A Call to Action for Optimizing the Electronic Health Record in the Parenteral Nutrition Workflow: Executive Summary

Abstract

Parenteral nutrition (PN) is a complex therapeutic modality provided to neonates, children, and adults for various indications. Surveys have shown that current electronic health record (EHR) systems are in need of functionality enhancement for safe and optimal delivery of PN. This is a consensus statement from the American Society for Parenteral and Enteral Nutrition, the Academy of Nutrition and Dietetics, and the American Society of Health-System Pharmacists outlining some of the key challenges to prescribing, order review/verification, compounding, and administration of PN using EHRs today and is a call to action for clinicians and vendors to optimize their EHRs regarding the PN build and workflow.

Forty‐Third ASPEN Presidential Address: “Our Time Is Now—Challenges and Strategies for the Field of Nutrition”

“…In 2018, a group led by past president Vincent Vanek, MD, and including ASPEN, the Academy of Nutrition and Dietetics, and the American Society of Health-System Pharmacists published a consensus statement outlining the shortcomings and challenges using current electronic health records (EHRs) to prescribe, review/verify the prescription, compound, and administer PN. 26 The group issued a call to action for clinicians and vendors to optimize their EHRs related to PN workflow. In her address, past president M. Molly McMahon, MD, described a successful example of information technology (IT) incorporation into her institutional EHR that helped improve the quality and safety of nutrition care, with standardized and efficient nutrition workflow, and an overall improvement in patient management.…”

“…ASPEN's efforts to harness the capabilities of the EHR for nutrition research, by optimizing nutrition documentation and facilitating workflow, are ongoing but have proven to be an uphill struggle. 26,35 The traditional model adopted in academic centers includes a dedicated approach to identifying and defining a problem, designing investigations to study the problem or intervention, and then analyzing data to incrementally increase knowledge by disseminating it in high-impact journals. However, the establishment of elegant databases, or even publication of trial results, does not automatically lead to the adoption of the new evidence-based knowledge or therapy.…”

“…This group advocates for standardization at each step along the continuum of PN prescription, review, and compounding. In 2018, a group led by past president Vincent Vanek, MD, and including ASPEN, the Academy of Nutrition and Dietetics, and the American Society of Health‐System Pharmacists published a consensus statement outlining the shortcomings and challenges using current electronic health records (EHRs) to prescribe, review/verify the prescription, compound, and administer PN 26 . The group issued a call to action for clinicians and vendors to optimize their EHRs related to PN workflow.…”

“…However, the promise of EHR as a tool to improve patient and population health has yet to be fully realized. ASPEN's efforts to harness the capabilities of the EHR for nutrition research, by optimizing nutrition documentation and facilitating workflow, are ongoing but have proven to be an uphill struggle 26,35 …”

Consensus Recommendations for Optimizing Electronic Health Records for Nutrition Care

“…The EHR should be able to transmit these orders via direct interface to an automated compounding device to avoid manual transcription of the electronic PN orders into the automated compounding device, which increases the chances of a transcription error. ASPEN, the Academy, and the American Society of Health‐System Pharmacists have published joint consensus recommendations that address, in more detail, the PN functionality needed in an EHR …”