Nutrition FHIR Resource Proposal

NutritionOrder

Owning committee name

Orders and Observations

Contributing or Reviewing Work Groups

• Patient Care (for review)
• Pharmacy (for review)

FHIR Resource Development Project Insight ID

Project ID - 1081

Scope of coverage

Nutrition Order resource covers information needed for ordering oral diets (including general diets such as General Healthy diet, or therapeutic diets such as Consistent Carbohydrate, 2 gram Sodium, Fluid Restricted), enteral nutrition (tube feedings), infant formula and oral nutritional supplements which govern the distribution of food and nutritional products used to feed patients in in-patient healthcare settings. These nutrition orders are combined with information on a patient's food allergies and intolerances, and ethnic or cultural food preferences (Kosher, Vegetarian) to inform healthcare personnel about the type, texture, and/or quantity of foods that the patient should receive or consume.

Out of scope for initial resource work:

• Parenteral Nutrition (IV nutrition)
• Food Preferences

RIM scope

SupplyRequest

Resource appropriateness

Diet and Nutrition is a critical aspect of human health. Many health conditions require dietary or nutrition modifications. It is essential to share or exchange information about a patient’s nutritional requirements with multiple healthcare providers and with the food and nutrition/catering operations within an in-patient healthcare setting.

Expected implementations

Can be expected to be implemented as messaging between EHR/EMR and Food and Nutrition Management Systems in hospitals and long-term care facilities.

Content sources

• Diet and Nutrition Domain Analysis Model, R2
• V3 Nutrition Orders Clinical Messaging DSTU
• C-CDA R2 Nutrition Templates (Nutrition Recommendation template)
• HL7 v2 specification (ORC – ODS segment)
• vMR Logical Model
• OpenEHR (?)

Example Scenarios

Provider orders a diet/enteral nutrition/infant formula/oral nutritional supplement for a patient or resident in a healthcare facility.

• Specific use cases were taken from the V3 Doman Analysis Model: Diet and Nutrition Orders, Release 2 [1]

1. Provider places an order for an oral diet which may include nutrient medications and texture modifications.

• Order a 'General Healthy' diet (no other dietary restrictions) for a newly admitted patient
• Order a complex nutrient modified diet (80 g Protein, Consistent Carbohydrate, 2 gram Sodium, 2 gram Potassium, 800-1000 mg Phosphorus, 1500 mL Fluid Restriction) for a diabetic patient undergoing renal dialysis for chronic kidney disease.
• Order a texture modified diet (Mechanical Soft with Pureed Meats) for a stroke patient in rehabilitation.

2. Oral for addition of high-protein oral nutritional supplement product 3 times per day between Meals (AM / PM / HS snack periods). Note this is in addition to the order for this patient's oral diet.

3. Enteral (tube feeding)for adult patient requiring a Standard High Energy (1.5 Calorie/mL) Enteral Formula product to be administered via continuous pump, start at 20 mL/hour and increase rate by 10 mL/hour every hour until target/goal rate of 60 mL/hour. Follow standard administration protocol (order set) for elevating head of bed, flushing tube with water.

4. Infant formula order for a specialty hydrolyzed protein infant formula prepared to 27 Calories/fluid oz plus 5 gram carbohydrate/fat additive per ounce; feeding 2 fluid ounces orally via bottle or syringe every 4 hours.

Resource Relationships

• Order
• OrderResponse
• Substance
• MedicationPrescription - (Need to harmonize overlap that relates to ordering dietary supplements vs. oral nutritional supplements/medical foods)

Timelines

Next FHIR DSTU Ballot - January 2015 Ballot Cycle

• Draft Content to be ready for QA by FHIR ballot prep deadline (2014-09-21)

gForge Users

Claude Nanjo

Jean Duteau

Lorraine Constable