Stream: implementers
Topic: Mapping Diet on FHIR
Domenico (May 04 2017 at 15:36):
Dear all,
I want to use FHIR to map the Diet prescribed/consumed by a specific patient. In my use case the Diet is a set of meal types (breakfast, lunch, dinner) and each meal type consists of a set of foods and beverages. I show you a possible an example in the following image.
Cattura.PNG
Diet has three meal types: breakfast, lunch and dinner. The breakfast consists of 200 milk, 2 units of cookies and a 1 cup of coffe. Lunch consists of 80 g of pasta, 30 ml of wine, 300 g of beef steak and 1 apple. Dinner consists of 400 g of fish, 150 g od salad and 100 g of potatoes.
My idea is to map this information using the resource CarePlan. In details I have 4 CarePlan resources: one for the diet, one for the breakfast, one for lunch and one for dinner. Since breakfast, lunch and dinner are component of diet the attribute “partOf” of the CarePlan representing the Diet contains three references:
- one reference for the CarePlan modelling breakfast
- one reference forthe CarePlan modelling lunch and
- one reference for the CarePlan modelling dinner.
Each CarePlan resource representing the meal type (breakfast, lunch and dinner) has a set of activities, one for each food or beverage. Consider, for example, the meal type “lunch” present in the figure (it consists of pasta, wine, beef steak and apple). There will be four CarePlan.activities and for each one of them there will be one CaraPlan.activites.detail. Each food/beverage present in lunch is mapped in this way:
- Pasta, 80 g: CarePlan.Activity.Detail.code=”pasta” (modelled as CodeableConcept), CarePlan.Activity.Detail.quantity.unit=”grams”, CarePlan.Activity.Detail.quantity.value=80.
- Wine, 30 ml: CarePlan.Activity.Detail.code=”wine” (modelled as CodeableConcept), CarePlan.Activity.Detail.quantity.unit=”millilitres”, CarePlan.Activity.Detail.quantity.value = 30.
- Beef staek, 300g: CarePlan.Activity.Detail.code=”beef steak” (modelled as CodeableConcept), CarePlan.Activity.Detail.quantity.unit=” grams”, CarePlan.Activity.Detail.quantity.value = 300.
- Apple, 1 unit: CarePlan.Activity.Detail.code=”apple” (modelled as CodeableConcept), CarePlan.Activity.Detail.quantity.unit=”unit”, CarePlan.Activity.Detail.quantity.value=1.
Breakfast and dinner (with their foods and beverages) are mapped on CarePlan in similar way of lunch.
In my use case of the Diet I need also to monitoring the activity to consume the foods/beverages (i.e. if the actions have been performed on no). My idea is to map this information using the Task resource, representing the intake activity of the single food/beverage, and create a reference in CarePlan.Activity.reference.
My questions are:
1) Is CarePlan the right resource to map Diet? I know that Fhir provides the NutritionOder Resource but I was not able to use it to map the Diet of my use case.
2) What is the difference between NutritionOrder and CaraPlan to map a Diet? When must I use the first and when the second?
3) Is my proposed mapping correct? if it is necessary, Can you suggest me any changes?
4) In my scenario the subject of the Diet can be both a patient that receive care (or other health-related service) and an individual without any problems that not receive any care or health-related service. In this case can I still use the CarePlan resource to map my diet? Must the subject of the CarePlan resource be only a patient that receive care or other health-related service?
5) Is the activity of consuming the food/beverage a Task Fhir Resource referenced in the CarePlan.Activity that represent the single food/beverage?
If the mapping on Fhir of my use case is wrong, can you provided a possible solution?
Thank you for your reply.
Bests regards,
Domenico
R&D lab
Engineenering Ingegneria Informatica S.p.A.
Eric Haas (May 04 2017 at 15:46):
Hi Domenico, I am pinging @Margaret Dittloff to help with this question. I worked with her and the academy of Nutrition and Dietetics to create this NutritionOrder resource based on the Domain model that they were instrumental in creating. Am interested to hear why the NutritionOrder resource is not meeting your needs.
Margaret Dittloff (May 04 2017 at 16:15):
Hi Domenico, This is a good use case. What you are capturing is not "diet" as it is defined in NutritionOrder and even v2/v3 messages as a nutrition therapy type of procedure (low carbohydrate diet) but the food intake data or observations. Food frequency, 24-hour recall or food records like your example (whether record/submitted by the pt or clinician) do need to be mapped. I'm not sure that the CarePlan activity as you have suggested. But we know we need this! We had been exploring similarities with our needs to state what the patient is doing/following by looking at how MedicationStatement has been modeled. I will add this to our next Nutrition on FHIR project call (bi-weekly Tuesdays at 6 PM ET). Can you join that next call on 5/16? @Eric Haas can you also join that one?
Domenico (May 04 2017 at 16:51):
Hi @Margaret Dittloff and @Eric Haas thanks for your replies. I am glad to attend the conf call, if you agree including some colleague of mine. I am actually in Italy with CEST timezone. Do you confirm you are in Eastern Time? it should be Wednesday 17 of May, 12 AM CEST, right? We can keep in touch in private for contact details to join to the conf call, if you like.
@Eric Haas a partial answer to your question is that I am not able to model with NutritionOrder "a breakfast with 200 ml of milk and one cookie", "at least two liters of water daily" and other similar things.
Antonio De Nigro (May 05 2017 at 07:47):
Hi Margaret, I'm a colleague of Domenico working on this topic in the context of European and National research projects. I understand and agree that the definitions of our "diet" and the NutritionOrder resource doesn't match very well. At a first glance, we investigated a possible use of NutritionOrder, then we moved to other Fhir resources. Our use case is a bit more complex of what described by Domenico. We have both the concepts of diet planned by someone (the clinician or the person by himself) and food intake by a subject. At the moment, we considered the CarePlan the most suited resource for the planned diet, because the diet in our use case could be considered a nutrition "plan". Looking at the definition of that resource (e.g. the description of the attribute product[x] in CarePlan.Activity.Detail) seems to confirm it, but as you also suggested we are not sure about this choice. Are you considering to extend the NutritionOrder resource or introduce new resources for this purposes? Concerning the food intake it could be an Observation or Procedure, but we also identified the Task resource suited for this purpose. I look forward to continue this discussion, maybe during the conf call or in further messages.
Mikael Rinnetmäki (Dec 09 2017 at 11:57):
@Margaret Dittloff What's the current status with the Nutrition on FHIR project? I found a page (http://wiki.hl7.org/index.php?title=Nutrition_Management) with notes from past telcos, but wasn't able to figure out current activities. I'd be interested in participating on the diabetes use case, especially tracking (estimated) carbohydrate intakes per meal. Data sources in my use case would be both nutrition logging apps and bolus (insulin dose) calculators.
Eric Haas (Dec 09 2017 at 16:17):
Just had a call with the nutrition folks who are looking at how to represent nutrition intake. We talked about profiling Observation vs new resource. I haven't seen all the requirements but will start with a profiles obs and see where that takes them. bottom line a work in progress. The general idea is mocked up here ( @David Hay's amazing ClinFHIR tool) : http://clinfhir.com/logicalModeller.html#9gms0
Eric Haas (Dec 09 2017 at 16:20):
Screen-Shot-2017-12-09-at-8.19.46-AM.png
Jose Costa Teixeira (Dec 09 2017 at 16:25):
@Eric Haas looking at the fields, this really is an administration.
Jose Costa Teixeira (Dec 09 2017 at 16:29):
for short-term and requirements validation, i think we can look at a profile, but i recommend that we follow up to see what is the best fit.
Jose Costa Teixeira (Dec 09 2017 at 16:29):
(btw, thanks for following up)
Eric Haas (Dec 09 2017 at 16:29):
I agree if it were its own resource, if a profille then would be a profile Observation.
Jose Costa Teixeira (Dec 09 2017 at 16:31):
my argument is that if an implementer has to register giving a food supplement, then their doubt should be between nutritionAdministration and medicationAdministration - which would be very similar in terms of data and metadata.
the doubt should not be between a medicatonAdministration and an obervation.
Jose Costa Teixeira (Dec 09 2017 at 16:33):
i just wanted to raise this, and do my best that observation does not become the swiss army knife for saying "here's some information", and that we avoid the pain with the many OBXs out there that are all HL7 compatible but not interoperable.
Eric Haas (Dec 09 2017 at 16:34):
crossed that Rubicon a while back I'm afraid
Eric Haas (Dec 09 2017 at 16:34):
Composition is getting there too
Jose Costa Teixeira (Dec 09 2017 at 16:37):
ok. i think that this is a good topic for the WGM - the pattern "ordering xxxx, delivering xxxx, informing about intake of xxxx", possibly "defining xxxx" and see where this should apply - so that we don't have to repeat the effort for every new resource like glasses, prosthesis, blood, nutrition, organs...
Margaret Dittloff (Dec 10 2017 at 22:23):
@Mikael Rinnetmäki Thanks for pointng out our missing minutes. I have updated the Nutrition Mgmt wiki page and also added slide presentions on the nutrition intake use cases we are trying to resolve. Last week the nutrition group presented our requirements and existing gap analysis to PatientCare (see PC FHIR call minutes from Dec 7th). I was traveling and unable to join that call but it sounds like the recommendation is to try to create an intake profile on Observation. One outstanding quesiton with that is how to handle the use case where dietitiant wants to send a recommended "menu or meal plan" - specific set of foods and amounts to be eaten (so a planned or future state). For your use case for related to insulin dose do you need to represent the event itself separetly like MedicationAdministration / MedicationStatement works? We are scheduled to have a Nutrition subgroup call this Tuesday Dec 12 at 6 PM ET - Can you join that call to tell us more about your requirements?
Eric Haas (Dec 10 2017 at 23:01):
planned or proposed diets are on the request side ...so NutritionOrder. we have status for planned and proposed although in the request pattern is an intent element that captures it. We still have not a chance to work on harmonized NO with the request pattern.
Mikael Rinnetmäki (Dec 11 2017 at 06:34):
@Margaret Dittloff 6 PM ET is 1 AM my time, so at least a bit inconvenient. :)
Margaret Dittloff (Dec 11 2017 at 11:40):
@Mikael Rinnetmäki Yes, I figured as much.
Mikael Rinnetmäki (Dec 11 2017 at 19:14):
Our current plan for the bolus calculator use case is to store the (estimate based) carbohydrate intake as the NutritionIntake profiled observation, and the resulting insulin dose as a MedicationAdministration entry. The MedicationAdministration could include other information from the bolus calculator, and perhaps have a reference to the NutritionIntake observation. Meal logging apps would just store the NutritionIntake observation.
Mikael Rinnetmäki (Aug 13 2018 at 20:00):
We're about to start defining and profiling both nutrition intake and diet recommendations in Finland soon. At least three different apps will be exchanging this information, on top of the #finnish PHR platform. @Margaret Dittloff @Eric Haas @Jose Costa Teixeira can you please let me know whether you know how things have progressed since we last discussed this?
Margaret Dittloff (Aug 13 2018 at 20:35):
@Mikael Rinnetmäki That is great to hear. AFAIK not much has changed. Our nutrition workgroup has not met since last Fall when folks were directed toward Observation resource . so no work on an intake profile has really taken off. NutritionOrder still needs worflow harmonization, correct @Eric Haas ? The CrowdHealth project in Italy is also using a mapping from their model to FHIR Observation for nutrition intake. @Francesco T recently sent me those models. Perhaps we should reconvene our group to meet before WGM?
Last updated: Apr 12 2022 at 19:14 UTC
