Combining Clinical Nutrition, Law and Public Health

Sandra Raup, R.D., J.D., M.P.H.TCDDA Meeting

April 10, 2012

Nutrition EducationB.S. Nutrition from University of Minnesota (1977)

Internship at Midway Hospital (1979)

Nutrition Support 1970’s through 1990’sAmerican Society of Parenteral and Enteral Nutrition first meeting in 1975

JPEN first published in 1977

Beagle puppies first fed with IV nutrition in the 1960’s Taken from: Sanchez JA, Daly JM.

Stanley J. Dudley, M.D.: A Paradigm Shift. Arch Surg 145(6):512-4 (2010).

Evolution of Nutrition SupportBetter central linesBetter parenteral nutrition solutions

Crystalline amino acids instead of hydrolyzed protein solutions and better lipid emulsions

Customized solutionsAdvanced enteral nutrition solutions

Specialized productsBetter tubes

Better monitoring and supportBetter pumpsBetter delivery systems for home supportBetter control of serum glucose levels

Education in Law and Public HealthJoint Degree in Law and Public Health from The George Washington University (2005)

Summer abroad program in health policy (2003)

New Frontiers:Interest in quality managementWork with plaintiff’s firms while in law school

Quality manager at a clinic in Minneapolis after returning to MinnesotaPay for performance programs

Process improvement for diabetes care Reporting for various diseases and screening

Chronic care program for heart diseasePatient satisfaction

Involvement in Health Information Technology (HIT)Asked to join leadership team of CareFacts, a software company for home care, hospice and public health

Participated in creating vision for new technology that facilitated cross-provider collaboration and communication and a more patient-centered approach to care delivery

Eventual sale of the company (December 2010) and creation of new company (March 2011) to develop and market new technology and its applications

Pros

Broadens your outlook to enter another professional community

Introduces you to current technologies

Expands career possibilities

Leverages nutrition background in diverse directions

ConsExpense that may not be easily recouped

Opportunities are not always available to older graduates

Nutrition background not always understood and/or appreciated“Are you a nurse?”“I’ve heard about hospital food!”

Effects of advancing age may be underestimated!

Bottom LineLook at your motivation to pursue another degree – will it get you where you want to go?

Evaluate the total costEducational expensesLost wagesLost timeOpportunity cost

Thoroughly evaluate your options – are there other possible paths to your goal?

Health Information In Silos

The Competition in Their SilosBig

HospitalSystems

ClinicSystems

CommunitySystems

PersonalHealthRecords

Health Information Exchanges

What Competition?Provider organizations

Professions

Payers

Software vendors Where’s the patient??

Patients and Providers Working Together

Medical Home Principles(As articulated by TransforMED)Continuous relationship with a personal physician who coordinates wellness and illness care

Clinician-patient communication based on trust, respect, and shared decision-makingPatient engagementProvider-patient partnershipCulturally sensitive, whole person care

Medical Home Characteristics*ACCESSTRACKING AND REGISTRIESCARE MANAGEMENT AND GUIDELINESSELF-MANAGEMENT SUPPORTELECTRONIC PRESCRIBINGTEST AND REFERRAL TRACKINGPERFORMANCE REPORTING AND IMPROVEMENTADVANCED ELECTRONIC COMMUNICATIONS

*Taken from the Patient-Centered Medical Home Content and Scoring published in the NCQA Physician Practice Connections (July 2008).

The NeedShared access to and utilization of Shared access to and utilization of patient information among healthcare patient information among healthcare providers and patients are needed to providers and patients are needed to support:support:

Patient-centered, coordinated care modelsParticipatory medicine - - patients having an active role in driving their care

Quality incentives and bundled payments that span providers

Government and other payer incentives for collaboration

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Specialty Care

Disease ManagementDiagnostics

Pharmacy

Primary Care

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•Coordinate•Collaborate•Communicate

Specialty Care

Disease ManagementDiagnostics

Pharmacy

Primary Care

Patient

The Solution: Applications Using Shared Documents

• Aggregate separately authored, standards-based electronic health documents in a Document Bank

• Flexibility to plug-in and un-plug Patient Care Applications

• Development tools for clients and third-parties to create applications

• Architecture cloud-based for real time use

• Security ensured with rights-based access by providers and consumers

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Patient Care Applications

Document Bank

Datuit Care Plan ManagerEnables capabilities Enables capabilities to:to:

Creatively communicate with patients, their families and providers

Bring many others into the conversation at the patient’s discretion

Facilitate data collection that can be used to manage populations and achieve Medical Home objectives

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Are We Ready For This?What Does It Mean?

Contact information:Contact information:Sandra RaupSandra Raupsraup@datuit.comsraup@datuit.com651-894-2814651-894-2814