Using nutrition technology to feed data-hungry managers: with the right software, information systems can add speed and accuracy to the facility's dietary operations.

Application of information technology (IT) to nutrition in long-term care is increasing as providers strive to offer better customer service and positive nutritional outcomes while maintaining and improving daily operations. Today's IT for nutrition offers everything from complete dietary department management systems (purchasing, receiving, inventory, menu and meal planning, clinical nutrition, and overall systems integration) to individual software components designed for specific tasks. Current trends in LTC dietary IT systems include areas listed in table 1.

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Significant cost savings through the use of nutrition software and databases have been reported. With proper IT use, accuracy of operations can be improved, while overall labor time is decreased. In fact, a retirement services company in Ohio operating 11 nursing centers reduced average daily food cost for each of its 2,700 residents by 10%. Individual meal costs dropped from $5.28 to $4.74, resulting in more than $500,000 in annual savings. Suppliers (see selected list, table 2) of nutrition-related IT are increasing and expanding the features available with it.

Integration of nutrition-related IT with overall facility IT systems has been on the rise, as well. For example, Alma Sudderth, MS, RD, LD, senior vice-president of sales, marketing, and business development for SureQuest Systems, Inc., noted that facilities are now including the writing of interfaces as a part of their contract. In the case of this company's product, the interface allows data to be imported from the facility's patient information system to SureQuest's Three Squares[R] Nutrition and Food Service Management Software. Information such as the current "diet order" can be imported from the patient information system to generate a meal/tray card. This ensures that the diet order is accurate when printing meal orders for the patient.

PDAs and Nutrition Management

Portability of nutrition-related IT is an emerging trend with the increased use of personal digital assistants (PDAs). A poll conducted by Today's Dietitian magazine found that 30% of dietitians use PDAs in their practices, and 35% are considering buying them. Registered dietitians state that the clinical documentation workload can be reduced by as much as 50% when using nutrition-related IT. PDAs can assist with data entry, assessments, calculations, tracking, database lookup (foods, nutrients, drugs, enteral formulas, etc.), and learning (some manuals are available on PDAs). A noticeable trend is that PDAs are quickly taking the place of traditional nutritional calculators.

Companies such as Dietary Software, Inc. offer handheld computers for dietary professionals. Handhelds can be extremely useful to nutrition professionals in LTC. The nutritional software is used with clinical nutrition assessments and medical nutrition therapy, while retaining all the functionality of a PalmPilot[TM]. Information can be entered into a main computer when it is available or into the PDA anywhere and anytime. The information is synchronized, new information replaces old information, and data are stored in multiple locations. Confidential data are then protected through use of a security password or auto-lock availability.

PDAs are often used as a companion to larger systems and are primarily used in nutrition for:

* Bedside menu entry

* Food inventory management

* Resident/patient assessment

* Resident/patient tracking

* 24-hour recalls and food records

In selecting the right handheld, it is important to check on details such as the operating system (Palm OS[R] or Pocket PC), storage capacity, features, screen quality, weight, size, and battery life. Privacy safeguards should be available for all protected healthcare information, and the PDA software should be designed for compliance with HIPAA requirements. The PDA informational resource http://pdaRD.com offers expert advice from registered dietitians on buying a PDA, looking for software, seeking tech solutions, and using PDAs to enhance nutrition practice or business. The Web site offers informative and up-to-date comparison charts on handhelds, as well as information on LTC nutritionrelated software and database companies for handhelds.

Summary

Although the state of nutrition-related IT changes daily, "technologically ready" options are available to achieve desired results. You can prevent your facility information system from being "nutritionally deficient" by knowing the types of nutrition-related IT available to the industry and determining which system is right for you. Nutrition-related IT can be incorporated into your facility's overall IT plan to prepare for comprehensive regulatory compliance, financial management of food service operations, and precise execution of medical nutrition therapy.

Table 1. Dietary System IT Trends in Long-Term Care

Purchasing
* Just-in-time purchasing
* EDI (electronic data interchange) allowing for real-time generation of
  purchase orders, order status, etc.
* Electronic purchasing through a variety of distributors
* Use of computer systems; fax/modem order transmission replacing
  traditional telephone ordering
* Order reports generated with accurate vendor information
* Sending orders to vendor's direct-order entry system
* Electronic price updates relayed from vendors' computers

Receiving
* Bar-coding technology or pen-based computing for data entry
* Radio frequency devices transmit information from a bar-code scan to a
  computerized inventory system wirelessly and in real time

Inventory and Cost Control
* Automatic adjustments to a perpetual inventory allowing the department
  to know what is on hand in the storeroom at all times
* Cost information on recipes, special functions (e.g., birthday
  parties, open houses), etc., using current ingredient prices
* Monitoring and controlling the cost of food items used by various
  departments
* Accurate costing of ingredients, recipes, menus, and nourishments
* Purchasing reports generated using the same categories used in
  budgeting
* Stock numbers for every item the user wants to track, order, budget,
  and manage
* Storeroom requisitions (pick lists) that combine ingredients needed
  for all recipes
* Generation of processing sheets that detail the amount of each
  ingredient that must be preprocessed, such as produce that must be
  minced, chopped, or sliced
* Printing of "thaw schedules" and freezer-pull labels that show all of
  the items and required amounts of each that must be transferred from a
  frozen location to a tempering location
* Stock numbers customized based on facility storage locations and
  product specifications
* Purchase orders generated directly from the forecasted order
* Bar-code inventory-tracking methods

Menu Planning and Meal Production
* Menu database electronically loaded into facility's software
* Spreadsheets with portions for each diet and texture type for
  best-practice industry standards
* Snack labels printed each day for each resident with the date,
  resident name, and food items
* Nutritional analysis of foods, recipes, daily menus, weekly menus,
  and cycles
* Census-driven and/or facility-forecasted meals and production counts
* Production sheets for all items available by dining location
* Hazard Analysis and Critical Control Points (HACCP) Ready Recipes
  (HACCP is a food safety system used to prevent outbreaks of foodborne
  illnesses through safe food handling, and these recipes incorporate
  identification of potentially hazardous foods, procedures in the
  preparation to reduce risks of foodborne illness outbreaks, and
  monitoring steps to ensure food safety.)
* Automatically quantifying recipes per production cost (Automatic
  quantification of recipes allows menu items to be purchased and
  prepared based on number of actual portions required. For example, if
  census changes from 110 to 125, the user can automatically convert all
  recipes from 110 to 125 portions.)
* Calculation of menu cost by diet types to ensure menus are within
  the specified budget

Clinical Nutrition Systems
In healthcare, systems integration takes on special significance for
clinical nutritional care applications. Clinical care applications for
nutrition include such features as: weights, snacks, supplements,
thickened liquids, nutrition assessments, nutritionally high-risk
protocols, enteral/parenteral calculations, etc. Current trends include:
* Integration of updated data, such as location, diet order, weight
  loss/gains, and food preferences
* Integration of clinical data, such as lab results and meds with
  clinical nutrition records
* Paperless menu

Overall Systems Integration
Today's business information systems are transcending the concept of
interfacing, choosing instead seamless integration. Networks operating
with Web browser software and supporting Internet connections can
improve communications by e-mail and make common applications and
data available to multiple users.

Table 2. Selected Dietary Software Applications Suppliers*

Dietary management systems usually include multiple features such as
inventory, purchasing, forecasting, cost analysis, clinical nutrition,
diet office, nutrient analysis, and menu planning. These systems may
interface with admissions, business office, patient information, order
entry, laboratory, and pharmacy systems. Many vendors offer dietary
systems bundled with other types of software. Check with the supplier
for specific feature information.

ADL Data Systems, Inc.
www.adldata.com
Computrition, Inc.
www.computrition.com
Continuex Corp.
www.continuex.com
Creative Solutions Unlimited, Inc.
www.creativesolutionsunlimited.com
Data Control Technology, Inc.
www.mealtracker.com
DFM Technologies, Inc.
www.dfmsoft.com
Dietary Software, Inc.
www.dietarysoftware.com
DietBook, LLC
www.dietbooksoftware.com
DietMaster Systems, Inc.
www.dietmaster.com
GeriMenu
www.gerimenu.com
Interactive Health Network
www.ihnet.com
Nutrition Company, The
www.nutritionco.com
OneTouch Technologies Corp.
www.onetouchtechnologies.com
PointClickCare
www.pointclickcare.com
Prime Care Technologies
www.primecaretech.com
Quality Business Solutions, Inc.
www.qbs.com
Reliable Health Systems, LLC
www.reliablehealth.com
SureQuest Systems, Inc.
www.surequest.com
Threshold Data Technology, Inc.
www.thresholddata.com
Vision Software Technologies, Inc.
www.vstech.com
WinCare, LLC
www.wincare.com

* Contact the individual supplier for specific prices. This list is for
informational purposes only. This is an incomplete list. Exclusion of
any related suppliers was unintentional and does not reflect an
endorsement of any supplier listed or excluded.
Disclaimer: All programs have their own license agreements. Please read
and follow them. Brenda E. Richardson, MA, RD, CD, LD, and Nursing
Homes/Long Term Care Management magazine are not responsible for damage
caused by or difficulty with suppliers' programs, or problems they might
cause to computer hardware and software, and make no warranty for their
fitness for their specific use.

BY BRENDA RICHARDSON, MA, RD, CD, LD

Brenda Richardson, MA, RD, CD, LD, is owner and president of Premier Nutrition, as well as an author, publisher, and a national speaker with 20+ years experience in directing multimillion-dollar food service operations. For more information, phone [phone], e-mail [e-mail], or visit www.brendarichardson.com. To comment on this article, please send e-mail to [e-mail]. For reprints in quantities of 100 or more, call [phone].