1

Nutrition Informatics – What is it?What does it mean to you?

Elaine J. Ayres, MS, RDDeputy Chief, Laboratory for Informatics Development

National Institutes of Health, Clinical Center

February 23, 2009

University of Maryland

2

Key Topics

• What is nutrition informatics?

• Data and information

• Technology

• Where is the profession?

• What are competencies for the field ofinformatics?

3

4

Informatics

• Informatics includes the science of information,the practice of information processing, and theengineering of information systems. Informaticsstudies the structure, algorithms, behavior, andinteractions of natural and artificial systems thatstore, process, access and communicateinformation.

http://en.wikipedia.org/wiki/Informatics

5

6

“The effective retrieval, organization, storage

and optimum use of information, data andknowledge for food and nutrition relatedproblem solving and decision making.Informatics is supported by the use ofinformation standards, information processesand information technology”.

(ADA Nutrition Informatics Work Group, 2007)

Nutrition Informatics

7

“The effective retrieval, organization, storage

and optimum use of information, data andknowledge for food and nutrition relatedproblem solving and decision making.Informatics is supported by the use ofinformation standards, information processesand information technology”.

(ADA Nutrition Informatics Work Group, 2007)

Nutrition Informatics

8

Data

• Raw information that has not beenanalyzed or interpreted

• Humans and/or computers can processdata

• Examples:

– Weight

– Brand of insulin

– Grams of carbohydrate in rice

9

Information

• Transforming data into information– Analysis

– Interpretation

– Comparison

– Aggregation

• Can be displayed graphically

• Humans and/or computers can turn datainto information

• Weight/insulin/CHO in rice = ?

10

Knowledge

• Trends, patterns, context

• Outcomes

• Decision support

• Artificial intelligence

• Research

• Humans with computers can efficientlycreate knowledge

11

Data to Knowledge

12

Sources of Data

• Printed materials• Electronic• Verbal• Databases• Images• Signals

How do you organize?The art of information processing…

13

Standards

14

Standards

• Term (a word)

• Terminology (a set of terms)

• Multiple terminologies developed to meetspecific needs

• Unified Medical Language System (UMLS)– SNOMED

– LOINC

– ICD-9

• Data transmission standards – HL7

15

Standard Hierarchy

USDA DatabaseVegetables

TomatoTomatoes, red, ripe, raw

WholeCherryItalianPlumOther

Nutrients

16

Knowledge-Based Terminologies

• Defines the relationship between termsrather than just organizing into a hierarchy

• Example

– Lab test linked to chemical substancemeasured

– Medication linked to chemical substance

– Diseases linked to body location

17

Knowledge-Based HierarchyKnowledge-Based Hierarchy

• Includes a traditional hierarchy

• Adds concepts such as

– Is a …..

– Attributes such as chemical composition

– Synonyms

• Each item is a number not a word

• Translation tables link numbers in adatabase

18

Knowledge-Based Hierarchy

IS A - VEGETABLE

HAS CHEMICALSTRUCTURE LIKE:

HAS ALLERGANPROFILE LIKE:

HAS GENETIC STRUCTURELIKE:

HAS NUTRIENTCOMPOSITION LIKE:

19

Nutrition Resources

• Nutrient composition tables

• Standardized languages– ADA Standardized language

– SNOMED

• Proteomics and genomics data

• Chemical composition tables– THINK BOTH WORDS AND NUMBERS!

• Career Tip: Many informaticists havetraining in information science!

20

Technology

21

Hardware

22

Look Familiar?

23

Applications

• Common tools – e-mail, browsers, officemanagement

• Query and reporting tools

• Statistical analysis

• Database management systems

• Networking and interfaces

• Electronic medical records

• Nutrition management systems

24

The Future?

25

Health Information Technology

Health information technology (HIT) allowscomprehensive management of medical information andits secure exchange between health care consumers andproviders. Broad use of health IT will:

* Improve health care quality;* Prevent medical errors;* Reduce health care costs;* Increase administrative efficiencies;* Decrease paperwork; and* Expand access to affordable care.

1) http://www.dhhs.gov/healthit/

26

27

Interoperable Health IT

Interoperable health IT will improve individual patientcare, but it will also bring many public health benefitsincluding:

* Early detection of infectious disease outbreaksaround the country;* Improved tracking of chronic disease management;and* Evaluation of health care based on value enabledby the collection of de-identified price and quality

information that can be compared.

1) http://www.dhhs.gov/healthit/

28

Electronic Health Record

The Electronic Health Record (EHR) is a longitudinalelectronic record of patient health information generatedby one or more encounters in any care delivery setting.

The EHR has the ability to generate a complete record of aclinical patient encounter - as well as supporting othercare-related activities directly or indirectly via interface -including evidence-based decision support, qualitymanagement, and outcomes reporting.

2) http://himss.org/ASP/topics_ehr.asp

29

Electronic Health Record

“The Electronic Health Record is thetechnology likely to have the mostprofound effect on the daily work ofphysicians and other health careproviders”.

3) Blumenthal, D, Glaser, JP NEJM 2007

30

Consumer Health IT

Health information technologies can be tools that helpindividuals maintain their health through better managementof their health information.

Health IT will help consumers gather all of their healthinformation in one place so they can thoroughly understandit and share it securely with their health care providers sothey get the care that best fits their individual needs.

1) http://www.dhhs.gov/healthit/

31

Personal Health Record

Personal Health Record (PHR) – acollection of information about anindividual’s health and health care, storedin an electronic format.

Personal Health Record System – a PHRwith computerized tools that help anindividual understand and manage theinformation contained in a PHR.

4) DHHS – Personal Health Records 2006

32

Personal Health Record

“ Personal Health Records have thepotential to affect the daily lives of patientsby involving them more actively inmanaging their own health”.

3) Blumenthal, D, Glaser, JP NEJM 2007

33

State of the Union

34

Nutrition Informatics Survey

• Electronic survey of all ADA members withvalid e-mail (55,063)

• Responses – 11,223 (20% response rate)

• Included students, interns and retirees

• 80% of respondents work in a dieteticsrelated position

• 35% work in clinical nutrition

• .4% work in informatics

35

• Access to a computer/internet– 97.3% have access to a computer at work

– 91.5% have access to the internet at work

– 1.3% had no access to a computer or the internet atwork

– 19% use a PDA

• Use of applications– 93% use e-mail daily

– 86% use the internet daily

– 50% use clinical nutrition applications daily

– 45% use some form of electronic health record daily

Survey continued

36

ADA Standardized Language

• 44% familiar with ADA standardizedlanguage

• Using standardized language in practice

– 16% using nutrition diagnostic terms

– 13% using nutrition intervention terms

– 11% using monitoring and evaluation terms

37

38

Practitioner or Informaticist?

• Six areas of practice as defined by ADA:

1. Community Nutrition

2. Clinical Nutrition

3. Consultation and Business Practice

4. Food and Nutrition Management

5. Education

6. Research

• Is #7 Informaticist?

39

Careers in Informatics

40

Informatics Competencies

• Dietetics– Nutrition science– Food composition– Food service management– Anatomy, physiology, microbiology

• Information Processing and Knowledge– Information science– Terminology– Evidence-based practice– Biostatistics– Evaluation methodologies

• Methods of Informatics– Software, hardware and networking– Database systems– Human/computer interactions– Project management

Huang, QR Health Informatics J 2007; 13: 89-103

41

Nutrition Informatics R.D.’s

• Learn from other professions

• Build our own expertise

• Develop our own programs

• Measure outcomes and value

• Do our own research

Be a NIRD !!

42

Rome was not built in a day….