1 Incorporating the EAL and ANDHII into Practice: Strategies for Success
2 Kristi Crowe-White, PhD, RDDisclosures Kristi Crowe-White, PhD, RD Board Member/Advisory Panel Chair – AND Evidence-Based Practice Committee Employee Associate Professor, University of Alabama Current Research Support American Heart Association No additional disclosures to report
3 Learning Outcomes At the end of this session, participants will be able to… strengthen evidence-based practice and documentation of d MNT through increased knowledge of updated resources from the EAL and new features available on ANDHII increase their credibility on the health care team through implementation of EAL evidence-based practice guidelines and data collection with ANDHII. access and utilize the Academy’s free member resources, EAL and ANDHII. Non-members will learn how to subscribe
4 Evidence-Based Practice (EBP)What is EBP? EBP in dietetics employs the use of systematically reviewed scientific evidence in making food and nutrition practice decisions How does EBP work? Achieved by integrating best available evidence with professional expertise and client values to improve outcomes Learn more at: The Academy defines EPB as ….. The Academy Scope of Dietetics Framework Definition of Terms 2007
5 The Academy’s Evidence Analysis LibraryA Free Member Benefit with two Major Components Systematic Reviews on various topics developed by Academy members for Academy members. Evidence-based Nutrition Practice Guidelines based on completed Systematic Reviews.
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7 Products of the Academy’s EALEvidence Summaries and Conclusion Statements Guideline Recommendations – course of action for the practitioner based on the evidence Systematic reviews: SR’s are a scientific investigation that focuses on a specific question and uses explicit, prespecified scientific methods to identify, select, assess, and summarize the findings of similar but separate studies (IOM 2011). This information is summarized into what the evidence says via evidence summaries and conclusion statements. Clinical practice guidelines: are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options (IOM, 2011). Trustworthy guidelines should be based on a systematic evidence review, developed by panel of multidisciplinary experts, provide a clear explanation of the logical relationships between alternative care options and health outcomes, and provide ratings of both the quality of evidence and the strength of the recommendations. course of action for the practitioner based on the evidence
8 Results of Evidence-Based PracticeImproved quality of care Increased patient safety Decreased variation in practice Efficient use of resources Increased likelihood of achieving desired patient outcomes Improved client, provider & payer satisfaction Increased credibility of the RDN within the healthcare team
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11 The Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII)Collect patient outcome data and clinical practice data All data categorized by IDNT Custom cross-tab report builder translates structured data into researcher-friendly format ready for statistical analysis Restriction to accept only de-identified data removes need for individual approval
12 ANDHII: Fueling Outcomes ResearchRDN-friendly tools promote ANDHII usage and build membership value ANDHII access included as member benefit Intelligent suggestions and auto-complete Quickly find the right IDNT terms Complete NCP chains across visits Customizable plain-text visit reports to copy/paste into medical record Patient trends reports to visually track patient progress or clinician performance
13 Sarah A. Johnson, PhD, RDN, CSODisclosures Sarah A. Johnson, PhD, RDN, CSO Board Member/Advisory Panel - Evidence-Based Practice Committee (Vice Chair and Member) Consultant - Nothing to disclose Employee - Assistant Professor, Department of Food Science and Human Nutrition, Colorado State University Research Support - Colorado Agricultural Experiment Station - Pear Bureau Northwest - Shaklee - US Apple Association Speaker’s Bureau Stock/Shareholder Other
14 Evidence-Based Practice (EBP) – What is It?The approach to healthcare in which practitioners use the best evidence possible to make decisions for individual patients to improve health outcomes Founded upon asking important questions, systematically searching for evidence, and assessing the validity, applicability, and importance of the evidence It involves complex and conscientious decision- making by the practitioner based not only on the available evidence but also on client characteristics, situations, and preferences
15 EBP – Why is It Important?Critical for achieving high-quality patient care as it applies valid and current research findings to clinical practice Contributes to the quality, effectiveness, and efficiency of the registered dietitian nutritionist (RDN) Enhances credibility of the RDN with other members of the healthcare team Helps standardize practice so that outcomes data can be collected and analyzed to improve the quality and effectiveness of practice
16 EBP – Perceptions, Attitudes, and Knowledge of the RDNResearch indicates that the majority of RDNs consider EBP to be valuable and relevant to their practice Increased frequency of applying EBP is associated with: More frequent use of resources More years of education Previously taking a research course Frequently reading research articles Advanced-level board certification Working full-time Work setting Memberships with professional associations
17 EBP – Perceptions, Attitudes, and Knowledge of the RDNMany RDNs believe they lack the knowledge and skills necessary to successfully use this approach in their practices Research indicates that the strongest barriers to applying EPC include: Lack of time Lack of team collaboration Poor organizational culture Inadequate resources Lack of access to mentors Lack of training in critical appraisal
18 What are EBP Toolkits? Set of companion documents for application of the practice guideline Disease/condition specific Include: MNT protocol for treatment of disease/condition Documentation forms (progress notes, summary notes) Outcomes monitoring sheets Client education resources Case studies Electronic downloadable purchase item
19 EBP Toolkits Disorders of Lipid Metabolism Adult Weight ManagementOncology Critical Illness Celiac Disease Heart Failure Diabetes Pediatric Weight Management
20 Objectives of ToolkitsTo assist Registered Dietitian Nutritionists in: Implementing evidence-based practice Implementing the Nutrition Care Process in a standard way using standardized language Promoting consistency Promoting quality care Achievement of expected outcomes
21 Evidence-Based Practice GuidelineToolkit Development Systematic Review Evidence-Based Practice Guideline Toolkit
22 Toolkit Development Develop toolkits to apply guidelinesConduct 60-day usability test of toolkit and revise Evidence-Based Practice Committee (EBPC) Review and Approval Make toolkits available for purchase
23 My Experience Previously worked as an inpatient and outpatient oncology dietitian for several years Setting: Large multi-hospital, nursing home, and outpatient clinical medical center Main hospital located in small town while many other hospitals, nursing homes, and clinics were located in surrounding rural areas Employed dietitians had a specific setting in which they primarily worked; however, all had to work in more than one setting and covered each other’s work when on vacation, sick, etc. My primary work setting was at an outpatient oncology center but also covered inpatient and nursing homes
24 My Experience Work environment:Inpatient setting used electronic and paper medical records Outpatient oncology center used only paper medical records initially Multiple responsibilities and need to cover for other dietitians led to everyone being stretched thin Time for professional development, use of resources, and improving practice was limited thereby presenting a major obstacle Although the nutrition care process was used, ensuring practice was based on the current evidence and practice guidelines was challenging Use of standardized language was nonexistent
25 My Experience Me: Recent graduate from a combined Master’s program in Nutrition and Food Science with a dietetic internship Fresh knowledge regarding the importance of the Nutrition Care Process, standardized language, and evidence-based practice Worked with a generally high-risk and complex population, i.e. cancer patients with wide-ranging issues and needs, and had a genuine concern and care for their health and betterment Recognized that the lack of use of standardized language and implementation of evidence-based practice was a problem
26 My Experience The general lack of use of standardized language and implementation of evidence-based practice coupled with the risk and complexities of my patient population lit a fire I knew that I had the responsibility to be the best practitioner possible for my patients I also recognized the importance of not giving in to the challenges and shortcomings of my work environment if I wanted to be the best that I could be for my patients, myself, and my profession
27 My Experience Initial steps to implementing EBP:Overcoming interpersonal barriers – what would my coworkers and supervisors think about me if I started doing things differently than them? Example: I was the only RDN writing PES statements in my assessments and follow-up notes where I worked. No one ever said anything to me about them or started writing them in their notes – but I knew I was doing the right thing and was making a difference.
28 My Experience Initial steps to implementing EBP:Making time – although it was difficult, I made sure to set aside some time everyday even if it meant staying going to work a few minutes early, staying a few minutes late, or taking some personal time Example: writing PES/nutrition diagnosis statements can be challenging and time consuming, especially in the beginning I began making an effort to use standardized language to write at least one PES statement for each assessment and follow-up note completed
29 My Experience Exploring resources – what resources could best help me to educate myself and provide the best care for my patients? Logically, with the Academy of Nutrition and Dietetics as our profession’s organization I started here with the Evidence Analysis Library Example: the EAL can be overwhelming at times due to the wealth of information and need for an understanding of the process of developing a guideline and the terminology I began making time once per week to explore the EAL including the EAL tutorial, the methodology, definitions and terminology, etc. to gain a better understanding With a foundational knowledge, I was then able to set aside time for at least one patient per week to read and begin implementing relevant EBP nutrition guidelines
30 My Experience Next steps:By taking initial steps to implement EBP, I had created an environment for myself in which I felt comfortable, established a habit of setting some time aside every week to educate myself and implement EBP, and I had the resources and tools available in my back pocket to be used as needed. An “opportunity” presented itself – we were going to transition from paper medical records to electronic medical records (EMR) I was the only RDN working at our oncology center and this presented a unique opportunity to be directly involved in the development of our documentation forms
31 My Experience EMR The structure of these records and documentation forms has an immense impact on the content that is documented With a new opportunity to make a difference, I began thinking about important questions How could I structure our documentation forms such that it would set the stage for using standardized terminology and implementing EBP? What resources did I have available to me to facilitate the creation of the best quality and most effective electronic medical records and documentation forms? Should I do this alone or would this be a good opportunity to involve my supervisor?
32 My Experience Exploration of the resources available to me for implementing EBP led me to have a foundational knowledge of the available and most relevant resources This led me to the Oncology Toolkit This resource would be the most helpful because of its content: Documentation forms (initial assessment notes, follow-up progress notes, PES examples, case examples) Protocol forms for implementing EBP guidelines for specific cancer types Flowcharts for encounters
33 My Experience I began exploring resources within the Oncology Toolkit to identify which would be the most helpful in designing and structuring our assessment and follow-up notes within our new EMR I had a meeting with my supervisor and presented to her the fact that we had this opportunity and the resources I thought would be best to use My supervisor and I soon began working on developing the content of the EMR we would be using for documentation Together, we used the examples and information provided within the Oncology Toolkit to make templates based on EBP
34 My Experience Use of the Oncology Toolkit allowed me to design our EMR such that it facilitated the use and application of EBP
35 My Experience Implementation of EBP with the guidance of the EAL and toolkit had several benefits: Helped me to standardize the way in which I provided nutrition care to my patients and I believe that it improved the quality of the care I provided Increased my credibility with other healthcare providers, particularly physicians Promoted collaboration with team members Led to more regular consultation requests by physicians and nurses Increased my credibility with my supervisors and upper administration within the organization
36 My Experience Increased my credibility within the professionIncreased confidence in using the Oncology Nutrition Dietetics Practice Group’s Electronic Mailing List to ask questions and communicate with other RDNs working in oncology This led to a request from the Editor of the Oncology Nutrition Connection to author a case study to be published documenting the nutrition care of one of my patients
37 My Experience Inspired me to pursue and receive Board Certification as a Specialist in Oncology Nutrition I eventually opted to pursue my doctorate full-time in nutrition and food science and left my position By this point I had established a credible reputation within my organization such that physicians, nurses, staff, and administrators were clearly vocalizing to me and others that my replacement had “big shoes to fill”
38 Suggestions for ImplementationBe brave – do not allow your fears, insecurities, perceived lack of knowledge or experience, etc. stand in your way Be willing to be a pioneer at your institution! Make time to educate yourself and to implement – set aside a little time every week to start with and increase the duration and/or number of days each week Know your resources – explore the EAL and tools offered, e.g. toolkits Read scientific articles – practice and repetition will increase your confidence and understanding Network and find a mentor
39 Practice ApplicationsEBP is critical for achieving high-quality and effective patient care, it enhances credibility of the RDN with other members of the healthcare team, and helps standardize practice so that outcomes data can be collected and analyzed to improve the quality and effectiveness of practice Application of EBP may be met with challenges and barriers and will require effort from the RDN – however, with effort and the right tools, these barriers can be overcome EBP toolkits are a great tool consisting of companion documents for application of the practice guidelines
40 Nicole V. Brown, MS, RDN, LD ACSM EP-CDisclosures Nicole V. Brown, MS, RDN, LD ACSM EP-C Board Member/Advisory Panel - Past President VAND Consultant - Private Practice Consulting RDN, Owner of “For the Health of It!” National Center for Weight and Wellness, Washington, DC Public Safety Occupation Health Center, Fairfax County, VA Cigna Educator Aetna, Cigna, and Medicare Provider Research Support - Will Murphy, MS, RDN Senior Manager, Outcomes Research, ANDHII Project Leader Academy of Nutrition and Dietetics
41 Learning Outcomes Understand framework to conduct a research study measuring client outcomes Understand the barriers to and solutions for using ANDHII to measure outcomes for clients of PPRDNs Access ANDHII which is free for Academy members to use individually or as part of a group
42 The ANDHII VAND Pilot History WSDA, CDA, AL, OADA, 1987-2000Virginia Academy of Nutrition and Dietetics—2000+ VAND President Impact! “Oh What a Difference We Make!” Strategic Plan to include outcomes Created an Outcomes Committee Idea to measure outcomes of PPRDNs—Representation from all five districts Make a difference, set ourselves apart, use EBP, reimbursement, marketing, licensure As a PP RDN, a common question is how well are you doing? How do you measure success? The discussion is focused on income not client outcomes. I have lived in three states where there is no licensure for RDNs: WA where I was state public policy chair, CA same, and VA active on the district and most recently as president of VAND Work in CA trying to get licensure; CDA leaders created an outcomes report modeled after MDA—in patient, out patient private practice client outcomes; letters by MDs; letters submitted by patients and clients. Cost saving as well as measurable changes: BS, Cholesterol, weight, BP. I have been carrying this around with me for so years and after participating in the WMDPG study and presenting my poster session in Portland about a pilot I conducted with firefighters in Fairfax County, as I entered my year as VAND President, my theme was Impact and the tag line of our Annual Meeting was “Oh What a Difference. . .We Make”; coincidentally enough, my year as President also coincided with revising our Strategic Plan which is a three year blueprint that guides our budget and activities as an affiliate and engages our districts, too. Licensure efforts in VA—many unsuccessful attempts: how can we set ourselves apart? One key way is to measure client outcomes and be able to share this with insurance companies, legislators, even use it to promote our successful practices.
43 The ANDHII VAND Pilot Time Line:June 2015 VAND Retreat &PPW: Connected with Academy Research Team/Will Murphy re: PPRDN study—ANDHII Fall 2015: VAND special project $ complete pilot by 3/16; present results at April AM; 5/16 request funding for larger study based on pilot September 2015 submitted study proposal for October 2015-Dec 2017 Invited Will Murphy to speak at VAND’s Annual Meeting and planned a workshop on ANDHII October 2015 sent eBlast to VAND members recruiting for pilot & VAND Webinar "Participating in Health Outcomes” by Will Murphy. 9 RDNs responded representing 3 of the 5 districts over summer 2015 created plan including asking him to do ANDHII webinar Webinars free for VAND members also posted on website. This presentation will inform attendees about the impact of RDNs working in private practice by measuring outcomes. While the expected impact of nutrition care provided by RDNs has been documented in clinical research practice guidelines, not all conditions frequently treated by RDNs have been thoroughly studied, and effectiveness of guidelines must be assessed in the field. The difficulty of reporting and aggregating of outcomes has prevented many RDNs from participating, but the Academy of Nutrition and Dietetics Health Informatics Infrastructure now provides outcomes monitoring using standardized terminology familiar to RDNs and facilitates the aggregation of outcomes from the individual practices of many RDNs. The aggregated data allow a more accurate assessment of impact on outcomes than would otherwise be possible.
44 The ANDHII VAND Pilot Health Outcomes and the Impact of Nutrition Care for Clients of RDNs in Private Practice Principal Investigator: Melissa Rittenhouse, PhD, RD, CSSD Co-Investigators: Nicole Brown, MS, RDN, LD, ACSM EP-C William Murphy, MS, RDN Melissa private practice RDN who no longer is our PI: got a position at the Naval Academy and moved to MD Nicole Brown: PPRDN, President of VAND Will Murphy just excellent to work with Senior Manager, Outcomes Research ANDHII Project Leader Academy of Nutrition and Dietetics
45 The ANDHII VAND Pilot Purpose:Observe current practices of RDNs working in PP Document their impact on client health outcomes Conditions with the greatest impact Conditions with room for improvement Differences between cases or care patterns that impact outcomes ANDHII will also be configured to suggest (but not require) recording the following specific assessments, which are routinely performed in nutrition practice, in order to encourage consistent documentation of key outcomes: Age (In years if less than 89, otherwise the indication “Age >89”) Height Weight Chief Nutrition Complaint Glucose, fasting Glycated Hemoglobin A1c Lipid Panel: cholesterol, LDL; cholesterol, HDL; Triglycerides, serum; cholesterol, serum Diet Experience: previously prescribed diets, previous diet/nutrition education/counseling, self-selected diets followed Food Intake – Amount of Food Area(s) and level of knowledge/skill Readiness to change nutrition-related behaviors
46 The ANDHII VAND Pilot Provide usual care Record that care in ANDHIITry not to do anything differently from how you already practice Record that care in ANDHII Nutrition Assessment Nutrition Diagnosis Nutrition Intervention Nutrition Monitoring & Evaluation Ran into an obstacle here: seasoned RDNs (many of whom are in PPs) may not use ADIME or may not use NCPT Biochemical data will be recorded only when available from the medical record (or in other official documentation provided by the client) and will never be performed specifically for the purposes of this study. For each client visit, one or more Nutrition Diagnoses will be recorded as a three part clinical judgment, composed of a nutrition problem, etiology of the problem, and signs or symptoms of the problem. The problem and etiology are recorded as selections from the Nutrition Diagnostic Terminology (attached), and the signs or symptoms are recorded as selections from the Nutrition and Assessment Terminology (same as attached for the assessment). For the etiology only, the RDN may opt to enter free text instead of using a standard term. For all three components, ANDHII provides suggestions based on entries for the current patient case according to the standard practices recommended in the Nutrition Care Process and Terminology Manual. Implemented Nutrition Interventions, such as an educational session or diet modification recommendation, will be recorded as a selection from the Nutrition Intervention Terminology (attached) paired with a free-text description of the intervention or recommended prescription. ANDHII provides suggestions for the intervention term based on entries for the current patient case according to the standard practices recommended in the Nutrition Care Process and Terminology Manual. The monitoring and evaluation plan is recorded as selections from the Nutrition Assessment, Monitoring, and Evaluation Terminology. ANDHII provides suggestions for the intervention term based on entries for the current patient case according to the standard practices recommended in the Nutrition Care Process and Terminology Manual.
47 The ANDHII VAND Pilot Study Information Sheet Health Outcomes and the Impact of Nutrition Care for Clients of RDNs in Private Practice You are being asked to take part in a research study. The study is about nutrition care for clients of Registered Dietitian Nutritionists (RDNs) in private practice in the state of Virginia. You were selected as a possible participant because you are a current client of a private practice RDN in Virginia. Please read this sheet and ask any questions that you have before agreeing to take part. Very positive response. Only one client declined. This person thought I would not be paid for the sessions by her because it was something that was benefitting me. Verbal, deidentified. Able to ask people after the first visit. Inform
48 The ANDHII VAND Pilot Informed Consent A process, not just a formDescribe the overall experience Describe the benefits Describe alternatives Describe use of identifiable information Right to withdraw at any time Allow time to consider/answer later Copy of study information sheet Verbal consent only Describe the overall experience --receiving usual care 2. Describe the benefits --no direct benefits 3. Describe alternatives --you may choose not to participate --Opting out will not negatively affect your care or relationship with your RDN 4. Describe us of identifiable information --all information is collected anonymously 5. Right to withdraw --no penalties or loss of benefits for changing your mind later 6. Allow time to consider and answer later if desired 7. Provide a copy of the study information sheet for the client to keep 8 Verbal consent only --Do not add name, signature, or any other info on the study information sheet
49 The ANDHII VAND Pilot Client Randomizer for Virginia Private Practice Outcomes Study Use this website to download lists that help you randomly select client for the study. Enter the number of clients you see in a typical week and the number of clients you can contribute to the study each week, then click the download button to retrieve your list. About how many clients do you see in a week? 20 How many clients can you contribute to the study each week? 5 Click here to download your selection list Selection List 1 Skip 2 Skip 3 Invite 4 Skip 5 Invite 6 Skip 7 Skip
50 The ANDHII VAND Pilot Time Line continuedInstitutional Review Board (IRB) APPROVED from 10/ /2016 Created Study Information Sheet (provided to clients) December 2015 RDNs advised to complete Research/Ethics training January-March 2016 Completed Research/Ethics Training 1 CEU February 2016 PPRDNs check in, ANDHII accounts created, get randomization guidelines March 2016: FNCE proposal accepted Incorporating the EAL and ANDHII Into Practice. Schedule conference calls/office hours to meet with Will as needed April 10-12, 2016: VAND Annual Meeting Will presents and does workshop May 2016 PPRDNs met to work on NCPT & drafted an ANDHII Tips Sheet January: one RDN said she couldn’t continue as parents had medical problems—down to 6 March: PI got job with Naval Academy; couldn’t continue April: another RDN too busy with her private practice/Academy responsibilities: down to 5 Nicole “turn up the volume” start collecting data Several of us in NOVA were able to meet in person/ ed others to ask for input Nicole’s mom had a stroke in May/busy taking care of family in CA over the next weeks with three week long trips to CA May-August.
51 The ANDHII VAND Pilot Time Line continuedJune 2016 Training for NCPT resources https://ncpt.webauthor.com/encpt-tutorials Highlighted NCPT sections based on usual clients for PPRDNs: WM, Chol, DM, HTN, healthy eating, sports nutrition July –September 2016 conference calls with Will, Kristen, and Nicole review terminology, data collection requested an initial and a follow up; Highlighted nutrition diagnostic terminology—asked for feedback Submit final ANDHII client info so Will can do analysis Essentially, only three of us were able to continue to be engaged: grad school, private practice, covering for a dietetic internship director’s child-bearing leave, time frame was months off from what was initially proposed Became clear a barrier to ANDHII was knowing NCPT, time available outside of PP, changing demands of those who had signed up initially. data collection requested an initial and a follow up if July 24 highlighted nutrition diagnostic terminology—asked for feedback
52 The ANDHII VAND Pilot Overview of PPRDNs/Clients7 RDNs: 4-33 years of experience Time constraints: grad school, busy practices, leadership obligations, file own claims or have biller, 5/7 no NCPT familiarity, 7/7 no ANDHII familiarity 3/7 submitted client info for pilot Clients Reactions Total number tracked: 27 One RDN had used NCPT as an inpatient RDN but parents dx w/dementia/did not continue One RDN 4 years, used NCPT since senior year of college, first heard of ANDHII 2011/12 senior year of college Nicole 28+ year, never heard of NCPT, never head of ANDHII Susan since 1979: 37 years, aware of but had never used NCPT, never heard of ANDHII until pilot idea surfaced Lise 19 years RDN, never used NCPT,never heard about ANDHII until I put out word about pilot Nancy 33 years, never used NCPT, learned about ANDHII from NVB Rosemary: RD 16 years, using NCPT since 2009, heard about ANDHII 2014 when attending FNCE—got discouraged when clients declined to participate PI had used NCPT (taught at JMU) and she and I met early on to practice using ANDHII
53 https://andhii.org/info
54 The ANDHII VAND Pilot OutcomesWill Murphy is analyzing ANDHII data from the pilot and I will update my slides when that info is available. Aiming for next week. Sub-bullet Bullet
55 The ANDHII VAND Pilot Challenge Solution NCPT Knowledge/familiarity5/7 little familiarity Set aside time to learn/recruit RDNs who know NCPT already PPRDNs time is $ Fund their time to improve ANDHII Limited time/ CST (Will) & EST (PPRDNs) Slack, phone calls, webinars, training modules ANDHII learning curve Create Tips Sheetl/training modules, webinars; Pilot time frame extended: Grad School, Family Illness, DI Director Coverage, Recruit RDNs who are not already overextended! Weigh filing claims, scheduling clients, using ANDHII—do a trial and see what you think Created lists of NCPT specific to PP RDNs
56 The ANDHII VAND Pilot Challenge for Nicole SolutionVAND President: ED search, Annual Meeting planning, VAND launched new website & Event Management Company; mom stroke/father hospitalized Extended time to do pilot Claims filing vs track outcomes Add efficiencies to ANDHII? NCPT Webinars need to be improved Principal Investigator moved Will & Nicole took over Weigh filing claims, scheduling clients, using ANDHII—do a trial and see what you think
57 The ANDHII VAND Pilot Lessons Learned/RecommendationsANDHII training tools very helpful. Divided into ADIME Initially might take 45 min/reduce to min RDNs whose practice model includes mainly initial consultations can check in by phone for a f/u Chrome, Firefox, Internet Explorer (not Safari!) Save/refresh often to avoid frozen screens Report of client session can be copied and saved into EMR
58 The ANDHII VAND Pilot Recommendations/NotesAcademy to partner with/help fund next steps If NCPT is the future/ANDHII has good possibilities Will Murphy was great to work with! Integrate ANDHII into existing EHR platforms: Healthie, Office Ally, Kalix, and Kaizen RD, Reach out to Aetna/Cigna/BCBS pay an additional unit to track outcomes? Plan a larger study: essential that RDNs complete NCPT and ANDHII training PPRDNs are not in a position to volunteer their time for improving ANDHII. Pursue funding to compensate them for their time/expertise Involve PPRDNs who have experience using NCPT then train them to use ANDHII Will is a great person to take the lead on this For long term viability of ANDHII/increase its use, recommend the Academy work with existing EHR platforms and incorporate ANDHII into them. RDNs are paying $30 or more per month and while ANDHII is free, it is a separate tool to have to switch to Plan a larger study
59 Practice ApplicationsPPRDNs do not need permission from clients to use ANDHII Affiliates/RDN Group Practices: PPRDNs can pool data to reflect what is happening on a statewide basis—licensure, marketing, Use of ANDHII for seasoned RDNs requires learning NCPT PPRDNs can get started with ANDHII after FNCE. You do not have to be part of a research study. Also, there is no need to request client’s permission to track outcomes. ANDHII was specifically created as a tool RDNs could use that is not subject to human subjects review. Pool data from your affiliate, practice use to promote RDN efficacy NCPT webinars need help! Dry and too long! New programmers have been hired, so look for some improvements.
60 Resources Study Information Sheet ANDHII Tips HandoutNCPT & ANDHII training tools are free for AND members https://ncpt.webauthor.com/encpt-tutorials. PPRDNs can get started with ANDHII after FNCE. You do not have to be part of a research study. Also, there is no need to request client’s permission to track outcomes. ANDHII was specifically created as a tool RDNs could use that is not subject to human subjects review. Pool data from your affiliate, practice use to promote RDN efficacy
61 Questions? Thank you for your time and attention!Nicole V. Brown, MS, RDN, LD ACSM EP-C For the Health of It! Washington, DC & Springfield, VA PPRDNs can get started with ANDHII after FNCE. You do not have to be part of a research study. Also, There is no need to request client’s permission to track outcomes. ANDHII was specifically created as a tool RDNs could use that is not subject to human subjects review. Pool data from your affiliate, practice use to promote RDN efficacy