Provider-authored request for the delivery of patient care services.

Data Element
Nutrition Order
Description

A clinician (provider)-authored request for a diet, formula feeding (enteral), or nutritional supplement.
Submitted By: Michelle Ashafa / Academy of Nutrition and Dietetics
Data Element Information
Use Case Description(s)
Use Case Description When a patient is admitted, re-admitted, seen in an ambulatory setting, or when a change in health status occurs, understanding their nutrition status is essential to the plan of care. A Nutrition Order is created based on this assessment, outlining specific nutrition requirements, including type of diet (e.g., regular, diabetic, renal), enteral nutrition, texture modifications, fluid restrictions, and cultural or nutrient needs.

The Nutrition Order aids in personalizing meal plans to optimize a return to health. This personalization includes capturing dietary cultural practices, such as Halal and Kosher. It helps in predicting recovery rates and potential complications by providing clear guidelines for nutritional support. It assists in tailoring food and nutrition transitions of care, ensuring a smooth transition to post-discharge nutrition needs. 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 Order should be available to provide care providers with a comprehensive understanding of the patient's nutritional needs and plan.

Frequency of use would be every time a patient is admitted or re-admitted to a care setting, when a referral is generated, or when a change in health status occurs. The Nutrition Order is a dynamic record/service request that can be updated as the patient's condition evolves.
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
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
  • Address public health interoperability needs of reporting, investigation, and emergency response
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) SNOMED CT

https://hl7.org/fhir/valueset-diet-type.html
Additional Specifications
HL7 Diet-Type

Dietary Regime (182922004) and its subtypes, Enteral Feeding (229912004) and its subtypes, Mixed Breast Milk and Bottle Feeding (35011000087100), Breast Milk Feeding (1297276008), Bottle Feeding of Patient (40043006)
HL7 FHIR R5 NutritionOrder maturity level 2 https://hl7.org/fhir/nutritionorder.html

PACIO Personal Functioning and Engagement Implementation Guide
2.0.0-ballot https://build.fhir.org/ig/HL7/fhir-pacio-pfe/toc.html
Current Use (Level 2) Captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer
Extent of exchange (Level 2) Between more than two production EHRs or other HIT modules using available interoperability standards
Supporting Artifacts NutritionOrder resource is at a maturity level of FMM 3 and was utilized in the 2024 CMS Connectathon with the support of the HL7 PACIO workgroup, to show how nutrition orders would be captured in an electronic record for post-acute care.
NutritionOrder is currently available in open.epic as a way to integrate between Epic EHR systems and external systems that use FHIR endpoints.

Many organizations are also using the ODS in HL7 V2 standards to exchange nutrition order data elements.

HL7 EHR-System Electronic Nutrition Care Process Record System (ENCPRS) Functional Profile, Release 2 (Normative)

HL7 CDA® R2 Implementation Guide: Consolidated CDA Templates for Clinical Notes - US Realm contains a Nutrition Section, including value sets, for Nutrition and Diet data elements.
https://www.hl7.org/fhir/nutritionorder.html; https://vendorservices.epic.com/OpenEpicApis; https://www.hl7.org/implement/standards/product_brief.cfm?product_id=369; https://hl7.org/cda/us/ccda/
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) There are no restrictions on the standardization of the data element.
Restrictions on Use (e.g. licensing, user fees) There are no restrictions on the use of nutrition order 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 order data in EHRs are readily available as the standard of care. Data is input and captured by various clinicians (e.g., providers, registered dietitians, speech language pathologists) during a patient’s journey throughout the continuum of care. The data are part of standard workflows, with the primary need being the efficient and meaningful consolidation and reporting of this data by implementers.
Other Implementation Challenges There are no known challenges to implement.
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 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 1 - Use cases apply to several care settings or specialties.

Comment

Submitted by jpatterson@mitre.org on

PACIO Appreciates and Supports Inclusion of Nutrition Order

  • Data Class: Orders
  • Data Element: Nutrition Order (Level 2)
  • Recommendation: Accept the Nutrition Order data element and include it in final USCDI as a Level 2 data element.
  • Rationale:  The PACIO Project Community* would like to thank ASTP for recognizing the importance of Nutrition Order and its inclusion in as a Level 2 data element. The community welcomes the submission of the Nutrition Order data element by the Academy of Nutrition and Dietetics. Nutrition orders are a foundational component of safe patient care across post-acute and acute care settings. The information in a nutrition order ranges from the nutritional contents of the patient’s diet, the textures and modifications needed for a patient to safely eat that diet, to restrictions (e.g., religious needs) that must be met for the patient to find the meal acceptable. Nutrition orders are a daily tool in many different provider workflows including practitioners, dietitians, and speech language pathologists and capture information that must be exchanged between settings for safe and effective care.
  • A Nutrition Order Profile has been developed as part of the Personal Functioning and Engagement FHIR Implementation Guide.  The profile has been successfully exchanged by a commercial EHR.
  • * 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.

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