| Submitted By: Becky Gradl / Academy of Nutrition and Dietetics | |
|---|---|
| Data Element Information | |
| Rationale for Separate Consideration | Food allergens are another substance that can cause allergies and intolerances. Medication and Drug Class are called out in USCDI V1 as specific elements, thus food allergens should be as well. Everyone consumes food and within the healthcare system, a person’s food allergies should be documented and well known so as to avoid causing unnecessary harm which can lead to increased costs of care. Food allergies are sometimes captured with drug allergies, but are a separate allergy causing substance and should be distinct from drugs. Food allergens are transmitted to a food service software system, but medication allergies are not. |
| Use Case Description(s) | |
| Use Case Description | When a patient is admitted to the healthcare system, they are given a “diet order” so that they can be provided with the proper meal, often based on disease state (problems). Food substances or food allergens that cause an allergic reaction or intolerance are included with the diet order that is transmitted to a food service software system (which is often separate from the EHR) so these substances can be avoided when a patient is served their meal. Food allergies are typically collected when a patient is admitted, possibly at the same time as medication and environmental allergies. |
| Estimated number of stakeholders capturing, accessing using or exchanging | This would impact all healthcare facilities who provide meals to patients, including, but not limited to hospitals, long term care, rehabilitation facilities, and home health. Practitioners such as physicians, nurses, and dietitians would capture, access, use and exchange this data and people who work to prepare and serve meals would also use the data element. Patients who have food allergies would be impacted by the lack of capture and submission. |
| Link to use case project page | http://www.hl7.org/implement/standards/product_brief.cfm?product_id=289 and http://www.hl7.org/implement/standards/product_brief.cfm?product_id=482 |
| Use Case Description | Food allergy information would also be available to the patient’s providers including, but not limited to physicians, nurses, and registered dietitians, regardless of the care setting. Typically a registered dietitian would use food allergy information while counseling or educating a patient with a food allergy so the patient knows what foods should be avoided; other practitioners might do the same. Food allergies may also be captured and displayed on patient portals. |
| Estimated number of stakeholders capturing, accessing using or exchanging | This would impact any practitioner who educates patients on their food intake and any patient who has food allergies. |
| Healthcare Aims |
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| Maturity of Use and Technical Specifications for Data Element | |
| Applicable Standard(s) | SNOMED CT with a value set created in VSAC (OID: 2.16.840.1.113762.1.4.1186.3) HL7 Cross Paradigm Specification: Allergy and Intolerance Substance Value Set(s) Definition: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=482 was used to create the value set https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1186.3/expansion |
| Additional Specifications | N/A |
| Current Use | In limited use in production environments |
| Supporting Artifacts |
FHIR R4 NutritionOrder via AllergyIntolerance https://www.hl7.org/fhir/nutritionorder.html https://www.hl7.org/fhir/allergyintolerance.html https://www.hl7.org/fhir/nutritionorder.html and https://www.hl7.org/fhir/allergyintolerance.html |
| Number of organizations/individuals with which this data element has been electronically exchanged | 2-3 |
| Supporting Artifacts |
HL7 Version 3 Diet and Nutrition Orders Domain Analysis Model: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=289 HL7 Cross Paradigm Specification: Allergy and Intolerance Substance Value Set(s) Definition: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=482 |
| Potential Challenges | |
| Restrictions on Standardization (e.g. proprietary code) | Since the work has already been done to create a value set of common food allergen substances with data from multiple hospital systems, there should be no restrictions on the standardization of this data element |
| Restrictions on Use (e.g. licensing, user fees) | The value set for common dietary food substances is available for free in VSAC so there are no restrictions on the use of this data element. |
| Privacy and Security Concerns | There are no privacy and security concerns with the use and exchange of this data element |
| Estimate of Overall Burden | The burden to capture this data element may be limited as some systems may already be capturing food allergies, just not sharing the information more widely outside of a food service software system. If this information is collected by practitioners, it may be in notes versus structured fields so the burden may increase since it should be captured in structured data fields and used for its multiple purposes. |
Harmful or undesired physiological responses associated with exposure to a substance.
Data Element |
Information from the submission form |
|---|---|
| Substance (Food) |
Description
Common food substances and allergens that can cause harmful or undesirable physioloical responses when exposed to the substance or the substance is consumed.
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Submitted by aphillips@imoh… on 2022-04-28
Level 2 Data Class: Allergies and Intolerances
Level 2 Data Element: Substance (Food) While IMO agrees that documentation of non-medication allergies is important in clinical care, we do have concerns regarding maturity and use of the technical specifications cited to support the proposed Level 2 data element submissions in this data class. The following technical specifications are cited to support the proposed level 2 data elements in the Allergies and Intolerances data class:- C-CDA Implementation Guidance Conformance (CONF:1098-16324), for Substance or Device Allergy - Intolerance Observation (V2)
- FHIR US Core Allergy Intolerance Profile: (v1.0.0: STU based on FHIR R3).
- FHIR US Core Resource Profile: USCore AllergyIntolerance (v5.0.0 Preview CI Build)
The C-CDA specification for Substance or Device Allergy is not widely implemented and therefore does not meet the requirement as a Level 2 data element. The value set referenced in the specification, Substance Reactant for Intolerance OID: 2.16.840.1.113762.1.4.1010.1 is poorly curated. This value set contains over 47,000 codes, includes active pharmaceutical ingredients (single and multiple ingredient drugs and mix of branded and non-proprietary names), drugs used in veterinary medicine to include Ivermectin (Heartgard Plus) and Chlorhexidine Gluconate (Vet One), as well as codes for non-medications. Neither FHIR technical specification meets the critiera for a Level 1 or Level 2 data element as they have not been implemented in production environments. The FHIR R3 US Core Allergy Intolerance Profile references the value set, Substance Other Than Clinical Drug OID: 2.16.840.1.113762.1.4.1010.9. This value set is poorly curated, contains over 21,000 codes that include codes for antibodies, antigens and amino acids in addition to relevant content for non-medications. It is also worth noting that the v5.0.0 FHIR AllergyIntolerance profile references an entirely different value set Common substances for allergy and intolerance documentation including refutations OID: 2.16.840.1.113762.1.4.1186.8 which includes substances, medications, and food. IMO does not support the inclusion of Level 2 data elements (Substance (Non-Medication), Substance (Food)) in the Allergies and Intolerances Data Class in USCDI V3 as currently proposed.