Stream: implementers
Topic: observation about food consumed
John Timm (Sep 26 2019 at 13:14):
Is observation the best way to represent a meal that was consumed by a patient? Does anyone have advice on this subject? Any best practices or implementation guides out there?
John Timm (Sep 26 2019 at 14:02):
Would something like this suffice?
{
"resourceType": "Observation",
"status": "final",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "226379006",
"display": "Food intake"
}
]
},
"component": [
{
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "226441002",
"display": "Fish intake"
}
]
},
"valueQuantity": {
"value": 250,
"unit": "grams",
"system": "http://unitsofmeasure.org",
"code": "g"
}
},
{
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "226404003",
"display": "Milk intake"
}
]
},
"valueQuantity": {
"value": 1,
"unit": "cup",
"system": "http://unitsofmeasure.org",
"code": "[cup_us]"
}
}
]
}
Lee Surprenant (Sep 26 2019 at 14:09):
Given presence of NutritionOrder (which seems like it should be NutritionRequest), would it make sense to have something analogous to MedicationStatement but for food/Nutrition?
Michel Rutten (Sep 26 2019 at 14:11):
Something like NutritionDispense/NutritionAdministration?
Jean Duteau (Sep 26 2019 at 14:13):
That is actually being worked on. It was discussed in Atlanta and the Nutrition sub-group of O&O is working on that. There were discussions with Pharmacy about whether MedicationUsage could be re-used but there was enough differences that the NutritionIntake or NutritionUsage resource will be separate.
Lee Surprenant (Sep 26 2019 at 14:14):
Cool. Would they mirror what Pharmacy has done with MedicationAdministration vs MedicationStatement for administerred vs patient-reported statements?
Jean Duteau (Sep 26 2019 at 14:15):
i don't think so. so far, it's just been talk of one resource for any statement about what a patient has been consuming
John Timm (Sep 26 2019 at 14:38):
How are people using Observation for representing historical food intake today?
Dave Carlson (Sep 26 2019 at 15:38):
@Becky Gradl ? We've discussed the idea of NutritionStatement in the past, statements made by patient.
John Silva (Sep 27 2019 at 09:44):
Would the NutritionIntake have the ability to record the list of nutrients in the food product as well as volumes since sometimes the volume of the fluids are important for intake and net fluid balance totals, especially for neonates where these volumes are more significant.
Jose Costa Teixeira (Sep 27 2019 at 09:48):
We promised to start the discussion calls soon, so hopefully as of next week.
My first take is that we should have the ability to record a nutrition product (e.g. baby formula) and assert the ingredients or nutrients in that product.
Jose Costa Teixeira (Sep 27 2019 at 09:50):
This would allow us to keep it simple for common uses ("60 ml of baby formula X every 4 hours"), but allow for a detailed description where needed ("60 ml of baby formula X which contains the following stuff...")
Jose Costa Teixeira (Sep 27 2019 at 09:54):
This should also work if we want to express ingredients in the definitional side or the instance side.
(definitional= definition of product is defined off the shelf e.g. "baby took 60 ml formula X which is normally mixed with 60 ml water"
instance= each instance can be defined differently "for this baby we used 2 spoons of powder in 70 ml water")
Jose Costa Teixeira (Sep 27 2019 at 09:54):
does that cover the question?
John Timm (Sep 27 2019 at 14:44):
It's good to hear that folks are thinking about this and that there will eventually be a more tailored solution to the problem. What I'd like to know at this point, however, is what folks are using today with R4 and if it is an Observation, are there some examples? are there any R4 profiles around this?
Michele Mottini (Sep 27 2019 at 16:05):
I never saw anyone storing / returning food data using FHIR. Using observations as you suggested seems totally fine - some systems _might_ have problems handling components, but easy enough to just split it into multiple observations if that's the case
Becky Gradl (Oct 04 2019 at 15:22):
The nutrition group put up a NutritionIntake resource prior to the Atlanta Connectathon in the hopes that it could be tested. It can be found here: http://build.fhir.org/nutritionintake.html. It definitely needs some more work. The thought is that nutritionProduct will become another resource, similar to medication where food items and their associated nutrients (calories, protein, carbohydrates, vitamins, minerals, etc). can be recorded. The group did discuss earlier this year if there should be a NutritionAdministration and NutritionUsage, similar to the medication resources, but decided we did not need to capture nutrition information with two resources, so we just created NutritionIntake.
I did meet with the Pharmacy WG in Atlanta to discuss the use of their medication related resources, but we found too many difference to make their resources generic enough to account for food, so instead, we will create nutrition resources similar to some of the medication ones.
There are calls on Fridays at 2PM ET where we discuss the nutrition resources; here is the link to today's call: http://www.hl7.org/concalls/CallDetails.aspx?concall=46114. Details of our work can be found here: https://confluence.hl7.org/display/OO/Nutrition
Mikael Rinnetmäki (Oct 06 2019 at 07:32):
In the scope of #finnish PHR, we have profiled the Observation resource with a Nutrition profile (https://simplifier.net/finnishphr/fiphr-sd-nutrition-stu3), a Fluid Intake profile (https://simplifier.net/finnishphr/fiphr-sd-fluidintake-stu3), a Macronutrient Intake profile (https://simplifier.net/finnishphr/fiphr-sd-macronutrientintake-stu3), and a Calorie Intake profile (https://simplifier.net/finnishphr/fiphr-sd-calorieintake-stu3). Happy to discuss the thought process behind this, if there is interest.
Mark Kramer (Oct 10 2019 at 20:00):
It would be better from my point of view if this idea of nutritional intake were generalized to exposure to any substance that could be ingested, smoked, injected, rubbed on the skin, etc. Exposure could then be generalized to environmental exposure, foods, drugs, tobacco, alcohol, etc.
Grahame Grieve (Oct 11 2019 at 02:23):
Sounds like a V3 SubstanceAdministration. But there's a price to be paid for generalization (see the God Class anti-pattern).
Lloyd McKenzie (Oct 11 2019 at 03:18):
The general rule in FHIR is - how do existing systems typically scope the content. A resource that spans wide breadth generally only makes sense if systems use the same persistence structure/user interface to span that same breadth
Michael Lawley (Oct 16 2019 at 06:51):
food consumed is also of great interest to people with type 1 diabetes (especially those looping) as well as elite sports. Probably also space medicine.
Last updated: Apr 12 2022 at 19:14 UTC
