Using Technology to Manage Your Practice Part 1

Posted on August 11, 2014May 6, 2022 by kalix_dev

This post is by Claire Nichols co-founder and director of Kalix EMR and practice management solution. Claire is an Accredited Practising Dietitian, who has previously worked in private practice as well as clinical dietetics.

Hi everyone, this is part 1 in a series of blogs that explore the ins and outs of using technology in private practice setting. It is based my experience working in private practice, as well as the lessons learned while starting my own business, Kalix. I do not come from a business background, nor a computing background. Starting Kalix was quite a steep learning curve for me, but overall rewarding experience. I hope you find this post useful.

Private Practice today

Starting a business like a private practice, making it profitable, and then ensuring it remains profitable can be hard, really hard.

It’s a lot of long hours of work and persistence, lots of persistence.

Keeping up with finances, admin, marketing and advertising, and not to mention staying up to date with the latest in your area of practice…well, it’s not a 9-to-5 job, that’s for sure.

But if you achieve success, the rewards are great. You have the freedom to be innovative and creativity, building something that is your very own. You can set your own work schedule and of course the chance to be your own boss!

Some of the duties and responsibilities when running a private practice

The image above demonstrates some of the duties and responsibilities when running a successful practice.

Even though the completion of these tasks is essential, none of them directly generate revenue.

Many of them are also very repetitive, e.g., admin tasks. And some can be beyond our training as health professionals e.g., legal, accounting tasks, marketing. The time it takes to complete these tasks, actually takes away from time that could be better spent seeing clients and generating money. Therefore, practically speaking, the time you spend completing on these tasks is actually losing you money.

So the question is can technology help?

The answer is obviously yes.

Technology can help us to work smarter, and more efficiently, avoiding duplication, and wasted time. And we use technology in this way every day. For example, think of PCs, smartphones and global positioning systems (GPS). I don’t know how I could run a business without my smartphone or PC, I wouldn’t be sitting here writing this blog for one. And my GPS has saved me countless hours. I use it to find the quickest route when driving anywhere and now I no longer need to look at maps or ask for directions.

Likewise, technology can be used in a private practice setting to improve the efficiency of these non-profitable (but essential) tasks and even automate them, i.e., make them happen automatically without any effort on your part.

You can think of using technology as essentially partnering with experts in a particular area that you lack experience in, e.g., by using Mail Chimp you are accessing their 13 years of experience in an email marketing or by using a practice management program, you are utilizing their expertise in security and data management.

The other side

On the other side of this discussion, I should also mention that it is essential to choose technology smartly. I like this quote by Bill Gates:

“The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency.”

You do not want to use technology, whether it is the latest mobile device or cloud-based software solution, just because it is new or ‘trendy’. You need to examine the tasks you are looking at improving, whether it’s emailing marketing or scheduling clients’ appointments and consider whether the solution will actually make a difference. For example, if I only drive around my local area and I know my local area quite well, then purchasing a GPS may not be a prudent investment.

Things to consider:

What are the current costs for completing the task e.g. monetary value of time lost, the wages of admin staff, equipment costs? What are the initial costs for investing in this new technology or solution? What are the ongoing costs? The costs of the new technology or solution should not be higher than what you are currently spending.

Why are you looking to adopt this new technology or solution? Do you want to complete a task faster? Are you looking to automate a job that takes up a lot of time? Are you seeking more consistency in how the task performed? You should have a clear understanding of the problem that you’re experiencing. You need to make sure that the technology or solution will solve your problem.

Finally, you need to consider the “human” element. How will your clients respond to this new technology, if you are looking to automate a task that was previously completed by humans, how will this make a difference?

Conclusion

The clever use of technology can make the difference between having a productive and profitable practice and running one that isn’t…Technology can assist a practice to become more efficient, through automation and the removal of unprofitable and wasted time. But remember, use technology smartly.

“The number one benefit of information technology is that it empowers people to do what they want to do. It lets people be creative. It lets people be productive. It lets people learn things they didn’t think they could learn before, and so in a sense it is all about potential.” Steve Ballmer

That’s all for now. In part 2, I will discuss actual examples of technology which may help you run a more organized & productive practice.

IDNT and the Nutrition Care Process: PART 3-PES Statements

Posted on July 30, 2014July 26, 2022 by kalix_dev

Welcome to Part 3 of my journey through the of IDNT and the Nutrition Care Process. I hope you enjoyed Part 1 Nutrition Assessment and Part 2 Nutrition Diagnosis.

The Nutrition Care Process is the systematic approach to providing high-quality nutrition care developed the Academy of Nutrition & Dietetics. Kalix’s electronic documentation feature was built on the back of the nutrition care process. Electronic documentation systems like Kalix make charting a lot quicker. They can even limit the need to learn and memorize standardized terminology.

So it is time to delve deeper into the PES Statement.

What is a PES Statement?

When discussing any topic, I like to start with a definition. Definitions help to check that we’re all on the same page before progressing further. So here goes… A PES statement (or Nutrition Diagnosis Statement) is a structured sentence that describes the specific nutrition problem that you (the dietitian) is responsible for treating and working toward resolving, the cause/s of the problem and the evidence that this problem exists.

Hence three components make up the PES statement :

The Problem (P)– the Nutrition Diagnosis
The Etiology (E)- the cause/s of the nutrition problem (Nutrition Diagnosis)
The Signs and Symptoms (S)– the evidence that the nutrition problem (Nutrition Diagnosis) exists.

The PES statement is a structured sentence, hence has a specific format:

Nutrition Diagnosis term (the nutrition problem)

related to

The Etiology (the cause/s of the problem or Nutrition Diagnosis)

as evidenced by

The Signs and Symptoms (the evidence that the nutrition problem or Nutrition Diagnosis exists).

An Example

Excessive energy intake, related to limited access to healthful food choices (healthful food choices not provided as an option by carer), as evidenced by estimated intake of energy (9 500kJ/day) is in excess of estimated energy needs (7 500kJ/day) and BMI equals 45kg/m2.

Lets look at its parts:

The Problem (P) (Nutrition Diagnosis): is excessive energy intake (NI-1.3). This is the specific nutrition problem that the Nutrition Intervention aims to treat and resolve.

related to

The Etiology (E) (the cause/s of the nutrition problem/Nutrition Diagnosis): is that the client has limited access to healthful food choices. The carer provides the client’s meals. Healthful (e.g., adequate amounts of fresh fruit and vegetables) food choices are not provided as an option by the carer.

as evidenced by

The Signs and Symptoms (S) (the evidence that the nutrition problem (or Nutrition Diagnosis) exists: the client’s estimated intake of energy (9 500kJ/day) is in excess of his estimated energy needs (7 500kJ/day). The client’s BMI equals 45kg/m2 (obesity class III).

Now lets discuss each component of the PES statement.

The Problem (P)– the Nutrition Diagnosis

I discussed the Nutrition Diagnosis in my previous post, it’s worth a read for a quick refresher. Let’s start with a definition again:

The Nutrition Diagnosis, identifies the specific nutrition problem that the dietitian is responsible for treating and works towards resolving.

The Nutrition Diagnosis comes from specific terminology found in eNCPT (previously the IDNT Reference Manual) .

The Nutrition Diagnosis terms are classified into three categories:

Intake: these diagnosis relate to intake and nutrition related problems (oral, enteral and parenteral nutrition). Intake diagnosis cover the areas including energy balance, fluid intake, bioactive substances and nutrient intake.

Examples: excessive energy intake, less than optimal intake of types of carbohydrate, inadequate calcium intake.

Clinical: these diagnosis include medical or physical conditions that have a nutritional impact. The clinical category covers the areas of functional changes or impairments, biochemical changes (altered ability to metabolize nutrients) and weight.

Examples: altered GI function, impaired nutrient utilization, overweight/obesity.

Behavioral-Environmental: this category covers the nutritional problems associated with nutrition knowledge and belief (including attitude), physical activity and function (e.g., ability to self care) and food access and safety).

Examples: undesirable food choices, physical inactivity and limited access to food or water.

As a general rule (as with most rules there are exceptions) choose from Intake related Nutrition Diagnosis first, Clinical related Nutrition Diagnosis second and Behavioral-Environmental last.

Diagnosis should be specific to the role of dietitians. Behavioral-Environmental related Nutrition Diagnosis often fit better as the etiology (E) (the cause of the nutrition problem), and not the Nutrition Diagnosis itself. Remember the aim of your Nutrition Intervention is to resolve (ideally) the Nutrition Diagnosis.

Make sure you check that your Nutrition Diagnosis is something that you as a dietitian can resolve (ideally) or improve. Some of the Behavioral-Environmental related Nutrition Diagnosis can be a bit tricky for a dietitian to solve.

How to choose the correct Nutrition Diagnosis

There are no right or wrong diagnosis choice (truly). Some choices may be better than others. Things to consider include:

Is it a nutrition based diagnosis, not a medical diagnosis (e.g., increased nutrient needs v.s. altered GI function)?
Is it the nutrition problem what your intervention aims to solve? Even though the client may have a particular nutrition problem e.g., inadequate fiber, if your intervention is not focused on increasing fiber intake i.e., your nutrition goals are around reducing saturated fat intake, leave that diagnosis for another time.
Can Nutrition Diagnosis be resolved (ideally) or improved?
Is the Nutrition Diagnosis specific to the role of the dietitian (i.e., something you as a dietitian is responsible for resolving)? For example Altered nutrition related laboratory values vs. Excessive carbohydrate intake.
Does your Nutrition Assessment data support the Nutrition Diagnosis?

The Etiology (E) -the cause/s of the nutrition problem/Nutrition Diagnosis

The ‘E’ in the PES Statement stands for Etiology. The definition of etiology is “the cause, set of causes, or manner of causation of a disease or condition.” (Oxford Dictionary).

Hence the Etiology in a PES Statement describes the cause of the nutrition problem (Nutrition Diagnosis). The Nutrition Intervention should be aimed at resolving the underlying cause of the nutrition problem (the Etiology).

The etiology in a PES Statement is free text. The eNCP includes some examples of etiologies for Nutrition Diagnosis terminology as well as the online Etiology Matrix. These resources are very useful, however, they are examples only. It’s an important skill for a dietitian to is able to identify the root cause of a client’s nutrition problem.

Etiology are also grouped into categories based on the type of cause or contributing risk. Below is the list of categories with an example etiology for each. I have not listed the related Nutrition Diagnosis, why not try to list them yourself?

Access: e.g. community and geographical constraints (client lives in rural area with limited access to public transport).
Behavior e.g. unwilling or disinterested in tracking progress.
Beliefs–Attitudes Etiologies e.g. perception that time and financial constraints prevent dietary changes.
Cultural: e.g. the practice of Ramadan prevents the intake of regular meals.
Knowledge: e.g. food- and nutrition-related knowledge deficit concerning appropriate fluid intake.
Physical: e.g. lack of self-feeding ability
Physiologic–Metabolic: e.g. altering fatty acid needs due to chyle fluid leak.
Psychological: e.g. binge eating behaviors associated with a diagnosed anxiety disorder.
Social–Personal: e.g. lack of social and family support for implementing dietary modifications.
Treatment: e.g. reduced appetite associated with the use of Ritalin.

How to choose the correct Etiology

Again there is no incorrect choice when deciding between Nutrition Diagnosis Etiology. Remember: use your critical thinking skills to identify the root cause.

The Etiology is the “root cause” of the nutrition problem (Nutrition Diagnosis).
The Nutrition Intervention, should aim to resolve the Etiology (ideally).
The Etiology is supported by the nutrition assessment data.**

Identifying the root cause

A colleague of mine suggests a very good trick for finding the root cause for a particular Nutrition Diagnosis. When looking for an etiology, ask WHY 5 times (or until you come to the last etiology, that you as a dietitian can address).

For example:

Excessive oral intake

Why? Excessive intake of high calorie-density foods and beverages.

Why? Excessive take away food intake.

Why? Client purchases most of his meals from fast food restaurants with limited healthful choices.

Why? The client does not prepare meals at home.

Why? The client lacks the food preparation skills to prepare healthful food at home –root cause.

Signs and Symptoms (S) -evidence that the nutrition problem (Nutrition Diagnosis) exists

Yes we start again with more definitions. Consistency is king! Signs and Symptoms detail the evidence or defining characteristics that prove that the nutrition problem (Nutrition Diagnosis) exists.

Signs are objective data obtained through direct physical examination, observation, lab values and test results.
Symptoms are subjective data reported by the client’s or their family’s rather than actual results.

Signs and Symptoms are also used during the last stage of the Nutrition Care Process- Monitoring and Evaluation, to determine the amount of progress made toward resolving the Nutrition Diagnosis (more on this in future blogs).

The Signs and Symptoms data is obtained during the first stage in the Nutrition Care Process, Nutrition Assessment. Like Etiology, Signs and Symptoms in the PES Statement are free text. The eNCP includes some examples of Sign and Symptoms for Nutrition Diagnosis terminology. They are examples only. It is an important skill for a dietitian to is able to identify the evidence (or Signs and Symptoms) that demonstrate that a Nutrition Diagnosis exists.

How to choose the correct Signs and Symptoms

Do the Signs and Symptoms support and provide evidence that the Nutrition Diagnosis (nutrition problem) exists?
Are the Signs and Symptoms supported by the Nutrition Assessment data?**
Are the Signs and Symptoms specific enough that they can be monitored to measure/evaluate changes from one visit to another?
Can measuring the Signs and Symptoms tell you that the problem is resolved or improved?

**Think back to the Nutrition Care Indicators mentioned in the previous blogs (assessment data that is used to identify a client’s Nutrition Diagnosis and its etiology and signs/symptoms.)

So that’s about it for now. I will go before this post turns into an essay. I hope you find it useful. Next time: Nutrition Intervention!! (One day!)

The Review of PCEHR: The good, the questionable and the ugly

Posted on June 7, 2014July 26, 2022 by kalix_dev

The findings of the PCEHR (stands for Personally Controlled Electronic Health Records, the Australian national e-Health records) review were released publicly two weeks ago. I thought I would provide a bit of a summary of this document, particularly in relation to what the review recommends for Allied Health. It’s a 91 page document and a bit of dry, but nonetheless, I would love to hear what you think. The Review of PCEHR can be found here. Please leave your comments at the bottom of the page.

Note: the PCEHR Review contains recommendations only, the government’s response to the review is said to be several months away.

This blog will focus on the discussing the Summary of Panel’s Recommendations. There are 38 points, I will only explore the points of particular relevance or interest.

Recommendation 1: Rename the Personally Controlled Electronic Health Record (PCEHR) to My Health Record (MyHR).

I like the new name because it’s easier to remember. The report states this name will better reflect the partnership between the clinician and the patient… again I will say I like the name because it’s easier to remember.

In this blog I will continue to refer to the Personally Controlled Electronic Health Records as PCEHR as the name change is a recommendation only.

Recommendations 2-12 are related to the establishment various committees…a Clinical and Technical Advisory Committee, a Jurisdictional Advisory Committee, a Consumer Advisory Committee, a Privacy and Security Committee a transition taskforce, a clinical systems capability group…..

Committees can be useful but we will move forward to something a bit more interesting.

Recommendation 13: Transition to an ‘opt-out’ model for all Australians on their MyHR [PREHR] to be effective from a target date of 1st January 2015.

This is a change from an opt-in model (current) to an opt-out model i.e. everyone gets a record unless they opt out.

This is a positive step forward. The suggested date of transitioning is the 1st January 2015. So very soon…but as previously said these are recommendations only, not plans of action. It will be interesting to see whether this goal date is achieved, especially considering the government’s response is still ages away…

A opt out system will obviously improve the uptake of PCEHR by the general population. I am not sure whether it will affect its usage by healthcare providers or their perception of the system.

We will jump forward again, skimming over recommendations 14-20. These recommendations are more of a mixed bag (not just about the establishment of committees), they include the commission of a number of reports, as well as a consumer (patient) and clinician education campaign. Then there are two separate recommendations about how to include over-the-counter drugs in PCEHR…ok sure…yet to find allied health mentioned…

Number 17: Clarify that the MyHR [PCEHR] is a supplementary source of information that may, but does not always need to be, used by clinicians in caring for their patients.

Ok got it… clinicians do not need to use PCEHR for every occasion of care and for every single patients…and the PCEHR is is only a supplementary source of information…so it is not a major source of client data…ok…since only 8% of the Australian population have a PCEHR… I think the description aptly fits. Anyways let’s move on… now onwards!

If the PCEHR is only a supplementary source of information, what is a primary source of information? It could be the patient themselves I suppose.

Recommendation 21: Implement a minimum composite of records…This will dramatically improve the value proposition for clinicians to regularly turn to the MyHR [PCEHR] , which must initially include:

• Demographics

• Current Medications and Adverse Events

• Discharge summaries

• Clinical Measurements

It is great that there will be more consideration to what information, at a minimum needs to be included in PCEHR. If there is useful patient information in the PCEHRs, clinicians are more likely to look at them. It will be interesting to see what clinical measurements are decided to be included and whether there will be anything relevant for Allied Health Professionals.

Recommendation 22 is to allow the integration of diagnostic imaging and pathology into PCEHRs… yep that will be useful.

Recommendations 23 : Implement a standardised Secure Messaging platform for the medical industry, prioritising support for standards compliant platforms.

Recommendation 24: Expand the Secure Messaging strategy to include exchange of secure communication between the medical industry and consumers to facilitate improved communications and workflow efficiencies.

I find these recommendations particularly exciting. The secure transfer of health information between clinicians as well as between clinicians and patients, is also a topic we at Kalix are regularly asked about.

Initially, I’ll like to point out that Australia does not have specific policies around how (mechanisms) health information should (or shouldn’t) be shared. It is not illegal to email, SMS or post patient information…whether it is a safe (and secure) thing to do, this is another matter. In Australia there are policies in place are about when it appropriate for health information to be shared, see Sharing health information to provide a health service for more details, but not how.

The secure exchange of health information is an area where reform would probably be useful. I am aware of many clinicians who unwittingly have a number of questionable practices in place.

Even with secure messaging, if users do not have proper safe guards in place, security breaches can still occur.

There are a few secure messaging exchange programs available in Australia and many more in the US. Unfortunately, these programs do not ‘talk to each other’. So users of the different programs cannot exchange information with each other. This review recommends that the vendors of these products, adopt a common messaging standards to ensure inter-program communication.

The review goes on to recommend that secure messaging is expanded to include messaging between clinicians and patients. It would be great for this to occur, but it is easier said than done. It is fairly difficult to have a system that is both cost effective and easy to use by both clinicians and patients. Any system would require both parties to have specialised software in order to receive messages from each other.

Next! Briefly, recommendations 25 to 35 call for the review of a few different programs, as well as improvements to be made to PCEHR’s usability. There is also a recommendation to “add a flag” for clinicians when their patients have restricted or deleted a document they have written. The review also recommends another notification system for patients to receive an SMS when their PCEHR have been opened or used i.e. by their healthcare professionals.

Recommendation 36: Change the ePractice Incentive Payment (ePIP) to introduce meaningful use metrics that incent contribution of clinical relevant information to the MyHR [PCEHR], including linking ongoing ePIP funding to actual usage of the MyHR [PCEHR].

These financial incentives are aimed at increasing PCEHR uptake by healthcare professionals. This particular recommendation includes a phrase that Americans are quite familiar with “meaningful use”. In the US there are incentives in place for eligible professionals to implement meaningful use of certified EHR technology. Doctors, dentists, chiropractors and nurse practitioners are classified as eligible professionals, most allied health professions are not eligible.

What is “meaningful use”? It is a bit of a buzz work in Health IT. The PCEHR Review does not directly provide a definition. If we look at the US definition.

The use of EHR technology in a meaningful manner (for example electronic prescribing); that provides for the electronic exchange of health information to improve the quality of care.

Centers for Disease Control and Prevention 2012.

Not that much clearer…well thinking back to Recommendation 21 about the minimum set patient of information:

Demographics
Current Medications and Adverse Events
Discharge summaries
Clinical Measurements

I think this is what it what the review is suggesting by using ‘meaning use’… (other than the authors decided to include the phase, so that the document appeared more ‘cutting edge’.)

How could one argue that PCHERs use shouldn’t to be meaningful i.e. why should they contain information that isn’t relevant the management of patients’ health? I wonder whether meaningful use should just be an implicit part of electronic health records. Well that’s my thought.

The current incentive program, the Practice Incentives Program (PIP) is for GPs only. Will PIP and other incentive programs continue to exclude allied health professionals?

The last recommendation, is the only one that mentions Allied Health (so we get 1 out of 37…)

Recommendation 37: Commission a scoping project to identify the options available to encourage further take up of electronic transmission of data by specialist medical and allied health professional practices and private hospitals.

They are suggesting that a project should be funded to investigate methods of encouraging allied health professionals to use PCHER (and the financial incentives that GPs receive are not suitable?)…we are getting considered at least but, probably not for financial incentives.

What are Allied Health Again?

Unfortunately Allied Health Professionals are not mentioned again in the body of the review. Our involvement in the use of PCEHR is not discussed until Addendum 3 “Key Themes from stakeholder feedback in detail.”

The authors of the review do not seem to know what an allied health professional is…they are some variety of nurse it seems. See the excerpt below.

It might just be a typo, although as an allied health professional myself I feel a bit insulted. But this just reflects the knowledge of the general community. So many, many people have told me that they do not know what allied health are.

At least the review acknowledges that the biggest barrier towards the uptake of the PCEHR by allied health, NEHTA’s focus on GPs only.

“There are significant features of the PCEHR which have not been realised, including the ability for allied health to have input into the Event Summary and Discharge Summary across various care settings (acute through to community) and to share these with relevant clinicians including other allied health. This lack of “horizontal integration” of patient care is a significant barrier towards meeting the goal of multidisciplinary care and collaboration. “

The PCHER has received funding for the next year (equalling $140 million.) It will be interesting to watch how things develop over the next few months.

This blog is by Claire Nichols, an Accredited Practising Dietitian, and co-founder of Kalix, a cloud-based, practice management and documentation solution. Kalix is used by hundreds of private practice allied health professionals Australia and the United States.

Disclaimer: everything expressed in this blog is my own personal only.This is a blog, not a peer-reviewed journal. While every caution has been taken to provide you with the most accurate information and a honest analysis, please use your discretion before taking any decisions based on the information in this blog. I make no representations as to the accuracy or completeness of any information in this blog or found by following any link. The owner of this blog will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

IDNT and The Nutrition Care Process: Part 2 Nutrition Diagnosis

Posted on May 12, 2014July 26, 2022 by kalix_dev

Welcome to Part 2 of my journey through the of IDNT and the Nutrition Care Process. I hope you enjoyed part 1 Nutrition Assessment, click here to read.

It’s time for the next step in the Nutrition Care Process (NCP), and this is the step that receives the most attention-Nutrition Diagnosis. The attention hogging Nutrition Diagnosis identifies the specific nutrition problem that we (the Dietitian) are responsible for treating and (ideally) resolving. We resolve this nutrition problem through our nutrition intervention.

So, I might have been a bit harsh towards poor Nutrition Diagnosis. Calling him an attention hog is bit unfair, it’s not his fault after all.

The fact is, most of the training on the Nutrition Care Process that I’ve attended (both in Australia and the US) focuses primarily on the Nutrition Diagnosis.

Sure, there are arguably good reasons for this;

The ability to create a Nutrition Diagnosis requires a shift in thinking.

The idea of using and identifying a Nutrition Diagnosis over a medical one may appear to be new, I argue it is something we, Dietitians have always done.

In our work as Dietitians, the focus of our thinking (as well as our documentation) is often on our client’s (or patient’s) medical diagnosis e.g. type II diabetes, stage 3 renal disease, and hypertension.

The Nutrition Care Process encourages us to move our thinking towards our area of specialty-Nutrition. Hence, the focus of the Nutrition Care Process is the nutrition problem (i.e., the Nutrition Diagnosis) that the Dietitian is responsible for treating independently. It is still important to consider the client’s medical diagnosis (obviously), but focus your thinking (and documentation) around the nutrition problem.

As Dietitians, it is not our job to diagnose medical conditions. Sure, through our nutritional interventions we help to treat/management them, but Dietitians do not diagnose medical conditions.

An example

A client with type II diabetes is referred to see you, a Dietitian for advice on modifying his diet. His referring practitioner wants him to achieve improved blood glucose control.

You know as a Dietitian, many things may be affecting this client’s blood glucose control, not just his diet. But you take a diet history, and you can see that there is definitely room for improvement. As you assess this client’s diet history, you see that he eats a very large, carbohydrate-heavy evening meal, he skips breakfast and lunch just consists of a white bread sandwich with jam.

What will your nutrition intervention focus on (write it down)?

Yes your right! Your interventions for this client are focused on establishing a consistent carbohydrate intake throughout the day, limiting heavy carbohydrate meals and choosing mostly low GI foods.

Now what is the Nutrition Diagnosis?

Considering, the Nutrition Diagnosis is the specific nutrition problem that you (the Dietitian) is responsible for treating and (ideally) resolving, what is the Nutrition Diagnosis for the above case?

Think: the nutrition problem (Nutrition Diagnosis) is what our interventions aim to solve.

Suggested Nutrition Diagnosis

• Inconsistent carbohydrate intake -a diagnosis for an intervention that is aimed at establishing consistent carbohydrate intake.
• Excessive carbohydrate intake– a diagnosis for an intervention that is aimed at limiting heavy carbohydrate meals.
• Less than optimal intake of types of carbohydrate-a diagnosis for an intervention that is targetted at choosing mostly low GI foods.

The Nutrition Diagnosis is not

Type II Diabetes –this is the medical diagnosis, not the nutrition problem.
Altered nutrition-related laboratory values– you can select this diagnosis, but remember, many factors may be affecting this client’s blood glucose control, not just his diet. Diet/intake related Nutrition Diagnosis are always preferable.

Even though the referring practitioner wants the client to improve his blood glucose control, the goal of your intervention is to achieve dietary modifications.

The IDNT manual (2013) explains;

“the [dietitian] identifies and labels a specific nutrition diagnosis (problem) that… he or she is responsible for treating independently (e.g., excessive carbohydrate intake). With nutrition intervention, the nutrition diagnosis ideally resolves.

In contrast, a medical diagnosis describes a disease or pathology of organs or body systems (e.g., diabetes)… [dietitians] do not identify medical diagnoses; they diagnose phenomena in the nutrition domain.”

This is the shift in thinking.

Some argue that the ability for Dietitians to identify a Nutrition Diagnosis (instead of a medical one) is new. As I said earlier, I believe it is something we Dietitians have always done.

The format that the Nutrition Diagnosis is written is in, is a bit different. But as Dietitians we have always been being able to identify the particular nutrition issue/s our clients have. These nutrition issues are the focus of our interventions.

How would a Dietitian know that a particular client needs to limit their heavy carbohydrate meals if they were not aware that the Nutrition Diagnosis (problem) is Excessive Carbohydrate Intake?

Ok not the right PES, but just as tasty.

The PES Statement

So onto the PES Statement (this will be discussed in detail next blog):
The Nutrition Diagnosis is summarized into a structured sentence called the nutrition diagnosis statement or PES statement. The PES statement links the Nutrition Assessment to the Nutrition Intervention to set realistic and measurable goals/outcomes from the nutrition care.

The PES statement:
(P) the nutritional problem (the selected Nutrition Diagnosis), related to (E) etiology, as evidenced by (S) signs and symptoms.

So why I call the Nutrition Diagnosis, an attention hog that it is often people’s primary focus when learning the Nutrition Care Process. However, the Nutrition Diagnosis should not be considered in isolation. Think of it concurrently with the other stages of the Nutrition Care Process (Assessment, Intervention and Monitoring/Evaluation).

Nutrition Assessment
As I discussed in the last blog, during the Nutrition Assessment, the Dietitian gains a lot of information specifically relating to the Nutrition Diagnosis.

Remember that I mentioned Nutrition Care Indicators last blog (assessment data that are used to identify a client’s Nutrition Diagnosis and its etiology and signs/symptoms.) This where you get the info needed to form your PES statement.

Nutrition Intervention
As discussed in this article, the Nutrition Intervention should be aimed at resolving the Nutrition Diagnosis; hence the two are directly linked (more on this next blog).

Monitoring and Evaluation
During this stage Dietitians monitor the client’s progress towards resolving the Nutrition Diagnosis. The factors that are monitored to measure the client’s the progress are also the Nutrition Care Indicators- the E and S from the PES statement (more on this in future blogs.)

Tips:

Nutrition Diagnosis, is not a medical diagnosis.
Nutrition Diagnosis, describes the nutrition problem that the intervention aims to solve.
Diet and intake related Nutrition Diagnosis are preferable over medical or behavioral based ones.
Do not think of the Nutrition Diagnosis in isolation. Think of it concurrently with the other stages of the Nutrition Care Process (Assessment, Intervention and Monitoring/Evaluation).

Next blog I will explore the PES Statement in more detail.

IDNT and the Nutrition Care Process: Part 1- Nutrition Assessment

Posted on March 23, 2014May 6, 2022 by kalix_dev

Nutrition Assessment

This post is Part 1 of IDNT and the Nutrition Care Process.

It’s an adventure through the world of IDNT (International Dietetic and Nutrition Terminology) and the Nutrition Care Process. I said it is an adventure right? So I hope to make it a fun experience for all. My aim to explain to you (in my own way) what the Nutrition Care Process is all about. I also plan to convert all you nonbelievers to the ways of IDNT. Tough task I have set myself…but I will give it my best.

If there is questions or topics around IDNT and the Nutrition Care Process you want me to cover, please let me know.

So here goes.

I hope you find it useful.

What is NCP and IDNT?

In a nutshell, the Nutrition Care Process (NCP) is a model for providing high-quality nutrition care and International Dietetics and Nutrition Terminology (IDNT) is the standardized language used to describe the NCP.

I have written about the benefits of NCP and IDNT a few times before, so I will not repeat myself here, but I will mention one of the uses for IDNT. IDNT is used for the documentation of clients’ (or patients’) nutrition care, i.e. medical note documentation. And this is how we use IDNT in Kalix. The standardized documentation format for NCP is ADIME (A-Assessment, D-Diagnosis, I- Intervention, ME-Monitoring, and Evaluation). And again this is the format we use in Kalix. In saying that, you can use IDNT to write notes in whatever format you like including SOAP, ABCD, etc.

Nutrition Assessment

The first stage in the Nutrition Care Process is the Nutrition Assessment, and hence, this is the first section in ADIME. Assessment contains the data you collect about a client/patient during the consultation, from medical records, food records, weight records, client observations, from discussions with other healthcare providers, carers or family members, etc.

There is one crucial point I would like everyone to understand about Nutrition Assessment in NCP. But, before I explain it, I would like to ask, a fundamental question:

Why do Dietitians conduct nutritional assessments with clients?

Sure, there is not one answer to this, but many. Some of the reasons include:

• To confirm clients’ medical history
• Collect anthropometric measurements
• Gather information about their diet and food intake
• Learn clients’ personal preferences to assist with providing tailored advice

The list can go on… but now I ask you, why do Dietitians collect this information and what do we do with it?

Dietitians conduct nutritional assessments to obtain client data, which we verify (check that it is accurate) and interpret (compare it to relevant reference standards). We determine whether the dietary modifications are required or not, i.e., that a nutrition-related problem exists (this problem is the Nutrition Diagnosis). Dietitians then examine this client data to identify the cause/s of the nutrition-related problem (its etiology) and its significance (the effect the nutrition-related problem has on client’s health and wellbeing). All of this information then used to determine how to go about resolving (this is the Nutrition Intervention) the nutrition-related problem.

Makes sense…so what is my important point?

Nutrition Assessment, should not be just list of assessment information, it should contain only relevant information that is used to demonstrate;
• Whether a nutrition-related problem exists
• The cause/s of the nutrition-related problem
• It’s significance (the effect the nutrition-related problem has on client’s health and wellbeing).

As Dietitians, our time as is too precious to be wasted writing irrelevant information in the Nutrition Assessment. So I recommend to you to only enter relevant information in the Nutrition Assessment section.

Now we have that clear, it will talk a bit about what makes up the Nutrition Assessment section.

In the ADIME the Nutrition Assessment is ordered a little bit different compared to other note writing formats, with Food/Nutrition-Related History listed first.

Food/Nutrition-Related History

This section includes all information about your client’s oral intake, as well as nutritional support plus enteral and parental nutrition. Basically, any diet-related information i.e., the client’s diet history (and your analysis of it), complementary/alternative medicine use, knowledge/beliefs about food and eating, access to adequate healthful food and nutrition quality of life. Physical activity history also lives here.

Ok, a common comment I hear about this section, is why isn’t Anthropometric first?

In ADIME, we list the most important stuff first. We know medical staff do not always read every part of a Dietitian’s notes, they may read the first part then skim the rest. Food/Nutrition-Related History is the most important part of a Dietitian’s documentation, right? A Dietitian’s ability accurate gather nutrition and diet-related information and interpret it, is what makes us unique as a profession. Other professionals measure weight and other anthropometric measurements (even doctors do it sometimes), all health professionals collect medical histories, most check the biochemical/lab data, but only dietitians assess dietary and nutrition-related history. That’s why is section is first.

Anthropometric Measurements

We all know what goes here, height, weight, body mass index (BMI), growth pattern indices/percentile, and weight history, etc.

Something I would like to talk about (and it’s something that I have touched on previously) is Nutrition Care Indicators. Nutrition Care Indicators are client data gathered during the nutrition assessment that is used to identify a client’s Nutrition Diagnosis and its etiology and signs/symptoms. i.e., they are indicators that nutrition care is required. Any Nutrition Assessment data can be a Nutrition Care Indicator, including anthropometric measurements e.g. the client’s BMI. If a client’s BMI is in the obese category, for example, this is an indicator that nutrition care is warranted for weight management. In this case, the client’s BMI will be used as a sign and symptom for the Nutrition Diagnosis of Excessive Energy Intake (the reason for why it is a sign and symptom and not the Nutrition Diagnosis will be explained in the next blog).

Biochemical Data (Blood Tests), Medical Tests and Procedures

Includes laboratory data, (e.g., electrolytes, blood glucose levels, and lipid panel) and tests (e.g., gastric emptying time, resting metabolic rate).

The critical thing to remember here, is the Nutrition Care Process supports evidenced-based practice, it is not enough to say client A has an HbA1c of 10%, you need to show what this means (interpret it). It does not have to be a long description…all you have to do is compare your client results against some relevant standard. It can be a reference standards, i.e., the Diabetes Society recommended HbA1c target or the client’s goal, e.g., reduce HbA1c by 1%.

Client A’s HbA1c is 11% [The client’s result and the Nutrition Care Indicator], which is above [the comparison- it does not need to be long] the recommended range of < 7% [the reference range].

Nutrition-Focused Physical Findings

These are findings obtained from the evaluation of “body systems” including overall appearance, cardiovascular, digestive system, skin and vital signs. The results should be nutrition-related physical characteristics, such as nausea, loss of subcutaneous fat and temporal wasting, and they should be associated with pathophysiological states e.g. cancer cachexia, malnutrition. So again, I emphasise only including relevant information. Nutrition-focused physical findings can be derived from a nutrition-focused physical exam, medical records, direct observation, client reports, etc.

Client History

This section includes current and past information related to personal, medical, family, and social history. Personal History includes general client information such as age, gender, race/ethnicity, language, education, and role in family. Medical history can be a history of the client or the family history. Medical history should only contain conditions that may have a nutritional impact, so no irrelevant information. Social History includes items such as socioeconomic status, living situation, medical care and involvement in social groups.

Client information is often used as part of the etiology for a Nutrition Diagnosis e.g., economic constraints, cultural practices and depression (etiology), can be the cause of Inadequate Energy Intake (Nutrition Diagnosis).

So that is all for Nutrition Assessment, next blog I will talk about Nutrition Diagnosis and PES Statements. Below are some final tips.

P.S. I would love to hear what you think about this blog, please share your thoughts below.

Tips

1. Decide on what data is appropriate to collect (consider the client, your setting, the referral reason, etc.)
2. Collect data using applicable validated assessment tools
3. Distinguishing relevant between relevant and irrelevant data (only include relevant data)
4. Validate your data by comparing it against relevant standards or client goals.

Why Dietitians are Effective!

Posted on August 2, 2013May 6, 2022 by kalix_dev

This post is by Claire Nichols, Co-founder of Kalix and Accredited Practising Dietitian. These are my personal thoughts about the article “Doubt over dietitian referrals for diabetes”. In Australia, over the last few weeks there has been much discussion about the effectiveness of Medicare-subsidised dietetic services (EPC plans) for Type 2 Diabetic patients. This came about after the publication of an article in the Australian Doctor titled “Doubt over dietitian referrals for diabetes”

It’s sad dietitians need to defend their role in the management of diabetes patients. Other than IDNT online, I do some private practice work and the vast majority of my patients are Type 2 Diabetics on EPC plans. From my personal experience, these patients have complex nutrition issues with many social, environmental, behavioural and economic influences. The 1-5 appointments (2 is my average) allowed on a EPC plan, is no where near enough. Sure, there is time to provide a bit of nutrition education, set some goals then review their progress. But to equip these patients with the knowledge and skills they need to make and then maintain nutrition related behaviour change long term, many more appointments are required.

But do I think I ‘m not effective as a dietitian? No, of course not. I know I am effective! But does everyone else know this? No, maybe not. The Australian study by Ball et al (2013) examined 38 individuals’ with chronic diseases (or high risk of) preferences for receiving nutrition care. General practitioners were the preferred provider of nutrition care (n=21) not dietitians! GPs were thought to give the “most trustworthy and personalised nutrition care'” as they had “the most detailed understanding of participants’ medical conditions.” Dietitians were second (n= 12) but there was confusion about the differences between dietitians and nutritionists. Dietitians were also perceived by some be overly strict, some participants “…referred to dietitians as health professionals that ‘punish’ individuals through restrictive eating, and also use negative counselling styles.” We all know that ‘food nazi’ stereotype.

Doubt over dietitian referrals for diabetes

The author of the offending article, a medical journalist called Michael Woodhead, based his piece on a research paper by Spencer et al (2013) published in the Australian Journal of Primary Health. The paper is titled “Attendance, weight and waist circumference outcomes of patients with type 2 diabetes receiving Medicare-subsidised dietetic services” and briefly, it is a prospective observational study conducted over a 9 month period in 2011. Three private practice dietitians in Queensland were involved. The participants in the study were 129 Type 2 Diabetes referred to the dietitans on EPC plans. Mr Woodhead argues that because most of the participants failed to achieve 5% loss of body weight over an average of 2 appointments, the benefits of attending the appointments were “limited.” The other point he makes is, the non-attendance rate was high (29%), and “high rates of non-attendance have the potential to cost several hundred million dollars per year.” Yes, GPs receive money for developing EPC plans, but I am yet to receive a Medicare payment for seeing a patient after they fail to attend.

Non-attendance

So, patients never fail to attend GP appointments? No, of course not, non-attendance is a major issue for everyone in healthcare. A systematic review found the non-attendance rate in US primary care ranged from 5 to 55% (George & Rubin 2003). An Australian randomised controlled trial comparing the different methods for following up diabetic patients, had a 65% drop out rate for GP care (the drop out rate for clinic care was 47% and 28% for shared care) (Hoskins et al 1993).

The benefits of dietetic care

I also disagree with Mr Woodhead’s first point, that the benefits of dietetic care to participants were “limited”. Five out of the 51 participants (9.8%) who returned for review appointments and had their weight remeasured (60 returned within the study period but 9 did not have their weight remeasured) lost greater than 5% of body weight. That’s a great result! Overall the average amount of weight loss between first and last appointment was 1.9 +/-2.9 kg. Participants who attended more than two consultations lost significantly more weight than those who attended two only (3.7 +/-4.2kg vs -1.1+/-1.6 kg, respectively). Unfortunately the study did not report blood glucose measures, HbA1c, blood lipids or blood pressure measurements, so it is unknown whether the participants achieved metabolic improvements. In another study, participants (Type 2 Diabetics on diabetic medication with HbA1c >7% and at least 2 co-morbidities) undergoing dietetic intervention achieved significant improvements in glycaemic control despite the amount of weight loss equalling less than 5%. The group on average lost only 2.4kg over a 6 month period, but achieved a significant reduction in HbA1c (0.5%) compared to no change in the control group (diabetic medication only) (Coppell et al 2010). So sure, Spencer et al (2013) should have recorded glucose levels, HbA1c, blood pressure etc. But you have to remember, EPC appointments are often only 20 minutes long, it’s very hard, if not impossible to review patients’ goals, answer questions, provide education and take all these measurements within the time frame. Also, accessing reliable patient data in a private setting is difficult! As a dietitian, I cannot order blood tests. Yes, I can ask the patient’s GP nicely to order tests. It does not mean I receive a copy. Any results received are often self reported by patients. The likelihood that they are reported incorrectly is high. Also I don’t know how many times I have heard “oh I’m sorry I forgot my glucose monitoring book.”

Dietitans are effective

My interpretations of the findings of Spencer et al (2013) research is- Dietitans are effective. If patients were give more appointments with us, we would be even more effective! While, Mr Woodhead’s article may be damaging short-term, the silver lining is-We are now talking about how we can do things better! We are talking about how we can include more research in private practice and how we can align research and the needs of dietitians in private practice better. That’s fantastic!

References

Ball, L., Desbrow, B., Leveritt, M. (2013), An exploration of individuals’ preferences for nutrition care from Australian primary care health professionals, Australian Journal of Primary Health, [Online]

Coppell KJ, Kataoka M, Williams SM, Chisholm AW, Vorgers SM and Mann J (2010), Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment- Lifestyle Over and Above Drugs in Diabetes Study (LOADD): randomised controlled trial BMJ: 341:c3337.

George A and Rubin G (2003), Non-attendance in general practice: a systematic review and its implications for access to primary health care. Family Practice; 20: 178–184.

Hoskins, P.L., Fowler, P.M., Constantino, M., Forrest, J., Yue, D.K. and Turtle, J.R. (1993), Sharing the Care of Diabetic Patients between Hospital and General Practitioners: Does it Work?. Diabetic Medicine, 10: 81–86.

Spencer L, O’Shea M-C, Ball L, Desbrow B and Leveritt M (2013), Attendance, weight, waist circumference outcomes of patients with type 2 diabetes receiving Medicare-subsidised dietetic services, Australian Journal of Primary Health [Online].

Woodhead, Michael (2013), Doubt over dietitian referrals for diabetes, Australian Doctor, https://www.australiandoctor.com.au/news/latest-news/doubt-over-dietitian-referrals-for-diabetes [contact-form]

How secure are your passwords?

Posted on July 14, 2013May 6, 2022 by kalix_dev

Do you use any of these passwords? If the answer is yes, your computer could be hacked almost instantly.

This post is by Felix Jorkowski- Co-founder of Kalix and Head Software Engineer

From time to time, there are stories in the media about hacker attacks on websites or computer networks. You may remember last year, the computer network at a Gold Coast medical center was hacked and their patient files corrupted. Have you wondered how hackers gain access to systems like this? To put it simply, hackers look for vulnerabilities (or weaknesses in computer systems), they then use these vulnerabilities to compromise the system. These weak spots are often referred to as “security loopholes.” Today I thought, I would discuss a much-overlooked security loophole – you.

Weak Passwords

Can you guess, what is the most critical aspect of security in a cloud-based system? No, it isn’t using Anti-virus Software… It’s your choice of password! Yes, the hackers, were able to access the Gold Coast medical center’s server by hacking their password. I think this cartoon explains it well.

The hackers, of course, didn’t literary hit the medical center’s staff on the head! They either guessed what their login password was or used password cracking software to hack it.

The table below shows the amount of time it takes for password cracking software to generate every possible combination of letters for a given number of characters (courtesy of Lifehacker). Longer passwords take much longer to hack, 5 minute for a 6 character password to 4.5 years for a 10 character word. Likewise, passwords containing a combination of characters (uppercase, lowercase, and symbols) take more time hack compared to lower case only (from 2.23 hours to 2.21 years for a 7 character password).

Alternatively, some hackers just guess what a password is. You can have all the layers of encryption possible, but if your password is literally the word ‘Password,’ it will take a potential hacker just seconds to access your personal data. You’re probably wondering who would use something so obvious, but take a look at the list of the most popular passwords, do you use any of these? (courtesy of SplahData).

password
123456
12345678
abc123
qwerty
monkey
letmein
dragon
111111
baseball
iloveyou
1234567

14. sunshine

15. master

16. 123123

17. welcome

18. shadow

19. ashley

20. football

21. jesus

22. michael

23. ninja

24. mustang

25. password1

Sharing Passwords

Another common mistake is reusing the same password on multiple sites. I have to admit, this is something I’ve been guilty of in the past. I changed my practices after the social networking website LinkedIn was hacked last year. The hacker stole nearly 6.5 million users’ passwords. If someone looked at the list and found my email and password together, they would have had easy access to a number of my other accounts.

Unfortunately when sites do not follow best practices, or human error occurs, password leaks can occur. The only way to stop these leaks from spreading, is to have a different password for each service you use. Of course, actually trying to think of unique passwords for each site, making sure they are ‘strong’ passwords and then remembering all of them, is near impossible! Luckily there is a simple solution…

Useful Password Tools

I’ll give you a small insight into what my own personal passwords look like (of course these are not my actual passwords!)

Google – vBMEVdHtFMbPtm5aWpSCPTQRy

LinkedIn – hSTw@CJNyyxH@NB4GtdFn9drd

In total I have about 50 passwords like this, including my banking, email, business-related services – the list goes on. Using these passwords makes it almost impossible for anyone to break into any of my accounts, and if one account is compromised then I can rest easy knowing, my other accounts are safe.

These passwords are also impossible to remember, which is why I use a product called lastpass. This is a password manager generates long ‘hack-proof” passwords for all of my logins and holds them an encrypted format. The passwords can only be “unlocked” by a single ‘master password.’ But if you use a ‘weak’ master password, you are right back to where you started. The trick is choosing a secure password, that is also easy to remember!

There is a great site where you can create your own strong password out of four random common words: passphra.se. I recommend that you keep generating passwords on this site until you find one you can remember.

Single Sign-on + Two-factor Authorization

Some sites do security really well are Google and Microsoft. These sites offer a feature called ‘two-factor authorization.’ When you want to log in, you have the option of also entering a code that is sent to your mobile device. It adds an extra security step, as any potential hacker would also have to steal your phone to log into your account.

While Kalix does not offer ‘two-factor authorization’, we do offer you the ability to log into our site via these highly secure sites. This method of logging is called ‘single sign-on.’ Our Google, Facebook or Microsoft ‘single sign-on’, effectively sends you to the selected site to sign in and by doing so this, the site verifies your identity for us. By using this feature, you can get all the extra security of using ‘two-factor authentication’ plus the added benefit of not needing to remember another password!.

Protecting Your Clients

Ensuring your client records remain safe and secure is very important. At Kalix, we work hard to make sure we follow best practices in security. However, as customers, there are steps you must take to close ‘the security loop’.

Choose strong passwords: at least 8 characters (the longer, the better), with a combination of uppercase and lowercase letters, numbers, and symbols.
Do not choose commonly used passwords.
Do not re-use the same password on multiple sites.
Consider using a password manager to generate and store ‘hack-proof” passwords.
Use ‘single sign-on’ for Kalix.

The Story of Kalix

Posted on June 25, 2013May 6, 2022 by kalix_dev

This post is by Claire Nichols, Co-founder of Kalix and Accredited Practising Dietitian.
Hi everyone. I am very excited to be sitting here writing our first ever blog post. Well, I actually have to admit, coming up with a topic for the blog was a bit daunting. I mean there are lots of things to write about really, our new features, for example, but what I really wanted to do was to start with something a bit different compared to our newsletter. I so thought I would try to answer some of the big questions; who are we, what are we doing, how we got here and the meaning of life (well maybe not that one). So here goes…

Two years ago I would have never guessed, I would be a co-founder of a software company. My knowledge of IT was little to none. Sure, I could turn on a computer, make a Word document, google a topic, but I didn’t know where, to begin with making a blog, let alone a website. Then came a problem, followed by an idea and then an opportunity.

The problem arose just after starting my previous job as Early Intervention Service Dietitian in North West Tasmania. The position was funded with a special government grant, so there was a lot of pressure to measure and evaluate the effectiveness of my professional practice. Evaluating the effectiveness of dietetic practice, is easy enough, isn’t it? When you see a patient, you measure their weight and the next time you see them, you measure it again. If they’ve lost weight you’ve done a good job if they haven’t, you then haven’t…Hopefully, you are all screaming NO right now.

For the non-Dietitians reading this;

1) Dietitians do not only see patients for weight control.

2) Weight loss is hard! Improving overall diet quality, and improved patient health is what we want to achieve as healthcare professionals, right? But how does one measure healthy lifestyle?more active and establishing a healthy lifestyle are all positive achievements. They all result in improved health, irrespective of the amount of weight loss.

The idea So I went about investigating how to measure and evaluate professional practice. I came across International Dietetics and Nutrition Terminology (IDNT) and the Nutrition Care Process (NCP). Well, actually I was using IDNT at the time and I had been since 2009 but only to write PES statements. There is a lot more to IDNT than PES statements.

For non-Dietitians NCP is a problem-solving method that Dietitians use to “think critically and make decisions that address practice-related problems”. IDNT is a “standardized set of terms used to describe the results of each step of the NCP model.” PES is a statement about the Nutrition Diagnosis or nutrition issue. Clear? If not that’s ok, I will talk about it more in future posts.

Why I like IDNT

There are lots of terms, getting to close to 1000 now I think (yes I actually like that).
They cover all the stages of the Nutrition Care Process (Assessment, Diagnosis, Intervention and Monitoring/Evaluation) i.e. initial and review assessments.
They include most factors in dietetics e.g. Food variety is a term, as well as Meal or snack pattern, Nutrition quality of life responses, Frequency, Consistency, Duration, and Intensity of physical activity and of course, good old Food intake, to name a few.

So my light bulb moment….because IDNT is standardized and covers all the data a dietitian would collect during initial and review assessments if I was to write all my patient documentation using IDNT then I could use a software system to track changes in the variables associated with IDNT terms. Tracking the changes in these variables would be an easy, sensitive and efficient way of evaluating professional practice. I could even use IDNT to evaluate the effectiveness of particular interventions by correlating Intervention terms with changes in the variables associated with Assessment and Monitoring/Evaluation terms.

By using IDNT I could evaluate my professional practice without having to spend extra time measuring, recording and analyzing data. The statistical analysis would be built into patient documentation and patient documentation is something I had to do anyway!

The problem was finding a software system that uses IDNT in this way. I needed a software system that supports quick electronic documentation using IDNT terms, tracks of changes in patient data over time and correlate changes in variables.

There must be something like that out there, right? No, not really. Why? My best guess is because 1) software developers are really really expensive to hire, and 2) actual building software with this functionality would take a long time.

The opportunity- I was very lucky to have my own software developer on hand, Felix Jorkowski. So we embarked on this little project together and it has grown and grown.

So I might be the most unlikely co-founder of a software company but win or lose I am glad I took the risk to try something new. I will finish this blog with a quote which I think sums things up really well.

“You can’t make footprints in the sands of time by sitting on your butt. And who wants to leave buttprints in the sands of time?” Bob Moawad

References

Nutrition Care Process and Model Part I. The 2008 Update. J Am Diet Assoc. 2008; 108:1113-1117.

Nutrition Care Process Part II: Using the International Dietetics and Nutrition Terminology to Document the Nutrition Care Process J Am Diet Assoc. 2008; 108:1287-1293.