Consensus Recommendations for Optimizing Electronic Health Records for Nutrition Care

The Age of Artificial Intelligence: Use of Digital Technology in Clinical Nutrition

“…NST members vary across institutions but may be compromised of physicians, advanced practice providers, dieticians, nurses, and pharmacists. Digital innovations, improvements, and integrations into the electronic health record (EHR) have impacted nutrition care provided by the NST over a spectrum of activities, such as diagnosis and coding, treatment interventions, and follow-up care [ 51 ].…”

“…Importantly, the widespread adoption of EHRs has enabled the integration of these screening tools into clinical workflows, such as admission orders or office visit intakes. In addition, the use of embedded screening tools in the EHR allows the ability to capture the discrete data and can drive clinical decision support processes that can be configured to notify the NST to perform a formal malnutrition assessment [ 51 , 55 ]. If malnutrition is not initially present, patients can be rescreened at regular intervals for ongoing assessment during the course of longitudinal care of the patient.…”

“…After a positive malnutrition screen, the NST performs a nutrition assessment of the patient to determine if the patient meets criteria for malnutrition. The nutrition assessment includes food intake and nutrition history, anthropometrics, nutrition focused physical exam, and review of clinical and medical history as well as review of tests and procedures [ 51 ]. A study by McCamley et al demonstrated that after implementation of an EHR, there was not only a 72% increase in admissions requiring nutrition intervention but also the time spent per nutrition event was reduced by 22% post-EHR implementation.…”

“…If after the nutrition assessment by the NST, the patient meets clinical criteria for malnutrition, the NST member or clinician should then accurately document and code the malnutrition diagnosis. Importantly, this has implications that not only can affect patient care but also is important for appropriate coding, billing, and reimbursement [ 51 , 56 , 57 ].…”

Nutrition Support Therapies on the Medication Administration Record: Impacts on Staff Perception of Nutrition Care

“…Several professional bodies have published documents related to best practices for NST and documentation of nutrition care. The 2016 American Society for Parenteral and Enteral Nutrition (ASPEN) consensus statements on safe practices for EN therapy recommend that the “EN order should be included in the patient's electronic medication profile to allow a pharmacist to review the EN order and patient medication profile and the pharmacist will assess: the appropriateness of the medication route of administration, the compatibility of medication with enteral formulas, and methods to optimize the medication regimen.” 30 In 2019, in recognition of issues surrounding fragmented EHR documentation of nutrition care, ASPEN published consensus recommendations for optimizing EHRs for nutrition care, which included enhancing documentation systems to support quality nutrition care 31 . In 2020, the Joint Commission issued National Patient Safety Goal NPSG.03.06.01 “Use Medicines Safely,” which states, “Record and pass along correct information about a patient's medicines, find out what medicines the patient is taking, compare those medicines to new medicines given to the patient, give the patient written information about the medicines they need to take, tell the patient it is important to bring their up‐to‐date list of medicines every time they visit a doctor.” 32 The recommendations by the American Society of Health‐System Pharmacists to have pharmacist verification and review of all dietary supplements and medications when patients are hospitalized further support the importance of diligence and care while prescribing, administering, and documenting NST 33…”