‘Making the System Work’: A Multi-Site Qualitative Study of Dietitians’ Use of iEMR to Support Nutrition Care Transitions for Older Adults with Malnutrition

Background: Older adults with malnutrition (≥65 years) require coordinated nutrition care during hospital-to-home transitions. A key purpose of integrated electronic medical record (iEMR) systems is to support clinicians in ensuring continuity of care across settings, yet little is known about their use in nutrition care discharge practices. This study explored how clinical dietitians use the iEMR to support nutrition care discharge practices for older adults with malnutrition and identified opportunities for optimisation to enhance care continuity. Methods: Semi-structured interviews were conducted with 16 clinical dietitians (11 frontline clinicians, 5 senior leaders) from 10 public hospitals across Queensland, Australia. Analysis combined deductive coding using the Consolidated Framework for Implementation Research 2.0 with inductive thematic analysis to identify system-level, organisational and behavioural influences on iEMR use and optimisation opportunities. Results: Four themes and ten subthemes were identified. System fragmentation, policy constraints and documentation burden limited dietitians’ ability to coordinate discharge care. Workarounds were common and reflected both practical adaptation and conditional trust in iEMR. Discharge practices were also shaped by local culture, professional norms and variable expectations for iEMR use. Despite these constraints, participants expressed aspirations for an optimised iEMR with embedded referral tools, real-time alerts and analytics to support improved service delivery. Conclusions: This study identified key factors influencing iEMR use by clinical dietitians to support nutrition care transitions for older adults with malnutrition. While current systems present significant challenges, optimising iEMR alongside organisational and policy enablers holds potential to strengthen nutrition care discharge practices and care continuity.