Submitted By: Michelle Ashafa
/ Academy of Nutrition and Dietetics
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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.
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Estimate the breadth of applicability of the use case(s) for this data element
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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.
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Estimate the breadth of applicability of the use case(s) for this data element
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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
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Maturity of Use and Technical Specifications for Data Element |
Applicable Standard(s) |
LOINC 75304-6 Nutrition status observation panel
https://loinc.org/75304-6/
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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).
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Current Use |
(Level 0) Captured, stored, or accessed in limited settings such as a pilot or proof of concept demonstration |
Extent of exchange
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(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
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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
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Criterion #1 Maturity - Current Standards |
Level 2
- Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
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Criterion #2 Maturity - Current Use
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Level 0
- Data element is captured, stored, or accessed in limited settings such as a pilot or proof of concept demonstration.
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Criterion #3 Maturity - Current Exchange |
Level 0
- Data element is electronically exchanged in limited environments, such as connectathons or pilots.
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Criterion #4 Use Case(s) - Breadth of Applicability |
Level 2
- Use cases apply to most care settings or specialties.
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Evaluation Comment |
This data element requires additional implementation and testing to be considered for higher Level. |
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Submitted by jpatterson@mitre.org on
PACIO Recommends Advancing Nutrition Status to Level 2