Newsletter

[ Vol. 14 No. 1 ] (January - April 2013 )
Use of computer in nutrition support

Nina M.Schwenk
Mayo Clinic College of Medicine (United States)

Goals
1. To understand the concept of Information Management
2. To apply the concepts of Information Management to Nutrition Support
3. To share an example of a technology solution to support nutrition care decision-making.

INFORMATION MANAGEMENT

Definition
A discipline that exploits information as an intellectual asset by acquiring, organizing, analyzing, and disseminating it to achieve desired outcomes.

Information-Based Clinical Care
Nutrition support is a very data rich discipline. It requires manipulation and interpretation of complex data and information in order to provide high quality care to patients with nutritional needs. Laboratory data, patient characteristics and nutritional data have to merge with clinical assessment and nutrition delivery systems to assure appropriate nutritional support. Information Management can be used as a tool to build upon data to achieve desired outcomes.

Information Management Pyramid

Once data is created or generated, it needs to be put in an appropriate context or given the appropriate relevance before it becomes information.

Inferences or conclusions then need to be drawn before that information becomes knowledge.

Decisions can be made on knowledge to guide actions. Appropriate accountability of these action lead to outcomes.

These statements are general and apply to any field. They are true in the electronic and paper environments. An illustrative, but simple, nutritional example follows.

Clinical Nutrition Example

Technology Support
Technology solutions are available to assist at each level of the Information Management pyramid.

Computers, hand-held devices (PDAs --- Personal Digital Assistants), and electronic medical records cancollate and store large amounts of data. These devices can also provide preset context to give normative values and alert care  providers of abnormal or clinically relevant results.

Simple diagnostic software programs are now also available to help generate plausible diagnoses or create knowledge about disease states based on inferences drawn from available information (ex. Dxplain, QMR, and lliad).

The newer and more exciting technology tools help reach the next level in decision making. These programs are decision support systems that categorize knowledge, apply preset rules and generate potential actions. Some of the first such systems helped identify drug/drug interactions and incompatible dosing schedules. Preventative screening recommendations and alerts are other forms of this simple decision support. More sophisticated programs are now available to track and manage hospital infections and appropriate antibiotic usage.

FEED -- An Example of a Nutrition Decision Support System
FEED stands for “Feeding Effectively using Electronic Data.” This system was created at Mayo Clinic to support the inpatient nutrition care of adult patients. It is a rule-based system that alerts clinical staff about potential nutrition-related problems. The development was a partnership between physicians, nutrition support staff, pharmacists, and information technology staff. The development fits into the Mayo Clinic Hospital Rule-Based Systems, which includes other decision support software for pharmaceutical care, electronically assisted infection surveillance and antimicrobial monitoring.

The FEED system includes:

• Census sheet
   
• Calculation to determine concentrated and standard volume parenteral nutrition formulas
   
• Anthropometric information needed to design a nutrition program
   
• Pharmacy information
   
• Laboratory information
   
• Caloric/protein/fat intake vs. estimated requirements

These data and information feeds are used to generate specific information and flag parameters outside of present guidelines for review. Drug/drug and drug/nutrient interactions are also tracked.

In addition to daily patient management, this system can be used to generate population data for clinical research and quality improvement projects. The value of these systems is still to be proven?though it would empirically appear to improve patient care and patient safety.

SUMMARY
Information Management concepts and Information Technology can provide powerful tools to aid in the care of patients with nutritional deficiency or nutrition–related illnesses.

More research needs to be done to show the value of these tools and explore novel uses to improve patient care and safety.

From  
The 14^th Congress of Parenteral and Enteral Nutrition Society of Asia
“From Nutrition Support to Nutrition Therapy”
October 14-16, 2011, Taipei, Taiwan 
Page: 15-17