WEBVTT 1 00:00:00.000 --> 00:00:00.500 2 00:00:00.500 --> 00:00:03.820 Our webinar this afternoon is entitled Engage Students 3 00:00:03.820 --> 00:00:07.370 by Adding ANDHII to the Classroom. 4 00:00:07.370 --> 00:00:13.970 And I would like to thank are our wonderful speakers, Carrie 5 00:00:13.970 --> 00:00:18.980 Hamady and Julie Sekula for participating and putting 6 00:00:18.980 --> 00:00:20.850 this material together for you. 7 00:00:20.850 --> 00:00:23.540 We hope that you will indeed learn 8 00:00:23.540 --> 00:00:28.770 some new ideas to implement in your class rooms. 9 00:00:28.770 --> 00:00:31.535 So first, let me introduce our fine speakers. 10 00:00:31.535 --> 00:00:34.250 12 00:00:37.310 --> 00:00:40.190 and she is the director of the undergraduate dietetics 13 00:00:40.190 --> 00:00:44.720 program at Bowling Green State University or BGSU. 14 00:00:44.720 --> 00:00:49.310 Carrie has presented at FNCE and at the Ohio NDEP Conference, 15 00:00:49.310 --> 00:00:53.030 at the Create Conference for innovative teaching practices 16 00:00:53.030 --> 00:00:58.520 as well as SCAN Symposium and the Ohio Academy Conference. 17 00:00:58.520 --> 00:01:01.580 She has been featured in Today's Dietitian for her use 18 00:01:01.580 --> 00:01:03.740 of Twitter in the classroom. 19 00:01:03.740 --> 00:01:06.050 And she won the award for best innovation 20 00:01:06.050 --> 00:01:11.190 in dietetics education at FNCE, and the Faculty Excellence 21 00:01:11.190 --> 00:01:14.870 Award for community based teaching of Bowling Green. 22 00:01:14.870 --> 00:01:19.910 Most recently, she was honored at the 2018 Outstanding 23 00:01:19.910 --> 00:01:22.150 Educator award in Ohio. 24 00:01:22.150 --> 00:01:24.950 Carrie is currently working on her doctorate in leadership 25 00:01:24.950 --> 00:01:27.410 studies at Bowling Green and she is 26 00:01:27.410 --> 00:01:31.280 the current chair of our ANDHII work group for the Academy. 27 00:01:31.280 --> 00:01:34.710 Welcome and please say, hi, to everyone. 28 00:01:34.710 --> 00:01:36.020 Hello. 29 00:01:36.020 --> 00:01:37.620 Thank you, Carrie. 30 00:01:37.620 --> 00:01:39.650 And next, let me introduce you to Julia. 31 00:01:39.650 --> 00:01:42.560 Julia is a New Zealand registered dietitian 32 00:01:42.560 --> 00:01:45.190 with a master's degree in health science 33 00:01:45.190 --> 00:01:48.080 and over 15 years of experience as a dietitian. 34 00:01:48.080 --> 00:01:50.930 She worked in the New Zealand region, 35 00:01:50.930 --> 00:01:54.800 in London, and in Auckland as the clinical dietitian 36 00:01:54.800 --> 00:01:58.550 in both the renal and oncology settings. 37 00:01:58.550 --> 00:02:01.970 Julia has held the position as a clinical director 38 00:02:01.970 --> 00:02:03.920 of the nutrition and dietetics clinic 39 00:02:03.920 --> 00:02:07.850 at the University of Auckland since early in 2014. 40 00:02:07.850 --> 00:02:11.510 She is the clinical leader for the dietetics training program, 41 00:02:11.510 --> 00:02:14.700 and provides the clinical leaderships to the clinic. 42 00:02:14.700 --> 00:02:18.920 She has particular interest in interprofessional education, 43 00:02:18.920 --> 00:02:21.390 the nutrition care process, and its use 44 00:02:21.390 --> 00:02:24.650 in demonstrating dietetic effectiveness and nutritional 45 00:02:24.650 --> 00:02:28.010 management of chronic disease within primary care 46 00:02:28.010 --> 00:02:29.130 environment. 47 00:02:29.130 --> 00:02:31.520 She's an active member of the Dietitians of New Zealand, 48 00:02:31.520 --> 00:02:34.340 has held numerous positions and is currently 49 00:02:34.340 --> 00:02:37.700 part of their professional supervision working group. 50 00:02:37.700 --> 00:02:43.700 Julie has also been a member of our NCPRO ANDHII work group. 51 00:02:43.700 --> 00:02:46.820 Say, hello, to everyone Julia and thanks for presenting. 52 00:02:46.820 --> 00:02:48.500 Hi, everyone. 53 00:02:48.500 --> 00:02:51.360 Our objective for today, at the end of this session, 54 00:02:51.360 --> 00:02:53.660 you should be able to discuss how ANDHII 55 00:02:53.660 --> 00:02:56.210 can be used to teach your dietetic students 56 00:02:56.210 --> 00:02:58.290 about outcomes-based practice. 57 00:02:58.290 --> 00:03:00.440 You should be able to plan a lesson using ANDHII 58 00:03:00.440 --> 00:03:03.830 to teach dietetic students about electronic health record, 59 00:03:03.830 --> 00:03:07.010 and to be able to describe the key concepts associated 60 00:03:07.010 --> 00:03:11.210 with EHRs, the nutrition care process, and the ADIME-style 61 00:03:11.210 --> 00:03:13.340 of assessment along with information 62 00:03:13.340 --> 00:03:17.086 about electronic clinical quality measures. 63 00:03:17.086 --> 00:03:19.810 First of all, I want to make sure we're all on the same page 64 00:03:19.810 --> 00:03:22.800 and we know what we're talking about this afternoon. 65 00:03:22.800 --> 00:03:25.260 So that is what we call ANDHII. 66 00:03:25.260 --> 00:03:28.730 ANDHII it stands for the Academy of Nutrition and Dietetics 67 00:03:28.730 --> 00:03:31.490 Health Informatics Infrastructure, 68 00:03:31.490 --> 00:03:34.200 and ANDHII is an online tool that 69 00:03:34.200 --> 00:03:38.880 helps with documenting the nutrition care process 70 00:03:38.880 --> 00:03:41.980 and collecting that data. 71 00:03:41.980 --> 00:03:44.700 It helps us facilitate that data collection using 72 00:03:44.700 --> 00:03:47.210 the in full aspects of the nutrition care 73 00:03:47.210 --> 00:03:51.250 process and the nutrition care process terminology. 74 00:03:51.250 --> 00:03:54.930 The data captured may be used to help develop and test 75 00:03:54.930 --> 00:03:58.830 the clinical guidelines, it may be used for a specific research 76 00:03:58.830 --> 00:04:01.680 study initiative, or by general members 77 00:04:01.680 --> 00:04:05.240 of the Academy including students to submit data 78 00:04:05.240 --> 00:04:07.590 into our registry. 79 00:04:07.590 --> 00:04:10.170 So general members are practitioners 80 00:04:10.170 --> 00:04:15.720 who are licensed, so either RDNs or DTRs may submit data 81 00:04:15.720 --> 00:04:19.320 into what we call the dietetics outcomes registry. 82 00:04:19.320 --> 00:04:21.420 Students have access to ANDHII and you'll 83 00:04:21.420 --> 00:04:23.230 hear more about this section today, 84 00:04:23.230 --> 00:04:27.250 to an area just limited to education and practice. 85 00:04:27.250 --> 00:04:30.760 So their data does not go into the registry. 86 00:04:30.760 --> 00:04:34.170 Outcomes research of course, affords us 87 00:04:34.170 --> 00:04:35.580 quite an opportunity. 88 00:04:35.580 --> 00:04:37.860 We have with ANDHII the capability 89 00:04:37.860 --> 00:04:41.310 to really explore real world data that practitioners 90 00:04:41.310 --> 00:04:45.930 are creating and adding as they go about their usual activities 91 00:04:45.930 --> 00:04:47.880 of assessing clients and patients 92 00:04:47.880 --> 00:04:50.100 and evaluating their outcomes. 93 00:04:50.100 --> 00:04:53.260 Because ANDHII users actually span the globe, 94 00:04:53.260 --> 00:04:55.770 we have a much broader perspective 95 00:04:55.770 --> 00:04:58.680 than you might get from an individual study, 96 00:04:58.680 --> 00:05:02.790 or just quality data collected or maintained 97 00:05:02.790 --> 00:05:06.550 at a local or even regional level. 98 00:05:06.550 --> 00:05:09.270 So quickly, the benefits of ANDHII 99 00:05:09.270 --> 00:05:11.675 include being able to walk through the interesting 100 00:05:11.675 --> 00:05:15.330 nutrition care process, and support searching the nutrition 101 00:05:15.330 --> 00:05:18.540 care process terminology as you enter your data 102 00:05:18.540 --> 00:05:20.000 and capture that. 103 00:05:20.000 --> 00:05:25.290 It lets you create an ADIME style format progress note. 104 00:05:25.290 --> 00:05:28.860 And as you move through from your initial assessment 105 00:05:28.860 --> 00:05:32.070 to follow up assessments, it copies forward 106 00:05:32.070 --> 00:05:35.030 information from the monitoring and evaluation and things 107 00:05:35.030 --> 00:05:37.230 you've captured along the way, making 108 00:05:37.230 --> 00:05:39.900 that process easier and faster. 109 00:05:39.900 --> 00:05:43.260 In the end, you get to actually track your patients 110 00:05:43.260 --> 00:05:47.460 and see their progress through the number of visits 111 00:05:47.460 --> 00:05:49.900 and implementation and interventions 112 00:05:49.900 --> 00:05:51.210 that you have done. 113 00:05:51.210 --> 00:05:53.020 The real world data as I mentioned 114 00:05:53.020 --> 00:05:55.630 is admitted into the diabetic outcomes registry 115 00:05:55.630 --> 00:05:59.175 to help us connect clinical practice back into research. 116 00:05:59.175 --> 00:06:01.770 118 00:06:06.610 --> 00:06:08.870 Thanks Margaret. 119 00:06:08.870 --> 00:06:11.310 So across the world, as Margaret's just mentioned, 120 00:06:11.310 --> 00:06:14.370 educators are starting to us ANDHII in dietetic education 121 00:06:14.370 --> 00:06:17.520 to reinforce the teaching of the nutrition care process 122 00:06:17.520 --> 00:06:19.330 throughout student training. 123 00:06:19.330 --> 00:06:21.080 As you will see by the end of the seminar, 124 00:06:21.080 --> 00:06:23.430 ANDHII can help students with critical thinking, which 125 00:06:23.430 --> 00:06:25.170 helps to ensure appropriate acquisition 126 00:06:25.170 --> 00:06:27.060 interpretation of data. 127 00:06:27.060 --> 00:06:29.260 The drop down boxes include the entire nutrition 128 00:06:29.260 --> 00:06:31.590 care process terminology and provide suggestions 129 00:06:31.590 --> 00:06:36.290 of possible etiology, signs, and symptoms under each diagnoses. 130 00:06:36.290 --> 00:06:38.040 This helps our students in the progression 131 00:06:38.040 --> 00:06:39.510 of their critical thinking skills 132 00:06:39.510 --> 00:06:42.540 as they gain knowledge and experience in practice. 133 00:06:42.540 --> 00:06:44.160 The foundation of dietetic knowledge 134 00:06:44.160 --> 00:06:46.860 is obtained through the novice and beginning stages 135 00:06:46.860 --> 00:06:49.170 apprentice and the reinforcement of the nutrition care 136 00:06:49.170 --> 00:06:51.750 process in this health informatics tool, 137 00:06:51.750 --> 00:06:53.560 and the application of nutrition assessment 138 00:06:53.560 --> 00:06:56.670 and supervised practice helps to create efficient practice 139 00:06:56.670 --> 00:06:58.910 for our student dietitians. 140 00:06:58.910 --> 00:07:01.320 In education, ANDHII links to outcomes-based 141 00:07:01.320 --> 00:07:02.535 practiced as well. 142 00:07:02.535 --> 00:07:04.750 Since students can see change over time 143 00:07:04.750 --> 00:07:06.630 with the nutrition diagnosis, especially 144 00:07:06.630 --> 00:07:09.350 when used with real clients, and this may occur more 145 00:07:09.350 --> 00:07:10.970 in the intern year. 146 00:07:10.970 --> 00:07:13.140 It allows both objectives and subjective data 147 00:07:13.140 --> 00:07:16.410 to be measured and reported on reinforcing the teaching that's 148 00:07:16.410 --> 00:07:19.320 carried out throughout a student's education. 149 00:07:19.320 --> 00:07:21.600 ANDHII also allows students to follow up their client 150 00:07:21.600 --> 00:07:24.720 over time as each visitor's link the same unique identifier 151 00:07:24.720 --> 00:07:27.040 with auto-filling, which saves time. 152 00:07:27.040 --> 00:07:28.770 But it also reinforces this practice 153 00:07:28.770 --> 00:07:31.940 of the monitoring and evaluation section, which 154 00:07:31.940 --> 00:07:34.960 then comes into the assessment section of the follow up note. 155 00:07:34.960 --> 00:07:39.620 ANDHII saves entries from education section from visit 156 00:07:39.620 --> 00:07:40.300 to visit. 157 00:07:40.300 --> 00:07:43.500 As we know, topics often repeated, they're reinforced, 158 00:07:43.500 --> 00:07:45.780 ANDHII added to it subsequent visits. 159 00:07:45.780 --> 00:07:47.310 So at the same time, the diagnosis 160 00:07:47.310 --> 00:07:50.980 is automatically to changed from new to continued until which 161 00:07:50.980 --> 00:07:52.630 time it is resolved. 162 00:07:52.630 --> 00:07:54.745 And as we know, students need multiple exposures 163 00:07:54.745 --> 00:07:57.570 in various setting to constantly demonstrate 164 00:07:57.570 --> 00:07:59.269 clinical competence, so ANDHII is 165 00:07:59.269 --> 00:08:00.560 a tool that can help with this. 166 00:08:00.560 --> 00:08:03.530 168 00:08:05.900 --> 00:08:08.750 of what we do within the faculties that we work. 169 00:08:08.750 --> 00:08:11.250 As dietitians as well, showing that we are effective 170 00:08:11.250 --> 00:08:12.930 is becoming increasingly important 171 00:08:12.930 --> 00:08:15.730 with the fiscal constraints across the health sector. 172 00:08:15.730 --> 00:08:19.050 The academy is able to work with educators and researchers 173 00:08:19.050 --> 00:08:22.080 to create customized templates specific to individual's 174 00:08:22.080 --> 00:08:23.130 teacher needs. 175 00:08:23.130 --> 00:08:25.740 And we'll discuss this later on in the webinar. 176 00:08:25.740 --> 00:08:27.130 This ensures that key information 177 00:08:27.130 --> 00:08:29.910 is entered at each clinic visit with must-do's as well 178 00:08:29.910 --> 00:08:33.809 as delete options in cases where it isn't relevant. 179 00:08:33.809 --> 00:08:35.610 For example, a customized template 180 00:08:35.610 --> 00:08:38.450 may have a variety of anthropoemetric assessment 181 00:08:38.450 --> 00:08:40.140 measures for the student to consider, 182 00:08:40.140 --> 00:08:42.710 rather than just having to think of what they need to do. 183 00:08:42.710 --> 00:08:44.760 But for an adult, growth centiles maybe there's 184 00:08:44.760 --> 00:08:47.550 an option, which as you know isn't required, 185 00:08:47.550 --> 00:08:50.210 so this would be deleted, but height, weight, weight 186 00:08:50.210 --> 00:08:52.770 change over time, and BMI would be required. 187 00:08:52.770 --> 00:08:55.020 And the student wouldn't be able to finalize the entry 188 00:08:55.020 --> 00:08:57.540 until those are filled in. 189 00:08:57.540 --> 00:09:00.960 So overall students are continually learning, 190 00:09:00.960 --> 00:09:02.910 and they need some direction to help in this. 191 00:09:02.910 --> 00:09:06.310 So having a tool that has established key NCP terms 192 00:09:06.310 --> 00:09:07.890 saves time, but more importantly, 193 00:09:07.890 --> 00:09:10.260 helps familiarize our students with key components 194 00:09:10.260 --> 00:09:12.240 of the nutrition consultation. 195 00:09:12.240 --> 00:09:14.170 They can then use this learning to demonstrate 196 00:09:14.170 --> 00:09:16.440 their progression towards registration competency 197 00:09:16.440 --> 00:09:18.180 requirement. 198 00:09:18.180 --> 00:09:21.330 As you can see from this infographic, 199 00:09:21.330 --> 00:09:23.185 ANDHII is not just being used in America, 200 00:09:23.185 --> 00:09:25.330 it's being used across the world. 201 00:09:25.330 --> 00:09:27.180 So as a global community, we have 202 00:09:27.180 --> 00:09:29.610 seen the implementation of the nutrition care process 203 00:09:29.610 --> 00:09:30.910 across the globe. 204 00:09:30.910 --> 00:09:32.970 And now we have the same with ANDHII. 205 00:09:32.970 --> 00:09:35.160 Though health care systems in New Zealand and those 206 00:09:35.160 --> 00:09:38.250 in Australia differ considerably to the United States, 207 00:09:38.250 --> 00:09:41.960 the core of what we do as dietitians and dietitian 208 00:09:41.960 --> 00:09:44.732 educators is the same. 209 00:09:44.732 --> 00:09:46.940 So I'm now going to pass this session over to Carrie, 210 00:09:46.940 --> 00:09:50.960 and she'll describe how ANDHII is taught within the DPD 211 00:09:50.960 --> 00:09:52.740 as a way to educate dietetic students 212 00:09:52.740 --> 00:09:55.730 to the electronic health record. 213 00:09:55.730 --> 00:09:57.290 Thank you Julia. 214 00:09:57.290 --> 00:10:00.035 And Carrie, I am passing the controls to you. 215 00:10:00.035 --> 00:10:01.350 All right, great. 216 00:10:01.350 --> 00:10:02.640 Thank you. 217 00:10:02.640 --> 00:10:06.150 I'm going to start with some of the benefits of using ANDHII 218 00:10:06.150 --> 00:10:09.610 at the DPD level of education, and then 219 00:10:09.610 --> 00:10:13.240 work through a lesson plan of sorts that could be used 220 00:10:13.240 --> 00:10:16.680 and I have used with my students in a nutrition care process 221 00:10:16.680 --> 00:10:17.680 class. 222 00:10:17.680 --> 00:10:20.010 I'm going to start by saying that this is just one 223 00:10:20.010 --> 00:10:24.240 method or tool that can be used to teach an electronic health 224 00:10:24.240 --> 00:10:26.430 record to dietetic students. 225 00:10:26.430 --> 00:10:29.250 I realize there are other products available that 226 00:10:29.250 --> 00:10:32.820 have varying costs or capabilities to choose from. 227 00:10:32.820 --> 00:10:35.880 In Ohio, one of the things that we're being asked about 228 00:10:35.880 --> 00:10:37.990 is to limit student costs. 229 00:10:37.990 --> 00:10:42.210 So by using ANDHII for free, I'm able to expose the students 230 00:10:42.210 --> 00:10:45.650 to an electronic health record using my own case 231 00:10:45.650 --> 00:10:48.660 studies without added cost to the students, 232 00:10:48.660 --> 00:10:51.330 or the program for that matter. 233 00:10:51.330 --> 00:10:54.750 We require Academy memberships for students 234 00:10:54.750 --> 00:10:57.160 starting in their freshman year. 235 00:10:57.160 --> 00:11:00.960 So that covers their access to ANDHII as we'll. 236 00:11:00.960 --> 00:11:03.470 238 00:11:06.990 --> 00:11:09.480 to be more comfortable with electronic health records 239 00:11:09.480 --> 00:11:12.480 when they enter a dietetic internship in case 240 00:11:12.480 --> 00:11:15.390 they were not able to gain experience to this area 241 00:11:15.390 --> 00:11:18.480 through paid or volunteer opportunities. 242 00:11:18.480 --> 00:11:22.500 This also helps to support our discussion about outcome based 243 00:11:22.500 --> 00:11:24.990 practice and how the use of charting 244 00:11:24.990 --> 00:11:27.630 a standardized language by dieticians in the field 245 00:11:27.630 --> 00:11:29.170 can be used. 246 00:11:29.170 --> 00:11:32.460 We can also include an eQM project from the data 247 00:11:32.460 --> 00:11:35.160 that we enter from each student. 248 00:11:35.160 --> 00:11:39.030 And I'll address that a little bit later. 249 00:11:39.030 --> 00:11:41.530 So getting started with this process, 250 00:11:41.530 --> 00:11:43.570 I began by explaining to the student 251 00:11:43.570 --> 00:11:46.840 the concept of the ADIME process. 252 00:11:46.840 --> 00:11:50.650 And I explained it to them in a longhand version first, 253 00:11:50.650 --> 00:11:53.290 and I compare this to doing long-hand division 254 00:11:53.290 --> 00:11:54.670 in math class. 255 00:11:54.670 --> 00:11:57.340 So you learn how to do long-hand division first 256 00:11:57.340 --> 00:11:59.560 and then you're given a calculator. 257 00:11:59.560 --> 00:12:04.540 So to me, I have them do an ADIME day note on paper, 258 00:12:04.540 --> 00:12:06.700 and learn that process. 259 00:12:06.700 --> 00:12:09.820 We spend time learning the five domains, practice 260 00:12:09.820 --> 00:12:13.150 with the standardized patient that I have for them, 261 00:12:13.150 --> 00:12:15.860 they receive feedback on the process. 262 00:12:15.860 --> 00:12:18.310 And once I feel that the students have 263 00:12:18.310 --> 00:12:21.790 a good handle on how the ADIME flows, 264 00:12:21.790 --> 00:12:25.280 and that they can write a decent nutrition diagnosis, 265 00:12:25.280 --> 00:12:29.080 then we moved to electronic health record, or ANDHII, 266 00:12:29.080 --> 00:12:32.820 or as I'd like to say, using the calculator. 267 00:12:32.820 --> 00:12:35.460 To start, I asked the students to watch 268 00:12:35.460 --> 00:12:38.190 the videos on their own before class 269 00:12:38.190 --> 00:12:39.660 from the Help and Training Center 270 00:12:39.660 --> 00:12:41.970 page of the ANDHII website. 271 00:12:41.970 --> 00:12:46.260 Then in class, most likely, I will review the intro video 272 00:12:46.260 --> 00:12:48.630 and/or the assessment videos just 273 00:12:48.630 --> 00:12:50.910 to make sure that we're all on the same page 274 00:12:50.910 --> 00:12:54.960 and answer any questions that the students may have. 275 00:12:54.960 --> 00:12:58.560 From there, we move into practice in the classroom. 276 00:12:58.560 --> 00:13:01.170 I use flipped classroom model where 277 00:13:01.170 --> 00:13:03.780 I expect students to review materials 278 00:13:03.780 --> 00:13:07.620 or lectures before the class, so we can execute activities 279 00:13:07.620 --> 00:13:09.370 during class time. 280 00:13:09.370 --> 00:13:13.340 This allows me to walk around, watch what students are doing, 281 00:13:13.340 --> 00:13:15.840 and answer any questions that they may have. 282 00:13:15.840 --> 00:13:19.050 This application model helps students understand concepts 283 00:13:19.050 --> 00:13:22.390 better, they turn in more comprehensive work. 284 00:13:22.390 --> 00:13:25.680 And students can work alone or in pairs. 285 00:13:25.680 --> 00:13:28.500 And I usually have them start in pairs so they can problem 286 00:13:28.500 --> 00:13:31.530 solve together, bounce ideas off of each other, 287 00:13:31.530 --> 00:13:35.140 and ask me questions as well. 288 00:13:35.140 --> 00:13:37.860 I have a standardized patient that 289 00:13:37.860 --> 00:13:40.180 progresses throughout the semester, 290 00:13:40.180 --> 00:13:43.650 and then they can also write follow up notes on as well. 291 00:13:43.650 --> 00:13:46.170 For the eCQM project, you can have 292 00:13:46.170 --> 00:13:49.840 students interview community members, family members, 293 00:13:49.840 --> 00:13:53.160 whomever that all have a specific disease, 294 00:13:53.160 --> 00:13:55.470 and need either a specific intervention, 295 00:13:55.470 --> 00:13:57.420 or half the class can do one intervention 296 00:13:57.420 --> 00:14:00.810 and the other half do a different intervention. 297 00:14:00.810 --> 00:14:04.410 And they do an education session with those patients. 298 00:14:04.410 --> 00:14:06.270 They follow up in two to four weeks 299 00:14:06.270 --> 00:14:08.460 and put the note in ANDHII. 300 00:14:08.460 --> 00:14:11.520 We can then look at the outcomes and see which interventions 301 00:14:11.520 --> 00:14:16.140 work best, et cetera, and talk about those outcomes 302 00:14:16.140 --> 00:14:19.210 in the classroom. 303 00:14:19.210 --> 00:14:23.000 So here's just an example of the Help and Training Center page. 304 00:14:23.000 --> 00:14:27.716 I clicked on this introduction about ANDHII, 305 00:14:27.716 --> 00:14:29.090 and that's where I get the videos 306 00:14:29.090 --> 00:14:32.170 that I referenced earlier. 307 00:14:32.170 --> 00:14:35.970 After clicking on that link-- 308 00:14:35.970 --> 00:14:37.500 there we go-- 309 00:14:37.500 --> 00:14:43.920 I recommend an overview of smart visits video, 310 00:14:43.920 --> 00:14:46.200 and then all of the areas of the ADIME. 311 00:14:46.200 --> 00:14:48.240 So recording nutrition assessment, 312 00:14:48.240 --> 00:14:50.940 entering an nutrition diagnosis, et cetera. 313 00:14:50.940 --> 00:14:53.760 It's very helpful as the instructor 314 00:14:53.760 --> 00:14:56.460 to review all the videos ahead of time 315 00:14:56.460 --> 00:15:01.500 and play around in ANDHII before you ask the students to do it. 316 00:15:01.500 --> 00:15:04.290 And then that way, it's much easier 317 00:15:04.290 --> 00:15:08.031 to answer their questions in the classroom. 318 00:15:08.031 --> 00:15:10.200 So here's some pictures of my students 319 00:15:10.200 --> 00:15:13.800 using ANDHII in our active learning classrooms. 320 00:15:13.800 --> 00:15:17.040 I have been working in pairs in these pictures. 321 00:15:17.040 --> 00:15:22.065 So we watched a couple of the introductory videos in class 322 00:15:22.065 --> 00:15:24.500 just to reinforce the concepts. 323 00:15:24.500 --> 00:15:28.530 They signed in using their Academy credentials. 324 00:15:28.530 --> 00:15:29.940 And then, as I mentioned earlier, 325 00:15:29.940 --> 00:15:32.040 initially, I gave them a standardized patient, 326 00:15:32.040 --> 00:15:35.280 so everyone turned in the same assignment, which obviously 327 00:15:35.280 --> 00:15:37.960 is easier to grade when everybody has the same patience 328 00:15:37.960 --> 00:15:39.240 to review. 329 00:15:39.240 --> 00:15:43.387 Otherwise, other assignments-- the students had to interview, 330 00:15:43.387 --> 00:15:44.970 they had to find the patient that they 331 00:15:44.970 --> 00:15:46.660 were going to interview. 332 00:15:46.660 --> 00:15:49.300 So not only would they turn in the PDF 333 00:15:49.300 --> 00:15:51.960 from ANDHII, their final ADIME note, 334 00:15:51.960 --> 00:15:56.370 but they would also turn in an intake sheet of sorts 335 00:15:56.370 --> 00:15:58.950 from my reference, so I could see all the notes that they 336 00:15:58.950 --> 00:16:01.620 took from their patient and then I could compare that 337 00:16:01.620 --> 00:16:04.950 to the final note that they put into ANDHII so I 338 00:16:04.950 --> 00:16:09.090 could see they gleaned all the relevant information or not. 339 00:16:09.090 --> 00:16:12.024 Students worked in pairs in class. 340 00:16:12.024 --> 00:16:13.440 And that was a good place to start 341 00:16:13.440 --> 00:16:15.360 with that standardized patient, but then they 342 00:16:15.360 --> 00:16:18.630 can also use ANDHII on their own outside of the classroom 343 00:16:18.630 --> 00:16:21.630 when they're doing those independent assignments as 344 00:16:21.630 --> 00:16:24.310 well. 345 00:16:24.310 --> 00:16:26.100 So once you're ready to start, you just 346 00:16:26.100 --> 00:16:29.330 have the students go to andhii.org to sign in. 347 00:16:29.330 --> 00:16:32.100 They'll use their Academy credentials, 348 00:16:32.100 --> 00:16:34.790 and then they'll be asked to establish their signature as 349 00:16:34.790 --> 00:16:35.290 well. 350 00:16:35.290 --> 00:16:40.520 So this is just kind of the launching area there. 351 00:16:40.520 --> 00:16:42.330 And after you sign in-- 352 00:16:42.330 --> 00:16:44.850 now, it looks a little bit different for you 353 00:16:44.850 --> 00:16:47.610 as an active member than it will for your student. 354 00:16:47.610 --> 00:16:50.730 Over here where I have the arrow and the number one, 355 00:16:50.730 --> 00:16:53.970 you can see it has education and practice as well 356 00:16:53.970 --> 00:16:56.610 as national quality improvement pool. 357 00:16:56.610 --> 00:17:00.150 Your students will only see education and practice, 358 00:17:00.150 --> 00:17:02.730 but when you're going in just to play around, 359 00:17:02.730 --> 00:17:07.770 you'll want the education and practice to be selected. 360 00:17:07.770 --> 00:17:09.930 So you just wanted to make sure you do that. 361 00:17:09.930 --> 00:17:12.490 And then your second step is down here 362 00:17:12.490 --> 00:17:15.839 where it says, Add Patient. 363 00:17:15.839 --> 00:17:17.819 And then after you select, Add Patient, 364 00:17:17.819 --> 00:17:19.440 this window will appear. 365 00:17:19.440 --> 00:17:22.109 Again, make sure education and practice is showing 366 00:17:22.109 --> 00:17:24.990 and click on the Add Patient to this Project. 367 00:17:24.990 --> 00:17:27.970 It will then take you to the next window, 368 00:17:27.970 --> 00:17:31.800 and it will ask you to indicate your country and state. 369 00:17:31.800 --> 00:17:34.865 And then you will click on Save and Add an Entry. 370 00:17:34.865 --> 00:17:37.400 372 00:17:40.260 --> 00:17:42.710 Here is the assessment section. 373 00:17:42.710 --> 00:17:44.330 And you will make selections based 374 00:17:44.330 --> 00:17:46.100 on the standardized language. 375 00:17:46.100 --> 00:17:52.550 This is a screenshot of me having clicked on the dropdown 376 00:17:52.550 --> 00:17:54.260 menu, and I can go through and look 377 00:17:54.260 --> 00:17:57.470 for the standardized language that I prefer. 378 00:17:57.470 --> 00:18:00.410 And then I will come over and complete the value 379 00:18:00.410 --> 00:18:03.980 and our standard dropdown is indicated for each field 380 00:18:03.980 --> 00:18:06.590 across the top as indicated. 381 00:18:06.590 --> 00:18:09.610 383 00:18:12.820 --> 00:18:15.940 I just entered a few parameters for this patient that 384 00:18:15.940 --> 00:18:18.880 has poor intake, weight loss, impaired skin turgor, 385 00:18:18.880 --> 00:18:20.650 and some muscle wasting. 386 00:18:20.650 --> 00:18:24.010 So that was my standardized language here, 387 00:18:24.010 --> 00:18:27.550 and I filled in the different parameters 388 00:18:27.550 --> 00:18:29.860 just for these four areas for the assessment. 389 00:18:29.860 --> 00:18:33.040 You can have more than this, but as I said, 390 00:18:33.040 --> 00:18:34.990 just for the purposes of this demonstration, 391 00:18:34.990 --> 00:18:37.690 this is what I chose. 392 00:18:37.690 --> 00:18:40.750 From here, and based on the terms that I've chosen, 393 00:18:40.750 --> 00:18:43.980 ANDHII auto-fills your diagnosis for you. 394 00:18:43.980 --> 00:18:47.620 So it chose as one of my problems, inadequate energy 395 00:18:47.620 --> 00:18:48.550 intake. 396 00:18:48.550 --> 00:18:52.390 As you can see here, you can choose another one, 397 00:18:52.390 --> 00:18:55.490 or I could have chosen this drop down box and said, 398 00:18:55.490 --> 00:18:57.710 I want to focus on something else. 399 00:18:57.710 --> 00:19:00.850 It also auto-fill's my etiologies and signs 400 00:19:00.850 --> 00:19:01.960 and symptoms. 401 00:19:01.960 --> 00:19:05.600 I can choose one of these etiologies if I want to, 402 00:19:05.600 --> 00:19:08.000 or I can choose a different one. 403 00:19:08.000 --> 00:19:10.150 This is a good reinforcer for your students 404 00:19:10.150 --> 00:19:16.830 of the standardized language in order to form a good diagnosis. 405 00:19:16.830 --> 00:19:20.120 So as you can see, I chose a different etiology here. 406 00:19:20.120 --> 00:19:22.340 I chose poor nutrition quality of life 407 00:19:22.340 --> 00:19:25.940 instead of the suggested etiologies that ANDHII gave me. 408 00:19:25.940 --> 00:19:27.980 And then I came over here and I checked 409 00:19:27.980 --> 00:19:30.500 a few of the signs and symptoms provided, 410 00:19:30.500 --> 00:19:32.960 and then I went to the dropdown menu, 411 00:19:32.960 --> 00:19:34.745 and I chose one or two more. 412 00:19:34.745 --> 00:19:37.390 414 00:19:39.710 --> 00:19:44.130 based on my etiology of poor nutrition quality of life, 415 00:19:44.130 --> 00:19:47.490 since the etiology drives the intervention. 416 00:19:47.490 --> 00:19:51.620 Standardized terms fill in the dropdown selections 417 00:19:51.620 --> 00:19:52.730 on the right. 418 00:19:52.730 --> 00:19:57.800 And then I'm able to free-type my specific interventions. 419 00:19:57.800 --> 00:20:00.410 So I've chosen general healthful diet. 420 00:20:00.410 --> 00:20:03.230 And I want this patient to have 2,200 calories, 421 00:20:03.230 --> 00:20:05.810 90 grams of protein, and a supplement, 422 00:20:05.810 --> 00:20:07.680 and so forth and so on. 423 00:20:07.680 --> 00:20:09.320 So I choose one standardized language 424 00:20:09.320 --> 00:20:13.280 but then I free-type the specifics for this patient. 425 00:20:13.280 --> 00:20:16.370 I move on to monitoring and evaluation, which is also 426 00:20:16.370 --> 00:20:20.240 auto-filled based on the signs and symptoms 427 00:20:20.240 --> 00:20:23.090 that I chose earlier in my diagnosis. 428 00:20:23.090 --> 00:20:27.230 And I can add more if desired to the dropdown menu once again, 429 00:20:27.230 --> 00:20:30.770 and then just complete the value unit and evaluation 430 00:20:30.770 --> 00:20:33.390 standard sections as needed. 431 00:20:33.390 --> 00:20:38.330 And then this section is complete as well. 432 00:20:38.330 --> 00:20:42.200 Once completed, you can choose the Save Entry 433 00:20:42.200 --> 00:20:44.450 option to save your work. 434 00:20:44.450 --> 00:20:46.880 And from there, you click on finalize entry, 435 00:20:46.880 --> 00:20:49.760 which will take you to a new screen where the student can 436 00:20:49.760 --> 00:20:52.850 download a PDF of the completed note 437 00:20:52.850 --> 00:20:56.880 after they sign the electronic note. 438 00:20:56.880 --> 00:20:59.700 440 00:21:03.410 --> 00:21:06.560 You can see the patient identification number here, 441 00:21:06.560 --> 00:21:10.670 it's also listed in the upper left two for referencing later 442 00:21:10.670 --> 00:21:12.470 for a follow up note. 443 00:21:12.470 --> 00:21:15.530 Over here in the upper right, it prompts the student 444 00:21:15.530 --> 00:21:19.310 that they can download the report as a PDF. 445 00:21:19.310 --> 00:21:21.600 This is what the PDF, the final PDF 446 00:21:21.600 --> 00:21:24.930 will look like that they can download. 447 00:21:24.930 --> 00:21:27.560 I highlighted up here the patient number. 448 00:21:27.560 --> 00:21:30.690 I like this, because then when they download the PDF 449 00:21:30.690 --> 00:21:33.397 and upload it in for an assignment, 450 00:21:33.397 --> 00:21:34.980 they always have this reference number 451 00:21:34.980 --> 00:21:37.980 so that when they come back in to do a follow up note, 452 00:21:37.980 --> 00:21:40.230 if they've added other patients along the way, 453 00:21:40.230 --> 00:21:42.930 they won't get confused as to who their patient is. 454 00:21:42.930 --> 00:21:45.300 But here you can see the assessment, the diagnosis, 455 00:21:45.300 --> 00:21:50.280 the intervention, and the monitoring and evaluation. 456 00:21:50.280 --> 00:21:53.120 As I said before, this isn't a standardized patient, 457 00:21:53.120 --> 00:21:54.660 and it's just somebody that they-- 458 00:21:54.660 --> 00:21:58.290 a patient they've chosen from the community to interview. 459 00:21:58.290 --> 00:22:01.650 I do have them turn in their raw note notes 460 00:22:01.650 --> 00:22:03.750 so I can make sure that they have gleaned 461 00:22:03.750 --> 00:22:06.720 the relevant information from those raw notes 462 00:22:06.720 --> 00:22:09.930 to make a diagnosis and so forth, to make sure 463 00:22:09.930 --> 00:22:12.640 that they're doing an appropriate assessment. 464 00:22:12.640 --> 00:22:15.600 So this is just a one simple example 465 00:22:15.600 --> 00:22:17.700 of an assessment that can be done. 466 00:22:17.700 --> 00:22:19.380 Now I'm going to turn it over to Julia, 467 00:22:19.380 --> 00:22:22.770 and she can discuss how she uses ANDHII in her clinic. 468 00:22:22.770 --> 00:22:26.010 OK, so I'm going to describe how we've been using ANDHII 469 00:22:26.010 --> 00:22:28.470 during year two of our dietetic master's program 470 00:22:28.470 --> 00:22:30.460 at University of Auckland. 471 00:22:30.460 --> 00:22:32.730 So this is the equivalent of the intern 472 00:22:32.730 --> 00:22:35.479 period for American trained dietitians. 473 00:22:35.479 --> 00:22:37.520 For background, in the first year of our program, 474 00:22:37.520 --> 00:22:40.870 we follow a similar process to what Carrie has just described. 475 00:22:40.870 --> 00:22:44.440 And this year, we will integrate ANDHII more into our first year 476 00:22:44.440 --> 00:22:47.280 of our program and use with it and the students 477 00:22:47.280 --> 00:22:49.360 for much of the assessment. 478 00:22:49.360 --> 00:22:52.330 So at the University, we've worked with the Academy 479 00:22:52.330 --> 00:22:54.780 to create an ANDHI group subscription 480 00:22:54.780 --> 00:22:56.910 for our student led clinic research that we 481 00:22:56.910 --> 00:22:58.730 are undertaking at present. 482 00:22:58.730 --> 00:23:01.740 The ANDHII subscription allows for supervising 483 00:23:01.740 --> 00:23:04.170 dietitians and myself as the instructor 484 00:23:04.170 --> 00:23:07.940 to see the student entries. 485 00:23:07.940 --> 00:23:10.630 So this is slightly different to the standard student member 486 00:23:10.630 --> 00:23:12.930 login that Carrie described earlier. 487 00:23:12.930 --> 00:23:15.060 We had the ability within our setting 488 00:23:15.060 --> 00:23:17.442 to work with the students to ensure that the data 489 00:23:17.442 --> 00:23:18.900 that they have inputted as correct. 490 00:23:18.900 --> 00:23:21.780 And we use ANDHII as a teaching tool to improve patient care 491 00:23:21.780 --> 00:23:24.840 as well as using it for the research purposes. 492 00:23:24.840 --> 00:23:27.240 So the group subscription that we've created 493 00:23:27.240 --> 00:23:31.350 is customized for our specific teaching and research needs. 494 00:23:31.350 --> 00:23:33.720 So we're concurrently evaluating the effectiveness 495 00:23:33.720 --> 00:23:36.630 of our student led clinic with a subjective patient satisfaction 496 00:23:36.630 --> 00:23:39.540 survey on their client experiences 497 00:23:39.540 --> 00:23:43.080 with our students in the on-site teaching clinic that we run. 498 00:23:43.080 --> 00:23:44.820 We've obtained ethical approval for this 499 00:23:44.820 --> 00:23:47.531 so that we can use the results from ANDHII, which I'll 500 00:23:47.531 --> 00:23:49.780 show you a little bit later on, and the survey to help 501 00:23:49.780 --> 00:23:52.190 determine the future direction of our program. 502 00:23:52.190 --> 00:23:55.170 We're changing registration competencies that are coming up 503 00:23:55.170 --> 00:23:57.170 here in New Zealand. 504 00:23:57.170 --> 00:24:03.240 So just to show you what we do in the customized templates-- 505 00:24:03.240 --> 00:24:05.130 at the end of a consultation, the student 506 00:24:05.130 --> 00:24:07.110 will input all relevant information 507 00:24:07.110 --> 00:24:11.690 into ANDHII using the customized template that we've set up. 508 00:24:11.690 --> 00:24:14.720 Now for the purposes of student training and working 509 00:24:14.720 --> 00:24:17.390 with the student to help them become familiar and proficient 510 00:24:17.390 --> 00:24:19.610 with what they need to do in clinical practice, 511 00:24:19.610 --> 00:24:21.710 they don't put information into ANDHII 512 00:24:21.710 --> 00:24:24.170 as they go, which as practitioners, 513 00:24:24.170 --> 00:24:26.230 that's what we're encouraged to do. 514 00:24:26.230 --> 00:24:28.440 So the reason for this is as you're aware, 515 00:24:28.440 --> 00:24:30.470 students have multiple factors to consider 516 00:24:30.470 --> 00:24:33.360 when seeing a client, and a key aspect of our teaching clinic 517 00:24:33.360 --> 00:24:35.210 is to support them in progressing 518 00:24:35.210 --> 00:24:37.765 towards registration competency requirements. 519 00:24:37.765 --> 00:24:39.140 So we're not setting out for them 520 00:24:39.140 --> 00:24:42.231 to fail and to worry about what they have to at the start. 521 00:24:42.231 --> 00:24:44.480 So it's more, how can we work through it over the time 522 00:24:44.480 --> 00:24:46.230 that they're in clinic with us. 523 00:24:46.230 --> 00:24:49.250 So health informatics is one of the registration competency 524 00:24:49.250 --> 00:24:51.980 requirements going forward as our communication 525 00:24:51.980 --> 00:24:54.310 and professionalism, which if they 526 00:24:54.310 --> 00:24:57.110 inputted all the data into ANDHII right from word, 527 00:24:57.110 --> 00:25:00.774 go, and tried to speak to the client at the same time, 528 00:25:00.774 --> 00:25:02.190 especially in the initial clinics, 529 00:25:02.190 --> 00:25:04.970 we may have a bit of an impact in terms of these competencies 530 00:25:04.970 --> 00:25:06.880 and their progression towards. 531 00:25:06.880 --> 00:25:09.170 So as they progress, they are able to input data 532 00:25:09.170 --> 00:25:10.507 as they see the client. 533 00:25:10.507 --> 00:25:12.340 And they can do this a bit more efficiently, 534 00:25:12.340 --> 00:25:14.840 but this is determined on a case by case basis. 535 00:25:14.840 --> 00:25:18.290 And we have the ability within our teaching clinic 536 00:25:18.290 --> 00:25:20.640 that there's the ability from a time perspective, 537 00:25:20.640 --> 00:25:22.730 but space as well to be able to work 538 00:25:22.730 --> 00:25:25.640 through this over the duration they're with us each clinic. 539 00:25:25.640 --> 00:25:27.790 One of the other things that we do consider 540 00:25:27.790 --> 00:25:29.470 is ANDHII does time out. 541 00:25:29.470 --> 00:25:32.085 So if we were doing it during a client consultation, 542 00:25:32.085 --> 00:25:34.990 the student may find that it times itself out before they've 543 00:25:34.990 --> 00:25:37.900 inputted data and it just becomes a bit messy. 544 00:25:37.900 --> 00:25:40.400 And again, distracting in terms of establishing that rapport 545 00:25:40.400 --> 00:25:42.900 and communication with the client. 546 00:25:42.900 --> 00:25:45.390 So once the client has been seen, 547 00:25:45.390 --> 00:25:50.980 the student accesses ANDHII through the various logins 548 00:25:50.980 --> 00:25:54.610 that we access, and select the customize entry template. 549 00:25:54.610 --> 00:25:56.330 So this found in the same location 550 00:25:56.330 --> 00:26:00.110 as the educational practice one that Carrie just described. 551 00:26:00.110 --> 00:26:03.230 So as shown by the one here, we just 552 00:26:03.230 --> 00:26:08.120 select University of Auckland, which we can as educators, 553 00:26:08.120 --> 00:26:11.990 we can use test patients, or we can put in our real patients 554 00:26:11.990 --> 00:26:13.470 as well. 555 00:26:13.470 --> 00:26:20.060 And the we select Add Patient as shown here by the two. 556 00:26:20.060 --> 00:26:23.450 So this then generates a new patient record 557 00:26:23.450 --> 00:26:25.430 with pre-determined assessment fields 558 00:26:25.430 --> 00:26:27.170 that the students can complete. 559 00:26:27.170 --> 00:26:30.780 So this is just a screenshot of a section of our templates. 560 00:26:30.780 --> 00:26:35.690 We have customized this so that the student can work through 561 00:26:35.690 --> 00:26:37.430 rather than sort of guess what they 562 00:26:37.430 --> 00:26:42.610 need to have within an assessment of a client. 563 00:26:42.610 --> 00:26:44.000 And it ensures that the student's 564 00:26:44.000 --> 00:26:46.445 input all relevant information from both a teaching 565 00:26:46.445 --> 00:26:50.200 perspective, but also a research perspective. 566 00:26:50.200 --> 00:26:54.380 There are also mandatory fields, and there's ones that aren't. 567 00:26:54.380 --> 00:26:58.145 So they're indicated by the x to the right of the screen. 568 00:26:58.145 --> 00:26:59.780 So as I mentioned right at the start, 569 00:26:59.780 --> 00:27:02.280 if there's something that's not relevant for that particular 570 00:27:02.280 --> 00:27:05.120 client consult, the student dietitian can unselect that, 571 00:27:05.120 --> 00:27:07.340 and it will disappear off the screen. 572 00:27:07.340 --> 00:27:10.270 As they work through the assessment, 573 00:27:10.270 --> 00:27:14.450 a variety of different NCP terms come up, 574 00:27:14.450 --> 00:27:16.070 and there's also the ability for them 575 00:27:16.070 --> 00:27:18.230 to add an any that we may have not put 576 00:27:18.230 --> 00:27:20.230 on the customized template. 577 00:27:20.230 --> 00:27:23.630 So you can't predetermine every single person that comes in, 578 00:27:23.630 --> 00:27:26.820 so there is that ability with the drop down box, which you 579 00:27:26.820 --> 00:27:28.490 see on Carrie's initial screen for them 580 00:27:28.490 --> 00:27:32.550 to include should they need it. 581 00:27:32.550 --> 00:27:35.270 So the rest of the process that they follow 582 00:27:35.270 --> 00:27:37.000 is the same in terms of coming up 583 00:27:37.000 --> 00:27:39.560 with the diagnosis and the intervention with the drop 584 00:27:39.560 --> 00:27:42.470 down boxes auto-filling. 585 00:27:42.470 --> 00:27:46.430 And when it comes to the finalizing entry part, 586 00:27:46.430 --> 00:27:50.030 we work with the student to do this, 587 00:27:50.030 --> 00:27:52.160 to ensure all aspects are correct, 588 00:27:52.160 --> 00:27:53.980 and then we finalized the entry. 589 00:27:53.980 --> 00:27:57.230 Once finalized, an entry summary report 590 00:27:57.230 --> 00:28:00.220 is generated as shown, which the student then copies and pastes 591 00:28:00.220 --> 00:28:02.520 into electronic health record. 592 00:28:02.520 --> 00:28:04.040 Now to get to this point, if there's 593 00:28:04.040 --> 00:28:05.625 a box that hasn't been completed, 594 00:28:05.625 --> 00:28:08.540 the student will be alerted to that or be shown in red, 595 00:28:08.540 --> 00:28:12.870 they need to go back into the visit, 596 00:28:12.870 --> 00:28:16.330 complete that before they are able to finalize the entry. 597 00:28:16.330 --> 00:28:19.340 So they've got the data that you can see in front of you. 598 00:28:19.340 --> 00:28:21.740 So rather than use a PDF, because 599 00:28:21.740 --> 00:28:24.870 with our electronic health record, we can't upload that. 600 00:28:24.870 --> 00:28:28.070 We have to use the Copy and Paste function. 601 00:28:28.070 --> 00:28:31.490 And bearing in mind that no system is perfect, 602 00:28:31.490 --> 00:28:33.850 we adapt the text that is generated and adjust 603 00:28:33.850 --> 00:28:36.056 it to suit our clinic needs. 604 00:28:36.056 --> 00:28:37.430 It's important for students to be 605 00:28:37.430 --> 00:28:39.138 aware of the variety of systems that they 606 00:28:39.138 --> 00:28:40.675 will come across in practice and be 607 00:28:40.675 --> 00:28:42.590 able to modify their approach. 608 00:28:42.590 --> 00:28:44.960 So how we do it is just one example 609 00:28:44.960 --> 00:28:46.970 of the electronic health record and the process 610 00:28:46.970 --> 00:28:51.020 that we go through across the world in various records 611 00:28:51.020 --> 00:28:53.800 that people will have to learn how to use. 612 00:28:53.800 --> 00:28:56.420 And dietitians are pretty movable as are many health 613 00:28:56.420 --> 00:28:57.460 professionals. 614 00:28:57.460 --> 00:29:02.460 So starting to realize that they do have to adapt is important. 615 00:29:02.460 --> 00:29:04.910 So as you are aware, they're understandable concerns 616 00:29:04.910 --> 00:29:06.470 with regards to the Copy and Paste 617 00:29:06.470 --> 00:29:09.574 process and the potential for errors to occur. 618 00:29:09.574 --> 00:29:11.240 So we have addressed this in our setting 619 00:29:11.240 --> 00:29:13.130 by ensuring that our students consider 620 00:29:13.130 --> 00:29:15.320 that each part of the electronic health record 621 00:29:15.320 --> 00:29:17.840 is an integral part of the patient's care. 622 00:29:17.840 --> 00:29:20.060 As educators, it's part of our teaching 623 00:29:20.060 --> 00:29:23.130 to ensure the students are aware of the importance of accurate, 624 00:29:23.130 --> 00:29:26.690 timely, and appropriate clinical entries, of which ANDHII copy 625 00:29:26.690 --> 00:29:29.960 and pasting into the electronic health record is part of. 626 00:29:29.960 --> 00:29:32.420 Regardless of the formats of the clinical entries, 627 00:29:32.420 --> 00:29:34.695 critical thinking is essential, and ANDHII 628 00:29:34.695 --> 00:29:38.090 allows students to do this throughout the process. 629 00:29:38.090 --> 00:29:40.070 And another safe guard, we also ensure 630 00:29:40.070 --> 00:29:43.530 that a licensed dietitian reviews each electronic health 631 00:29:43.530 --> 00:29:44.780 record before it is finalized. 632 00:29:44.780 --> 00:29:47.990 634 00:29:52.320 --> 00:29:53.170 record looks like. 635 00:29:53.170 --> 00:29:54.670 So this is relatively simple. 636 00:29:54.670 --> 00:29:57.300 This is just an example of a nutrition assessment template 637 00:29:57.300 --> 00:29:59.730 that we use in our student led clinic, 638 00:29:59.730 --> 00:30:01.530 in this case, the "Mickey Mouse", which 639 00:30:01.530 --> 00:30:05.040 seems to be the chief client across the multiple settings. 640 00:30:05.040 --> 00:30:07.740 So following the copy and paste process, 641 00:30:07.740 --> 00:30:09.360 we add patient identifiers. 642 00:30:09.360 --> 00:30:12.260 So in this case, the client's name, the date of birth, 643 00:30:12.260 --> 00:30:15.480 our national health number, and play around a little 644 00:30:15.480 --> 00:30:18.810 with the formatting, capital letters, calculating things 645 00:30:18.810 --> 00:30:20.790 correctly to suit our needs. 646 00:30:20.790 --> 00:30:23.397 Our student led clinic health electronic record 647 00:30:23.397 --> 00:30:25.730 as I mentioned, is relatively simple compared to others, 648 00:30:25.730 --> 00:30:27.807 but a good learning tool to have our students 649 00:30:27.807 --> 00:30:29.640 become familiar with the health care setting 650 00:30:29.640 --> 00:30:30.639 that you're about enter. 651 00:30:30.639 --> 00:30:33.270 653 00:30:36.340 --> 00:30:40.480 is in a Word format that then saved and is uploaded 654 00:30:40.480 --> 00:30:43.696 onto electronic health record. 655 00:30:43.696 --> 00:30:46.320 This is someone one that's used within some of the primary care 656 00:30:46.320 --> 00:30:48.560 environments around New Zealand. 657 00:30:48.560 --> 00:30:51.240 So highlighted in yellow in this example 658 00:30:51.240 --> 00:30:53.600 is the finalize nutrition assessment, 659 00:30:53.600 --> 00:30:56.160 which was shown in the previous slide. 660 00:30:56.160 --> 00:30:58.470 When we see patients at subsequent reviews, 661 00:30:58.470 --> 00:31:01.920 we repeat the process using the ANDHII template, 662 00:31:01.920 --> 00:31:04.950 and then again, through the variety of systems we have, 663 00:31:04.950 --> 00:31:08.730 we save those, and students can see the changes in parameters 664 00:31:08.730 --> 00:31:10.590 and diagnoses, and ultimately, look 665 00:31:10.590 --> 00:31:12.300 at the effectiveness of dietetic input 666 00:31:12.300 --> 00:31:16.014 within this clinic system. 667 00:31:16.014 --> 00:31:17.430 So that's just a bit of an example 668 00:31:17.430 --> 00:31:21.240 of what we do here in our clinic at the University of Auckland. 669 00:31:21.240 --> 00:31:25.230 And going forward from this, what we can do 670 00:31:25.230 --> 00:31:28.724 is actually track outcomes using ANDHII. 671 00:31:28.724 --> 00:31:30.970 So we got lot's of data that we've got 672 00:31:30.970 --> 00:31:32.470 within our student led clinics. 673 00:31:32.470 --> 00:31:36.460 And the supervising dietitian's able to track outcomes 674 00:31:36.460 --> 00:31:39.370 of individual patients or in the case of the research that we're 675 00:31:39.370 --> 00:31:41.350 doing, entire groups. 676 00:31:41.350 --> 00:31:43.480 So you can use the tracking outcome's tab, 677 00:31:43.480 --> 00:31:46.680 which is available within the ANDHII program 678 00:31:46.680 --> 00:31:50.520 to choose one outcome or several to plot a single graph. 679 00:31:50.520 --> 00:31:52.630 So as an educator, this provides me 680 00:31:52.630 --> 00:31:54.580 with a wider perspective on the impact 681 00:31:54.580 --> 00:31:57.850 of the student led clinic and the community that it serves. 682 00:31:57.850 --> 00:32:00.680 And it also helps to evaluate what we're actually doing. 683 00:32:00.680 --> 00:32:04.060 So as a dietitian, we seem to often undermine, 684 00:32:04.060 --> 00:32:05.630 we don't show what we're doing. 685 00:32:05.630 --> 00:32:07.255 We know we're good at what we're doing, 686 00:32:07.255 --> 00:32:09.310 but we don't need to really demonstrate that. 687 00:32:09.310 --> 00:32:12.520 So initial research that we've carried out in this setting, 688 00:32:12.520 --> 00:32:14.930 not using ANDHII, but using paper based, 689 00:32:14.930 --> 00:32:16.480 highlighted the difficulties that we 690 00:32:16.480 --> 00:32:18.910 had with improving outcomes for patients seen. 691 00:32:18.910 --> 00:32:20.620 And this lead us into investigating 692 00:32:20.620 --> 00:32:22.510 and starting to use these customized 693 00:32:22.510 --> 00:32:24.370 templates with ANDHII. 694 00:32:24.370 --> 00:32:27.490 So now we can look at when and the year the client was seen, 695 00:32:27.490 --> 00:32:30.670 their motivations to change, and a variety of other data 696 00:32:30.670 --> 00:32:32.220 to determine what we need to change 697 00:32:32.220 --> 00:32:35.712 in our practice or our services delivered as educators. 698 00:32:35.712 --> 00:32:38.170 At present, we're only using ANDHII in our two-way teaching 699 00:32:38.170 --> 00:32:41.200 rooms in our on site clinics, but plan 700 00:32:41.200 --> 00:32:43.140 to expand this to our satellite services, 701 00:32:43.140 --> 00:32:45.370 as we ourselves of the teaching team become more 702 00:32:45.370 --> 00:32:47.832 familiar with this program. 703 00:32:47.832 --> 00:32:49.540 So I'm now going to leave you with Carrie 704 00:32:49.540 --> 00:32:51.515 to run through how you can implement ANDHII 705 00:32:51.515 --> 00:32:53.910 into your dietetic teaching program. 706 00:32:53.910 --> 00:32:56.580 708 00:32:59.500 --> 00:33:02.320 So the first thing is, as educators, we really 709 00:33:02.320 --> 00:33:05.140 need to familiarize ourselves with a nutrition care 710 00:33:05.140 --> 00:33:08.350 process and ANDHII. 711 00:33:08.350 --> 00:33:10.780 It is part of our accreditation standards 712 00:33:10.780 --> 00:33:13.870 to know the standardized terminology. 713 00:33:13.870 --> 00:33:17.410 And I think it really helps to enforce those critical thinking 714 00:33:17.410 --> 00:33:20.170 skills that our students need to know, 715 00:33:20.170 --> 00:33:22.280 and it's vital to our profession. 716 00:33:22.280 --> 00:33:25.360 And working through that ADIME process really 717 00:33:25.360 --> 00:33:29.140 does help the students think from section 718 00:33:29.140 --> 00:33:32.230 to section what's best for the patients 719 00:33:32.230 --> 00:33:34.900 and kind of moving through those best practices 720 00:33:34.900 --> 00:33:36.680 as we move through it. 721 00:33:36.680 --> 00:33:41.440 It does require some training and some consistent instruction 722 00:33:41.440 --> 00:33:43.160 throughout the curriculum. 723 00:33:43.160 --> 00:33:47.230 And I know we could debate to whether the ADIME note is 724 00:33:47.230 --> 00:33:51.610 the best type of note to teach a student, 725 00:33:51.610 --> 00:33:55.010 but that's meant for another time. 726 00:33:55.010 --> 00:34:00.720 But I think it is important as a faculty 727 00:34:00.720 --> 00:34:06.940 to really have best practices developed in order to ensure 728 00:34:06.940 --> 00:34:09.610 that the students are getting a consistent message 729 00:34:09.610 --> 00:34:11.020 throughout their education. 730 00:34:11.020 --> 00:34:14.260 And that as educators, we are speaking 731 00:34:14.260 --> 00:34:17.380 with those people in practice to make sure 732 00:34:17.380 --> 00:34:21.030 that it is a seamless approach from education 733 00:34:21.030 --> 00:34:24.250 into the practice setting. 734 00:34:24.250 --> 00:34:28.239 Also to understand, especially what Julia and Margaret 735 00:34:28.239 --> 00:34:32.620 both talked about, in using this data that we've collected 736 00:34:32.620 --> 00:34:36.400 on real patients for research, that the data that 737 00:34:36.400 --> 00:34:40.780 is collected in ANDHII is de-identified for research. 738 00:34:40.780 --> 00:34:47.980 So the real patient data that we have that's being utilized, 739 00:34:47.980 --> 00:34:50.110 the Academy or researchers will not 740 00:34:50.110 --> 00:34:54.310 be contacting those patients nor can they identify them. 741 00:34:54.310 --> 00:34:57.790 Therefore, it's not considered human subjects research 742 00:34:57.790 --> 00:35:00.640 under the Common Rule, so that is best to understand. 743 00:35:00.640 --> 00:35:03.330 745 00:35:05.090 --> 00:35:09.160 clinic, such as Julia described or placements in internship 746 00:35:09.160 --> 00:35:11.550 like we have here, need to be reviewed, 747 00:35:11.550 --> 00:35:15.110 and appropriate student training is provided. 748 00:35:15.110 --> 00:35:19.940 And I think ANDHII could be one of those options that we have. 749 00:35:19.940 --> 00:35:22.960 Now with any system that you choose no matter what it is, 750 00:35:22.960 --> 00:35:26.540 I think there can be pros and cons to any of those things. 751 00:35:26.540 --> 00:35:29.590 Some of the pros that I think we've talked about here today 752 00:35:29.590 --> 00:35:33.390 is that it does reinforce that NCP terminology, 753 00:35:33.390 --> 00:35:35.230 and they think this is very helpful 754 00:35:35.230 --> 00:35:39.220 as students and dietitians move across different disciplines 755 00:35:39.220 --> 00:35:41.800 within our fields. 756 00:35:41.800 --> 00:35:43.510 As I mentioned earlier, I think it 757 00:35:43.510 --> 00:35:45.400 does help our students think critically, 758 00:35:45.400 --> 00:35:49.240 and this is going to help them in all aspects. 759 00:35:49.240 --> 00:35:52.450 It's free to Academy members. 760 00:35:52.450 --> 00:35:56.710 Now that ANDHII does have the PDF download for assignment 761 00:35:56.710 --> 00:36:00.010 submissions, that's very helpful, compared 762 00:36:00.010 --> 00:36:04.000 to having to copy and paste what was on the screen before. 763 00:36:04.000 --> 00:36:07.810 I like the auto-fill feature that it has, 764 00:36:07.810 --> 00:36:09.790 and I'll go back to what I mentioned 765 00:36:09.790 --> 00:36:12.550 before about learning that long division 766 00:36:12.550 --> 00:36:14.380 and using the calculator. 767 00:36:14.380 --> 00:36:16.780 I think as long as you teach the students 768 00:36:16.780 --> 00:36:19.630 how to understand the terminology 769 00:36:19.630 --> 00:36:24.520 and how to do a diagnosis, that the etiology drives 770 00:36:24.520 --> 00:36:27.350 that intervention, that signs and symptoms drive 771 00:36:27.350 --> 00:36:29.500 the monitoring and evaluation. 772 00:36:29.500 --> 00:36:31.300 And then when they get into ANDHII 773 00:36:31.300 --> 00:36:33.640 and they see that auto-fill feature, 774 00:36:33.640 --> 00:36:35.440 it's like a light bulb moment to them, 775 00:36:35.440 --> 00:36:37.930 and they see it all coming to fruition. 776 00:36:37.930 --> 00:36:40.420 I think that's a great tool. 777 00:36:40.420 --> 00:36:42.850 They can use it during dietetic internships 778 00:36:42.850 --> 00:36:45.569 as part of their electronic health record. 779 00:36:45.569 --> 00:36:47.860 And it can generate information about the effectiveness 780 00:36:47.860 --> 00:36:50.350 of student led clinics. 781 00:36:50.350 --> 00:36:53.110 Now a little bit on the con side of things. 782 00:36:53.110 --> 00:36:56.320 It might be difficult for all to log in at once 783 00:36:56.320 --> 00:36:58.030 if you have a very large class. 784 00:36:58.030 --> 00:37:02.080 As I mentioned before, I think my class had 42 people in it, 785 00:37:02.080 --> 00:37:04.660 and we did have some difficulty with that. 786 00:37:04.660 --> 00:37:06.100 And that's when we worked in pairs 787 00:37:06.100 --> 00:37:08.660 and that worked just fine. 788 00:37:08.660 --> 00:37:13.150 It does not exactly mimic a real electronic health record 789 00:37:13.150 --> 00:37:15.580 if used in the classroom alone. 790 00:37:15.580 --> 00:37:20.050 So it is important as educators for us 791 00:37:20.050 --> 00:37:22.360 to have those conversations with the students about 792 00:37:22.360 --> 00:37:25.630 what is in the real world, how does this look compared 793 00:37:25.630 --> 00:37:28.750 to that, and talk about those differences. 794 00:37:28.750 --> 00:37:31.690 I had some students in my classrooms 795 00:37:31.690 --> 00:37:34.900 who are dietetic technicians registered, and they 796 00:37:34.900 --> 00:37:38.500 spoke about their experiences as practitioners 797 00:37:38.500 --> 00:37:39.400 and how it differed. 798 00:37:39.400 --> 00:37:42.580 And it was a great classroom discussion. 799 00:37:42.580 --> 00:37:46.570 The NCP terminology mapping to things such as SNOMED 800 00:37:46.570 --> 00:37:51.250 and LOINC, not 100% visibility. 801 00:37:51.250 --> 00:37:54.860 And the next slide is going to show that a little bit more. 802 00:37:54.860 --> 00:38:01.770 And I think it's something that as an educator, 803 00:38:01.770 --> 00:38:04.183 I don't know that we always, maybe once we're 804 00:38:04.183 --> 00:38:05.670 out of practice for a little bit, 805 00:38:05.670 --> 00:38:08.440 kind of talking about this a little bit further. 806 00:38:08.440 --> 00:38:10.950 I know when I first started teaching the nutrition care 807 00:38:10.950 --> 00:38:13.230 process, I thought, oh, this is great, 808 00:38:13.230 --> 00:38:15.160 we have all the standardized language. 809 00:38:15.160 --> 00:38:17.940 And we can get all this reimbursement 810 00:38:17.940 --> 00:38:21.300 and everything is just all nice and tidy. 811 00:38:21.300 --> 00:38:23.700 And then I started learning more about informatics, 812 00:38:23.700 --> 00:38:26.890 and I realized it's not all nice and tidy. 813 00:38:26.890 --> 00:38:31.300 But I think it's moving in a great situation. 814 00:38:31.300 --> 00:38:33.480 And I think this slide can kind of 815 00:38:33.480 --> 00:38:35.597 help us maybe understand that. 816 00:38:35.597 --> 00:38:37.680 So I'm going to kind of talk us through this slide 817 00:38:37.680 --> 00:38:42.660 a little bit, but due to the requirements now included 818 00:38:42.660 --> 00:38:46.170 in certain health IT in the United-- or in certified health 819 00:38:46.170 --> 00:38:49.320 IT in the United States, certain terminologies 820 00:38:49.320 --> 00:38:52.390 are required for clinical and reimbursement terms. 821 00:38:52.390 --> 00:38:57.180 So for example, SNOMED, CT, LOINC, ICD-10 822 00:38:57.180 --> 00:38:59.460 are now required in the US. 823 00:38:59.460 --> 00:39:01.230 To gather a clear picture of what 824 00:39:01.230 --> 00:39:07.440 mapping the NCP terms to other terminologies means, 825 00:39:07.440 --> 00:39:10.470 we'll begin in that lower left hand of the slide. 826 00:39:10.470 --> 00:39:13.650 So imagine this is that hospital dietitian who's 827 00:39:13.650 --> 00:39:18.630 documenting his or her patient via the NCP terms 828 00:39:18.630 --> 00:39:20.250 and definitions that we just have 829 00:39:20.250 --> 00:39:25.200 been talking about within ANDHII, or the ENCPT. 830 00:39:25.200 --> 00:39:28.470 The area of the screen that he or she is observing 831 00:39:28.470 --> 00:39:31.710 is called the user interface, or the UI. 832 00:39:31.710 --> 00:39:34.680 This UI should show only the content 833 00:39:34.680 --> 00:39:40.320 that she needs to complete the NCP process for the patient. 834 00:39:40.320 --> 00:39:43.260 Then imagine what happens kind of behind the screen 835 00:39:43.260 --> 00:39:45.550 at that server or computer level. 836 00:39:45.550 --> 00:39:49.170 So that's where the SNOMED, ICD-10, LOINC, and they're 837 00:39:49.170 --> 00:39:53.280 standardized terminologies kind of come together. 838 00:39:53.280 --> 00:39:57.720 The computer matches the NCP term like calcium intake, 839 00:39:57.720 --> 00:40:02.160 for example, with SNOMED CT term calcium intake, 840 00:40:02.160 --> 00:40:08.770 and that code, which could be 230122008 to be specific. 841 00:40:08.770 --> 00:40:11.700 So computers use codes to process information. 842 00:40:11.700 --> 00:40:14.820 So that pink box showing these terminologies, 843 00:40:14.820 --> 00:40:16.890 they're not seen by the user, but it's 844 00:40:16.890 --> 00:40:20.790 critical for the other processes on the screen. 845 00:40:20.790 --> 00:40:24.510 So the codes and terms, which are behind the scenes, 846 00:40:24.510 --> 00:40:28.140 are pulled into those transitions of care documents 847 00:40:28.140 --> 00:40:32.820 so that they can be sent to a dietitian or other provider 848 00:40:32.820 --> 00:40:37.130 at a nursing home or other institution, for example. 849 00:40:37.130 --> 00:40:39.330 Those codes and terms can be pulled 850 00:40:39.330 --> 00:40:45.690 into ANDHII, and other eCQM measures, such as malnutrition 851 00:40:45.690 --> 00:40:47.730 that we've all heard so much about. 852 00:40:47.730 --> 00:40:51.140 And can be used to show facility level 853 00:40:51.140 --> 00:40:53.730 revenue or financial saving. 854 00:40:53.730 --> 00:40:56.640 So just to kind of sum that up, the design 855 00:40:56.640 --> 00:40:59.760 of nutrition codes and terms behind the UI 856 00:40:59.760 --> 00:41:03.090 are critical to the secondary use of that data. 857 00:41:03.090 --> 00:41:06.810 And that data is what helps to support the validity of what 858 00:41:06.810 --> 00:41:08.940 we as dietitians do. 859 00:41:08.940 --> 00:41:10.890 A nutrition and dietetics professionals 860 00:41:10.890 --> 00:41:14.790 should work with their health information systems department 861 00:41:14.790 --> 00:41:17.100 to assure that the correct codes are being 862 00:41:17.100 --> 00:41:20.500 used for those eNCPT map codes. 863 00:41:20.500 --> 00:41:22.800 And in addition, the dietitian's should 864 00:41:22.800 --> 00:41:24.900 make sure code mappings are maintained. 865 00:41:24.900 --> 00:41:26.910 While users may not see them when 866 00:41:26.910 --> 00:41:29.850 they look at their screens, having the correct codes 867 00:41:29.850 --> 00:41:32.395 and mandated clinical terminology 868 00:41:32.395 --> 00:41:35.460 is critical to demonstrate nutrition care outcomes 869 00:41:35.460 --> 00:41:37.800 and improve nutrition care. 870 00:41:37.800 --> 00:41:44.580 So this is really vital for our continued job opportunities 871 00:41:44.580 --> 00:41:47.340 as dietitians to really show that 872 00:41:47.340 --> 00:41:51.450 what we are doing as interventions relates to better 873 00:41:51.450 --> 00:41:53.280 outcomes for our patients. 874 00:41:53.280 --> 00:41:56.250 And it's kind of that behind the scenes terminology 875 00:41:56.250 --> 00:41:58.000 that make such a big difference. 876 00:41:58.000 --> 00:42:02.580 So I hope that kind of helps to explain it a little better. 877 00:42:02.580 --> 00:42:05.860 Margaret, I think you want to do this slide. 878 00:42:05.860 --> 00:42:07.050 Yes, thank you. 879 00:42:07.050 --> 00:42:09.060 And thank you Carrie for that explanation. 880 00:42:09.060 --> 00:42:11.720 I think the diagram and the pieces 881 00:42:11.720 --> 00:42:15.650 of trying to connect your nutrition care process 882 00:42:15.650 --> 00:42:18.960 and that flow of an ADIME note for the students 883 00:42:18.960 --> 00:42:22.600 as they experience that and learn how to do it in ANDHII. 884 00:42:22.600 --> 00:42:26.400 And then relating that into a different application where 885 00:42:26.400 --> 00:42:30.540 they're going out into their clinical rotations, 886 00:42:30.540 --> 00:42:33.690 into their first position, and then 887 00:42:33.690 --> 00:42:37.080 have a number of different electronic health record tools. 888 00:42:37.080 --> 00:42:39.600 But to see the fact that what we want 889 00:42:39.600 --> 00:42:42.690 is to be able to move that data through and put 890 00:42:42.690 --> 00:42:46.480 into those codes and that piece to enable that. 891 00:42:46.480 --> 00:42:50.070 And as part of that, I just want to highlight 892 00:42:50.070 --> 00:42:53.460 an exciting development that does connect us 893 00:42:53.460 --> 00:42:54.830 with that process. 894 00:42:54.830 --> 00:42:59.310 So ANDHII, as the dietetics outcomes registry, 895 00:42:59.310 --> 00:43:02.080 obviously, one of our goals to be 896 00:43:02.080 --> 00:43:07.030 able to support and to collect that data, 897 00:43:07.030 --> 00:43:09.010 and be able to do that surveillance, 898 00:43:09.010 --> 00:43:13.630 that secondary research to look at across that broad picture, 899 00:43:13.630 --> 00:43:16.970 what are the nutrition diagnoses that are there. 900 00:43:16.970 --> 00:43:18.940 And what are the interventions that 901 00:43:18.940 --> 00:43:22.270 have been driven based on the etiologies that 902 00:43:22.270 --> 00:43:23.830 have been entered. 903 00:43:23.830 --> 00:43:27.610 And we can use that from our own surveillance research 904 00:43:27.610 --> 00:43:28.930 perspective. 905 00:43:28.930 --> 00:43:32.770 But we know that for practitioners, it's 906 00:43:32.770 --> 00:43:35.350 sometimes difficult, right, to get their data 907 00:43:35.350 --> 00:43:37.230 and to be able to put it into ANDHII, 908 00:43:37.230 --> 00:43:40.510 because you have that chart often in electronic health 909 00:43:40.510 --> 00:43:42.880 record, or in your system, and it's then 910 00:43:42.880 --> 00:43:45.170 taking a different step to actually data 911 00:43:45.170 --> 00:43:47.680 enter it into ANDHII the way that you're explaining it 912 00:43:47.680 --> 00:43:48.910 to your students. 913 00:43:48.910 --> 00:43:52.030 So we are working on an Application Programming 914 00:43:52.030 --> 00:43:57.970 Interface, which is simply a way that two software applications 915 00:43:57.970 --> 00:44:02.650 can talk to each other without needing the user to intervene 916 00:44:02.650 --> 00:44:04.570 or push the buttons. 917 00:44:04.570 --> 00:44:06.820 So this is going to make it possible 918 00:44:06.820 --> 00:44:11.110 for us to say, hey, from your electronic health records, 919 00:44:11.110 --> 00:44:13.960 you could actually submit electronically 920 00:44:13.960 --> 00:44:18.340 the data that you want to pushed into the ANDHII registry. 921 00:44:18.340 --> 00:44:22.300 And to vise versa, if there are practitioners out there who 922 00:44:22.300 --> 00:44:27.400 want to use ANDHII they could push their care plan data 923 00:44:27.400 --> 00:44:29.410 and their nutrition diagnosis back 924 00:44:29.410 --> 00:44:35.290 to those standardized formats using a new standard 925 00:44:35.290 --> 00:44:39.010 called FHIR which is called Fast Health Care Interoperability 926 00:44:39.010 --> 00:44:39.910 Resources. 927 00:44:39.910 --> 00:44:44.050 And we'll be demonstrating that at the upcoming Health Care 928 00:44:44.050 --> 00:44:46.840 Management Information Management Systems Society 929 00:44:46.840 --> 00:44:50.500 show, which is a very technical oriented show, 930 00:44:50.500 --> 00:44:53.890 but it will have a lot of providers and folks 931 00:44:53.890 --> 00:44:57.550 out there looking at the newest and latest technology. 932 00:44:57.550 --> 00:44:59.650 And we want them to know about nutrition, 933 00:44:59.650 --> 00:45:02.290 and to get nutrition data to be included 934 00:45:02.290 --> 00:45:05.200 in all of the care plans. 935 00:45:05.200 --> 00:45:08.080 Currently, that data is often missing, 936 00:45:08.080 --> 00:45:11.230 because the capabilities of either the electronic health 937 00:45:11.230 --> 00:45:15.950 records or the system that folks are using. 938 00:45:15.950 --> 00:45:19.300 So hopefully today, you have kind of 939 00:45:19.300 --> 00:45:23.800 heard from both Carrie and Julia about the benefits 940 00:45:23.800 --> 00:45:25.030 of teaching your students. 941 00:45:25.030 --> 00:45:28.570 And Carrie, I'd like to pass this one back to you. 942 00:45:28.570 --> 00:45:32.050 OK, so kind of just looking at ANDHII and practice 943 00:45:32.050 --> 00:45:34.660 the big picture here. 944 00:45:34.660 --> 00:45:36.400 Consistent nutrition care process 945 00:45:36.400 --> 00:45:39.040 terminology use for documentation 946 00:45:39.040 --> 00:45:41.350 across all settings. 947 00:45:41.350 --> 00:45:43.490 And then it can be more easily analyzed 948 00:45:43.490 --> 00:45:47.950 in research studies, or just consistency of care 949 00:45:47.950 --> 00:45:49.540 across settings. 950 00:45:49.540 --> 00:45:53.200 Specific outcome data for clients seen by students 951 00:45:53.200 --> 00:45:56.860 is easily aggregated in spreadsheets or graphs, 952 00:45:56.860 --> 00:46:00.250 and could be used to provide relevant teaching and learning 953 00:46:00.250 --> 00:46:00.910 feedback. 954 00:46:00.910 --> 00:46:04.420 So some of those graphs that Julia showed, 955 00:46:04.420 --> 00:46:09.220 how can we use those then when we are teaching the students, 956 00:46:09.220 --> 00:46:12.280 or having them give feedback not only to the students, 957 00:46:12.280 --> 00:46:14.980 but they can use that feedback to give to patients as 958 00:46:14.980 --> 00:46:16.900 well on their outcomes. 959 00:46:16.900 --> 00:46:19.300 Monitor success or need for improvement 960 00:46:19.300 --> 00:46:22.350 by tracking patient progress over time with those charts 961 00:46:22.350 --> 00:46:24.810 and reports like I just mentioned. 962 00:46:24.810 --> 00:46:28.750 Individual visit data is pooled into a dietetics outcome 963 00:46:28.750 --> 00:46:31.750 registry that can also be used for research, 964 00:46:31.750 --> 00:46:35.440 which just strengthens our ability to have 965 00:46:35.440 --> 00:46:38.380 research-based programs. 966 00:46:38.380 --> 00:46:41.770 And use data from individual visits across practice settings 967 00:46:41.770 --> 00:46:44.170 to determine if current standards of practice 968 00:46:44.170 --> 00:46:46.930 actually achieved desired outcomes. 969 00:46:46.930 --> 00:46:51.100 All of this helps to improve our push forward 970 00:46:51.100 --> 00:46:55.000 for better reimbursement, and shows how best practices 971 00:46:55.000 --> 00:46:56.690 improve patient outcomes. 972 00:46:56.690 --> 00:47:00.190 I think it's a very exciting time for us in nutrition, 973 00:47:00.190 --> 00:47:04.060 and as Margaret said, as we're moving forward 974 00:47:04.060 --> 00:47:07.480 with different things like HL7 and with HIMSS, 975 00:47:07.480 --> 00:47:11.830 getting nutrition within that standardized language 976 00:47:11.830 --> 00:47:14.890 and getting better recognition for that is just going to help 977 00:47:14.890 --> 00:47:18.340 our profession move forward. 978 00:47:18.340 --> 00:47:20.700 So great, Margaret. 979 00:47:20.700 --> 00:47:22.900 Yeah, thanks Carrie. 980 00:47:22.900 --> 00:47:25.870 And we're coming to the close of our presentation 981 00:47:25.870 --> 00:47:30.490 and we have time for questions, so while we cover a couple 982 00:47:30.490 --> 00:47:34.960 that we usually get, I want to pick the opportunity to say, 983 00:47:34.960 --> 00:47:38.190 please enter any questions you have into the chat, 984 00:47:38.190 --> 00:47:41.860 and I will get those read back out to you 985 00:47:41.860 --> 00:47:44.680 Carrie and Julia, so that they can give you 986 00:47:44.680 --> 00:47:49.850 their firsthand opinions and expert advice. 987 00:47:49.850 --> 00:47:52.450 So first of all, we often hear folks 988 00:47:52.450 --> 00:47:54.930 trying to connect or want to know if ANDHII can 989 00:47:54.930 --> 00:47:57.010 be used on a mobile platform. 990 00:47:57.010 --> 00:48:00.900 And there was an upgrade that was done this last fall, 991 00:48:00.900 --> 00:48:04.080 so you should definitely check it out if you haven't, you 992 00:48:04.080 --> 00:48:05.535 can actually connect. 993 00:48:05.535 --> 00:48:08.460 And we have changed the user interface so 994 00:48:08.460 --> 00:48:13.680 that if you connect to ANDHII on a tablet or mobile phone 995 00:48:13.680 --> 00:48:19.200 that you can actually navigate much more easily now. 996 00:48:19.200 --> 00:48:21.680 And so get those questions in the chat box, 997 00:48:21.680 --> 00:48:24.030 I think I've got one more. 998 00:48:24.030 --> 00:48:28.530 As Carrie and Julia highlighted, there 999 00:48:28.530 --> 00:48:33.130 are separate projects in ANDHII. 1000 00:48:33.130 --> 00:48:36.660 So at the top when you first log in based on your level 1001 00:48:36.660 --> 00:48:40.230 and criteria, so if your credentials practitioner 1002 00:48:40.230 --> 00:48:44.010 in RDN or a DTR, you'll have a national quality improvement 1003 00:48:44.010 --> 00:48:47.960 pool as well as education and practice under your projects. 1004 00:48:47.960 --> 00:48:51.690 So anybody can put people and patients or clients 1005 00:48:51.690 --> 00:48:53.460 into the education and practice, it's not 1006 00:48:53.460 --> 00:48:55.035 like it's just for students. 1007 00:48:55.035 --> 00:48:57.480 So if you ever want to just try and learn 1008 00:48:57.480 --> 00:48:59.700 your way around ANDHII, that's the best way. 1009 00:48:59.700 --> 00:49:03.240 Go into the education and practice, add a patient, 1010 00:49:03.240 --> 00:49:09.080 get familiar with searching for the term, have at it 1011 00:49:09.080 --> 00:49:10.240 and see how it goes. 1012 00:49:10.240 --> 00:49:12.630 That's the best I think advice that we have. 1013 00:49:12.630 --> 00:49:16.200 And then of course, check out those training videos. 1014 00:49:16.200 --> 00:49:18.810 So I have a couple of questions in the pool. 1015 00:49:18.810 --> 00:49:23.770 Carol has asked about where the case studies come from, 1016 00:49:23.770 --> 00:49:26.820 and are you able to utilize case study textbooks? 1017 00:49:26.820 --> 00:49:29.930 1019 00:49:33.150 --> 00:49:36.900 because I find from the case study textbooks 1020 00:49:36.900 --> 00:49:40.440 that a lot of students, I've seen on our list 1021 00:49:40.440 --> 00:49:42.120 serve too that some of the students 1022 00:49:42.120 --> 00:49:46.360 find some of the answers online to some of those things. 1023 00:49:46.360 --> 00:49:51.600 So I tend to create a lot of my own just off the top of my head 1024 00:49:51.600 --> 00:49:56.520 or from patients maybe I've had in practice 20, 15 years ago, 1025 00:49:56.520 --> 00:49:58.020 and go from there. 1026 00:49:58.020 --> 00:50:02.220 I also have in my nutrition care process, 1027 00:50:02.220 --> 00:50:05.760 I have standardized patients who are graduate assistants, 1028 00:50:05.760 --> 00:50:09.360 and they've already gone through their internships. 1029 00:50:09.360 --> 00:50:12.960 So they're RDs or RD eligible, and they're just finishing up 1030 00:50:12.960 --> 00:50:14.980 their master's degrees. 1031 00:50:14.980 --> 00:50:17.820 So they work as a standardized patients, 1032 00:50:17.820 --> 00:50:21.450 and either are at risk for heart disease or diabetes 1033 00:50:21.450 --> 00:50:22.920 or something like that. 1034 00:50:22.920 --> 00:50:25.620 And my students have to interview them 1035 00:50:25.620 --> 00:50:27.760 and do interventions with them. 1036 00:50:27.760 --> 00:50:31.680 So I don't just have a standardized patients on paper, 1037 00:50:31.680 --> 00:50:34.110 I also have an actual standardized patient 1038 00:50:34.110 --> 00:50:36.120 who is a "grad student", who they 1039 00:50:36.120 --> 00:50:38.100 have to meet with outside of class 1040 00:50:38.100 --> 00:50:41.140 and do an intervention with as well. 1041 00:50:41.140 --> 00:50:46.560 So I'm lucky to have a GA that I can work with too. 1042 00:50:46.560 --> 00:50:47.640 That's terrific. 1043 00:50:47.640 --> 00:50:50.710 So our next question, and I will have folks, 1044 00:50:50.710 --> 00:50:53.260 if they have questions that can come directly to me 1045 00:50:53.260 --> 00:50:55.170 at mdittloff @eatright.org. 1046 00:50:55.170 --> 00:50:59.130 Or even to the andhii@eatright.org. 1047 00:50:59.130 --> 00:51:02.910 I'm happy to answer questions if we run out of time. 1048 00:51:02.910 --> 00:51:06.810 One of them is tell us about how we set up a group subscription. 1049 00:51:06.810 --> 00:51:11.340 So that it is a for cost project that we would 1050 00:51:11.340 --> 00:51:13.330 do with you from the Academy. 1051 00:51:13.330 --> 00:51:15.150 So you can certainly reach out to me, 1052 00:51:15.150 --> 00:51:18.780 send a note to the andhii@eatright.org, and I 1053 00:51:18.780 --> 00:51:22.500 can certainly walk you through those parameters, 1054 00:51:22.500 --> 00:51:25.650 and get new quotes for that. 1055 00:51:25.650 --> 00:51:28.300 Next question is whether either of the speakers 1056 00:51:28.300 --> 00:51:32.070 could talk to you the time that it takes to enter a patient, 1057 00:51:32.070 --> 00:51:35.460 and have they noted a decrease in the time 1058 00:51:35.460 --> 00:51:38.520 that it takes as you build your experience with ANDHII? 1059 00:51:38.520 --> 00:51:41.750 1061 00:51:43.995 --> 00:51:48.181 Yeah, from our clinic perspective, 1062 00:51:48.181 --> 00:51:49.930 when the students are new into the clinic, 1063 00:51:49.930 --> 00:51:51.210 it takes a lot longer, because they're 1064 00:51:51.210 --> 00:51:52.840 getting used to the program, they're 1065 00:51:52.840 --> 00:51:54.770 getting used to how it goes. 1066 00:51:54.770 --> 00:51:58.295 But given that historically, the students have seen the patient, 1067 00:51:58.295 --> 00:52:00.235 have written things down on paper, 1068 00:52:00.235 --> 00:52:01.950 they then look at what they've written, 1069 00:52:01.950 --> 00:52:05.290 and it's not perfect to them, they rewrite it, 1070 00:52:05.290 --> 00:52:08.510 regardless of how many times we say, just write it out, 1071 00:52:08.510 --> 00:52:10.630 it's actually fine what you've done, 1072 00:52:10.630 --> 00:52:12.600 it meet all the requirements. 1073 00:52:12.600 --> 00:52:16.300 So in terms of time, entering into ANDHII, 1074 00:52:16.300 --> 00:52:19.030 it does become quicker as they become 1075 00:52:19.030 --> 00:52:22.060 more familiar with the process, because 1076 00:52:22.060 --> 00:52:25.960 throughout in our example, we use a customize template, which 1077 00:52:25.960 --> 00:52:28.892 is similar to the template that they have 1078 00:52:28.892 --> 00:52:30.350 that they can write down while just 1079 00:52:30.350 --> 00:52:33.280 seeing the patient in person. 1080 00:52:33.280 --> 00:52:35.310 They can just transcribe straight across. 1081 00:52:35.310 --> 00:52:38.110 So it actually ends up quicker than what they would write, 1082 00:52:38.110 --> 00:52:40.720 because they're not having to put all the things into which 1083 00:52:40.720 --> 00:52:46.150 make statements fully correct from sentence structure 1084 00:52:46.150 --> 00:52:47.850 perspective. 1085 00:52:47.850 --> 00:52:51.050 It's also the auto-filling saves time. 1086 00:52:51.050 --> 00:52:53.410 So patient by patient out probably takes a little bit 1087 00:52:53.410 --> 00:52:56.860 longer than maybe one that Carrie was describing before, 1088 00:52:56.860 --> 00:53:01.390 just because we have quite a few NCP terms from the assessment 1089 00:53:01.390 --> 00:53:03.800 side of things that we're asking to students to input. 1090 00:53:03.800 --> 00:53:06.660 And that's because we're using this as a research piece 1091 00:53:06.660 --> 00:53:07.800 at the same time. 1092 00:53:07.800 --> 00:53:12.430 But all in all, if I started here 1093 00:53:12.430 --> 00:53:13.840 to the nearer the end of the year 1094 00:53:13.840 --> 00:53:17.080 when the students are with us, it would save time overall. 1095 00:53:17.080 --> 00:53:19.360 It just that becoming more familiar 1096 00:53:19.360 --> 00:53:21.100 with the whole process. 1097 00:53:21.100 --> 00:53:23.020 And that's what I hear from other users 1098 00:53:23.020 --> 00:53:26.540 and other programs as well is that first part. 1099 00:53:26.540 --> 00:53:28.830 And I guess as the students progress 1100 00:53:28.830 --> 00:53:32.680 and they actually become more familiar with the NCPP terms 1101 00:53:32.680 --> 00:53:36.090 themselves, that also helps. 1102 00:53:36.090 --> 00:53:38.170 Because obviously, that's the searching 1103 00:53:38.170 --> 00:53:40.270 that they're doing in ANDHII as they 1104 00:53:40.270 --> 00:53:43.060 enter each of their visit data. 1105 00:53:43.060 --> 00:53:44.770 The next question I have is there 1106 00:53:44.770 --> 00:53:48.530 a way to delete practice patients you've created? 1107 00:53:48.530 --> 00:53:51.580 So we don't actually delete patients in ANDHII, 1108 00:53:51.580 --> 00:53:53.530 but there is a new feature that we 1109 00:53:53.530 --> 00:53:57.660 added that can be marked as a test patient. 1110 00:53:57.660 --> 00:54:02.440 So if you're a supervisor of a program, 1111 00:54:02.440 --> 00:54:04.240 we do have some capabilities. 1112 00:54:04.240 --> 00:54:06.910 So if you're worried about a patient 1113 00:54:06.910 --> 00:54:09.850 that you don't want in a part of your data collection 1114 00:54:09.850 --> 00:54:12.650 or whatnot, we can help you with making that a test patient. 1115 00:54:12.650 --> 00:54:17.340 So it would not be included in the reporting components. 1116 00:54:17.340 --> 00:54:21.220 And you'll see that prompt in the new report, it will say, 1117 00:54:21.220 --> 00:54:25.990 exclude test patients, and that's checked off by default. 1118 00:54:25.990 --> 00:54:28.570 And then there's a question about whether the mobile app is 1119 00:54:28.570 --> 00:54:31.640 available from the app store for the iPhone? 1120 00:54:31.640 --> 00:54:34.630 So that's a great question, and it can certainly be confusing 1121 00:54:34.630 --> 00:54:36.390 in this day and age. 1122 00:54:36.390 --> 00:54:38.890 The ANDHII application is actually a web app, 1123 00:54:38.890 --> 00:54:43.480 so it does not require that you go into the App 1124 00:54:43.480 --> 00:54:45.940 Store or the Google Play and actually 1125 00:54:45.940 --> 00:54:48.070 download and have to do an install. 1126 00:54:48.070 --> 00:54:52.780 You can simply go to www.andhii.org. 1127 00:54:52.780 --> 00:54:55.760 And when you go there on your phone, 1128 00:54:55.760 --> 00:54:59.855 I would recommend that you click and actually Add to Home screen 1129 00:54:59.855 --> 00:55:01.735 from that browser. 1130 00:55:01.735 --> 00:55:03.610 And then you'll have a little icon for ANDHII 1131 00:55:03.610 --> 00:55:06.490 that you can launch just directly from your home screen 1132 00:55:06.490 --> 00:55:08.895 if you're an iPhone user. 1133 00:55:08.895 --> 00:55:11.020 And then there was the question about whether you'd 1134 00:55:11.020 --> 00:55:14.830 be willing to share your data for the standard patient, 1135 00:55:14.830 --> 00:55:17.600 and Carrie can certainly connect you with folks 1136 00:55:17.600 --> 00:55:21.160 if that's something that you are willing to share. 1137 00:55:21.160 --> 00:55:25.060 Yeah, if anybody would like to see how the assignment works, 1138 00:55:25.060 --> 00:55:27.330 I'd be happy for you to email me, that would be fine. 1139 00:55:27.330 --> 00:55:29.880 1141 00:55:33.060 --> 00:55:35.230 questions. 1142 00:55:35.230 --> 00:55:38.880 Michelle says, I teach resource methods, 1143 00:55:38.880 --> 00:55:41.550 my students need data to analyze. 1144 00:55:41.550 --> 00:55:44.725 They are graduate students than usually working professional, 1145 00:55:44.725 --> 00:55:47.910 how can we leverage ANDHII to analyze data and write 1146 00:55:47.910 --> 00:55:49.330 and analyze the data? 1147 00:55:49.330 --> 00:55:51.760 So that's a great question. 1148 00:55:51.760 --> 00:55:54.120 And it is one of the great things, 1149 00:55:54.120 --> 00:55:58.430 we are making available for Academy members 1150 00:55:58.430 --> 00:56:01.760 and researchers, there are certain secondary data sets. 1151 00:56:01.760 --> 00:56:07.310 And I can point you in the follow ups to this webinar 1152 00:56:07.310 --> 00:56:11.520 to the web page, the research web page on eatrightPRO. 1153 00:56:11.520 --> 00:56:12.690 So you can look at that. 1154 00:56:12.690 --> 00:56:16.170 Now I can say right now that the amount of data 1155 00:56:16.170 --> 00:56:21.760 that we have in ANDHII for the dietetics outcomes registry 1156 00:56:21.760 --> 00:56:27.240 is probably too limited to actually run 1157 00:56:27.240 --> 00:56:29.490 extensive kind of analysis, but if you're 1158 00:56:29.490 --> 00:56:32.820 looking for things like just the experience of how 1159 00:56:32.820 --> 00:56:37.420 data collection works, how you download and pull it 1160 00:56:37.420 --> 00:56:41.460 into other research packages, if you enter data 1161 00:56:41.460 --> 00:56:44.970 for your students, you can then have them actually walk 1162 00:56:44.970 --> 00:56:46.690 through that process. 1163 00:56:46.690 --> 00:56:49.560 There are several reports, they can download those trends, 1164 00:56:49.560 --> 00:56:52.020 they can output them to CSV files, 1165 00:56:52.020 --> 00:56:54.780 and then they can work with you and your program 1166 00:56:54.780 --> 00:56:59.010 to develop those other research competencies. 1167 00:56:59.010 --> 00:57:01.500 I'd like to thank everyone for taking the time 1168 00:57:01.500 --> 00:57:05.160 this afternoon to meet with us and learn 1169 00:57:05.160 --> 00:57:08.922 about these innovative teaching techniques such as ANDHII 1170 00:57:08.922 --> 00:57:09.630 in the classroom. 1171 00:57:09.630 --> 00:57:13.860 So thank you very much for sharing Carrie and Julia. 1172 00:57:13.860 --> 00:57:17.220 It's been wonderful to hear about how you've used the tool. 1173 00:57:17.220 --> 00:57:19.170 And hopefully all of our participants 1174 00:57:19.170 --> 00:57:22.020 have had an opportunity to get a new idea 1175 00:57:22.020 --> 00:57:24.420 that they might explore. 1176 00:57:24.420 --> 00:57:27.980 So I want to give you this link to a short survey. 1177 00:57:27.980 --> 00:57:31.740 This is feedback about the webinar and new information 1178 00:57:31.740 --> 00:57:34.830 that you might like to have us present related 1179 00:57:34.830 --> 00:57:36.660 to ANDHII and webinars. 1180 00:57:36.660 --> 00:57:39.000 And then at the conclusion of that survey, 1181 00:57:39.000 --> 00:57:42.090 you can print your CEU certificate. 1182 00:57:42.090 --> 00:57:45.450 We look forward to future webinars that 1183 00:57:45.450 --> 00:57:46.980 might be of interest to you. 1184 00:57:46.980 --> 00:57:48.720 Have a great day. 1185 00:57:48.720 --> 00:57:50.570 Thank you.