CIM Diet Detail Data Elements – 11/1/2011
CIM Object
Name
CIM Object Definition
CDA ID References
CIM Object Priority
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.
Clinical Example: Patient is advised to follow a low
salt, low fat and reduced calorie diet.
“B” Data Elements for PCP to
Specialist with Consultation Request
(including closed loop referral)
“B” Data Elements from Hospital to
1.3.6.1.4.1.19376.1.5.3.1.3.33
PCP or other facility (e.g. long term
care or sub-acute care)
“B” Data Elements to Patient: Data
Exchange to a PHR.
Diet
Narrative
Current Text: 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.
Recommend as in Consolidated CDA Templates (US
Realm) September 2011: This section records a
narrative description of the expectations for diet and
nutrition including nutrition prescription, proposals,
goals, and order requests for monitoring, tracking, or
improving the nutritional status of the patient, used
in a discharge from a facility such as an emergency
department, hospital, or nursing home.
“B” Data Elements for PCP to
Specialist with Consultation Request
(including closed loop referral)
“B” Data Elements from Hospital to
1.3.6.1.4.1.19376.1.5.3.1.3.33
PCP or other facility (e.g. long term
care or sub-acute care)
“B” Data Elements to Patient: Data
Exchange to a PHR.
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Name of Data Element
Nutrition Assessment
Definition of Data Element
ISO/HL7 Data type
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 &
CE (Coded Element)
supplies availability, physical
ED (Encapsulated Data)
activity, nutrition quality of
PQ (Physical Quantity)
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,
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Examples & Guidance
Data Element
Priority
Clinical Examples:
Three-day food record reflects
patient has been severely restricted
in protein/kcalorie intake. Average
intake was 1250 kcal, 30 grams
protein.
BMI:22
Mid-arm muscle circumference:
B
Name of Data Element
Definition of Data Element
ISO/HL7 Data type
Examples & Guidance
Data Element
Priority
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. Typically includes three
categories:
ED (Encapsulated Data)
1. Intake (too much or too little CE (Coded Element) (value
of a food or nutrient
set is all of the SNOMEDcompared to actual or
coded interventions in the
estimated needs.)
IDNT list.
2. Clinical (nutrition problems
that relate to medical or
physical conditions)
3. Behavioral-Environmental
(knowledge, attitudes,
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Clinical Examples:
Inadequate oral intake related to
intolerance as evidenced by
frequent nausea and vomiting prior
to admission.
Altered nutrition-related laboratory
values related to diabetes mellitus
B
as evidenced by diabetic
ketoacidosis.
Biting/Chewing (masticatory)
difficulty (SNOMED CT CID
175130015) related to xerostomia as
evidenced by Speech Language
Pathologist evaluation.
Name of Data Element
Definition of Data Element
ISO/HL7 Data type
Examples & Guidance
Data Element
Priority
beliefs, physical
environment, access to
food, or food safety)
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.
This includes the nutrition
recommendation by the dietitian.
It may not be what the patient
currently receives. The prescription is
different than the Nutrition
ED (Encapsulated Data)
CE (Coded Element) (value
set is all of the SNOMEDcoded interventions in the
IDNT list.
CE (Coded Element) or
CF (Coded Element with
formatted values)
or
PQ (Physical Quantity)
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B
Clinical Examples:
Recommend Isosource 1.5 tube
feeding per small bowel feeding
tube at 70 ml per hour to provide
2310 calories (27 Kcal/Kg), and 105
gm protein (1.2 gm/Kg) per day.
B
Recommend patient consume 2000
calories, 80 grams protein per day
for optimal wound healing.
Typically includes a PES Statement:
Problem/Etiology/Symptoms
Name of Data Element
Definition of Data Element
ISO/HL7 Data type
Examples & Guidance
Data Element
Priority
Intervention because it is more
nutrient-based and excludes things like
feeding, education, counseling,
coordination of care.
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.
Areas include:
1. Food and nutrient delivery
(Individualized approach for food &
nutrition delivery, including meals &
snacks, enteral and parenteral
feeding & supplements)
2. Nutrition Education (formal
process to instruct/train in a skill to
help manage or maintain eating
behavior to maintain or improve
Clinical Examples:
Enteral nutrition solution: 1 Kcal/cc
formula for 1600 Kcal/day
CE (Coded Element) (value
Adaptive equipment for feeding
set is all of the SNOMEDassistance.
B
coded interventions in the
IDNT list.)
Nutrition counseling based on
motivational interviewing strategy.
Includes SNOMED Codes (IDNT
mapped to SNOMED) and/or LOINC
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Name of Data Element
Definition of Data Element
ISO/HL7 Data type
Examples & Guidance
Data Element
Priority
health)
3. Nutrition Counseling (supportive
process via collaboration to set
priorities, establish goals and create
individualized action plans that
acknowledge and foster
responsibility for self care to treat
an existing condition & promote
health.)
4. Coordination of nutrition care
(consultation with, referral to, or
coordination of nutrition care with
other health care providers,
institutions, or agencies that can
assist in treating or managing
nutrition-related problems)
Patient Instructions
Directions to the patient which have
been agreed upon between dietitian
ED (Encapsulated Data)
and patient and conform to diet order,
goals and care plan.
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Clinical Example:
Reduce intake of refined
carbohydrates, reduce fat
consumption & increase omega-3
fatty acid intake per written
guidance.
B
Name of Data Element
Diet Description
Definition of Data Element
ISO/HL7 Data type
Examples & Guidance
Examples:
General Healthful Diet;
or
“80 gm protein + Consistent
Carbohydrate + 2g sodium + 2g
potassium + 800-1000mg
Phosphorus + 1500 ml Fluid
Restricted “
Narrative description of the
recommended diet or daily nutrient
intake
Data Element
Priority
B
Or Per IHE: LOINC 42344-2
Discharge Diet
Diet Type Code
(dietType)
CE (Coded Element)
A code that controls the type of diet
E.g., DASH (Dietary Approaches to
that a patient should receive of follow,
Note: Local codes only at Stop Hypertension), Kosher, Vegan, B
e.g., Cultural Preference,
present
6 Small Meals
Portion Size, Timing.
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Name of Data Element
NPO Flag
(isNPO)
Definition of Data Element
ISO/HL7 Data type
Indicator specifying that patient should
not receive food or drink. NPO (nil per
os) or NBM (nothing by mouth) is a
BL (Boolean)
medical order to withhold food and
liquids
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Examples & Guidance
Patient test home and told to return
tomorrow for a surgical procedure
or test may be instructed not to eat
or drink anything after midnight.
E.g., NPO (nil per os) or NBM
(nothing by mouth) is a diet type
code for a medical order to withhold
food and liquids
Data Element
Priority
Name of Data Element
Definition of Data Element
ISO/HL7 Datatype
Examples and
Guidance
Data Element Priority
Patient safety issue: need
an easy way to flag patients
who require foods with
altered textures to avoid
choking.
Texture Modification
Required
(isTextureModified)
Indicator specifying whether the
patient/client requires food texture
modifications
BL (Boolean)
Texture Modifier Code
(textureModifier)
Describes the consistency or how the
food or type of food should be
modified for consumption.
CE (Coded Element)
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E.g., Patient has
B
documented difficulty
chewing/swallowing due to
stroke. Failure to properly
convey this information
could lead to a choking
hazard.
E.g., Pudding-thick ,
chopped or ground
B
Name of Data Element
Food Type Code
(foodType)
Nutrient Modification
Required
(isNutrientModified)
Definition of Data Element
Indicates what type of food, e.g.,
meats, or liquids, require a texture
modification
ISO/HL7 Datatype
CE (Coded Element)
Indicator specifying whether the
patient/client requires a therapeutic
or modified diet
BL (Boolean)
to eliminate, decrease, or
increase certain substances in the diet
(e.g., sodium, potassium)
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Examples and
Guidance
Patient undergoing
treatment and
rehabilitation following a
stroke may require honeythickened liquids, ground
meats and chopped
vegetables.
Data Element Priority
B
Modify distribution, type,
or amount of food and
nutrients (IDNT: ND-1.2)
Example: Diabetic patient
requires controlled intake
of carbohydrates.
B
Renal dialysis patient
requires 1.2 grams
protein/kg body weight, < 2
grams sodium/day, and
800-1000 mg
Phosphorus/day
Name of Data Element
Definition of Data Element
Nutrient Type Code
(nutrientType)
Code that identifies the type of
nutrient and unit of measure that is
being indicated, e.g.,
Carbohydrate, Energy(Kcal), Protein,
Sodium
Nutrient
Quantity/Quantity
Modifier
Indicates the recommended daily
intake amount for the specified
nutrient.
May need to be expressed as a range,
thus a modifier e.g, <, > or
ISO/HL7 Datatype
CE (Coded Element)
PQ (Physical Quantity)/
Ratio
Narrative that includes a description of
a preparation intended to supplement
the diet and provide energy (calories)
or nutrients, such as vitamins,
minerals, fiber, fatty acids,
carbohydrates, or amino acids, that
Nutritional Supplement may be missing or may not be
Order
consumed in sufficient quantity in a
person's diet. Such products may be
ordered or recommended in addition
to the diet (either general or
therapeutic) to enhance a person’s
intake.
Page 11 of 15
Examples and
Guidance
E.g., Energy (Kcal), Sodium
(milligrams) or Protein
(grams)
Data Element Priority
B
Renal dialysis patient
requires 80 grams
protein/day, < 2 grams
sodium/day, and 800-1000
mg phosphorus/day
B
E.g., Patient should
consume a high protein
liquid nutritional
supplement (such as
Product A) 3 times per day
between meals.
IDNT: Medical Nutritional
Supplements. ND-3.1.1
Commercial beverage
B
Name of Data Element
Definition of Data Element
Narrative which describes the Enteral
nutrition: A way to provide food
Enteral Nutrition Order through a tube placed in the nose,
Narrative
mouth, the stomach, or the small
intestine.
(isEnteral)
This value indicates whether the diet
recommendation includes an enteral
nutrition component.
Product
Name/Description
productDescription
A description of the nutritional
supplement or enteral product
formulation, e.g.,
High Protein/2.0 Kcal formula.
Product ID
productID
A string given by a manufacturer to
uniquely identify the nutritional
supplement or enteral product.
ISO/HL7 Datatype
String
Examples and
Guidance
Clinical Examples:
Recommend Isosource 1.5
tube feeding per small
bowel feeding tube at 70
ml per hour to provide
2310 calories (27 Kcal/Kg),
and 105 gm protein (1.2
gm/Kg) per day.
BL (Boolean)
String
String (?) or Code (?)
B
B
E.g., Generic description
such as Standard or HighCalorie Formula (1.5
Kcal/oz); or specific brand
name product
E.g.,
Isosource
Manufacturer – Nestle
Nutrition,
UPC/Item # 18180100 1000 mL Closed System
Container
Note: Some formulas are
treated by medications &
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Data Element Priority
B
B
Name of Data Element
Definition of Data Element
ISO/HL7 Datatype
Examples and
Guidance
managed by outside
vendors (First Data Bank);
NDC codes are updated as
formulas are modified.
Data Element Priority
Quantity
How much of a supplement or enteral
formula the patient should receive
PQ (Physical Quantity)
E.g., 250 mL
, 60 mL
Frequency
How often the product should be
consumed or administered
IVL (Interval)
E.g., 3 times per day, q 3 hr B
B
B
Enteral Rate or
Frequency
Time frame over which a product is
administered
PQ
IVL_TS
Rate or Frequency of the
enteral feeding:
Continuous tube feeding
via pump, 65 mL per hour
Or
720 mL bolus feedings, 3 x
per day
Or
Liquid protein supplement
3 times per day
Concentration/Strength
Dilution or lack of dilution of the
product prior to administration.
CE (Coded Element) or
INT (Integer) - ?
Full Strength (1.0)
Half Strength (0.5)
Infant Formulas (0.67)
Page 13 of 15
B
Name of Data Element
Definition of Data Element
ISO/HL7 Datatype
Examples and
Guidance
Data Element Priority
Infant formulas are mixed
to a specified caloric
density, e.g., 24 kcal/fluid
oz, or 27 kcal/fluid oz
B
A description or code that details how
Administration Method the nutritional supplement or enteral String
formula is to be
(Maybe a CE – Code)
administered, e.g., Pump-assisted.
E.g., Pump-assisted,
Gravity-assisted (30-60
min), Bolus/Syringe (10-20
min) or OG
(pediatric/infant)
B
A code that identifies where the
Delivery Site - Route & feeding tube should
Access
deliver food to, e.g. gastric or postpyloric and how that site is accessed
E.g. Oral (PO) – in case of
supplements or infant
formulas; or Enteral
Nutrition accessed via
Nasogastric, Gastrostomy,
Nasojejunal, Gastrojejunal,
orJejunostomy
B
Energy Density
Instructions
Amount of energy (in kilocalories)
provided per volume
Narrative instructions pertaining to
care and maintenance of the feeding
tube.
PQ
Code
String
Example:
Flush tube with __mL water
every 3 hours.
IDNT Feeding Tube Flush
(ND-2.1.4)
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B
Name of Data Element
Monitoring &
Evaluation
Definition of Data Element
Utilization of consistent data
longitudinally for the purpose of
evaluation and outcomes. Includes
both patient evaluation of goals, reassessment of existing parameters and
evaluation of new data.
Includes the same general categories
as assessment: Food/Nutrition-Related
History outcomes, Anthropometric
measurements, Biochemical Data,
Medical Tests, and Procedure
Outcomes and Nutrition-Focused
Physical Finding Outcomes
ISO/HL7 Datatype
Examples and
Guidance
Data Element Priority
Clinical Examples:
Patient has reduced sodium
CE (Coded Element) (value
and cholesterol
set is all of the SNOMEDconsumption and reduced
coded interventions in the
B
BMI from 30 to 27.
IDNT list.
Outcomes over past 9
ED (Encapsulated Data)
months reflect a reduction
in BP and LDL.
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