This
page
is
part
of
the
FHIR
Specification
v6.0.0-ballot3:
Release
6
Ballot
(3rd
Draft)
(see
Ballot
Notes
).
The
current
version
is
5.0.0
.
For
a
full
list
Continuous
Integration
Build
of
available
versions,
see
FHIR
(will
be
incorrect/inconsistent
at
times).
See
the
Directory
of
published
versions
Note
to
Implementers:
This
module
page
describes
the
context
and
usage
of
Nutrition
and
related
resources.
This
module
supports
and
clarifies
the
traceability
requirements
for
nutrition.
HL7
seeks
specific
feedback
on
the
usefulness
of
this
module
page
and
the
implementability
of
the
referenced
resources.
The
future
location
and
navigation
links
to
this
module
are
outstanding
items
to
be
revisited
in
a
future
FHIR
version.
17.1
Introduction
The
Nutrition
module
in
FHIR
provides
a
structured
framework
to
document
and
manage
consumable
food,
drinks,
and
supplements
integral
to
patient
care.
It
captures
essential
information
on
nutrition-related
items
and
how
they
are
utilized,
whether
for
therapeutic
purposes
or
routine
consumption.
Nutrition
is
key
in
patient
care,
from
standard
diets
to
more
specialized
nutrition
delivery
systems.
For
more
inforamtion,
please
see
the
HL7
Domain
Analysis
Model:
Nutrition
Care,
Release
3
The
following
are
the
core
nutrition
related
resources:
Nutrition
Order
-
(also
known
as
Diet
Order,
Diet
,
Nutritional
Supplement,
Enteral
Nutrition)
Describes
a
request
for
oral
diets
(including
general
diets
such
as
General
Healthy
diet,
or
therapeutic
diets
such
as
Consistent
Carbohydrate,
2-gram
Sodium,
or
Fluid
Restricted),
oral
nutrition
supplements
(such
as
nutritionally
complete
pre-packed
drinks),
enteral
nutrition
(tube
feedings)
and
infant
formula
which
govern
the
distribution
of
food
and
nutritional
products.
Nutrition
Intake
-
Utilized
to
capture
details
about
the
consumption
of
foods,
fluids,
and
enteral
nutrition.
Nutrition
Product
-
Represents
the
identification
of
a
food
(i.e.,
solid
and/or
liquid)
product
consumed
by
patients.
17.3
Related
Resources
The
following
are
the
secondary
resources
that
are
used
in
many
nutrition
related
activities:
A
record
of
a
clinical
assessment
performed
to
determine
what
problem(s)
(Nutrition
Diagnosis)
may
affect
the
patient
and
before
planning
the
treatments
or
management
strategies
that
are
best
to
manage
a
patient's
condition.
Describes
the
intention
of
how
one
or
more
practitioners
intend
to
deliver
care
(Nutrition
Intervention)
for
a
particular
patient,
group
or
community
for
a
period
of
time,
possibly
limited
to
care
for
a
specific
condition
or
set
of
conditions.
Measurements
and
simple
assertions
made
about
a
patient
or
other
subject.
The
diagram
below
illustrates
the
relationship
between
the
related
resources
associated
with
nutrition
resources.
The
Nutrition
module
is
designed
to
differentiate
between
various
types
of
nutritional
intake
and
their
relevant
documentation:
NutritionIntake:
This
resource
is
used
to
document
the
intake
of
foods,
drinks,
oral
nutrition
supplements,
and
other
consumables
like
infant
formula
or
breastmilk.
It
records
patient
consumption—whether
past,
present,
or
planned—based
on
inputs
from
the
patient,
family
members,
or
healthcare
providers.
Add
examples
See
Nutrition
Intake
Examples
NutritionProduct:
Focuses
on
identifying
consumable
food
products,
both
solid
and
liquid,
intended
for
human
consumption.
This
includes
general
food
items,
beverages,
and
other
nutritional
consumables
used
in
patient
care
settings.
Add
examples
See
Nutrition
Product
Examples
NutritionOrder:
This
resource
describes
various
dietary
requests
made
for
patients.
It
includes
general
oral
diets
(e.g.,
General
Healthy
diet),
therapeutic
diets
(e.g.,
low-sodium
or
fluid-restricted
diets),
oral
nutrition
supplements,
enteral
feedings
(tube
feeding),
and
infant
formulas.
Add
examples
See
Nutrition
Order
Examples
17.4
Common
Use
Cases
Heart
Failure
Inpatient
Use
Case.
The
dietitian
performs
a
comprehensive
nutrition
assessment
(Observation).
The
dietitian
documents
the
patient's
admitted
weight
(65kg)
and
nutrition
history
(ClinicalImpression).
The
assessment
reveals
the
patient
adheres
to
a
low
sodium
diet.
The
patient
reports
decreased
food
intake
due
to
dental
issues
and
prefers
foods
that
are
easy
to
chew.
Additionally,
the
patient
is
lactose
intolerant
and
adheres
to
the
Halal
diet.
The
patient
also
reports
a
dislike
of
strawberries.
The
dietitian's
nutrition
diagnoses
(Condition)
are:
Excessive
sodium
intake
related
to
intake
of
processed
foods
at
home
as
evidenced
by
food
recall.
Excessive
fluid
intake
related
to
new
recommendation
to
restrict
fluid
intake
as
evidenced
by
client
statements
of
intake
of
~2.4
liters
of
fluid/day.
The
dietitian's
nutrition
intervention
care
plan
is
to
recommend
a
diet
that
includes
2gm
sodium,
1500ml
fluid
restriction,
mechanically
altered,
lactose-free,
and
Halal.
The
physician
reviews
the
dietitian's
recommendations.
The
physician
enters
a
comprehensive
diet
order
into
the
Computerized
Provider
Order
Entry
(CPOE)
system.
The
order
includes:
2gm
sodium
1500ml
fluid
restriction
Mechanically
altered
Lactose-free
Halal
diet
Dislikes
strawberries
The
diet
order
is
transmitted
to
the
Food
&
Nutrition
Services
via
an
HL7-compliant
interface
to
the
Food
&
Nutrition
Management
System
(FNMS).
The
dietitian
schedules
nutrition
monitoring
and
evaluation
of
the
patient's
acceptance
of
foods
consistent
with
NutritionOrder
as
well
as
goal
of
less
lower
extremity
edema
and
shortness
of
breath.
Outpatient/Ambulatory
Use
Case.
The
dietitian
performs
a
comprehensive
nutrition
assessment
(Observation).
A
52-year-old
male
was
seen
in
the
amyotrophic
lateral
sclerosis
(ALS)
clinic
regarding
placement
of
a
gastrostomy
tube
(GT)
as
they
have
been
losing
weight
and
respiratory
status
is
worsening
making
it
difficult
for
the
patient
to
take
medications,
to
eat,
and
to
maintain
weight.
In
the
multi-disciplinary
office
visit
including
the
speech
therapist
and
dietitian,
the
dietitian
identified
the
patient's
nutritional
status
to
be
moderate
malnutrition
(
Observation
).
Speech
therapy
noted
that
the
patient
requires
IDDSI
minced
and
moist
level
5
foods
and
IDDSI
mildly
thick
level
2
drinks.
Due
to
the
patient's
inadequate
oral
intake
meeting
<
50%
of
needs
and
weight
loss,
the
dietitian
also
recommended
placement
of
GT
with
750
mLs
of
a
high
protein
enteral
nutrition
feeding
via
an
evening
bolus
to
provide
750
kcals
and
45
gm
protein.
Nutrition
education
was
provided
pre-op
during
the
multi-disciplinary
office
visit.
Indication
for
G-tube
is:
Dysphagia,
increased
work
of
breathing.
The
dietitian's
nutrition
diagnosis
(Condition)
is
moderate
chronic
disease
or
condition
related
malnutrition
related
to
dysphagia
and
increased
work
of
breathing
as
evidenced
by
unintended
weight
loss
of
7
%
in
the
past
3
months,
moderate
temporalis
muscle
atrophy,
and
moderate
Interosseous
hand
muscle
atrophy.
Nutrition
Order
:
International
Dysphagia
Diet
Standardisation
Initiative
Framework
(IDDSI)
minced
and
moist
level
5
foods
and
IDDSI
mildly
thick
level
2
drinks.
Also,
GT
placement
to
supplement
oral
intake
with
750
mLs
of
a
high
protein
enteral
nutrition
formula
via
an
evening
bolus
via
gastrostomy
tube
to
provide
750
kcals
and
45
gm
protein.
After
reviewing
the
multidisciplinary
team's
note,
the
physician
entered
orders
for
insertion
of
a
gastrostomy
feeding
tube.
The
physician
also
entered
post-op
nutrition
orders
by
selecting
from
the
available
diet
and
enteral
nutrition
codes
in
the
CPOE
system:
Diet:
International
Dysphagia
Diet
Standardisation
Initiative
Framework
-
Minced
and
moist
Level
5
foods
The
NutritionOrder
is
sent
to
Food
&
Nutrition
Services
via
HL7-compliant
interface
transmitted
to
the
FNMS.
Durable
Medical
Equipment
(DME)
supplier
(tube
feed
&
tube
feedinb
supplies)
&
home
care
agency.
The
enteral
home
care
company
provides
enteral
feeding
supplies
and
instructions
for
the
patient
and
caregivers
at
home
based
on
the
referral
from
the
ALS
clinic
physician.
The
patient
will
follow-up
with
speech
therapy
and
dietitian
at
the
next
multidisciplinary
clinic
visit
for
speech
and
nutrition
monitoring
and
evaluation
of
the
care
plan
with
revisions
as
needed.
Malnutrition
Case
in
Long-Term
Care
Setting
Use
Case.
The
dietitian
performs
a
comprehensive
nutrition
assessment
(Observation)
on
a
60-year-old
male
patient
with
Alzheimer's
disease
in
a
long-term
care
setting.
The
dietitian
documents
(ClinicalImpression):
Patient's
age:
60
years
old
Recent
unintentional
weight
loss:
15
lbs
(6%)
in
1
month
Nutrition-Focused
Physical
Exam
(NFPE)
results:
Indicates
moderate
deltoid
and
quadriceps
muscle
atrophy
and
moderate
subcutaneous
fat
loss
(Observation).
The
dietitian's
nutrition
diagnosis
(Condition)
is
Moderate
chronic
disease
or
condition
related
malnutrition
due
to
decreased
appetite
as
evidenced
by
6%
unplanned
weight
loss
in
1
month
and
moderate
deltoid
and
quadriceps
muscle
atrophy
and
moderate
subcutaneous
fat
loss.
Oral
nutrition
supplement:
Standard
pudding
supplement,
1
serving
3
times
per
day
with
meals
Allowing
the
patient's
daughter
to
bring
favorite
foods
from
home
Staff
to
document
food
intake
(NutritionIntake)
Patient
reports
the
food
and
fluid
consumed
(NutritionIntake)
Goal:
75%
of
nutritional
needs
are
met
daily,
maintain
weight
or
weight
gain
The
physician
reviews
the
dietitian's
care
plan.
The
physician
enters
a
comprehensive
diet
order
into
the
Computerized
Provider
Order
Entry
(CPOE)
system.
The
order
includes:
Regular
diet
Increased
energy
diet
Increased
protein
diet
Oral
nutrition
supplement:
Standard
pudding
supplement,
1
serving
3
times
per
day
with
meals
Allow
patient's
daughter
to
bring
favorite
foods
from
home
Staff
to
document
meals
and
supplements
consumed
Staff
to
obtain
weekly
weights
The
diet
order
is
transmitted
to
Food
&
Nutrition
Services
via
an
HL7-compliant
interface.
The
nursing
staff
is
notified
of
the
new
diet
order
and
supplementation
schedule.
The
long-term
care
facility's
kitchen
staff
is
informed
about
the
increased
energy
and
protein
requirements
for
the
patient's
meals
and
supplement
order.
The
facility's
staff
is
instructed
to
document
the
patient's
food
intake
,
including
regular
meals,
supplements,
and
foods
brought
from
home.
Patient
reports
the
food
and
fluid
consumed.
The
dietitian
meets
with
the
patient's
daughter
to
discuss
the
nutrition
care
plan
and
is
encouraged
to
bring
the
patient's
favorite
foods
from
home.
The
dietitian
schedules
regular
nutrition
monitoring
and
evaluation
per
MDS
(Minimum
Data
Set)
requirements
to
track
the
patient's
weight,
intake,
and
nutritional
status,
adjusting
the
nutrition
care
plan
as
needed.
Human
Milk
Use
Case.
Infant
is
delivered
and
admitted
to
Mother/Parent-Baby
unit
Interprofessional
team
provides
education
on
breastfeeding
and
determines
parent
desired
feeding
plan.
Medical
provider
refers
neonate
to
Registered
Dietitian
Nutritionist
(RDN)
for
nutrition
assessment
and
management
(composition
and
advancement)
of
enteral
feeding.
Documentation
is
in
the
electronic
health
record
(EHR)
implementing
the
Nutrition
Care
Process.
RDN
prescribed
feedings
are
initiated.
Upon
follow
up
and
monitoring
and
evaluation,
feeding
tolerance
is
assessed
and
Care
Plan
and
Goal
developed.
Human
milk
fortifier
(HMF)
at
22kcal/oz
is
added
to
the
Nutrition
Order.
After
a
few
more
days,
the
neonate
currently
weighs
1400
grams
and
has
symptoms
of
feeding
intolerance.
Nutrition
follow
up
conducted
and
infants
condition
are
modified
accordingly
to
reflect
noted
feeding
intolerance.
The
care
team,
including
the
neonate’s
mother,
agrees
to
try
a
treatment
formula
(amino
acid
formula)
infant
formula
at
22kcal/oz
continuing
advancing
by
20ml/kg
per
day
to
a
goal
rate
of
160ml/kg
per
day.
Documentation
and
prescription
are
entered
into
the
EHR.
After
treatment
period
is
complete
(about
2
weeks),
the
treatment
formula
is
discontinued
and
feedings
with
22kcal/oz
of
fortified
mother’s
(donor)
milk
are
resumed
at
the
previous
goal
of
160ml/kg
per
day.
Neonate
demonstrates
satisfactory
growth
and
current
weight
is
now
1800
grams.
Documentation
and
prescription
are
entered
in
the
EHR.
17.5
Security
and
Privacy
The
Nutrition
resources
typically
represent
patient-specific
data,
and
as
such
are
susceptible
to
data
breaching.
Necessary
privacy
and
security
provisions
must
be
in
place
when
searching
and
fetching
this
information.
For
more
general
considerations,
see
the
Security
and
Privacy
module
.
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