1. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Food and Nutrition Terminology HL7 San Antonio WG Meeting Monday Lunch January 19, 2015

2. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Agenda Items C-CDA Nutrition Templates (R2)  Terms in SNOMED and LOINC  Value sets Allergy and Intolerance Food Substances  C-CDA -- Discuss use of UNII vs. other systems Diet Orders  Update on SNOMED Terms  Issues Amounts Negatives  Need for means to display enterals, baby formula and food supplements FoodNORM and Structured Product Labels Preferences FHIR resources for nutrition

3. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off C-CDA R2 Nutrition Templates

4. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off

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

6. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off C-CDA Terms Nutrition Status Observation  SNOMED-CT Nutrition Assessment  LOINC (need more) Nutrition Recommendations  SNOMED-CT Status of US Extension

7. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Status of Mapping NCPT - SNOMED

8. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off NCPT Assessment Terms Working on LOINC Mappings

9. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off C-CDA R2

10. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Nutrition Status Value Set: Nutritional Status 2.16.840.1.113883.1.11.20.2.7 A Value Set of SNOMED-CT codes representing nutrition problems. Value Set Source: http://vtsl.vetmed.vt.edu/ http://vtsl.vetmed.vt.edu/ CodeCode SystemCode System OIDPrint Name 371597004SNOMED CT2.16.840.1.113883.6.96emaciated (finding) 284670008SNOMED CT2.16.840.1.113883.6.96 nutritionally compromised (finding) 248325000SNOMED CT2.16.840.1.113883.6.96undernourished (finding) 248324001SNOMED CT2.16.840.1.113883.6.96well nourished (finding) 75051000SNOMED CT2.16.840.1.113883.6.96Food intolerance (finding) 414285001SNOMED CT2.16.840.1.113883.6.96Food allergy (disorder) 414915002SNOMED CT2.16.840.1.113883.6.96Obese (finding) 288939007SNOMED CT2.16.840.1.113883.6.96Swallowing difficulty (finding) 61578001SNOMED CT2.16.840.1.113883.6.96Altered GI function 95907004SNOMED CT2.16.840.1.113883.6.96drug interaction with food (finding)...

11. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Nutrition Recommendations Value Set: Nutrition Recommendations 2.16.840.1.113883.1.11.20.2.9 Types of nutritional regimes, therapies or interventions. Specific URL Pending Value Set Source: http://www.hl7.org http://www.hl7.org CodeCode SystemCode System OIDPrint Name 61310001SNOMED CT2.16.840.1.113883.6.96 nutrition education (procedure) 386373004SNOMED CT2.16.840.1.113883.6.96 nutrition therapy (regime/therapy) 418995006SNOMED CT2.16.840.1.113883.6.96 feeding regime (regime/therapy) 413315001SNOMED CT2.16.840.1.113883.6.96 nutrition / feeding management (regime/therapy) 182922004SNOMED CT2.16.840.1.113883.6.96 dietary regime (regime/therapy) 229912004SNOMED CT2.16.840.1.113883.6.96 enteral feeding (regime/therapy) 225372007SNOMED CT2.16.840.1.113883.6.96 total parenteral nutrition (regime/therapy) 448556005SNOMED CT2.16.840.1.113883.6.96oral nutritional support

12. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Need for Value Sets C-CDA R2 testing and implementation  VA Smart Forms FHIR nutrition resources Quality measures

13. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Allergy Model

14. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off NutritionOrder Resource

15. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off FHIR ClarificationNeeded: Encounter-diet or Pref Modifier

16. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off FluidConsistency: Dietary Regime vs Substance

17. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off ALLERGY AND INTOLERANCE

18. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Allergy and Intolerance Models

19. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Terminology Bindings C-CDA -- UNII vs. SNOMED for food substances Substances project - IHTSDO

20. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Example Nuts Tree Positions

21. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Dietary Substance vs. Food Allergen Dietary Substance (116273005) Substance Allergen Food allergen or pseudoallergen - 414284002

22. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Food Allergens Food Pseudoallergens …..

23. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Diet Orders

24. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Version 3 Diet Order 1 2 3 4 6 7 8 9 5

25. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off HL7 Model – Diet Orders

26. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off vMR – CDS (Quality Improvement and Clinical Knowledge)

27. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Issues Need “coding” standards for enteral nutrition products and baby formula Used in EHR’s  To order products for use  Check for allergies  Clinical decision support  Support information exchange between providers Critical issue for allergies and intolerances Need a system similar to drugs (RxNORM)

28. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Diet Orders  Update on SNOMED - CT Terms  Issues Amounts Negatives  Need for means to display enterals, baby formula and food supplements  RxFOOD and Structured Product Labels

29. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Supplements & Formulas – Class Structure

30. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off FoodNORM Similar to RxNORM for drugs  Avenue for substances without rate, dose, strength Use Structured Product Labeling pathway for provision of supplements and food through NLM

31. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Manufacturers FoodNORM Knowledge Based Systems SPL FoodNORM Codes EHR Role of GS1 Food/Products?

32. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off FDA and FoodNORM FDA – CFSAN has agreed to pilot Start with medical foods (supplemental enterals) Also exploring database of supplements through the NIH Office of Dietary Supplements

33. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Preferences Additional terms added to SNOMED-CT?  Examples Raw fruit Hot cereal Toddler foods

34. © 2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off FHIR Resources Nutrition Orders  In current publication Clinical Assessment  In current publication