GN's newsletter is published quarterly for receipt by members late March, June, September, and December. Regular features include the Chair's Column, Legislative Update, Resources, Worth Writing For, Practice Coordinator's Coordinator, Calander, and Nutrition Education Aid. Special features are identified in the Annual Index. Below is a featured article from the Fall, 2000 issue.

Gerontological Nutritionists Utilize Computer Technology - Part II

Part one of this article, found in the summer 2000 issue, focused on the many uses of computer technology in various practices areas of the Gerontological Nutritionist. Spotlighted were specific member work place experiences with software systems. Also, reviewed were considerations for selecting software that best fits the predetermined needs of a facility or practice setting.

This article will continue by discussing ideas for implementation tips and further looking at benefits derived when software systems are in use. We will also discuss the ways dietitians are using computer technology for communication, information retrieval, continuing education, and entrepreneurial opportunities.

Virtual Implementation

The sequence of steps for implementing a new software system into work place settings will vary according to the immediate goals of the operation. Implementing a comprehensive program may mean beginning with one part and gradually increasing functions as staff becomes comfortable with each part of the system. Adequate time for planning is essential to avoid any roadblocks that prevent you from achieving the best possible results as quickly as possible. Before actually using software to manage a food service and meal delivery system the user must be familiar with the database, know the back-up system and in all best possible situations receive formal training. Smaller programs for nutrition assessment will usually require only reading the manual and a few hours of practice.

The Database
A database is a set of facts that determine the results of a software system. How a software system functions is a whole other matter than the database contained within. Databases normally include nutritional information, ingredient product specifications, recipes, sanitation standards, prepared convenience foods, and may include developed menus. Options available for databases when purchasing food service and nutrition management systems are 'start from scratch', 'take as is', and 'modify existing'. Often a database may be a deciding factor for choosing one particular system over another. What are the standards of the facility and how closely does an existing database meet those standards? Does it make the most sense to build your own database, specifying each ingredient for each recipe? Or, can an existing database be modified to meet the needs of an operation and modified over time? The answers to these questions depend on the immediate goals available time and personnel to do the work.

In long term care besides the ingredients, recipes and menus, diet modifications there is client information to consider. A fully integrated system translates the food preferences of each client into production numbers. Building and customizing a database will be a time consuming effort. Plan on three-six months to do the work yourself. The cost of outsourcing the work will be approximately $25 per hour. In today's tight labor market, this cost may be well justified; especially considering a trained operator will be doing the work of a new user.

Database Back-up Procedure
When new software is first installed to a facility computer, the database may or may not be included. As soon as the facility begins work on its own database, the next most important step is to know what the back-up procedure is and how often it needs to be preformed. A 'back-up' is simply a duplicate of the database stored in another location such as a floppy disk, compact disk or on a network. The back-up will effectively restore facility information following computer malfunction. Computers fail much the same as other electrical appliances, though perhaps not as often. When failure occurs, very often the database becomes unusable. If computer failure losses the program itself, it can be easily re-installed. However, the database is another matter. Since considerable time and effort is spent creating the database and maintaining client information, it is very important to protect that work. The database information to be restored, will as current as the most recent available duplicate database.

Most databases are extremely large and will need compression to make the back up procedure efficient. Extra hardware or additional software may be required to do the compression. Your software vendor will likely make recommendations for the best back-up system. Price should be no object here. Chose a system that is easy for everyone to master. Not saving the database to another location on a regular periodic basis is akin to putting a Ming vase (except your database is more valuable) in a barrel over Niagara Falls. There will most certainly be a 'crash' with very little chance of ever putting the pieces back together again.

Training
Most software vendors recommend taking some form of training before using their product. Budgeting for training costs should not be overlooked. Add to the trainer fee and expenses the cost of removing employees from their daily assignments. Plan on twenty-five to fifty cents per dollar cost of software for training expenses. One thing is certain about training, after the first session you will forget most of what you learned unless you immediately practice, practice, practice. Do not expect to learn everything you need to know at a single training session. Training on software is expensive so the more preparation done ahead of the training session the greater the benefit of training will be. Essentially, experience, using software is the best teacher, but here are some tips to minimize potential frustrations:

• Read, or at least review, the manual before the training session. Having questions in mind before going into training will help with retention.
• Take notes during training sessions directly on the manual, this helps to remember later. Keep the manual and all reference material in on place close to the computer workstation.
• If the training is to take place in the facility, be sure that the session takes place away from the your office and any distractions. Let staff know that that you will be available on break.
• Plan an in-house introduction session for staff before training takes place. This will help to create excitement about the new system and provide a starting knowledge base.
• Have as many staff attend the training session as possible. Assign each member a certain area of responsibility. That way each can follow up by training other staff members on 'their' section after the instructor as left. One person one training another within a work place will re-enforce learning.
• After the training session make 'cheat sheets' for key functions. These should be one-sentence lines that can direct staff members quickly to commonly used functions. Keep these sheets posted near the workstation.
• Introduce changes production staff who will be working with reports produced by the new system before implementation. New formats can be unsettling. If staff is aware of what changes are coming and how they, the facility, and client will benefit from the system, they will more likely greet the change with enthusiasm.
• Follow up with additional training every year, even if it consists of a telephone session. You will want to make sure that the software is being used to it's greatest potential.

Security
Security in software system allows each user who goes to the computer will need to enter a password. Fully integrated programs will have feature settings so that the manager/director will be able to allow each password to access specific parts of the system. An example the diet clerk may run production reports and keep resident current but the director may not want the diet clerk to be able to change menus. If the system is multi-user and networked a several workstations security is an important feature.

Benefits of Computer Technology for Food Service Management

Cost Control
Fully integrated systems that connect client info to ingredient to purchase order requires a streamlined database. Specifying the products that may be purchased will help to keep within budgetary requirements. Joan Stoppleman, RD, Corporate Dietitian at Integrated Health Services, Inc (IHS), recently implemented a company wide formulary of ingredient products. Managers at each facility accessed the company's Internet site to order products. Managers are able to view a perchase history by category on screen along with dollars spent on each food category. This effort has resulted in significant cost savings per patient day over the first year of the program. Joan is truly a pioneer in computerization of dietary departments in long term care. She began installing computers in facilities over ten years ago for diet office management. Instituting the on-line ordering procedure completed the computerization and integration of all phases of food purchase and production management.

Empowerment
As computer technology is empowering to the dietitian, it can also empower individual staff members. There will be those connected to the department who express interest in learning parts of the system, as a nourishment aide who can run the report for nourishment label reports. Such interest can very well learn to career path advancement. Gretchen Robinson, RD, Corporate dietitian for part of Health Care Facilities, Inc of Ohio, installed tray ticket and production software for the companies 33 facilities two years ago. 'Some of my dietary managers had never turned on a computer before:, says Gretchen, "Many of the managers have achieved a real sense of accomplishment from learning the system". Gretchen continued "on hire they know up front that they will use a computer on the job, as a result computerization in the facilities, I believe I have greater retention of managers."

Client satisfaction
The elderly client benefits most of all from a well-run integrated food and nutrition software program. Providing the preferred food to the right location and at the right time is paramount.

Technology for communication and Continuing Education

E-mail
The personal computer affords the busy RD a fast and paperless communication route using electronic mail. Keeping in touch with colleagues across the state and country in this way is inexpensive and easier than telephone correspondence. E-mail allows the user to send, receive and respond at a convenient time. Any avid user of e-mail will tell you the downside 'junk e-mail'. Communication software programs have features to screen and sort messages to a file folder' so that the user will not have to wade through unwanted mail. The e-mail address book has all but replaced the 'Rolodex' for professional networking purposes. Meet a colleague at a professional meeting; send an e-mail the next day to follow-up on your discussion or share reference material. Electronic mail requires access to an Internet service provider (ISP) such as AOL or Prodigy.

Listserv
A listserv is an automatic electronic mailing list, a way to share information within a group. Any member of the listserv can sent out a request for a shared experience or solution to a problem. Dietetic practice groups maintain listservs for their members as CD-HCF and GN. Professional associations Currently 66 GN members are on the list of the total membership of 2500. The upside of belonging to the list is that you are "in the loop" of your chosen practice area. The down side is taking the time to read all the mail received. However, it is easy to delete unwanted mail and very easy to remove one's address from a list.

Internet Web Sites
The Internet has replaced the laborious task of the library search for information. Millions of facts are obtainable without ever leaving one's home or work place. Virtually every professional organization, governmental agency, and manufacturer now has an Internet site posted on the World Wide Web. The American Dietetic Association recently launched their second site, this one for members only. Growing in popularity in Internet sites is the 'hyperlink'. The hyperlink gives an Internet address to another site that the visitor may want to visit also for related information. For example, CD-HCF site has hyperlinks to all of their alliance organizations. All the visit need do is double click on the hyperlink line and immediately the connection to that site takes place. Hyperlinks speed up further the search for information. The growth of the Internet as a source of information and products has been astounding in the last five years. RD's too have a presence on the Internet by contributing information to food and nutrition related sites. Many RD's are taking advantage of this venue for creating e-based practices. There are so many nutrition information sites on the Internet that Tufts University has an Internet site, which offers ratings, and descriptions of nutrition related sites for consumer, professional, and the journalist. ADA's Internet site, www.eatright.org, rated 24 out of 25 points as a source for nutrition information for journalists. See the "Cyber Dietitian" feature located in this newsletter for a listing of 100 important Internet sites that offer fast valuable information or the dietitian practicing in the gerontology area.

Summary
The personal computer offers the dietitian tools to accomplish tasks in new and exciting ways. Computer technology is empowering to the dietitian in any practice setting. Using software systems to reap maximum benefits requires preplanning for selection and implementation. Nevertheless, the benefits are great in terms of cost effective and efficient management of resources to provide client and program with the best possible product.