Download Combining Clinical Nutrition, Law and Public Health

Sandra Raup, R.D., J.D., M.P.H.
TCDDA Meeting
April 10, 2012
Nutrition Education
B.S. Nutrition from
University of
Minnesota (1977)
Internship at Midway
Hospital (1979)
Nutrition Support 1970’s through 1990’s
 American 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 Support
 Better central lines
 Better parenteral nutrition solutions
 Crystalline amino acids instead of hydrolyzed protein
solutions and better lipid emulsions
 Customized solutions
 Advanced enteral nutrition solutions
 Specialized products
 Better tubes
 Better monitoring and support
 Better pumps
 Better delivery systems for home support
 Better control of serum glucose levels
Education in Law and Public Health
Joint Degree in Law and
Public Health from The
George Washington
University (2005)
Summer abroad program
in health policy (2003)
New Frontiers:
Interest in quality management
 Work with plaintiff’s firms while in law school
 Quality manager at a clinic in Minneapolis after
returning to Minnesota
 Pay for performance programs


Process improvement for diabetes care
Reporting for various diseases and screening
 Chronic care program for heart disease
 Patient 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
Cons
 Expense 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 Line
 Look at your motivation to pursue another degree –
will it get you where you want to go?
 Evaluate the total cost
 Educational expenses
 Lost wages
 Lost time
 Opportunity cost
 Thoroughly evaluate your options – are there other
possible paths to your goal?
Health Information In Silos
The Competition in Their Silos
Big
Hospital
Systems
Clinic
Systems
Community
Systems
Personal
Health
Records
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-making
 Patient engagement
 Provider-patient partnership
 Culturally sensitive, whole person care
Medical Home Characteristics*
 ACCESS
 TRACKING AND REGISTRIES
 CARE MANAGEMENT AND GUIDELINES
 SELF-MANAGEMENT SUPPORT
 ELECTRONIC PRESCRIBING
 TEST AND REFERRAL TRACKING
 PERFORMANCE REPORTING AND IMPROVEMENT
 ADVANCED ELECTRONIC COMMUNICATIONS
*Taken from the Patient-Centered Medical Home Content and Scoring
published in the NCQA Physician Practice Connections (July 2008).
The Need
Shared access to and utilization of patient information
among healthcare providers and patients are needed
to support:
 Patient-centered, coordinated care models
 Participatory 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
Our Current Fragmented System: Patients Interact With
Each Provider Separately
Primary Care
Specialty Care
Disease Management
Pharmacy
Diagnostics
19
The Patient Centric Design: More Effective
Communication
Primary Care
Patient
Specialty Care
Pharmacy
•Coordinate
•Collaborate
•Communicate
Disease Management
Diagnostics
20
The Solution: Applications Using Shared
Documents
Patient Care Applications
• Aggregate separately authored,
standards-based electronic health
documents in a Document Bank
• Flexibility to plug-in and un-plug
Patient Care Applications
Document Bank
• 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
21
Datuit Care Plan Manager
Enables capabilities 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:
Sandra Raup
[email protected]
651-894-2814