| Summary: | 碩士 === 國立陽明大學 === 醫學工程研究所 === 100 === Non-communicable disease - a common disease occurs in aging population - needs a long-term and continuous care. It is affect aspect on personnel health, family and society.
Diet control plays an important role in non-communicable disease. For example, chronic kidney disease (CKD) - a non-communicable disease that has high prevalence rate in Taiwan –is an irreversible disease in disease progress. At the end stage of CKD, patient would accept a long-term hemodialysis care or other dialysis way for extending life. Diet control is one of medical care way for delaying the disease progress.
Medical document text could continuous care, so it could maintain care quality. Electronic form is a useful tool for recording, and it builds a comprehensive data for data entry. Electronic form also makes workflow reconstructing in recent medical care.
Today, electronic health record (EHR) in Taiwan has a formal form, but the EHR template is not including dietetic form. It appears that - there is a non-consistency data in nutrition documentation.
“Advice on prescription” is another concept in medical documentation. It is first used in physical therapy. “Advice on prescription” mains getting a record of exercise recommendation on prescription. The physical therapists hope this concept could have more adherences on rehabilitation. Nutrition intervention in diet control needs long-term care as exercise intervention in rehabilitation, so “Advice on prescription” maybe is a way to solve diet adherence problem in nutrition care process.
Based on the mention on above, the author was tried to develop a structured dietetic form for out-patient care, and hope this work could make a sure the clinical nutrition information completeness in nutrition documentation. On the other hand, we designed “food for recommend/restrict list” feature to let this form to be a food tool for nutritionist and patient using in diet control plan. It would be re-constructed the workflow in Nutrition care.
The form we designed is constructed by the “International Dietetic and Nutritional Terminology” (IDNT) 3 edition. We collected the related term that use in chronic kidney disease nutrition care and built food list for recommend/restrict for CKD care. The form recording process is designed by ADIME (Assessment, Diagnosis, Intervention and Monitoring and Evaluation). The terms on the form we collect is use Delphi method revised by 3 clinical nutrition experts, and the form and food list feature is verified by 1 clinical nutritionist who has more than 2 yr-experience on diet consultation. This trail is approval by Taipei Veterans General Hospital Institutional Review Board and Joint Institutional Review Board. The development environment we used is LabVIEW 10.0.
The result indicates that: 1) the term we collected 132 terms for using in CKD care. 2) Compared with recent clinical nutrition information system in hospital, our system has more data to be collect. This system we designed has further research to test whether it could decrease the work load for nutritionist or not. 3) “The food recommend/restrict list” feature is considered need more portion food concept in health education in patients. 4) LabVIEW has a graphic user interface and easily to learn the concept for computer programming. This character let LabVIEW be a tool for communicate what system feature need to be designed in clinical information system between clinical care-provider and computer experts. It maybe promotes clinical information system development. 5) The form verified by clinical nutritionist shows that our form has easily user interface but the operation would be add more work load on clinical use.
The conclusion is the form we develop in this research is use IDNT terminology and IDNT is matured enough to used in CKD nutritional care. The food list feature is a way to implement the concept “Dietary advice on prescription” and it need to add “portion size” feature for clinical education use. The further research could be how to redesign the user interface for be more easily to operate clinical data entry and whether the DAP concept could evaluate diet adherence in a long-term nutrition care.
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