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Capturing the Use of Dietary Supplements in Electronic Medical Records

Room for Improvement

Costello, Rebecca B. PhD; Deuster, Patricia A. PhD, MPH; Michael, Madeline MPH, RD; Utech, Anne PhD, RDN, LD

doi: 10.1097/NT.0000000000000348
Nutrition Science

Of importance to federal agencies that administer healthcare facilities is capturing patient use of dietary supplements (DSs) to avoid potential drug-supplement interactions. Digital technologies, such as use of the electronic medical record and the electronic health record (EHR), are key to monitoring healthcare. The particular electronic software package and the healthcare professional using this software influence how this documentation is recorded. A survey was conducted to determine how information on DSs is being collected, recorded, and processed in EHRs across federal agencies. Four federal agencies providing direct healthcare services to large numbers of men and women in the United States were surveyed on current practices regarding the recording and processing of information on DS use on either an outpatient or inpatient basis. A point of contact for each of the following federal agencies was identified, and a 13-question survey was sent to each for completion: National Institutes of Health Clinical Center, Department of Defense Military Nutrition Committee, Veterans Health Administration Office of Specialty Care Services, and Indian Health Service, Office of Information Technology. All 4 agency representatives completed the survey. No agency used the same EHR software reporting system. Most EHRs have searchable fields that are in a structured format, but some information is free text and allowed entry by multiple members of the healthcare team. Three different medication formulary or drug knowledge databases were used across the agencies. Most agencies using EHR management systems have adequately described procedures for entering and charting information on DSs. The responsibility for charting, however, varies across agencies whether captured by the admitting doctor, nurse, dietitian, or pharmacist. Direct linkage between the pharmacy system and the drug knowledge database is a feature of the EHR for several but not all federal agencies. An unmet need still exists in the EHR to implement DS/drug interaction checks as many DS products have multiple active ingredients and, when taken with other DSs or prescription drugs, increase the likelihood of an adverse event. Establishing common EHR practices could facilitate monitoring the use and potential interactions of DSs with prescribed drugs.

Rebecca B. Costello, PhD, is a scientific consultant for the Office of Dietary Supplements at the National Institutes of Health and is an adjunct professor at the Uniformed Services University.

Patricia A. Deuster, PhD, MPH, is a professor at the Uniformed Services University and is the Director of the Consortium for Health and Military Performance (CHAMP).

Madeline Michael, MPH, RD, is the Chief of Clinical Nutrition Services in the Nutrition Department at the Clinical Center, National Institutes of Health.

Anne Utech, PhD, RDN, LD, is the National Director for Nutrition and Food Services in the Veterans Health Administration and an assistant professor in the Department of Medicine at Baylor College of Medicine.

This work was supported by the National Institutes of Health Office of Dietary Supplements and the Department of Veterans Affairs, Veterans Health Administration. This is a US Government work and is in the public domain in the United States.

The authors have no conflicts of interest to disclose.

Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the National Institutes of Health, Uniformed Services University, Department of Defense, or Department of Veterans Affairs.

Correspondence: Rebecca B. Costello, PhD, Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd, Room 3B01, MSC 7517, Bethesda, MD 20892-7517 (

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