ToC+Clinical+Information+Model+WG+Meeting+10-13-2011

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ToC CIM Vocab WG Meeting Minutes

 * Date:** 10-13-2011
 * Time:** 1:00-2:00pm EDT
 * Dial-in:** 1-408-600-3600 | **Passcode:** 660 213 377

Attendance
Amy Berk, Margaret Dittloff, Ernest Grove, Lindsey Hoggle, Emma Jones, Les Keepper John King, Anne Kling, Russell Leftwich, Holly Miller, Adrienne Pugh, John Snyder, Ashley Swain, Cyndalynn Tilley, Bob Yencha

Action Items

 * **#** || **Date Initiated** || **Action** || **Owner** || **Status** || **Date Closed** ||
 * 1 || 10-13-2011 || Begin transfer the data elements from PowerPoint Presentations into a overall B/C CIM document || Harmonization Team || Open ||  ||
 * 2 || 9-29-2011 || Continue development of the BCD data element sets || Volunteers || Open ||  ||
 * 3 || 10-6-2011 || Review the [|BC Data Element PowerPoint] and provide comments & revisions on [|discussion page] || Volunteers || Open ||  ||

Agenda Items

 * 1) Welcome and Announcements (Meredith Lewis)
 * 2) Review "Diet" of Data Elements (Lindsey Hoggle)
 * 3) Review of BC Data elements (WG Leads)
 * 4) Next Steps (WG Leads)

Meeting Notes

 * Diet Overview
 * Background of Nutrition Standards
 * Nutrition professionals in all forms of care use a process called the Nutrition Care Process (NCP), a process used by dieticians to provide a plan of care
 * NCP includes four main steps Nutrition Assessment, Diagnosis, Intervention, and Monitoring & Evaluation
 * Each step has a set of standardized terms published by the Academy for Nutrition and Dietetics (AND) and as the International Dietetics & Nutrition Terminology (IDNT).
 * Work is currently underway to submit these terms to SNOMED-CT. The narrative summary and underlying IDNT codes would represent the nutrition and diet data that should be included in clinical summaries, nutrition consult request summaries, as well as discharge summary and instructions.
 * Use of Nutrition Care processed standardized language has increased over time after the latest study Nutrition Informatics Survey 2011 HIMSS Analytics
 * IDNT-SNOMED Project summary, a project to map the terms and headings into SNOMED CT
 * Aside from the HL7 nutritional model, the only other additional nutritional model is the Federal Health Information Model, a model of healthcare data developed for federal agencies, the Veterans Administration; untested.
 * The presentation than covered the potential data elements that could be incorporated under Diet and more specifically "Nutrition Intervention"
 * Diet
 * The diet that has been ordered or recommended by the clinician. (Distinct from the diet that the patient reports they follow, e.g. a vegetarian diet). Diet appears in 2 places. The first is the diet that has been “ordered” or recommended by the clinician. The second is the diet that the patient is actually consuming. This second instance will be for patient self-monitoring.
 * Diet Narrative
 * Records a narrative description of the expectations for diet, including proposals, goals and order requests for monitoring, tracking, or improving the dietary control of the patient, used in a discharge from a facility such as an emergency department, hospital, or nursing home.
 * Nutritional Assessment
 * Food and Nutrition related indicators which are used to evaluate the nutritional status of the patient. Five general categories used to evaluate and later assess outcomes are:
 * 1) Food/Nutrition-Related History Outcomes (Food & nutrient intake, food & nutrient administration, medication/herbal supplement use, knowledge/beliefs, food & supplies availability, physical activity, nutrition quality of life)
 * 2) Anthropometric Measurement Outcomes (height, weight, body mass index (BMI), growth pattern indices/percentile ranks, and weight history)
 * 3) Biochemical Data, Medical Tests and Procedures (Lab data (e.g. electrolytes, glucose) and tests (e.g. gastric emptying time, resting metabolic rate)
 * 4) Nutrition-Focused Physical Finding Outcomes (Physical appearance, muscle & fat wasting, swallow function, appetite and affect)
 * 5) Client History (Personal history, medical/health/family history, treatments and complementary/alternative medicine use, and social history)
 * Nutrition Diagnosis
 * Identification and labeling of a nutrition problem that a food and nutrition professional is responsible for treating independently.
 * PES Statement (Problem/Etiology Signs/Symptoms)
 * Problem or Nutrition Diagnosis Label (Describes alterations in the patient’s nutritional status) Etiology (Cause/Contributing factors linked to the nutrition diagnosis ) Signs/Symptoms (Data used to determine that the patient has the nutrition diagnosis specified, linked to etiology)
 * Nutrition Prescription
 * The patient’s individualized recommended dietary intake of energy and/or selected foods or nutrients based on current reference standards and dietary guidelines and the patient’s health condition and nutrition diagnosis.
 * Nutrition Intervention
 * Purposefully planned actions intended to positively change a nutrition-related behavior, environmental condition, or aspect of health status for an individual (and his or her family or caregivers), target group, or the community at large. A food and nutrition professional works in conjunction with the patient/client(s) and other health care providers, programs, or agencies during the nutrition intervention phase.
 * Patient Instructions
 * Mostly free text but essentially directions to the patient which have been agreed upon between dietitian and patient and conform to diet order, goals and care plan.
 * Nutrition/ Diet Order (Detail)
 * Have conducted a informative ballot with the information model and will plan to reballot the model in the Spring
 * The data elements have been pulled from the previous ballot
 * Diet Description
 * Narrative description of the recommended diet or daily nutrient intake
 * Diet Type Code
 * Set of codes that controls the type of diet modification that a patient should receive or follow
 * Texture Modification Required
 * Indicator specifying whether the patient/client requires food texture modifications
 * Texture Modifier Code
 * Describes the consistency or how the food or type of food should be modified for consumption.
 * Food Type Code
 * Indicates what type of food, e.g., meats, or liquids, require a texture modification
 * Nutrient Modification Required
 * Indicator specifying whether the patient/client requires a therapeutic or modified diet to eliminate, decrease, or increase certain substances in the diet (e.g., sodium, potassium)
 * Nutrient Type Code
 * Code which identifies the nutrient which is to be modified
 * Quantity/Quantity Modifier
 * Indicates how much of the nutrient is being ordered - However it could be two elements within the information model
 * Ultimate goal is identify Nutrition Care Provider
 * The data elements assigned entity, clinician contact info, effective time, healthcare provider info
 * Final Piece of Process is Nutrition Monitoring & Evaluation
 * Utilization of consistent data longitudinally for the purpose of evaluation and outcomes. Includes both patient evaluation of goals, re-assessment of existing parameters and evaluation of new data.
 * Lindsey then identifies potential data elements for the A, B & C data groupings from a Diet perspective
 * In terms of the nutrition care process, there are three large major vendor who have the product developed and licensed for over 150+ hospitals
 * Additionally, there are physicians in private practices who have bought licenses for the nutrition care process software
 * B/C Data Element Review
 * Meredith continued a review of a presentation from last week that contained the B/C data element groups, and supporting data elements, that were assigned to the Harmonization Team. The presentation is available on the BCD data elements wiki page, under works in progress.
 * The Care Team Members group should be a presentation of what is aligned in the Provider Directory data set and an individual role's for the care of a particular patient could potentially be another data element


 * Next Steps**
 * Continue adherence to Roadmap and build out of B,C Data Elements
 * Begin transfer of B/C Data element groups from Powerpoints by Lindsey Hoggle and the Harmonization team to a comprehensive ToC CIM

Next Meeting

 * Date:** 10-27-2011
 * Time:**1:00-2:00pm EDT

Reference Materials

 * 1) TOC Clinical Information Model
 * 2) TOC BCD Data Element Roadmap
 * 3) TOC Classification of Data Elements

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