Interoperability and Health Information Standards

Interoperability ensures that health information is secure, accessible, and can be exchanged between health information systems for the purposes of demonstrating and improving health care outcomes including nutrition outcomes. Health information technology standards provide the expectations and rules for data sharing among health information systems. The international standards setting organization for electronic health records (EHRs) is Health Level Seven (HL7). Standards, combined with standardized health terminologies, promotes meaningful exchange of health information.

Through CDR’s Interoperability and Standards Committee, nutrition standards are developed to ensure that the nutrition care process is included and represented correctly in healthcare standards. These standards are intended to improve the efficiency of outcomes data collection, decision support, quality, and streamline nutrition care workflow.

The dedicated space for nutrition on HL7’s confluence platform is available and confluence accounts are free to anyone: https://confluence.hl7.org/display/OO/Nutrition. 

Standards published to support the nutrition care process:

• HL7 Domain Analysis Model for Nutrition Care, Release 3, STU (standard for trial use) published in December 2022: Provides the business use case for nutrition and shows workflow activity diagrams, information models with the flow of data, and other details of  nutrition care. While previous version focused only on diet orders of inpatients, this version includes the entire nutrition care process and includes outpatient examples as well.  Submit feedback
• HL7 EHR-System Electronic Nutrition Care Process Record System (ENCPRS) Functional Profile, Release 2: Details the functions that should be contained in an electronic health records (EHR) to support the nutrition care process (NCP) and the terms from the nutrition care process terminology (NCPT) promoting information interoperability between nutrition, food systems, and other areas of healthcare.
• HL7 Fast Healthcare Interoperability Resource (FHIR) Release 4B, NutritionOrder: Using the newest type of HL7 standard, this resource describes a request for oral diets, oral nutrition supplements, enteral nutrition, and infant formula in the inpatient setting as well as other settings (eg, outpatient, home health). Although not published yet, the newly drafted FHIR Release 5 includes NutritionIntake and NutritionProduct in addition to NutritionOrder.
• HL7 Version 3 Standard, Care Provision; Food and Medication Preferences, Release 1: Food and medication preferences can be communicated using this messaging specification standard.

Starting in 2007 and approximately every three to four years following, the Academy has conducted a survey related to the use of technology by nutrition and dietetics practitioners. The most recent publication: Hamady CM, Pellechia K, Atkinson BE, et al. 2019 Nutrition Informatics Survey: Results and Future Directions. J Acad Nutr Diet. 2021;121(11):2301-2309. doi:10.1016/j.jand.2020.12.009 (sign-in required)

• Global Malnutrition Composite Score (GMCS)  
• Nutrition Care Process and Terminology, eNCPT (ncpro.org) (sign-in required)
• Academy of Nutrition and Dietetics’ Nutrition Informatics Dietetics Practice Group
• Freely available Nutrition Care Process terms
• Academy of Nutrition and Dietetics’ Health Informatics Infrastructure (ANDHII) (sign-in required)
• US Office of the National Coordinator for Health Information Technology (ONC)
  • CDR Provides Comments for ISA 2023 and USCDI Version 5