Assessments of a health-related matter of interest, importance, or worry to a patient, patient’s family, or patient’s healthcare provider that could identify a need, problem, or condition.

Data Element
Nutrition Status
Description

A systematic nutrition assessment of an individual's nutrition intake, physical exam, anthropometric measurements, biochemical, and health condition data compared to accepted standards, recommendations, and/or goals to arrive at a determination of the client’s nutrition well-being or malnutrition.
Submitted By: Michelle Ashafa / Academy of Nutrition and Dietetics
Data Element Information
Use Case Description(s)
Use Case Description Among the initial assessments in healthcare settings, a comprehensive nutritional evaluation is performed to establish a baseline Nutrition Status. This involves nutrition intake patterns and food availability, clinical evaluations like anthropometric measurements (BMI, waist circumference, etc.), and laboratory tests like mineral status, vitamin levels, or other nutrient markers and encompasses various medical professionals in its completion. Upon admitting a patient with a chronic condition, such as diabetes, kidney disease, heart disease, or before surgery, understanding the patient's Nutrition Status is essential to the plan of care. It aids in personalizing meal plans during a hospital stay to optimize a return to health. It helps in predicting recovery rates and potential complications. It assists in tailoring food and nutrition transitions of care. When a primary care provider refers a patient to a specialist, such as an endocrinologist for diabetes management or a registered dietitian for specific nutritional therapy, the Nutrition Status should be available to provide care providers with a comprehensive understanding of the patient's nutritional baseline.
Frequency of use would be every time a patient is admitted or re-admitted to the hospital or care setting, when a referral is generated, or when a change in health status occurs.
Estimate the breadth of applicability of the use case(s) for this data element Level 2 - Use cases apply to most care settings or specialties.
Link to use case project page https://www.hl7.org/implement/standards/product_brief.cfm?product_id=289
Use Case Description To manage conditions, such as cancer, the NCP contributes to the development, modification, and communication of the Nutrition Status to the care team.
Nutrition Assessment provides a baseline on the nutritional contributors to the patient's nutrition status and problem(s) and enables targeted and effective interventions. Effective interventions consider the comprehensive nutrition status of the patient, social determinants that may impact care, and the medical treatment plan (eg, surgery, chemotherapy) improving the ability to adhere to medical therapies and better treatment outcomes. Nutrition Monitoring and Evaluation, the continuous review of the nutritional status, ensures that the interventions are and remain effective and can be modified as the patient's needs change. The nutrition status helps inform the standardized evidence-based approach to nutritional management.
Estimate the breadth of applicability of the use case(s) for this data element Nutrition Status is universally applicable across all age groups. From pediatric care (evaluating growth, development, and nutritional adequacy) to geriatric care (where malnutrition risk is heightened), every age bracket can benefit. On a broader scale, understanding the nutritional status of populations can guide public health initiatives, policies, and interventions.
ONC Priority
  • Address behavioral health integration with primary care and other physical care
  • Mitigate health and health care inequities and disparities
  • Address the needs of underserved communities
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) LOINC 75304-6 Nutrition status observation panel
https://loinc.org/75304-6/
Additional Specifications HL7 CDA® R2 Implementation Guide: C-CDA R2.1 Supplemental Templates for Nutrition, Release 1 - US Realm.
4.2 Diagnosis Etiology (Nutrition)
a. This code SHALL contain exactly one [1..1] @code="75306-1" Nutrition Status Etiology (CONF:3352-165).


5. SHALL contain exactly one [1..1] code (CONF:3352-147).
Nutrition Diagnosis (Nutrition)
5. SHALL contain exactly one [1..1] code (CONF:3352-555). a. This code SHALL contain exactly one [1..1] @code="75305-3" Nutrition Status (CONF:3352-556).
Current Use (Level 0) Captured, stored, or accessed in limited settings such as a pilot or proof of concept demonstration
Extent of exchange (Level 0) Limited environments, such as connectathons or pilots
Supporting Artifacts EHRs commonly incorporate nutrition assessment tools for patients to detail their food habits, allergies, and supplement intake. These systems also capture essential metrics such as BMI, weight changes, and specific lab results like vitamin D levels. To ensure consistency and ease of access, EHRs have designated fields for such metrics, along with special sections for dietitians to input thorough nutritional assessments. Additionally, some health institutions integrate nutrition status assessment tools within their main EHR to centralize patient data.

Such examples are C-CDA R2.1 Supplemental Templates for Nutrition.

Organizations may use HL7 V2 standards and C-CDA R2.1 Supplemental Templates for Nutrition to exchange Nutrition status related data elements. The emerging development and use of the FHIR Resources: NutritionOrder. NutritionProduct, and NutritionIntake expand the applicability of Nutrition Status data element for electronic exchange. NutritionOrder resource is at a maturity level of FMM 3. Nutrition Product and NutritionIntake stand at a maturity level of FMM 2.

https://www.hl7.org/implement/standards/product_brief.cfm?product_id=478
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) Standardization of nutrition status through LOINC 75304-6 Nutrition status observation panel promotes interoperable exchange of nutrition findings.
Restrictions on Use (e.g. licensing, user fees) There are no restrictions on the use of nutrition status or nutrition status data elements.
Privacy and Security Concerns The concepts within this proposed data element are currently being exchanged and will continue to follow privacy and security requirements if applicable.
Estimate of Overall Burden Nutrition status data in EHRs are data that are readily available, like food allergies, anthropometric, and lab data results. While some results, such as vitamin D levels, may come from external lab systems, many EHRs already have these integrated, easing the burden on implementers. Some nutrition data such as food and nutrition patterns require manual input. All of the data is part of standard workflows, with the primary challenge being the efficient and meaningful consolidation and reporting of this data by implementers.
ASTP Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 0 - Data element is captured, stored, or accessed in limited settings such as a pilot or proof of concept demonstration.
Criterion #3
Maturity - Current Exchange		 Level 0 - Data element is electronically exchanged in limited environments, such as connectathons or pilots.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 2 - Use cases apply to most care settings or specialties.
Evaluation Comment This data element requires additional implementation and testing to be considered for higher Level.

Comment

Submitted by jpatterson@mitre.org on

PACIO Recommends Advancing Nutrition Status to Level 2

  • Data Class: Health Status Assessments
  • Data Element: Nutrition Status (Level 0)
  • Recommendation: Advance the Nutrition Status data element from Level 0 to Level 2.
  • Rationale: The PACIO Project Community* recommends advancing the Nutrition Status data element from Level 0 to Level 2. This information is often collected by a nutrition specialist, such as a registered dietitian (RD), and includes comprehensive nutritional assessments that account for allergies, swallowing ability, and nutrient needs, among other things. The PACIO Project’s clinical community of practice agrees with the Academy of Nutrition and Dietetics that these comprehensive nutrition assessments are critical to patient safety, health, and recovery. These comprehensive nutrition assessments support the clinical decision-making of healthcare practitioners, such as physicians, advanced practice nurses, speech language pathologists, occupational and physical therapists, and pharmacists, who consider food, eating, and nutrition in their clinical decision-making and therefore need access to nutrition specialists’ insights into patients’ dietary needs. Dietitians provide needed information about malnutrition risk, dietary intake, and other specialist information that impact patient safety and care decisions across settings and care-team members. Ultimately, nutrition status is important for patient outcomes and safety in care setting and at home, including during transitions of care, making the Nutrition Status data element critical for capture within and transmission between EHR systems.
  • * The PACIO (Post-Acute Care Interoperability) Project, established February 2019, is a collaborative effort between industry, government, and other stakeholders, with the goal of establishing a framework for the development of FHIR implementation guides to facilitate health information exchange.

Submitted by HCapon on

PACIO Recommends Advancing Nutrition Status

  • Data Class: Health Status Assessments (V5) 
  • Data Element: Nutrition Status (Level 0) 
  • Recommendation: Advance the Nutrition Status data element from Level 0 to Level 2. 
  • Rationale: The PACIO (Post-Acute Care Interoperability) Project, established February 2019, is a collaborative effort between industry, government, and other stakeholders, with the goal of establishing a framework for the development of FHIR implementation guides to facilitate health information exchange. 
  • The PACIO Project’s clinical community of practice agrees with the Academy of Nutrition and Dietetics that comprehensive nutrition assessments are critical to patient safety, health, and recovery. Comprehensive nutrition assessments allow all practitioners who must consider food, eating, and nutrition, to have specialist insight into a patient’s dietary needs. These providers include practitioners, speech language pathologists, occupational and physical therapists, and pharmacists. Dietitians provide needed information about malnutrition risk, dietary intake, and other specialist information that impact patient safety and care decisions across settings and care-team members. 

Log in or register to post comments