Nutrition Management

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Nutrition Orders Projects

This page provides background information on a number of nutrition orders related projects which are currently in ballot reconciliation or were recently published as DSTU. The goal of these projects is to create new V3 and FHIR standards for exchanging diet and nutrition orders including orders for oral diets, nutritional supplements and medical foods, enteral nutrition (tube feedings) and nutrition service-related special requests in addition to food preference information. These projects have been joint initiatives between HL7 and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) and international dietetics representatives. This work is happening in parallel with the terminology development to leverage the placement of the International Dietetics and Nutrition Terminology into standardized vocabularies such as SNOMED and LOINC.

  • Domain Analysis Model: Diet and Nutrition Orders - R2 (DSTU--Normative)
  • v3 Nutrition Orders Clinical Messages (DSTU-->Normative)
  • v3 Food & Medication Preferences (Project ID 1009) (DSTU)
  • FHIR Nutrition Orders (DTSU)

DAM Normative R1 (Project ID #974)

This is the next phase (Normative May 2016) of the Nutrition Orders DAM project. The previous project was successfully balloted as an informative document. There are some errata that need to be fixed in the document. Additionally, we want to expand the scope to add patient/resident preferences for both foods and medications. This will allow us to build models to support documentation and exchange of patient requests and refusals for both foods and drugs. We intend to ballot this on the Normative track since it has artefacts being derived from it. Drug and Food Preferences are required to be noted in a EHR as they are important patient information that differs from allergies and intolerances.

Timeline

Normative May 2016

Nutrition Order Clinical Messages (Project #902)

The goal of this project is use the Diet and Nutrition Orders Domain Analysis Model work balloted in May 2012 to map the identified domain class model to the RIM and create all necessary version 3 artifacts including an implementation guide to support the exchange of electronic nutrition order clinical messages. Nutrition order messages will support the following types of nutrition orders: oral diets including texture modifications, oral nutritional supplements, enteral formula orders for tube feedings and infant formulas, patient food preferences, and special meal service orders/instructions. Currently, there is no accepted controlled vocabulary standard (codes or value sets) for diets. However, the Academy of Nutrition and Dietetics has already submitted many of the terms from the International Dietetics and Nutrition Terminology (IDNT) into SNOMED-CT and seeks to continue to pursue this effort. Therefore we have included development of the required Vocabulary Concept Domains as part of the scope of this project. The Diet and Nutrition Orders DAM also references the allergies and intolerances work in progress within Patient Care (see Project Id 881). This project will be informed by that work such that component messages specific to food allergies and food intolerances can be exchanged whenever nutrition orders are exchanged.

To Be Condsidered: CDA document use of Nutrition Orders

FHIR Nutrition Resources (Project #1081)

This project will identify and define the initial set of 'key' FHIR resources related to the domain of Nutrition. These resources will be defined using the available FHIR tooling and in accordance with documented quality guidelines and balloted as part of the initial FHIR specification. Expected FHIR resources to be produced include:

1. Dietitian performs and documents a nutritional assessment/consultation

2. Dietitian recommends a nutritional intervention

3. Provider orders a diet/supplement/enteral feeding/baby formula/consult

4. Patient selects menu items for transmission to a food and nutrition management system

5. Dietitian provides nutrition education/counseling

6. Patient provides recorded intake and dietitian provides summary of nutrient intake/calorie intake.

In addition, as the committee deems appropriate and time availability permits, it will define a small number of FHIR extensions relevant to domain content and expected to be necessary to support consistent early implementations.


Working Documents - Nutrition FHIR Project

Note: NutritionOrder resource is currently maturity level 2 as of FHIR STU3 release. Refer to FHIR builds for latest details.



  • File:Ni-spreadsheet.zip: Draft Observation Profile showing how to use this resource to represent the NutritionIntake information. See the structure view here:[2]

Leadership

Project Facilitators:

Margaret Dittloff, mdittloff@eatright.org
Ben Atkinson, batkinso@u.washington.edu
Elaine Ayres, eayres@nih.gov
Lorraine Constable, lorraine@constable.ca

Co-Modeling Facilitators:

Jean Duteau, jean@duteaudesign.com (V3)
Lorraine Constable, lorraine@constable.ca (V3)
Eric Haas, ehaas@healthedatainc.com (FHIR)


Domain Expert Representatives (Representing Academy of Nutrition and Dietetics:

Ben Atkinson, batkinso@u.washington.edu
Margaret Dittloff; mdittloff@eatright.org
Elaine Ayres; eayres@nih.gov
Lindsey Hoggle, lhoggle@eatright.org

Conference Calls and Minutes

Nutrition on FHIR Project Calls

Bi-weekly Calls Tuesday at 6 PM ET - Calls will resume after the January 2018 WGM

December 12, 2017 - Cancelled

December 26, 2017 - Cancelled

January 9, 2018 - Cancelled


Note - Use HL7 OO phone number, NOT phone number in the Webex.


Usual WebEx Meeting Info for Bi-Weekly Calls beginning Jan 26 2016 thru May WGM 2016


Join WebEx meeting https://eatright.webex.com/eatright/j.php?MTID=m358cf20a8bd56801d7287051ace25702

Meeting number: 749 688 042

Meeting password: 4sBfPAsE


Join by phone

  • New Free Conference Call OO Line


Minutes - Nutrition on FHIR Project

2017-11-28 - Meeting Cancelled 2017-12-07 - Joined Patient Care FHIR call to present NutritionIntake gap analysis (see PC minutes)


Archive Minutes from Past Projects

Minutes - Nutrition DAM - Normative Track Project

Minutes - Nutrition FHIR Project


Minutes - Past Nutrition Orders Project Calls

Working Documents

Nutrition Intake (meal/tray intake) Use Cases


Storyboards

Status & Deliverables

Diet and Nutrition Orders Domain Analysis Model R2 - DSTU Ballot May 2013 Cycle / Status - Published

Food and Medication Preferences - DSTU January 2014 Ballot - Published; STU Extension until June 2018

FHIR NutritionOrder - Published as part of FHIR STU (current release 3)

Key Dates:

Sept 2017 = FHIR Connectathon & Clinicians on FHIR

Links

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