1. Food and Nutrition Terminology HL7 Phoenix WG Meeting May 5, 2014

2. Agenda Items Allergy and Intolerance Substances – Update on analysis with the VA Diet Orders – Enterals, supplements and baby formula Preferences C-CDA – Value sets FHIR resources for nutrition

3. SNOMED-CT Substances Decision in San Antonio – Dietary Substance will be hierarchy of choice – Allergen Class will not be used – Note some food substances have two parent concepts Comparison of SNOMED-CT and UNII coverage of food substances completed – VA – 422 food concepts – Ayres – 110 unique concepts in addition to VA

4. SNOMED-CT vs. UNII *VA has decided to use SNOMED-CT *Discussed food allergies in C-CDA R2 – UNII specified but we will file a DSTU comment to add a value set of SNOMED-CT terms *Using substances and not organisms or products

5. Question re classes Alcohol (Dietary?) Chocolate Coffee Egg Fish (Dietary?) Food Additives Fruit Ground Nuts? Gelatin Meat Milk Peanuts Poultry Seeds Shellfish (Dietary?) Soy Spices Sugars Tree Nuts – vs almonds, cashews, …….. Vegetables Wheat Translation of classes/terms into value sets? Does this work with the V3 model?

6. Example Nuts Tree Positions

7. Allergy Model

8. Dietary Substance vs. Food Allergen Dietary Substance (116273005) Substance Allergen Food allergen or pseudoallergen - 414284002

9. Food Allergens Food Pseudoallergens …..

10. Diet Orders Enterals, Supplements and Baby Formula

11. HL7 Version 3 Diet Order

12. LEGENED 1.Existing SNOMED CT terms 2.Requested terms are in red 3.New suggested are in blue 4.More new suggested terms

13. Questions re Enterals, Supplements and Baby Formula Product hierarchy? Other suggestions for inclusion?

14. Preferences Additional food substance work needed?

15. C-CDA – R2 Use of SNOMED and LOINC (vs. UNII) Definition of value sets for – Nutrition Observation – Nutrition Assessment – Nutrition Recommendation

17. FHIR Resources PSS just approved for: 1.Dietitian performs and documents a nutritional assessment/consultation 2.Dietitian recommends a nutritional intervention 3.Provider orders a diet/supplement/enteral feeding/baby formula/consult 4.Patient selects menu items for transmission to a food and nutrition management system 5.Dietitian provides nutrition education/counseling 6.Patient provides recorded intake and dietitian provides summary of nutrient intake/calorie intake.