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  1. FHIR Specification Feedback
  2. FHIR-41338

Create extension profile for NutritionIntake

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US QI Core (FHIR)
    • current
    • Clinical Quality Information
    • NutrientOrder example
      QICore NutritionOrder
    • QI-Core Profiles
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      Create an extension Nutrition Intake profile based on the FHIR R5 resource [NutritionIntake|https://hl7.org/fhir/nutritionintake.html] for use by measure developers to create expressions to retrieve information about documented nutrition intake by patients.

      Recommended MustSupport elements for the proposed profile:

      These element designations were reviewed with Orders and Observations WG on a conference call June 28, 2023.

      There is no need for a negation profile for NutritionIntake since the only consumedItem.notConsumed if documented would be for specific items that are part of an identified diet.  Note that NutritionIntake.code is not listed since that references a diet type which is not relevant to the eCQM use case identified. Rather than a negation profile, a measure expression should indicate notExists NutritionIntake for .consumedItem that would not be measure intent. Guidance to this effect is needed as is an Exclusive Breast Milk Feeding pattern example to support its use.

      ConsumedItem.nutritionProduct = breast milk and notExists consumedItem.nutritionProduct = All non-breast milk substances

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      Create an extension Nutrition Intake profile based on the FHIR R5 resource [NutritionIntake| https://hl7.org/fhir/nutritionintake.html ] for use by measure developers to create expressions to retrieve information about documented nutrition intake by patients. Recommended MustSupport elements for the proposed profile: NutritionIntake status - value set binding to [EventStatus| EventStatus ] required subject (reference QICorePatient) encounter (encounter associated with nutritionIntake - CONSIDER) { } occurrence[x] dateTime consumedItem cardinality 1..* consumedItem. type cardinality 1..1 preferred binding to Types of Edible Substances consumedItem.nutritionProduct cardinality 1..1 preferred binding to Food Type Codes These element designations were reviewed with Orders and Observations WG on a conference call June 28, 2023. There is no need for a negation profile for NutritionIntake since the only consumedItem.notConsumed if documented would be for specific items that are part of an identified diet.  Note that NutritionIntake.code is not listed since that references a diet type which is not relevant to the eCQM use case identified. Rather than a negation profile, a measure expression should indicate notExists NutritionIntake for .consumedItem that would not be measure intent. Guidance to this effect is needed as is an Exclusive Breast Milk Feeding pattern example to support its use. ConsumedItem.nutritionProduct = breast milk and notExists consumedItem.nutritionProduct = All non-breast milk substances
    • Floyd Eisenberg/Jen Seeman: 24-0-0
    • Enhancement
    • Compatible, substantive

    Description

      QI-Core 5.0 and previous versions have included a [NutritionOrder|http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-nutritionorder.html|http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-nutritionorder.html] profile which fails to meet the need for its intended purpose. See related tracker FHIR-41337. The intent that led to inclusion of NutritionOrder was basically to determine all intake received by a newborn in the hospital to assure it included only one substance at exclusion of all other substances. The way to address that intent is to identify the intake record in clinical systems.  FHIR R5 includes a new resource, [NutritionIntake|https://hl7.org/fhir/nutritionintake.html] which allows specification of nutrition (and other substances) received by a patient (orally, enterally, or otherwise). The resource is not yet available in FHIR R4 and its maturity level in FHIR R5 is only 1. That means that QI-Core would have to create a profile as an extension based on the FHIR R5 resource and that any use by a measure developer would be somewhat "experimental" for testing and evaluation. But, allowing such evaluation will help inform use of the profile.  

      Recommended MustSupport elements for the proposed profile:

      The new profile will require guidance regarding how to express the "not done" concepts handled for other QI-Core profile. The use case of determining NutritionIntake includes nutritionProduct = breast milk and nothing else could be identified by indicating something to the effect that NutritionIntake status=not-done for nutritionProduct = All non-breast milk substances.  It is not clear that QI-Core needs a NutritionIntakeNotDone profile but that requires discussion.

       

      Note that this request is orthogonal to other change requests for the September 2023 ballot (version 6.0). Many other requests are to keep QI-Core as close to US Core as possible. However, there are concepts required that US Core does not address and such concepts should be considered with the understanding that any user o such profiles must evaluate implementer feedback regarding feasibility and potential burden. This request falls into the category of new and/or considered additional data needs. 

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            jen_seeman Jennifer Seeman
            feisenberg Floyd Eisenberg
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