Nutrition Informatics

Nutrition informatics is the intersection of information, nutrition and technology. Nutrition and dietetics professionals work in an immensely "data rich" world. As many paper-based tools transition to technology, there are more efficient ways to collect, display and study data from such tools as food/nutrient analysis tables, electronic health records (EHRs) and mobile apps. Nutrition informatics allows nutrition and dietetics professionals to more effectively use their knowledge and skills through the support of technology, whether collecting data to document outcomes, for decision support, or streamlining workflow.

Nutrition informatics is not just limited to those who work in or have an interest in technology — it impacts all areas of dietetics practice, for example:

  • Clinical: EHRs, clinical decision support, telehealth
  • Consumer-based: apps and wearables, mHealth, social media
  • Food and Nutrition Management: staffing and workload statistics, recipe analysis
  • Public Health: disease surveillance, disease prevention, surveys such as NHANES
  • Research: clinical trials, other data collection and analysis
  • Retail: consumer purchasing trends, sales history, inventory
  • Public Policy: evidence-based policy making, measuring policy outcomes

Academy Resources

Nutrition Informatics DPG
The Nutrition Informatics Dietetics Practice Group was founded in 2019. The NI DPG provides a great place for those experienced in nutrition informatics and those wanting to learn more about informatics to share information and resources. More detailed information about nutrition informatics can be found on their website, with some content available for non-members.

Nutrition Informatics Position Paper
It is the position of the Academy of Nutrition and Dietetics that nutrition informatics is a rapidly evolving area of practice for registered dietitian nutritionists and nutrition and dietetics technicians, registered and that the knowledge and skills inherent to nutrition informatics permeate all areas of the dietetics profession.

The electronic Nutrition Care Process Terminology (eNCPT) is the online resource that houses the Nutrition Care Process Terminology (NCPT). The NCPT provides a standardized language for nutrition and dietetics professionals to communicate their work in all client settings. Using a standardized language gives the ability to explore and understand the links between nutrition problems, interventions used and the associated outcomes. Designed for use in the EHR, the NCPT offers specific terminology for data collection, nutrition research and documentation of quality measures.

The Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII®) enables RDNs to track nutrition care outcomes and advance evidence-based nutrition practice research. ANDHII® offers secure online data collection using familiar nutrition terminology and a format that makes it easy to integrate into practice workflow. The knowledge gained through the collection and analysis of information in ANDHII® will add to the evidence base for nutrition practice and help ensure high-quality patient care.

Nutrition Informatics 360: An Introduction to Nutrition and Health Informatics Webinar
Nutrition informatics is the intersection of nutrition, information and technology and it is an exciting and ever-evolving field. Yet, it is important to first understand the principles of informatics as a discipline and how nutrition informatics fits into the larger picture of health informatics and HIT. This presentation will walk through this pathway from all angles and will highlight examples from various aspects of nutrition practice (clinical, public health, research, etc.).

Informatics Surveys
Starting in 2007 and approximately every three to four years following, the Academy has conducted a survey related to the use of technology by nutrition and dietetics professionals. The results from the 2008, 2011, 2014 and 2019 surveys have been published in the Journal of the Academy of Nutrition and Dietetics.

Resources external to the Academy

Health Level Seven International
Since 1987, Health Level Seven International (HL7) has worked to develop and maintain standards for integrating and exchanging electronic health information. HL7 is a not-for-profit organization with more than 1,600 members from over 50 countries. These members represent healthcare providers, government stakeholders, payers, pharmaceutical companies, vendors/suppliers, consulting firms and others.

Systemized NOmenclature of MEDicine
Systemized NOmenclature of MEDicine (SNOMED) is a not for profit organization that develops and administers the SNOMED CT comprehensive clinical terminology. Much of the NCPT has been mapped to SNOMED to facilitate interoperability.

Logical Observation Identifiers Names and Codes
Logical Observation Identifiers Names and Codes (LOINC) is an international standard to define clinical and laboratory results in electronic documents. LOINC is used with HL7 standards to identify test results or clinical observations. Some of the NCPT has been mapped to LOINC to facilitate interoperability.

NIH Value Set Authority Center
The Value Set Authority Center (VSAC) is a repository of value sets that can be used for interoperability to support the exchange of healthcare data. Value sets are used to define clinical concepts and contain lists of terms and their associated code. They are often created from clinical vocabularies such as SNOMED or LOINC.

Office of the National Coordinator for Health Information Technology
The Office of the National Coordinator for Health Information Technology (ONC) is the primary federal agency for coordinating the promotion and adoption of HIT and a national health information exchange. ONC was created in 2004 and legislatively mandated the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009. Focus areas for ONC include:

  • the certification of HIT (includes EHRs)
  • clinical quality and safety
  • health information exchange and interoperability
  • patient access to medical records
  • privacy, security and HIPAA

Interoperability and Standards Advisory
The Interoperability and Standards Advisory (ISA) is a collection of vocabulary standards, implementation specifications and other interoperability standards for health IT. The ISA is updated and published annually by ONC based on public comments, including those from the Academy.

Healthcare Information and Management Systems Society
The Healthcare Information and Management Systems Society (HIMSS) offers a global forum for individuals and organizations to network, skill-build and advocate for the use of technology and information management principles to advance the healthcare field. HIMSS membership includes more than 70,000 individual members, 630 corporate members and over 450 non-profit organization members.

American Medical Informatics Association
The American Medical Informatics Association (AMIA) is a professional organization for clinicians, researchers, educators, scientists, government leaders and others working to advance the field of informatics. AMIA offers training opportunities and guidance on the provision of informatics to clinical care, research, education and policy.

Centers for Medicare and Medicaid Services
The Centers for Medicare and Medicaid Services (CMS) is the federal agency responsible for managing the Medicare, Medicaid and Children 's Health Insurance Programs. CMS focus areas include the development and testing of innovative health care payment and service delivery models and identifying tools and processes for data integrity, integration and interoperability for data for providers and patients.

Nutrition Related Health IT Standards

The Academy participates in standards development organizations, such as Health Level 7 (HL7). Through its Interoperability and Standards Committee, the Academy has been the voice for nutrition and dietetics professionals to ensure nutrition is included and represented correctly in healthcare standards. Without these standards, healthcare cannot achieve interoperability and allow the data to follow the patient. All HL7 standards that the Academy has participated in are available free on the HL7 website.

Electronic Nutrition Care Process Record System Functional Profile
The Electronic Nutrition Care Process Record System Functional Profile (ENCPRS) is an HL7 standard that describes the functions the functions that should be contained in an EHR to support the nutrition care process. While all EHRs might not have the functionality described in the ENCPRS, the functional profile serves as the "gold standard" for documenting the nutrition care process in an EHR. The ENCPRS is useful for new EHR implementations to ensure all nutrition functionality is incorporated, system upgrades when additional nutritional functionality is needed and for evaluating requests for proposals to convert from one EHR to another. This Frequently Asked Questions document summarizes the functions and benefits of the ENCPRS.

Consolidated Clinical Document Architecture
The Consolidated Clinical Document Architecture (C-CDA) is HL7 standards that can be used to share clinical documents, such as discharge summaries. C-CDA is essentially a library of templates assigned to a set of specific document types to generate the document content. While some nutrition information has been incorporated into the main HL7 C-CDA standards, the Academy created the Implementation Guide "HL7 CDA® R2 Implementation Guide: C-CDA R2.1 Supplemental Templates for Nutrition, Release 1 - US Realm". This nutrition-specific implementation guide details a standardized approach to exchange the data generated from of the steps of the nutrition care process across care settings.

Fast Healthcare Interoperability Resources
Fast Healthcare Interoperability Resources (FHIR) is the newest set of HL7 standards for electronically sharing healthcare data. FHIR was created to simplify implementation practices and mechanisms to exchange healthcare data. The basic components of FHIR are called "resources," which represent the smallest pieces of healthcare data. For example, there are patient, observation and medication resources. The patient resource would contain the data about a patient, such as name, address, etc., while the observation resource would contain clinical observations at a point in time about a patient, such as vital signs, height, or weight. Combined, these resources tell a story about a patient's visit to a hospital or other medical provider.

The Academy has also been involved in creating nutrition-related resources:

  • NutritionOrder is a FHIR resource to communicate the details of an oral diet, oral nutritional supplements and enteral nutrition in an inpatient setting.
  • NutritionIntake and NutritionProduct are used together to share information about a patient 's intake. NutritionIntake is the resource to document the intake event and NutritionProduct is the resource used for documenting the nutrition item; NutritionProduct captures all the nutritional information about that specific product.

Implementing FHIR starts with building FHIR profiles. A resource is created broadly, but profiles constrain a resource to specify data elements, data sets and other details to be used in that particular implementation. Multiple FHIR profiles are then bundled into an implementation guide describing how to share data. The Academy is working to map the nutrition care process to where the data can be found in FHIR resources so that profiles and an IG can eventually be created to facilitate sharing dietitian-generated data.

To improve and mature FHIR resources and implementation guides, both need to be tested for interoperability through "connectathons" or early adopters. FHIR has a clear path to mature resources to a normative level, where the resource is considered to be unchanging and stable. The Academy is working to mature all the nutrition-related FHIR resources and encourages implementers to participate in connectathons or provide feedback on the resources.

Domain Analysis Model
In order to understand the landscape of a given topic, a domain analysis model (DAM) is created. DAMs include use cases to illustrate typical usage scenarios, activity diagrams to show the workflow, information models to show the flow of data and other details to support the subject of the document. To facilitate the work of the NutritionOrder FHIR resource, the Academy created the "HL7 Version 3 Domain Analysis Model: Diet and Nutrition Orders" to describe the usage, data and workflow of diet orders. In the future, the nutrition DAM will be expanded to incorporate the nutrition care process.

Other HL7 Standards