Data also allows to to determine what areas of the program may present challenges and what adjustments might need to be made to address or avoid those challenges. Sandra: Discrete data is important to establish the value of our work, track processes, and demonstrate improvement. Malnutrition identification and coding data, for example, not only improves hospital reimbursements but also impacts the acuity metrics of our hospital patient mix. Acuity levels impact various government mandated quality metrics such as re-admissions. A hospital's quality metric performance and acuity mix impact rankings within publicly reported scores such as Hospitals Compare, Star ratings, and Leapfrog. Those rankings drive customers and additionally effect reimbursement. I am currently working on an interoperability project with our informatics team to link the RDN-generated clinical nutrition assessment malnutrition problem statement to an alert that will automatically be communicated to the physician for verification and agreement. In building our EMR diet order sets our organization needed to ensure those diet orders were consistent across the system and could be recognized and transmitted to our patient menu management system. Ensuring interoperability is a key factor to consider as systems continue to advance health information technology.
What advice would you give for developing a successful career focusing on the effective management, retrieval, and use of data for food and nutrition-related problem solving and decision making?
What potential or real issues in data/information safety and security do you encounter in your practice setting?
Describe how your education, training, or work experience supports your use of data and information systems?
Kelli: As Registered Dietitians, we are trained to work with the full integrative team, including physicians and specialists. Data and information systems are utilized to improve quality, safety, and efficiencies in health care. I have been fortunate to have work experience and groups such as this DPG to continue to grow my knowledge and experience. Nicholas: I would say work experience has benefited me the most. I have always had an interest in technology and data collection, but my last job allowed me to really get involved in the technical side of information systems. I was tasked with upgrading our entire health care system food service software from 5 standalone databases to an enterprise database. This required me to not only do all the programming, but project manage the entire transition and ensure go-live needs and education were taken care of. It was incredibly stressful, but also very rewarding to understand the technical side of the EHR interface infrastructure, IT project management, and go-live implementation. On the clinical side, I have also gained valuable work experience with large scale data extraction for research purposes, report building for quality assessment process improvement, and leveraging EHR technologies to streamline and improve clinical dietitian workflows. I do hope to gain a more formal education by obtaining a master's in health informatics. Margaret: My nutrition and dietetics formal education gave me the foundation and critical thinking skills to use assessment or operational data to support my decisions or advocate for my ideas. No matter where I have worked, I have had to retrieve and organize data (sometimes relatively large volumes of data). Throughout my career, I have been involved in data-intensive activities such as planning and costing menus, nutritionally analyzing recipes, and even designing software systems that automate patient meal ordering and hospital trayline operations. I've often had to find some creative ways to collect new or missing information, then apply and test what I learned. I acquired most of my informatics and technical skills through on the-the-job training but augmented that by the AMIA 10x10 and SNOMED International Terminology courses, and many Health Level Seven International (HL7) classes as well. Tamara: I attended a graduate certificate program in health informatics at Duke University. During that program, I took courses that taught me the elements of database design, as well as data analytics. While I'm not working directly in the health care space, the knowledge and skills that I learned related to proper data retrieval and analysis have absolutely been applicable to the work I do now. I also love training, presenting, and teaching . Because of that I have realized the importance of effective data visualization since a a well-designed data visualization can really enhance a presentation. I have done a lot of my own reading and researching to increase my skills in data visualization. Kalli: I would suggest taking every opportunity to learn more and to grow yourself in how to use these systems and drive decisions based on the data. There is so much opportunity in improving processes and efficiencies through these systems, many facilities are looking for those with this talent or experience. Nicholas: Get involved in any and all information systems projects. Even if it is not directly related to your department or skill set, it will likely benefit you to understand how data and technology works in health care. Also, if you don't know how to do something, ask for help. Far too many people don't ask for help and fail to ever use technology to help make things easier. Technology is the future, embrace it! The more you understand that, the better prepared you will be in the coming years. Margaret: If you like the idea of combining nutrition with technology and data analysis, now seems like a great time as there is such a demand for data-driven decision making in all organizations. Learn as much as you can by attending webinars and following informatics leaders on social media to keep up with the latest advances. It is all changing so rapidly! Seek out an informatics project, volunteer to be a super-user, or participate in a research or quality improvement project where you work. My experience volunteering as a subject matter expert (SME) with HL7 helped me learn so much and has also connected me to new opportunities. Completing a graduate certificate or degree in informatics is likely a requirement for many positions, but if you have gained on-the-job experience, don't be afraid to apply for positions that match your interests and skills. Sure, they may be looking for a nurse informaticist but if you have a strong clinical background and informatics training/skills, it could be a great fit. Tamara: Data analysis just for the sake of data analysis will only get you so far. Keep in mind the WHY behind the data collection. This will help to create better data collection tool design and will lead to more useful presentation of data analysis,. Also, keep being curious and learning. Be determined to constantly improve your skills around use of data. Sandra: Go for it. You do not need to be an expert, ask questions, find mentors, seek training opportunities and you will learn along the way. The Nutrition Informatics, Food and Nutrition Management, and Clinical Nutrition Management DPGs serve as excellent resources for knowledge and mentors. Volunteer to work on Academy level committees. I am currently a member of the Interoperability and Standards Committee (ISC). This is a huge stretch to my comfort zone but a huge opportunity to sharpen my skills and contribute to the profession. Kalli: Sharing if there is a concern or if something does not seem to be accurate is key to alerting to potential problems within the system. In addition, understanding how the data is pulled, collected, and utilized is extremely helpful. I suggest clear definitions to offer guidance and education to the data provided. Nicholas: The major issue I see is food and nutrition are often the bottom of the totem pole in the medical hierarchy. Many essential projects you hope to implement get delayed year after year to focus resources to 'bigger bang for their buck projects.' Many organizations are also reducing their information system workforce when advancements are being made at a pace never before seen in health care. Margaret: Data privacy and security threats are real and everyone in an organization needs to be aware and vigilant to maintain secure environments. Developing an organizational culture for trust and security is key to successful training and implementation. Much of what I deal with relates to HIPAA- compliance and securely accessing different environments. There is a lot of misunderstanding out there about HIPAA, but it should be outlined in your Business Associate Agreements and Data Use Agreements. On a more technical side, I work closely with system architects/engineers to design in security for our own applications by following security best practices (Secure Development Lifecycle) like vulnerability scanning of the code base and threat modeling, which helps identify a feature or product's "attack" surface and how to mitigate those. I also spend time on design and user experience to any potential for errors. As informaticists we need to examine and learn from patient safety issues that may be related to EHR-enabled technologies. One of the AMIA 2020 policy principles is that "assuring the safe use and general safety of health IT is a shared responsibility among oversight bodies, developers, implementers, organizations, hospitals, practices, users, and patients." This is an area where informatics professionals can lead to ensure that we have a continuous improvement process in place for health IT just like we do for care delivery. Tamara: The tried and true of hacking-phishing emails sent to our employees. When I was at Compass, the majority of our workforce was working on the frontline, and they were only spending a fraction of their time in front of their computers checking emails. They were often rushing because they had little time to do administrative work. Our data security team was vigilant about keeping us informed of potential phishing scams that could catch our associates unaware. Sandra: Compliance with HIPAA is a factor to consider in all of our work. I currently submit quality data to CMS and other large AI data clearinghouses. Data is gleaned off identifying patient information prior to submission. Within our organization various firewalls and double password protected locked systems are in place and all work must be done on company computers. Additionally, I must be cognizant of protecting our physicians and health care providers. When presenting cases for peer-review and process improvement projects I am cognizant of both protecting the patient identity and maintaining physician confidentiality.
"Technology is the future, embrace it! The more you understand that, the better prepared you will be in the coming years."
Grace Jones, RD
Greetings from your delegate. If you are like me, you probably have seen delegates on the ballot but never really knew exactly what they did. Delegates represent various areas such as the state affiliates, DPGs, and at-large members to total 105 members of the HOD. Delegates request input and listen to the needs of our members. We communicate effectively to keep members aware of Academy activities. We face challenges, focus on the positives, and prioritize our next steps. In other words, through our governance process and member focus, delegates advocate for our profession. The delegate then looks at the issues their members bring up and use those to suggest the areas they would like to see the HOD address. It is important for you as a member to share issues with the Academy and the HOD. This year the critical issue to address is Diversity, Equity, and Inclusion. This has many facets such as the demographics of dietitians as well as how we present information to our patients as the public. If we can quantify where we are and collect and analyze data about our markets we can better target our message. The topic area for the fall 2020 HOD meeting before FNCE® was a Systems Approach to Nutrition and Health Equity. There were many great speakers and one slide that resonated very well with me was this one demonstrating the difference between equality and equity. Another aspect we had to evaluate was our own implicit bias. It is definitely eye-opening to see the results and even if we don’t think we have any implicit bias, we probably do. If you’d like to check your own implicit bias, you can take the online test. Once at the website, choose I wish to proceed and then choose the Race IAT (or any other test). Diversity, equity, and inclusion will not be solved in one year, but it is very important for the Academy and HOD to prioritize diversity in the profession as well as training dietitians how to work with diverse patient populations in a culturally sensitive way. This theme has been the focus of all HOD meetings this year. For more information from the HOD and to see on the Critical Issues and Updates please visit EatRightPro.
Delegate Report
Interested in volunteering with the NI DPG or contributing content to Nutrition Bytes? Contact us today via our website.
ni.eatrightpro.org/home
Nutrition Informatics Dietetic Practice Group