Guest Blogger: Margaret Dittloff, MS, RD (Vice-Chair, Nutrition Informatics Committee/Chair, Interoperability & Standards Sub-Committee)

You could say I have made standardizing diet orders an obsession.  It was critically important to me to make sure that ADA joined the world of standards development to make sure that diets were nutrition’s domain in the realm of HIT standards.  It all started about 18 months ago when I was alerted to changes going on within the Health Level Seven International’s (HL7) reference information model regarding how diets and diet orders were being classified.  A preliminary model was about to be created and it wasn’t clear where things were headed. 

To make a long story short, this was enough to get ADA’s Nutrition Informatics and Nutrition Care/Standardized Language committees aligned to help work on a project to standardize how diet orders will be transmitted using HL7 interfaces in the future.  HL7 is the global authority on standards for interoperability of health information technology with members in over 55 countries.  ADA is now an organizational voting member of HL7.  Most hospitals in the U.S. use HL7 version 2 standards to interface diet orders between Electronic Health Records/Computerized Provider Order Entry systems and computerized Food & Nutrition Management/Diet Office software systems. 

HL7 version 3, the next generation of standards currently under development, aims to improve interoperability among systems by utilizing controlled vocabularies for coded data attributes.  Moving towards defining a controlled vocabulary for diets is one step towards the real ability to share information about the nutrition interventions for patients and clients.  Won’t it be amazing to be able to pull up your Personal Health Record (PHR) and see the details for your discharge diet from your most recent hospitalization outlined in your copy of the Discharge Summary as part of your Transitions of Care package?  Wouldn’t it be even better if the details listed there stating you should follow a “Low fat, low-salt, cardiac” diet were defined and understood by all health and nutrition professionals across the country or even the world?  We are working hard toward that goal. 

ADA has collaborated with HL7 to create a nutrition and diet order model that will form the foundation of future work toward standardizing diets and the electronic exchange of diet order information. Our initial work on a Diet and Nutrition Orders Domain Analysis Model is now open for ballot.   This is the first “informative” ballot of the Nutrition Orders Domain Analysis Model and it is a work in progress. 

Our ultimate goal is to develop V3 Clinical Messages and V3 Clinical Documents to support the exchange of information between nutrition care providers, foodservice operations responsible for feeding patients and residents in all levels of care and other healthcare providers.  Members of HL7 or those who work in HL7-member healthcare organizations are encouraged to sign up by August 30, 2011 for the Diet and Nutrition Orders Domain Analysis Model ballot pool on the HL7 website and submit comments.

To review the diet order model materials, follow these steps:

1. Open a web browser

2. Go To: http://www.hl7.org/v3ballot/html/welcome/environment/index.html

3. Under Section 2 Welcome, click on: V3 Ballot Packages - this section lists      ballotable documents in this ballot web site. You can use it to quickly identify the location of ballot items. GO HERE FIRST!!!

4. Under Section 4.1.2 Domain Analysis Model, Click on: Diet and Nutrition Orders Domain Analysis Model, Release 2

If you are a member of HL7 or work in an HL7 healthcare organization, you can submit comments by following these steps:

1. Open a web browser

2. Go To: http://www.hl7.org/v3ballot/html/welcome/environment/index.html

3. Under Section 2 Welcome, click on: HL7 V3 Ballot Instructions - this section provides information helpful in completing the HL7 V3 ballot.

If you are not a member of HL7 but would like to submit comments, contact lhoggle@eatright.org and we can compile comments on your behalf.