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12.20 Resource NutritionIntake - Content

Orders and Observations icon Work GroupMaturity Level: 3 Trial UseSecurity Category: Patient Compartments: Encounter, Group, Patient, Practitioner, RelatedPerson

A record of intake by a patient. A NutritionIntake may indicate that the patient may be consuming the food (i.e., solid and/or liquid), breastmilk, infant formula, supplements, enteral formula now or has consumed it in the past. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay or through an app that tracks food (i.e., solid and/or liquid), breastmilk, infant formula, supplements, enteral formula consumed. The consumption information may come from sources such as the patient's memory, from a nutrition label, or from a clinician documenting observed intake.

12.20.1 Scope and Usage

Note to Implementers: For an overview of this resource and others in the Nutrition domain, also see the module page.

This resource is an event resource from a FHIR workflow perspective - see Workflow. It is the intent of the Orders and Observation Workgroup to align this resource with the workflow pattern for event resources.

The NutritionIntake resource, in conjunction with the NutritionProduct resource, is utilized to capture details about the consumption of foods (i.e., solid and/or liquid), supplements, enteral nutrition, and infant formula. Dietitians and other practitioners use the data to calculate how much nutrition a patient has taken in. NutritionIntake represents the event of consuming food (i.e. solid and/or liquid), etc. and NutritionProduct represents the actual food and formula items.

NutritionIntake can also be used to record a person’s intake through the use of food tracking apps (e.g.MyFitnessPal), inpatient hospital consumption or administration, or a student’s meal consumption in a school district.

NutritionIntake can be utilized in many environments where food is served or consumed: hospitals/acute care, meal tracking systems, enteral or supplement in a home setting, outpatient settings, long-term care, etc. NutritionIntake should be general enough to capture intake regardless of country or region.

Parenteral nutrition is out of scope as this ordering is handled through MedicationRequest, thus administration of parenteral nutrition should also be captured through MedicationAdministration.

12.20.2 Boundaries and Relationships

  • Intake of food (i.e. solid and/or liquid), oral nutritional supplements, enteral nutrition, or infant formula should be recorded using the NutritionIntake resource.
  • Supplements, such as vitamins, minerals, and herbals, should be recorded using the medication resources
  • Parenteral nutrition should be recorded using the medication resources

12.20.3 Background and Context

As a dietitian, it is important to be able to know what a person is consuming and/or administered to assess the adequacy of the patient’s intake. Capturing a patient’s intake is important to establish a baseline, determine care, track trends, and see improvement in that patient. Dietitians might use intake data to see patterns, such as when a diabetic patient’s blood glucose is consistently high given the distribution of carbohydrates. Other practitioners have the need to monitor intake as well; for example, a nurse might need to know intake for administering insulin prior to meals, a speech therapist needs this information for ensuring safe administration of food, or a physician may need to ensure a patient fluid restriction is consistent with recommendations.

Having intake documented within its own resource allows for consistency in documentation across multiple disciplines and settings. In some instances, the Observation resource has been extended to capture intake; while this allows for a quick way to document intake, the Observation resource does not provide all the detail necessary, such as capturing energy and nutrients (including vitamins, minerals, carbohydrates, etc.). Previous implementation attempts of using the Observation resource have noted this is cumbersome and has required too many extensions without being able to document all the necessary details tied to ingredients in food (i.e., solid and/or liquid) products.

12.20.4 References to this Resource

  • Implements: Event
  • Resource References: Goal and itself

12.20.5 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. NutritionIntake TU DomainResource Record of intake by a patient

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ 0..* Identifier External identifier

... basedOn Σ 0..* Reference(NutritionOrder | CarePlan | ServiceRequest) Fulfils plan, proposal or order

... partOf Σ 0..* Reference(NutritionIntake | Procedure | Observation) Part of referenced event

... statusReason 0..* CodeableConcept Reason for current status
Binding: Nutrition Intake Status Reason (Example)

... code Σ 0..1 CodeableConcept Code representing an overall type of nutrition intake
Binding: Diet Codes (Preferred)
... subject Σ 1..1 Reference(Patient | Group) Who is/was consuming the food (i.e. solid and/or liquid)
... encounter Σ 0..1 Reference(Encounter) Encounter associated with NutritionIntake
... occurrence[x] Σ 0..1 The date/time or interval when the food (i.e. solid and/or liquid) is/was consumed
.... occurrenceDateTime dateTime
.... occurrencePeriod Period
... recorded Σ 0..1 dateTime When the intake was recorded
... reported[x] 0..1 Indicates if this is a reported rather than a primary record. Can also indicate the source that provided the information about the consumption
.... reportedBoolean boolean
.... reportedReference Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization | Group)
... nutritionItem C 0..* BackboneElement The nutrition product intended for consumption and/or administration
+ Rule: If nutritionItem is present then SHALL have at least one of nutritionItem.type or nutritionItem.nutritionProduct[x]

.... type Σ 0..1 CodeableConcept The type of food (i.e. solid or liquid) product
Binding: Food Type Codes (Example)
.... nutritionProduct Σ 0..1 CodeableReference(NutritionProduct) A product used for nutritional purposes (e.g. food or supplement)
Binding: Types of Edible Substances (Preferred)
.... consumedItem 0..* BackboneElement What nutrition item was consumed

..... schedule 0..1 Timing Scheduled frequency of consumption
..... amount Σ 0..1 SimpleQuantity Quantity of the specified food (i.e. solid and/or liquid)
..... rate[x] Σ 0..1 Rate of enteral feeding administration
...... rateQuantity Quantity
...... rateRatio Ratio
..... totalIntake 0..* BackboneElement Nutrients and/or energy contained in the intake

...... nutrient 1..1 CodeableReference(Substance) Type of nutrient consumed in the intake
Binding: Nutrient Codes (Example)
...... amount 1..1 SimpleQuantity Total amount of nutrient consumed
...... energy 0..1 SimpleQuantity Total energy consumed in kilocalories or kilojoules
.... notConsumedItem 0..* BackboneElement What nutrition item was not consumed

..... reason 0..1 CodeableConcept Reason the nutrition item was not consumed
Binding: Reasons for why a food item was not consumed (Example)
..... schedule 0..1 Timing The intended frequency of consumption that was not followed
..... amount Σ 0..1 SimpleQuantity Quantity of the specified food (i.e. solid and/or liquid) that was not consumed
... performer 0..* BackboneElement Who or what performed the intake and how they were involved

.... function 0..1 CodeableConcept Type of performer
Binding: Procedure Performer Role Codes (Example)
.... actor 1..1 Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson | Group) Who or what performed the intake
... location 0..1 Reference(Location) Where the intake occurred
... derivedFrom 0..* Reference(Any) Additional supporting information

... reason 0..* CodeableReference(Condition | Observation | DiagnosticReport | DocumentReference) Reason for why the food (i.e. solid and/or liquid) is /was consumed
Binding: Condition/Problem/Diagnosis Codes (Example)

... note 0..* Annotation Further information about the consumption


doco Documentation for this format icon

See the Extensions for this resource

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

12.20.5.1 Terminology Bindings

Path ValueSet Type Documentation
NutritionIntake.status EventStatus Required

Codes identifying the lifecycle stage of an event.
NutritionIntake.statusReason NutritionIntakeStatusReason Example

This value set represents codes indicating reasons for the status of the nutrition intake.
NutritionIntake.code DietCodes Preferred

Codes that can be used to indicate the type of food being ordered for a patient. It includes codes from SNOMED CT icon where concept is Dietary Regime (182922004) and its sub-concepts, Enteral Feeding (229912004) and its sub-concepts, Mixed Breast Milk and Bottle Feeding (35011000087100), Breast Milk Feeding (1297276008), Bottle Feeding of Patient (40043006).
NutritionIntake.nutritionItem.type FoodTypeCodes Example

This value set represents codes for types of foods and is provided as a suggestive example. It include codes from SNOMED CT icon where concept is-a 255620007 (Foods (substance)).
NutritionIntake.nutritionItem.nutritionProduct TypesOfEdibleSubstances Preferred

This value set represents codes for types of edible substances. It include codes from SNOMED CT icon where concept 762766007 Edible Substance (substance) and its sub-concepts, Infant Formula (412413001) and its sub-concepts, Enteral and Supplement Feeds (346415002) and its sub-concepts, Water (11713004), Potable Water (890302005) and its sub-concepts, and Tap Water (444923006).
NutritionIntake.nutritionItem.consumedItem.totalIntake.nutrient NutrientCodes Example

NutrientModifier : Codes for types of nutrients that are being modified such as carbohydrate or sodium. This value set includes codes from SNOMED CT icon where concept is-a 226355009 (Nutrients(substance)), and the concepts for Sodium, Potassium and Fluid. This is provided as a suggestive example.
NutritionIntake.nutritionItem.notConsumedItem.reason ReasonsFoodItemNotConsumed Example

This value set represents codes for types of edible substances and is provided as a suggestive example. It include codes from SNOMED CT icon where concept is-a 762766007 Edible Substance (substance).
NutritionIntake.performer.function ProcedurePerformerRoleCodes Example

This example value set defines the set of codes that can be used to indicate a role of a procedure performer.
NutritionIntake.reason ConditionProblemDiagnosisCodes Example

Example value set for Condition/Problem/Diagnosis codes.

12.20.5.2 Constraints

UniqueKeyLevelLocationDescriptionExpression
img nin-1Rule NutritionIntake.nutritionItemIf nutritionItem is present then SHALL have at least one of nutritionItem.type or nutritionItem.nutritionProduct[x](type.exists() or nutritionProduct.exists())

12.20.6 Notes:

12.20.7 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
code token Returns statements of this code of NutritionIntake NutritionIntake.code 21 Resources
date date Date when patient was taking (or not taking) the medication NutritionIntake.occurrence.ofType(dateTime) | NutritionIntake.occurrence.ofType(Period) 26 Resources
encounter reference Returns statements for a specific encounter NutritionIntake.encounter
(Encounter)		 29 Resources
identifier token Return statements with this external identifier NutritionIntake.identifier 65 Resources
nutrition token Return intakes for a specific consumed item NutritionIntake.nutritionItem.nutritionProduct.concept
patient reference Returns statements for a specific patient. NutritionIntake.subject.where(resolve() is Patient)
(Patient)		 65 Resources
source reference Who or where the information in the statement came from (NutritionIntake.reported as Reference)
(Practitioner, Group, Organization, Patient, PractitionerRole, RelatedPerson)
status token Return statements that match the given status NutritionIntake.status
subject reference The identity of a patient, animal or group to list statements for NutritionIntake.subject
(Group, Patient)