Food Substances for Allergies and Intolerance and Diet Orders
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Transcript Food Substances for Allergies and Intolerance and Diet Orders
Food and
Nutrition
Terminology
HL7
San Antonio WG Meeting
Monday Lunch
January 19, 2015
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Agenda Items
C-CDA Nutrition Templates (R2)
Allergy and Intolerance Food Substances
Terms in SNOMED and LOINC
Value sets
C-CDA -- Discuss use of UNII vs. other systems
Diet Orders
Update on SNOMED Terms
Issues
Amounts
Negatives
Need for means to display enterals, baby formula and food supplements
FoodNORM and Structured Product Labels
Preferences
FHIR resources for nutrition
© 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off
Nutrition Templates
C-CDA R2
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C-CDA – R2
Use of SNOMED and LOINC (vs. UNII)
Definition of value sets for
Nutrition Observation
Nutrition Assessment
Nutrition Recommendation
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C-CDA Terms
Nutrition Status Observation
Nutrition Assessment
LOINC (need more)
Nutrition Recommendations
SNOMED-CT
SNOMED-CT
Status of US Extension
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Status of Mapping NCPT SNOMED
Nutrition Diagnosis
Terms: 178
Mapped terms: 160
Terms that will not be mapped: 16
Terms that have been rejected for inclusion in SNOMED CT: 0
Terms to be submitted: 2
Nutrition Intervention
Terms: 320
Mapped terms: 287
Terms that will not be mapped: 17
Terms that have been rejected for inclusion in SNOMED CT: 10
Terms to be submitted: 6
Disposition of Remaining Terms
All remaining terms in Diagnosis and Intervention not listed in the following section are either headers
which will not be mapped, or have been reviewed by the SCT editor and been determined to be
unmappable due to their structure.
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NCPT Assessment Terms
Working on LOINC Mappings
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C-CDA R2
(identifier: http://vt Represents diet and nutrition
LOINC
urn:oid:2.16.8 sl.vetme information including special diet SNOMED-CT
(identifier:
LOINC
Patient's nutrition abilities & habits
urn:oid:2.16.8
SNOMED-CT
Nutrition Assessment
pending including intake, diet requirements
40.1.113883.1
(regime/therapy)
or diet followed.
0.20.22.4.138
(findings)
Nutritional Status (identifier:
Overall nutritional status of the SNOMED-CT
Observation
urn:oid:2.16.8
patient including findings related (findings)
Represents nutrition regimens
(identifier:
(e.g., fluid restrictions, calorie
http://w
Nutrition
urn:oid:2.16.8
minimum), interventions (e.g., SNOMED-CT
ww.hl7.o
Recommendation 40.1.113883.1
NPO, nutritional supplements), (regime/therapy)
rg
0.20.22.4.130)
and procedures (e.g., G-Tube by
bolus, TPN by central line). It may
Nutrition Section
Nutritional Status Observation
Author Participation
(Nutrition Assessment)
Planned Act (V2)
Planned Encounter (V2)
Planned Medication Activity (V2)
Planned Observation (V2)
Planned Procedure (V2)
Planned Supply (V2)
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Nutrition Status
Value Set: Nutritional Status 2.16.840.1.113883.1.11.20.2.7
A Value Set of SNOMED-CT codes representing nutrition problems.
Value Set Source: http://vtsl.vetmed.vt.edu/
Code
Code System
Code System OID
Print Name
371597004
SNOMED CT
2.16.840.1.113883.6.96
emaciated (finding)
284670008
SNOMED CT
2.16.840.1.113883.6.96
nutritionally compromised
(finding)
248325000
SNOMED CT
2.16.840.1.113883.6.96
undernourished (finding)
248324001
SNOMED CT
2.16.840.1.113883.6.96
well nourished (finding)
75051000
SNOMED CT
2.16.840.1.113883.6.96
Food intolerance (finding)
414285001
SNOMED CT
2.16.840.1.113883.6.96
Food allergy (disorder)
414915002
SNOMED CT
2.16.840.1.113883.6.96
Obese (finding)
288939007
SNOMED CT
2.16.840.1.113883.6.96
Swallowing difficulty (finding)
61578001
SNOMED CT
2.16.840.1.113883.6.96
Altered GI function
95907004
SNOMED CT
2.16.840.1.113883.6.96
drug interaction with food (finding)
...
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Nutrition Recommendations
Value Set: Nutrition Recommendations 2.16.840.1.113883.1.11.20.2.9
Types of nutritional regimes, therapies or interventions. Specific URL Pending
Value Set Source: http://www.hl7.org
Code
Code System
Code System OID
Print Name
61310001
SNOMED CT
2.16.840.1.113883.6.96
nutrition education
(procedure)
386373004
SNOMED CT
2.16.840.1.113883.6.96
nutrition therapy
(regime/therapy)
418995006
SNOMED CT
2.16.840.1.113883.6.96
feeding regime
(regime/therapy)
413315001
SNOMED CT
2.16.840.1.113883.6.96
nutrition / feeding
management (regime/therapy)
182922004
SNOMED CT
2.16.840.1.113883.6.96
dietary regime
(regime/therapy)
229912004
SNOMED CT
2.16.840.1.113883.6.96
enteral feeding
(regime/therapy)
225372007
SNOMED CT
2.16.840.1.113883.6.96
total parenteral nutrition
(regime/therapy)
448556005
SNOMED CT
2.16.840.1.113883.6.96
oral nutritional support
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Need for Value Sets
C-CDA R2 testing and implementation
VA Smart Forms
FHIR nutrition resources
Quality measures
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NutritionOrder Resource
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FHIR ClarificationNeeded:
Encounter-diet or Pref Modifier
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FluidConsistency:
Dietary Regime vs Substance
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ALLERGY AND
INTOLERANCE
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Allergy and Intolerance Models
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Terminology Bindings
C-CDA -- UNII vs. SNOMED for food
substances
Substances project - IHTSDO
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Diet Orders
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Version 3 Diet Order
1
2
4
3
5
8
6
7
9
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HL7 Model – Diet Orders
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vMR – CDS (Quality Improvement and Clinical Knowledge)
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Issues
Need “coding” standards for enteral nutrition
products and baby formula
Used in EHR’s
To order products for use
Check for allergies
Clinical decision support
Support information exchange between providers
Critical issue for allergies and intolerances
Need a system similar to drugs (RxNORM)
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Diet Orders
Update
on SNOMED - CT Terms
Issues
Amounts
Negatives
Need for means to display enterals,
baby formula and food supplements
RxFOOD and Structured Product
Labels
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Supplements & Formulas – Class
Structure
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FoodNORM
Similar to RxNORM for drugs
Avenue for substances without rate, dose,
strength
Use Structured Product Labeling pathway
for provision of supplements and food
through NLM
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FoodNORM
Role of GS1
Food/Products?
Manufacturers
SPL
Knowledge Based Systems
FoodNORM
Codes
EHR
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FDA and FoodNORM
FDA – CFSAN has agreed to pilot
Start with medical foods (supplemental
enterals)
Also exploring database of supplements
through the NIH Office of Dietary
Supplements
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Preferences
Additional terms added to SNOMED-CT?
Examples
Raw fruit
Hot cereal
Toddler foods
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FHIR Resources
Nutrition Orders
In current publication
Clinical Assessment
In current publication
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