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School Healthcare Information Framework leveraging Technology (SHIFT)

School Healthcare Needs for Standards

Draft - 2019-08-10

HL7 Mobile Health Work Group White Paper



Sponsored by: Mobile Health Work Group

NOTE:  This Work Group White Paper (WGWP), once completed, will be reviewed and approved by the Mobile Health Work Group.  It has not been balloted or subject to formal review by the full HL7 organization. This WGWP expires five years from the date of publication.

Point of Contact Name and Email:   

John Ritter; johnritter1@verizon.net  

Gora Datta; gora@cal2cal.com  

Instructions:  Insert URL for the co-chairs of the Work Group; on the Work Group web page select “Leadership” then right click and open in new window.  Copy the URL which displays names of the WG co-chairs.

Instructions: If Work Group does not want to require Copyright, delete the optional section below.

Copyright © 2019 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher.  HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.


IMPORTANT NOTES:

This White Paper is not subject to routine HL7 license requirements for HL7 standards, because it is an un-balloted document and solely the opinion of the sponsoring Work Group(s).

Ownership. HL7 owns all right, title, and interest, in and to the Trademark. Recipient shall take no action contrary to, or inconsistent with, the foregoing.

HL7 may not own all right, title, and interest, in and to the Materials and that the Materials may contain and/or reference intellectual property owned by third parties (“Third Party IP”).  This White Paper does not grant Recipient any rights with respect to Third Party IP. Recipient alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize Third Party IP in connection with the Materials or otherwise. Any actions, claims or suits brought by a third party resulting from a breach of any Third Party IP right by the Recipient remains the Recipient’s liability.


Following is a non-exhaustive list of third-party terminologies that may require a separate license:


Terminology

Owner/Contact

Current Procedures Terminology (CPT) code set

American Medical Association
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-products-services/licensing.page?

SNOMED CT

International Healthcare Terminology Standards Developing Organization (IHTSDO) http://www.ihtsdo.org/snomed-ct/get-snomed-ct or info@ihtsdo.org

Logical Observation Identifiers Names & Codes (LOINC)

Regenstrief Institute

International Classification of Diseases (ICD) codes

World Health Organization (WHO)

NUCC Health Care Provider Taxonomy code set

American Medical Association. Please see 222.nucc.org. AMA licensing contact: 312-464-5022 (AMA IP services)


<Insert Table of Contents>

<Insert Table of Figures if applicable>

 

 

 

Insert Acknowledgements if desired

Contributor

Affiliation

 

 

 

 

Insert Publication History if desired

Version

Date

 0.09

 20190804




[Suggested Sections – adapt as appropriate for your Work Group White Paper]

 

1.   Abstract or Purpose

This White Paper proposes a visionary SHIFT in students’ health and wellness leading to an improved educational experience. SHIFT (“School Health Information Framework leveraging Technology”) describes an approach for improving/harmonizing the school’s programs, services, initiatives, information, and technology related to a student’s health, namely, a standards-based framework that promotes advancements in School Health Technology and Services.

2.   Introduction or Overview

2.1.                     Intended Audience

  • Students
  • Parent/Guardian
  • Nurse and School Health System
  • Staff (teachers, coaches, athletic trainers, nutritionists, mental health, school counselors)
  • External healthcare providers; emergency responders; public health providers; social services; law enforcement
  • State (immunization registries; Medicaid; CHIP; required reporting;
  • School District (reimbursement; budget; risk-reduction; grants)
  • System and Technology vendors
  • Supported by the international standards community.
  • Governmental and Professional Organizations

2.2.                     Scope

The scope of the White Paper is to create a Framework that addresses the needs of various stakeholders who are involved in the health and well-being of students to facilitate learning and activities in the school environment. The White Paper envisions the set of healthcare standards that will support the Framework.

2.3.                     Background

School students need an adequate level of healthcare in order to thrive in the educational process. We propose a set of policies and practices that will SHIFT the educational process using a student-centered approach that integrates academic and health disciplines to enhance student learning and health. School Health currently comprises a complex patchwork of siloed and disconnected mandates, programs, services, initiatives, information, and technology. This Framework accommodates an incremental approach (for what? TBD) for all States to improve student learning and health.

2.4.                     Document Organization and Flow

 ????what is this????

3.   Topics/Content (adapt as needed)

3.1.                     Actors, Goals, and Messaging Transactions 

3.1.1Actors:

  • Students
  • Parents, Guardians, Chaperones
  • Staff and Building Support (custodians, security, maintenance)
  • Nutrition and Food Service Personnel (food service director, cook, cashier, dietitian)
  • Special Education (Educational-Instruction Program)
  • Legislative Requirements
    • ADA
    • HIPPA
    • FERPA
  • School Visitors
  • Types of Schools
    • Public
    • Private
    • Charter; Cyber-Charter
    • Career Technical Center
    • Home School
    • Magnet
    • Advanced Placement courses at Colleges
    • Foreign Exchange
    • Course-of-Study at a non-local school (State, Regional, National, International)
  • Extracurricular (External) Activities
    • Staffing school events (e.g., concession workers; escorts during school orientation days; lifeguards)
    • College-related activities (e.g., enrollment in college courses; participation in college athletics)
    • Field trips (college visitation; museums; ballet; symphony)
    • Performances and Practices (e.g., performing in civic parades; attending training camps)
    • Competitions (marching band competitions, academic competitions;  scientific competitions; robotics competitions; competitive cheerleading competitions)
    • Volunteer Activities (e.g., reading to children; helping at a nursing home)
    • Career Shadowing (e.g., following an employee in their work environment)
    • Internship and Employment (e.g., working at a library during summer hours; working as a student chef at a restaurant as part of a career-technical program)
  • School Transportation Services
  • Legislators
  • Internal Healthcare Provider (School Nurse, School Physician, Athletic Trainer, Speech Language Pathologist, Occupational Therapist)
  • External Healthcare Providers
  • Payers
  • Pharmacies
  • Researchers and Academics
  • System Vendors
  • State 
    • Department of Education
    • Legislative, Executive, and Judicial branches
    • Department of Health
    • Department of Social Services
    • Law Enforcement Agencies
    • Foster Child Agencies
    • Penal System
    • Indian Health Services
  • Local, City, County 
    • Community Health Centers
    • Child Development Centers; After-School Programs
    • Mobile Health Clinics
    • Public Health Department
  • U.S. Federal 
    • Department of Education
    • Department of Health and Human Services (CMS, CDC, SAMHSA, FDA, NIH, ATF, HRSA)
    • Department of Commerce (NIST)
    • Department of Homeland Security
    • Special (Diplomat, Military Base (local or foreign))
    • United States Department of Agriculture
  • Standards Development Organizations
  • Workforce Development organizations (to train people on the SHIFT)
  • School Foundations

3.1.2Goals

  • Improve school health services
  • Improve social services
  • Educate the students regarding healthy/safe practices
  • Leverage technologies
  • Improve attendance
  • Improve Quality of life
  • Improve Student safety (hardening against threats)
  • Address social factors (poverty, homelessness, etc)
  • Seamless integration with the rest of the child’s healthcare team (dental, immunization, pediatrician, behavioral health, mental health, social determinants of health, nutrition health)
  • Consumer-generated data (self-reported or machine-generated)


3.2.                     Information and Service Delivery Methods

NOTE: POLISH THE FOLLOWING: 

  • Mobile Health Devices and Platforms

  • Health Information Exchanges
  • Local Information systems
  • Public Registries
  • Extracurricular Activities (Field Trips; Competitions)
  • Blueprints
  • Pilot programs
  • Models/templates
  • Educational and healthcare initiatives

Use Cases

“Safe2Say” in Pennsylvania (where student uses mobile technology to report possible trouble: drugs, threats, bullying, etc)


Communication Interaction Framework

Comprehensive communication strategies that support interactions with:

  • EMS; Public health clinics; weather services; air quality; food services; asthma, diabetes, obesity; administration of drugs; drug interactions; diet and nutritionals

3.3.                     Usage Conformance Rules

3.4.                     Data Types

3.5.                     Segments and Messages

3.6.                     Technical Guidance and Clarification


3.7Framework Models

Here’s the CDC’s Whole School, Whole Community, Whole Child (WSCC) model:

  1. Physical education and      physical activity.
  2. Nutrition environment and      services.
  3. Health education.
  4. Social and emotional school      climate.
  5. Physical environment.
  6. Health services.
  7. Counseling, psychological      and social services.
  8. Employee wellness.
  9. Student wellness
  10. Community involvement.
  11. Family engagement.

                       



4.   Open Issues


5.   Conclusions


6.   Appendices


yyyyyyyyyyyyyyyyyyy

1       SHIFT White Paper

1.1    School Healthcare Information Framework leveraging Technology (SHIFT)

School Healthcare Needs for Standards

Draft - March 2019



Date

Author

Revision

Notes

20190301

Small-team

Original (skeleton) draft


20190717

Ben Atkinson

Nutrition section additions. Academy of Nutrition and Dietetics (AND) reviews.


20190718

John Ritter

Some minor edits. Request for AND’s inspection of EHR-S FM functionality regarding Allergies.


20190802

Gora Datta

John Ritter

Agree to use existing Analytical Frameworks to guide the layout of the SHIFT White Paper


20190805

Gora Datta

John Ritter

Created “SHIFT White Paper - Stakeholders Grid 20190805.xlsx” to identify categories for Stakeholders


20190809

Ben Atkinson

John Ritter

Organized the Nutrition text into the Use Case Template (for Nutrition); Added some text

Ben will be unavailable the week of 2019-08-12.

20190810

Gora Datta

John Ritter

Perfected the PSS-Lite. Reviewed/edited the Nutrition Use Case.


20190811

Gora Datta

John Ritter

Moved additional text to its proper location in the Nutrition Use Case.


20190812

Gora Datta

John Ritter

Added to the ICT Infrastructure and Outcomes sections of the Nutrition Use Case


20190813

John Ritter



20190902

Gora Datta

John Ritter

Added about 20 more stakeholder types.


20190903

US Realm Task Force

Voted to approve the PSS-Lite.


20190915

John Ritter

Added snippets to the Security section (based on recommendations from Security exerts).


20191002

John Ritter

Added “Smart School Bus” to Transportation Section.















Table of Contents

1       SHIFT White Paper 1

1.1          School Healthcare Information Framework leveraging Technology (SHIFT) 1

2       Abstract or Purpose. 6

3       Introduction or Overview.. 6

3.1          Intended Audience. 6

3.2          Scope. 7

3.3          Background. 7

3.4          Document Organization and Flow.. 7

4       Topics/Content (adapt as needed) 7

4.1          Actors, Goals, and Messaging Transactions. 7

4.2          Actors: 7

4.3          Goals. 8

4.4          Information and Service Delivery Methods. 9

4.5          Use Cases. 10

4.5.1      Use Case template. 10

4.6          Communication Interaction Framework. 10

4.7          Usage Conformance Rules. 10

4.8          Data Types. 10

4.9          Segments and Messages. 10

4.10       Technical Guidance and Clarification. 10

4.11       Framework Models. 10

5       Open Issues. 11

6       Conclusions. 11

7       Appendix A: Use Cases (Specific to a Domain OR UNIVERSAL) 11

7.1          Use Case (Template): DomainX.. 11

7.1.1      Description: Use Case DomainX.. 11

7.1.2      Definition of Maturity Levels of DomainX.. 11

7.1.3      Foundation Components – eHealth Infostructure (Specific to a Domain OR UNIVERSAL) 11

7.1.4      Foundation Components - ICT Infrastructure (Specific to a Domain OR UNIVERSAL) 11

7.1.5      Outcomes / Goals / Successes (Specific to a Domain OR UNIVERSAL) 11

7.2          Nutrition. 12

7.2.1      Description: Use Case Nutrition. 12

7.2.2      Definition of Maturity Levels of Nutrition. 13

7.2.3      Foundation Components – eHealth Infostructure. 14

7.2.4      Foundation Components - ICT Infrastructure Specific to the Nutrition Domain. 17

7.2.5      Outcomes / Goals / Successes. 17

7.3          Immunizations. 18

7.4          Oral Health. 18

7.5          Athletic Training. 18

7.6          Schools on Military bases. 18

7.7          Foster Children. 18

7.8          School Transportation Services. 18

From: [Elementary Principal] 19

Date: : Late August DayX, 2019 at 5 PM... 19

To: .[School Transportation Leader], [School Leaders] 19

Subject: A Student’s Family. 19

7.9. 20

7.10       X.. 20

7.11       X.. 20

7.12       X.. 20

7.13       X.. 20

7.14       X.. 20

7.15       X.. 20

7.16       X.. 20

7.17       X.. 20

7.18       X.. 20

7.19       X.. 20

7.20       X.. 20

7.21       X.. 20

7.22       X.. 20

7.23       X.. 20

7.24       x. 20

7.24.1         Description: Use Case DomainX.. 20

7.24.2         Definition of Maturity Levels of DomainX.. 20

7.24.3         Foundation Components – eHealth Infostructure. 20

7.24.4         Foundation Components - ICT Infrastructure. 20

7.24.5         Outcomes / Goals / Successes. 20

7.24.6         Description: Use Case DomainX.. 20

7.24.7         Definition of Maturity Levels of DomainX.. 20

7.24.8         Foundation Components – eHealth Infostructure. 20

7.24.9         Foundation Components - ICT Infrastructure. 20

7.24.10       Outcomes / Goals / Successes. 20

8       Appendix B: Standards. 21

8.1          EHR-S FM Standards for SHIFT.. 21

8.2          Mobile Health Standards for SHIFT.. 22

8.3          Vocabulary Standards for SHIFT.. 22

8.3.1      Dental 22

8.3.2      Immunizations. 22

8.3.3      (Other) 22

9       Appendix C: References. 22

10          Appendix: xxxxx. 22




HL7 Mobile Health Work Group White Paper

 


Sponsored by:

Mobile Health Work Group






NOTE:  This Work Group White Paper (WGWP), once completed, will be reviewed and approved by the Mobile Health Work Group.  It has not been balloted or subject to formal review by the full HL7 organization. This WGWP expires five years from the date of publication.



Point of Contact Name and Email:  

 Matthew Graham

John Ritter

Gora Datta

Instructions:  Insert URL for the co-chairs of the Work Group; on the Work Group web page select “Leadership” then right click and open in new window.  Copy the URL which displays names of the WG co-chairs.





Instructions: If Work Group does not want to require Copyright, delete the optional section below.

Copyright © 2019 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher.  HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.


IMPORTANT NOTES:

This White Paper is not subject to routine HL7 license requirements for HL7 standards, because it is an un-balloted document and solely the opinion of the sponsoring Work Group(s).


Ownership. HL7 owns all right, title, and interest, in and to the Trademark. Recipient shall take no action contrary to, or inconsistent with, the foregoing.

 

HL7 may not own all right, title, and interest, in and to the Materials and that the Materials may contain and/or reference intellectual property owned by third parties (“Third Party IP”).  This White Paper does not grant Recipient any rights with respect to Third Party IP. Recipient alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize Third Party IP in connection with the Materials or otherwise. Any actions, claims or suits brought by a third party resulting from a breach of any Third Party IP right by the Recipient remains the Recipient’s liability.


Following is a non-exhaustive list of third-party terminologies that may require a separate license:


Terminology

Owner/Contact

Current Procedures Terminology (CPT) code set

American Medical Association
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-products-services/licensing.page?

SNOMED CT

International Healthcare Terminology Standards Developing Organization (IHTSDO) http://www.ihtsdo.org/snomed-ct/get-snomed-ct or info@ihtsdo.org

Logical Observation Identifiers Names & Codes (LOINC)

Regenstrief Institute

International Classification of Diseases (ICD) codes

World Health Organization (WHO)

NUCC Health Care Provider Taxonomy code set

American Medical Association. Please see 222.nucc.org. AMA licensing contact: 312-464-5022 (AMA IP services)

Electronic Nutrition Care Process Terminology

Academy of Nutrition and Dietetics (AND) https://www.ncpro.org/


<Insert Table of Contents>

<Insert Table of Figures if applicable>

 

 

 

Insert Acknowledgements if desired

Contributor

Affiliation

 

 

 

 

Insert Publication History if desired

Version

Date

 

 


[Suggested Sections – adapt as appropriate for your Work Group White Paper]

Editor’s note: Here is some new language that needs to be edited and posted somewhere in this documents (perhaps in the Telehealth section??):

The PA General Assembly recently passed a Telemedicine Act (SB780) in mid-2018. The goal of that Act is to promote the effective use of telemedicine (a virtual healthcare visit) in Pennsylvania. Perhaps PA schools can leverage this new technological highway for schools that might: have a nursing shortage; be in a rural location; need an emergency (virtual) consultation with an emergency-care professional; need a consultation with a clinical specialist; need to coordinate care with certain members of a student’s care team; et cetera.

2       Abstract or Purpose

This White Paper proposes a visionary SHIFT in students’ health and wellness leading to an improved educational experience. SHIFT (“School Health Information Framework leveraging Technology”) describes an approach for improving/harmonizing the school’s programs, services, initiatives, information, and technology related to a student’s health, namely, a standards-based framework that promotes advancements in School Health Technology and Services.

3       Introduction or Overview

3.1    Intended Audience

  • Students
  • Parent/Guardian
  • Nurse and School Health System
  • Staff (teachers, coaches, athletic trainers, dietitians, mental health, school counselors)
  • External healthcare providers; emergency responders; public health providers; social services; law enforcement
  • State (immunization registries; Medicaid; CHIP; required reporting; financial assistance eligibility)
  • School District (reimbursement; budget; risk-reduction; grants)
  • System, Technology, and Material Supply  vendors
  • Supported by the international standards community.
  • Governmental and Professional Organizations

3.2    Scope

The scope of the White Paper is to create a Framework that addresses the needs of various stakeholders who are involved in the health and well-being of students to facilitate learning and activities in the school environment. The White Paper envisions the set of healthcare standards that will support the Framework.

3.3    Background

School students need an adequate level of healthcare in order to thrive in the educational process. We propose a set of policies and practices that will SHIFT the educational process using a student-centered approach that integrates academic and health disciplines to enhance student learning and health. School Health currently comprises a complex patchwork of siloed and disconnected mandates, programs, services, initiatives, information, and technology. This Framework accommodates an incremental approach (for what? TBD) for all local, state, and national  education systems to improve student learning and health.

3.4    Document Organization and Flow

 ????what is this????

4       Topics/Content (adapt as needed)

4.1    Actors, Goals, and Messaging Transactions 

4.2    Actors:

  • Students
  • Parents, Guardians, Chaperones
  • Staff and Building Support (custodians, security, maintenance)
  • Nutrition and Food Service Personnel (food service director, cook, cashier, dietitian)
  • Special Education (Educational-Instruction Program)
  • Legislative Requirements
    • ADA
    • HIPPA
    • FERPA
  • School Visitors
  • School Districts
    • Public
    • Private
    • Charter; Cyber-Charter
    • Career Technical Center [See: “Cooperative Education program at Keystone Central School District 20190730.docx” to help determine whether student’s health information ought to be exchanged with external businesses (where students serve as interns)]
    • Home School
    • Magnet
    • Advanced Placement courses at Colleges
  • School Transportation Services
  • Legislators
  • Internal Healthcare Provider (School Nurse, School Physician, Athletic Trainer, Speech Language Pathologist, Occupational Therapist)
  • External Healthcare Providers
  • Payers
  • Pharmacies
  • Researchers and Academics
  • System Vendors
  • State 
    • Department of Education
    • Legislative, Executive, and Judicial branches
    • Department of Health
    • Department of Social Services
    • Law Enforcement Agencies
    • Foster Child Agencies
    • Penal System
    • Indian Health Services
  • Local, City, County 
    • Community Health Centers
    • Child Development Centers; After-School Programs
    • Mobile Health Clinics
    • Public Health Department
  • U.S. Federal 
    • Department of Education
    • Department of Health and Human Services (CMS, CDC, SAMHSA, FDA, NIH, ATF, HRSA)
    • Department of Commerce (NIST)
    • Department of Homeland Security
    • Special (Diplomat, Military Base (local or foreign))
    • United States Department of Agriculture
  • Standards Development Organizations
  • Workforce Development organizations (to train people on the SHIFT)
  • School Foundations


4.3    Goals

  • Improve school health services
  • Improve social services
  • Educate the students regarding healthy/safe practices
  • Leverage technologies
  • Improve attendance
  • Improve Quality of life
  • Improve Student safety (hardening against threats)
  • Address social factors (poverty, homelessness, etc)
  • Seamless integration with the rest of the child’s healthcare team (dental, immunization, pediatrician, behavioral health, mental health, social determinants of health, nutrition health)
  • Consumer-generated data (self-reported or machine-generated)

4.4    Information and Service Delivery Methods

NOTE: POLISH THE FOLLOWING: 

  • Mobile Health Devices and Platforms
  • Health Information Exchanges
  • Local Information systems
  • Public Registries
  • Extracurricular Activities (Field Trips; Competitions)
  • Blueprints
  • Pilot programs
  • Models/templates
  • Educational and healthcare initiatives

xxxxxxxxxxxxx

SHIFT Architectural components and maturity model


Ingredients for School Health Systems (see the Parthenon method of categorizing the ingredients)

  1. Governance and national ownership
  2. Health process domain components
    1. School Nurses
      1. Description
      2. State of the art
      3. Low Maturity
      4. Med Maturity
      5. High Maturity
      6.  
    2. Athletic Trainers
    3. Asdf
    4. Asdf
    5. Asd
    6. Fasdf
    7.  
    8. 20 Nutrition Experts
  3. Foundation Components – eHealth infostructure
  4. Foundation Components - ICT Infrastructure
  5. Outcomes / Goals / Successes

xxxxxxxxxxxxxx

"C:\Ritter\Healthcare\HIMSS\Rural Underserved HIT Work Group\The-Rural-Health-Facets-Framework_20150629.pdf"

"C:\Ritter\HL7\Mobile Health\LMIC subgroup\HL7-LMIC-Adoption-Phases 20130612.pptx"


4.5    Use Cases

“Safe2Say” in Pennsylvania (where student uses mobile technology to report possible trouble: drugs, threats, bullying, etc)

4.5.1        Use Case template

  • Description: Use Case DomainX
  • Definition of Maturity Levels of DomainX
    • Low Maturity
    • Medium Maturity
    • High Maturity
  • Foundation Components – eHealth infostructure
  • Foundation Components - ICT Infrastructure
  • Outcomes / Goals / Successes

               

4.6    Communication Interaction Framework

Comprehensive communication strategies that support interactions with:

  • EMS; Public health clinics; weather services; air quality; food services; asthma, diabetes, obesity; administration of drugs; drug interactions; diet and nutritional analysis

4.7    Usage Conformance Rules

4.8    Data Types

4.9    Segments and Messages

4.10   Technical Guidance and Clarification

4.11   Framework Models

Here’s the CDC’s Whole School, Whole Community, Whole Child (WSCC) model:

  1. Physical education and      physical activity.
  2. Nutrition environment and      services.
  3. Health education.
  4. Social and emotional school      climate.
  5. Physical environment.
  6. Health services.
  7. Counseling, psychological      and social services.
  8. Employee wellness.
  9. Student wellness
  10. Community involvement.
  11. Family engagement.

                       



5       Open Issues


6       Conclusions


7       Appendix A: Use Cases (Specific to a Domain OR UNIVERSAL)


7.1    Use Case (Template): DomainX

7.1.1        Description: Use Case DomainX

7.1.2        Definition of Maturity Levels of DomainX

7.1.2.1           Low Maturity

7.1.2.2           Medium Maturity

7.1.2.3           High Maturity

7.1.3        Foundation Components – eHealth Infostructure (Specific to a Domain OR UNIVERSAL)

7.1.4        Foundation Components - ICT Infrastructure (Specific to a Domain OR UNIVERSAL)

7.1.5        Outcomes / Goals / Successes (Specific to a Domain OR UNIVERSAL)

 

 

 

 

7.2    Nutrition [Nutrition and Food Service Personnel (food service director, cook, cashier, dietitian)]

7.2.1        Description: Use Case Nutrition


The nutrition and food service operations of a school affect students, staff, and the public. Its operations can cross internal and external stakeholders. For student safety and student academic performance, it is essential that the food service operation utilizes up to date recipe and menu information and that nutrition-related health concerns are documented accurately and accessible to the appropriate stakeholders that require them.


There are several main areas for improvement in school nutrition operations, each described separately below.


  • Allergens and Ingredients:

[[[[[[EDITOR’S NOTE (John Ritter 20190718): Should “allergies” (in Ben’s text, below) be expanded to “allergies, intolerance, adverse reactions, sensitivities, and food-drug (or nutritionals-drug) interactions”??]]]]]

Student allergens are an area requiring improvement in interoperability and standardization across school information systems and the FNMS. Allergies are usually reported by the parent or guardian, with varying levels of authenticity or accuracy. A paper or faxed copy of a medical provider document, a paper form filled out by the parent or guardian, or even a handwritten note written on paper are common forms of allergy documentation. Therefore, the allergy record of a student is likely incomplete or inaccurate. The USDA estimates that 20-25% of epinephrine injections occurring at schools are the result of school personnel being unaware of students’ allergies (https://www.usda.gov/media/blog/2018/05/14/food-allergies-helping-schools-prepare-respond).

Interoperability between a school and a medical provider or health information exchange could help alleviate the inaccurate and incomplete school allergen record. Medical systems internationally utilize standard messages to communicate and store medical diet and allergies, such as the HL7 Diet Order for V3 (https://www.hl7.org/implement/standards/product_brief.cfm?product_id=317) or FHIR Nutrition Order (https://www.hl7.org/fhir/nutritionorder.html). The ability for a school information system or school-based FNMS to receive and store this information via existing standards is a great opportunity. Similarly, the student allergen record within the school information system and/or FNMS should be able to be accessed in other interoperable systems or mobile and personal health record systems in order to improve the safety of students away from the traditional school campus.


  • Cafeteria setup and operations (material supplies (e.g., food thermometers, mops, and dishwashing soap), food-consumption dinnerware, cleaning (disinfecting tables and doorknobs), personal hygiene (aprons, hairnets, and hand soap), restaurant devices (ovens, can openers, ladles, freezers, cutting blocks, garbage cans), food presentation and selection devices (bins, trays, racks, sneeze guards)


  • Morning Breakfast delivery (grab-and-go foods)


  • After School food delivery (athletics, clubs, events, daycare, shows, trips, ceremonies, celebrations)


  • School-based waiting areas that may accommodate food consumption (e.g., staging area for early-arrival or late-stay students)


  • Concession Stands / Coffee Shoppes / Vending Machines


  • Shipping and Receiving of Food Materials


  • Returns / Rejections / Waste Management (governance, measurements, and reporting)


  • Storage of information regarding Free-and-Reduced student food-services


  • IEP (Individualized Educational Plan) that contains a nutrition component (e.g., based on clinical orders, parental preference, or student need (e.g., verifying that a student successfully chews then swallows per each bite))


  • Delivery / Administration of specialized nutritional-product or nutrition-supplement (e.g., delivering nutritionals to a student via a feeding tube or spoon-feeding)


  • Staff (e.g., Nurse / Teacher) ad hoc examination or regularly-scheduled assessment regarding a student’s allergies, intolerances, adverse reactions, sensitivities, and food-drug (or nutritionals-drug) interactions


  • Non-traditional (e.g., Home schooled, cyber school, outdoor educational, study abroad, study at community college, internships) students’ nutritional requirements


  • others



7.2.2        Definition of Maturity Levels of Nutrition

7.2.2.1           Low Maturity: Nutrition

Food insecurity; no coordination with Social Determinants of Health protocols

No cafeteria; no milk service; students bring their own foods

No special or additional food services

Little ability to administer and assess students’ nutritional needs

Little or no communication with student’s care-community

Little oversight and reporting

Minimal student nutritional-health information exists; such information exists on paper

Minimal descriptions of nutritional ingredients; such information only exists on food-purchase forms and food encyclopedias

No food-related hygiene (e.g., no time for students to brush their teeth)

7.2.2.2           Medium Maturity Nutrition

Food stability; some coordination with Social Determinants of Health protocols

In-school cafeteria

Adequate communication with student’s care-community; Paper-based information interchange

Adequate oversight and reporting; general (summary) reports regarding food sufficiency

Food descriptions of nutritional ingredients and minimum daily requirements are posted on walls

Some food-related hygiene (e.g., Posters reminding students to clean their teeth; students routed to lavatories for teeth brushing after meals)


7.2.2.3           High Maturity: Nutrition

Food security; excellent coordination with Social Determinants of Health protocols

In-school cafeteria and other types of food acquisition and delivery (e.g., vending machines; delivery of specialized food products defined by students’ IEP specifications)

Readily available foods for consumption before, during, or after school (including take-home and weekend foods)

Excellent ability to administer and assess students’ nutritional needs

Excellent food choices; good oversight and assessment regarding the foods selected and actually consumed

Excellent communication with student’s care-community (including parents); information is interchanged electronically; reports, trends, and graphs are created and shared electronically

Excellent oversight and reporting regarding the food ordered, consumed, returned, and wasted; reporting regarding the food storage and operations

Food descriptions of nutritional ingredients and minimum daily requirements are readily available (at each food-delivery station; electronically or via daily poster; requirement-fulfillment is dynamically presented during cash register checkout)

Recommendations for – or warnings against – the selection of certain foods is presented either at the moment of food selection or during cash register checkout)

Excellent food-related hygiene (e.g., dental pics and floss available; tooth brushing and oral rise practiced, measured, and reported)

Advanced devices are utilized (e.g., Bluetooth-enabled toothbrush (how many brushing strokes; date/time of brushing)

National School-Lunch programs (and corresponding funding) are in place (e.g., U.S. Realm’s CHIP (Child Health Insurance Program).


7.2.3        Foundation Components – eHealth Infostructure

Food and Nutrition Management Systems (FNMS):

  • The FNMS in the school setting provide both food service and health-related, or clinical nutrition, functions. For food service functions these systems require the capacity to store and analyze food ingredients (or any pre-made or purchased food item, such as frozen pizza or a pre-made ham and cheese sandwich) at its most basic level. The details about food ingredients include: ingredient description, the size of the container or case the ingredient resides in, the weight or volume of the ingredient, the nutrition analysis of the ingredient, specific attributes of the ingredient (kosher, organic, local, etc), the USDA Child Nutrition label (denotes the components that the ingredient fulfills, for example: a slice of pre-made pizza could meet the requirements for one meat/meat alternate and two grains), the price of the item, the vendor from which the item was purchased, the vendor’s item identification number, the manufacturer of the item, the classification of the item for budgeting and planning purposes (dry goods, canned goods, fresh produce, seafood, poultry, etc), the storage location of the item within the school warehouse or kitchen for inventory purposes (item is stored in the freezer on shelf A2). There are many other pieces of information that school nutrition staff and students may require about a food ingredient or item, but the FNMS must be capable of storing, sharing, and analyzing all of them in order to provide accurate information for student health and departmental operations.
  • These systems must then be able to incorporate the food ingredients into recipes. Recipes are a summarization of food ingredients, the instructional steps that need to be performed with the ingredients, the altered yield of the ingredients and final recipe as they are processed, the food safety considerations to be utilized throughout the preparation. After recipes are created, the FNMS must be able to organize them into menus for a particular service type, such as a lunch meal or afterschool snack. The system must be able to store current and historical predictions about how many of each recipe item within a given menu will be served. This is to demonstrate that the school is providing recommended or required amounts of certain types of foods, but also to accurately project how much food to make to ensure that all students are fed and to minimize food waste. The school menus then must be able to generate food purchasing information. By recording how many portions of a recipe to make, the FNMS should therefore know how much of a recipe ingredient to purchase and when to purchase it based on the recipe production details (for example, if an item is required to be thawed before baking it may need to be purchased several days in advance of when the item is to be served).
  • Interoperability of the FNMS is also crucial to obtain accurate information and reduce staff labor. By knowing the amount of food to be purchased, the FNMS should be able to communicate its food order to vendors. Similarly, vendors should be able to electronically send information about the filled food order back to the school; including information about any items that aren’t able to be delivered, or substitute items that are sent. This workflow exists in the commercial healthcare industry, so it should also be possible in the school setting. Since all schools create recipes and menus, the ability to share and store this information between schools, recipe and menu databases (such as https://healthyschoolrecipes.com/), students, and healthcare providers should be required functionality. The Health Level Seven, International (HL7) Orders and Observations Work Group and the Academy of Nutrition and Dietetics are developing a Fast Healthcare Interoperability Resource (FHIR) information exchange standard that will address these needs.
  • Many school information systems and FNMS also do not utilize standardized value sets for allergens. Recently created food, drug, and environmental value sets present an opportunity to prepare for interoperability between school and medical systems, as well as to improve the accuracy of records; for example in clarifying a shellfish allergy into a specific mollusk or crustacean allergy as recommended by medical professionals. Utilization of the HL7 allergy and intolerance data sets should be considered to improve this lack of standardization (https://www.hl7.org/implement/standards/product_brief.cfm?product_id=482 ).
  • Once a student’s allergy is known, identifying foods that may contain the allergen is a further hurdle. While the pharmaceutical industry in the United States has developed structured product labels that can communicate medication ingredients, instructions, and other label information, there is no such system for food or nutrition supplements. Adding food ingredient, allergen, characteristics (such as organic, local, kosher, halal, or low sodium), or other official labels such as USDA Child Nutrition labels to indicate food component values, is a manual task performed by food vendors, food manufacturers, and school nutrition staff. The manual entry of these descriptors of food items is laborious—for example all 300+ school districts in Washington State, USA likely manually added the calories, ingredients, an allergen code, a product weight and volume, and a price to the same Mozzarella Cheese Stick item. The manual entry may also be inaccurate a small percentage of the time.
  • While allergies are very important for student safety, other components of food are also crucial. Diabetic students rely on carbohydrate content records of school food in order to properly dose insulin or other anti-diabetic medication. Students managing other acute or chronic medical conditions may also need to limit or increase their intake of macro- or micronutrients. Students following halal food recommendations from their mosque, or those observing a fast as part of their religious beliefs may also need to know how their food was prepared or what its ingredients are.


Students’ Health Information:

  • School information systems and school-based FNMS also do not consistently store or share data in a standardized format. To both prepare for interoperability between these school-based systems and medical provider, health information exchange, and personal and mobile medical record systems, and to accurately store student medical information with school-based systems; utilizing standard clinical documentation is crucial. For nutrition services, the Nutrition Care Process is a method to communicate nutrition care that is recognized internationally (https://www.ncpro.org). Further, recent collaboration between the HL7 EHR workgroup and the Academy of Nutrition and Dietetics have resulted in a detailed framework for requirements of the Nutrition Care Process in an electronic system (https://www.hl7.org/implement/standards/product_brief.cfm?product_id=369). An implementation guide that details how to share nutrition-related documentation in transitions of care, such as from the medical provider to a school, also exists (https://www.hl7.org/implement/standards/product_brief.cfm?product_id=478). By utilizing these existing standards, school information systems and school-based FNMS can greatly improve their ability to store and transmit health information to increase student safety.


Financial Management and Student Financial Information Exchange

  • Schools’ foodservice programs rely on personal financial data about students and their parents or guardians to determine whether a student is required to pay cash, or whether the school can be reimbursed by the federal or state government in the United States for a student meal or snack. Interestingly, this same financial information that determines free or reduced student nutrition payment status, also affects many other aspects of school funding. So it is crucial to obtain timely and accurate financial information about students, siblings, and parents or guardians. Trends to reduce embarrassment of families or students about their financial status, language difficulties, and outdated web or mobile technologies can all lead to a school’s inability to collect accurate financial information. This can lead to decreased revenue for a school, as well as a missed opportunity to improve a student’s food security status and increase their ability to physically grow and learn. Interestingly, financial information is often self-reported, leading to inaccuracy.
  • Students and their parents or guardian however can enroll in local, state, or federal financial assistance programs, such as the Supplemental Nutrition Assistance Program in the United States. Enrollment in many of these programs may automatically classify them as able to receive free or reduced price meals at school, or classify them as low-income and enable the school itself to be eligible for additional revenue or desirable programs. Therefore, enrollment status in a financial assistance program could be valuable information to be shared with a school, the same way that a medical insurer may share insurance plan enrollment status with a medical provider. This information should follow the student between different schools within the same district or group, and when the student transfers to another school district.
  • Communication related to student or staff foodservice payment accounts is another area for improvement. With the continued move to cashless payment systems, many schools rely on outdated point of sale or web payment methods. Schools should utilize current payment systems whenever possible in order to increase revenue and increase participation in their foodservice programs. Systems should also allow secure and timely communication with parents or guardians about the status of foodservice (and other fee-based program, such as art supplies) accounts. A timely alert to a parent or guardian can prevent a student from accumulating large amounts of debt to the foodservice program.
  • Students, parents/guardians, and school staff regularly require nutrition information away from the school campus. Class trips, athletic or performance events, or simply wanting to know what the special entrée on the menu for the next day is—these are all situations in which access to nutrition information may be beneficial or potentially lifesaving. The ability to access a student’s personal health information during an off-campus event may help the student, or the staff supervising the student, make a safe food choice if the student has food allergies or other nutritional needs. Detailed information about food served or prepared by the school could ensure that a student with specific nutrition requirements gets the safe and nutritious food that they need. All of this should be available in a mobile format, easily accessible to those with the documented need to access it.



7.2.4        Foundation Components - ICT Infrastructure Specific to the Nutrition Domain

Nutrition “app” (application)

Electronic smart cash registers

Label readers

Bar code readers

Card readers

Student ID cards that have monetary debit information for purchasing food

Student ID cards that have health conditions / restrictions / goals / contact information for external care team / instructions for emergency personnel / access token to break-the-glass-health information

Ability to monitor and manage personal nutritional requirements and corresponding nutritional consumption activities via an electronic application (that communicates with the school health system)




7.2.5        Outcomes / Goals / Successes

Goals

Student consumes the appropriate amount and type of nutritionals (as defined by the CDC and related healthcare / nutritional specialists)

The nutritionals that the students consume are compatible with the student’s:

health conditions (allergies; diabetes; gluten / lactose intolerance; anorexic / bulimic)

restrictions (obesity; malnutrition)

personal preferences (vegan; cultural; religious)

goals (athletic competitions; body building; growth chart ranges)


Outcomes

Increased parental / staff awareness of the student’s nutritional status, progress, conditions, and compliance to an established regimen

Increased student understanding of their nutritional goals and awareness of progress made towards those goals

Increased student nutritional education regarding requirements, guidelines, and consumption methods


Appearances of Successes versus Failures

Schools that have good food services yield:

  • higher attendance and graduation rates (citation?)
  • increased grade-point averages (citation?),
  • fewer disciplinary problems (citation?)
  • higher tuition costs (citation?) but lower overall food-related costs (citation?)
  • fewer health problems (citation?)


7.3    Immunizations

7.4    Oral Health

7.5    Athletic Training

7.6    Schools on Military bases

7.7    Students (Consumer-Generated data; health goals; data-collection devices; data communication devices; PHRs; packet of basic health information about the student’s health; biometric information (student id card; medic alert bracelet); administration/compliance of medicinals or therapies; SDOH; adverse behaviors; nutritionals; apps that the student uses (Safe2Say; Weight Control; Food Selection, etc)

7.8    Parents, Guardians, Chaperones

7.9    Staff and Building Support (custodians, security, maintenance)

7.10   Security, Privacy, Confidentiality, Consents, Authorizations, Business Rules, Provenance; Personal Preferences

7.10.1    Description: Use Case Security Issues

Security issues appear at many different levels within the SHIFT continuum.

Since need to be addressed through the creation and adoption of policies.

7.10.2    Definition of Maturity Levels of DomainX

7.10.2.1       Low Maturity

7.10.2.2       Medium Maturity

7.10.2.3       High Maturity

7.10.3    Foundation Components – eHealth Infostructure (Specific to a Domain OR UNIVERSAL)

7.10.4    Foundation Components - ICT Infrastructure (Specific to a Domain OR UNIVERSAL)

7.10.5    Outcomes / Goals / Successes (Specific to a Domain OR UNIVERSAL)

 

7.11   Special Education (Educational-Instruction Program)

7.12   Legislators

7.13   Legislative Requirements (Food Stamps; Safe2Say; many other related to health and safety)

7.14   School Visitors (Information regarding Food Restrictions on in-classroom celebrations; speakers about school-health issues)

7.15   School District Types (Public; Private; Charter; Cyber-Charter; Career Technical Center; Home School; Magnet; Advanced Placement courses at Colleges)

7.16   School Transportation Services

7.17   Internal Healthcare Provider (School Nurse, School Physician, Athletic Trainer, Speech Language Pathologist, Occupational Therapist)

7.18   External Healthcare Providers (Pediatrician; Hospital; Clinic; etc)

7.19   Payers and Insurance Providers

7.20   Pharmacies

7.21   Research Organizations and Academic Institutes

7.22   System Vendors

7.23   Governmental Stakeholders (Local; County; State; Federal; Regional; International)

7.23.1    Local, City, County

7.23.1.1       Community Health Centers

7.23.1.2       Child Development Centers; After-School Programs

7.23.1.3       Mobile Health Clinics

7.23.1.4       Public Health Department

7.23.2    State

7.23.2.1       Department of Education

7.23.2.2       Legislative, Executive, and Judicial branches

7.23.2.3       Department of Health

7.23.2.4       Department of Social Services

7.23.2.5       Law Enforcement Agencies

7.23.2.6       Foster Child Agencies

7.23.2.7       Penal System

7.23.2.8       Indian Health Services

7.23.3    Federal

7.23.3.1       Department of Education

7.23.3.2       Department of Health and Human Services (CMS, CDC, SAMHSA, FDA, NIH, ATF, HRSA)

7.23.3.3       Department of Commerce (NIST)

7.23.3.4       Department of Homeland Security

7.23.3.5       Special (Diplomat, Military Base (local or foreign))

7.23.3.6       United States Department of Agriculture


7.23.4    Regional

7.23.5    International


7.24   Standards Development Organizations

7.25   Workforce Development organizations (to train people on the SHIFT)

7.26   School Foundations; Philanthropy; Grant

7.27   Foster Children

From Mark Stevens to Tom Boyd (see email of 20190207) – In regards to the Ask for 3b, it would be incredibly beneficial for foster children to have cloud-based EMRs as they are frequently displaced and are often denied access to services and education for a lack of a physical medical record…


7.28   School Transportation Services

Xxxxxxxxxxxx

20191002


From: John Ritter [mailto:johnritter1@verizon.net]
Sent: Wednesday, October 02, 2019 7:06 PM
To: (…)


(…) the following perspectives:

  • My “School Board member’s” perspective.
  • My “HL7 Personal Health Record Work Group” facilitator (and co-author of the “HL7 PHR System Functional Model” perspective).
  • My leadership role in the SHIFT (“School Health Innovation Framework leveraging Technology) Project (via the HL7 Mobile Health Work Group).


(…):

  • (…) children in primary and secondary school are primarily viewed as students, not “Patients”. Similarly, other people in the schools are not viewed as “Patients”, but as Teachers, Cafeteria Workers, Maintenance Workers, Administrators, Bus Drivers, Coaches, Athletic Trainers, Social Workers, Librarians, Police Force workers, et cetera. Some of these people are likely to have or use health care information and/or health care devices. As a result, the term “Patient” seems to be outmoded (particularly in the healthcare devices universe-of-discourse).
  • Health care devices are not as narrowly scoped as they were fifteen years ago. Nowadays, there is a much wider variety of health care and safety devices, innovations, and “engines” that are likely to generate, contain, use, require, share, or route health care and safety information than previously envisioned. An extreme example of a new view of a health care and safety device might be a “Very Smart Bus”. That is, a bus that transports students whereby the bus: knows how many students are on the bus; knows the medications that the bus driver takes; knows the medical conditions of the students; knows the phone numbers of the nearest first-responders services and the corresponding alert-codes; discloses the GPS location of the bus; knows the bus route (and alternate bus routes); knows the weather conditions; knows the current traffic situations; displays photographs of the “bad guys” who might appear at a bus stop; knows the identity of the students who are supposed to depart the bus at a given stop (in case a student might be asleep or distracted); deploys a small helicopter drone from the bus, takes video images, and calls for help when an emergency occurs; utilizes a sniffer device that detects and distinguishes various types and levels of smoke; employs a breathalyzer device that prohibits a bus from starting if a driver is impaired; utilizes a set of sensors that apply the brakes or steers the bus to avoid danger; utilizes a set of cameras, flashing lights, and horns to alert other drivers regarding their dangerous/unlawful movements near the bus; utilizes accelerometers that notify appropriate directors and responders that the bus has been hit, broken down, or tipped over; and/or utilizes messaging devices that inform school personnel that the bus driver will need help when the school bus arrives (e.g., urgently needs a bathroom break; needs some coffee; needs a substitute driver; needs a police or security-staff presence; needs a nurse; needs a principal, social worker, or psychologist; needs a special education worker; needs to transfer a student to another bus; needs an emergency responder, first aid measures, or emergency supplies (e.g., orange juice for a diabetic, a band aide, or bee sting ointment)).
  • Thus, the term “Patient Care Device” needs to be broadened to include patient, non-patient, health, wellness, safety, trouble-prevention, situational-awareness, and information-reporting devices. (Note: I have no clue of a single term that might adequately encompass these broader perspectives.)
  • I also wonder whether (…) adequately accommodate the broader scoping and functionality that newer devices and their corresponding services can afford. To be specific, can a single (…) Profile be written that depicts a “Very Smart Bus” (as described above)? What are the (…) standards that support a “Very Smart Bus (…) Profile”?? I can envision the need for: Patient Records; Student Records; Care Coordination; Imaging; Sounds; Decision Support; Privacy, Security, and Confidentiality; Consents and Authorizations; Telehealth; Road Maps; Weather Maps; Communications; Broadband; Cloud Storage; Audit; Codes; Artificial Intelligence; Computer Vision; Remote Control; Automotive Sensors; Light Sensors; Smell Sensors; et cetera. This certainly exceeds (…) standards (alone) – and it exceeds the other organizations’ individual offerings as well. Perhaps a “Framework” approach might best accommodate the Next-Generation-Devices set that will succeed the (highly successful) “Patient Care Devices” base.


(…)


john


John Ritter, FHL7

HL7 EHR Work Group co-chair; PHR Work Group co-facilitator; EHR System Usability Work Group co-facilitator

Western Pennsylvania HIMSS Board of Director member

+1-412-403-4749 (Mobile)

JohnRitter1@verizon.net





xxxxxxxxxxxxxxxxxxxxxxx


From: [School Leader]

Sent: Late August Dayx, 2019 11:00 PM

To: [School Leaders]

Subject: (…)


FYI... Elementary School bus driver on afternoon route did not have a certain street listed (…). Elementary student was safe on bus, and was returned to Elementary school where a parent was waiting .

School Leader will follow up with the parents tomorrow and ensure them this will be resolved (…) with the bus garage supervisor.  In addition, (…) ask the bus company about "live" real time communication between buses and Principals.


[School Leader]


7.29    

7.30   X

7.31   X

7.32   X

7.33   X

7.34   X

7.35   X

7.36   X

7.37   X

7.38   X

7.39   X

7.40   X

7.41   X

7.42   X

7.43   X

7.44   x

7.44.1    Description: Use Case DomainX

7.44.2    Definition of Maturity Levels of DomainX

7.44.2.1       Low Maturity

7.44.2.2       Medium Maturity

7.44.2.3       High Maturity

7.44.3    Foundation Components – eHealth Infostructure

7.44.4    Foundation Components - ICT Infrastructure

7.44.5    Outcomes / Goals / Successes

 

7.44.6    Description: Use Case DomainX

7.44.7    Definition of Maturity Levels of DomainX

7.44.7.1       Low Maturity

7.44.7.2       Medium Maturity

7.44.7.3       High Maturity

7.44.8    Foundation Components – eHealth Infostructure

7.44.9    Foundation Components - ICT Infrastructure

7.44.10Outcomes / Goals / Successes



8       Appendix B: Standards

8.1    EHR-S FM Standards for SHIFT


EDITOR’S NOTE (John Ritter 20190718) Here are the EHR-S FM functions that likely apply to School Nutrition (though some of these might need to be adapted to School Health systems, Student-Attendance systems, Personal Health Record systems, Health Statistics systems, Food and Nutrition Management Systems, School Nursing Systems, Health Care Devices systems (or apps), Food Label-Reading systems, Student-Transportation Systems, Student-Athletics systems, Social Services systems, and other systems). Also, consider adding other types of functionality here as well:

  • CP.1.2 DESCRIPTION (“In this function the term "allergy" is used to refer to allergies, intolerances, adverse reactions and sensitivities.”
  • CP.1.1 Manage Patient History
  • Evaluate all of CP.1.2 Manage Allergy, Intolerance and Adverse Reaction List
  • CP.1.3 Manage Medication List
  • CP.1.4 Manage Problem List
  • CP.1.5 Manage Immunization List
  • CP.1.7 Manage Medical Equipment, Prosthetic/Orthotic, Device List
  • CP.1.8 Manage Patient and Family Preferences
  • CP.1.9 Manage Adverse Events
  • CP.2.1 Render externally-sourced Clinical Documents
  • CP.2.2 Render externally-sourced Data
  • CP.2.5 Manage Patient-Originated Data
  • CP.3.4 Manage Patient-Specific Care and Treatment Plans
  • CP.3.5 Acknowledge/Amend Other Provider Documentation
  • CP.4.2.1 Medication Interaction and Allergy Checking
  • CP.4.2.2 Patient-Specific Medication Dosing & Warnings
  • CP.4.3 Manage Non-Medication Patient Care Orders
  • CP.8.1 Generate, Record and Distribute Patient-Specific Instructions
  • CP.9 Manage Care Coordination & Reporting
  • CPS.1.7.1 Support for Patient and Family Preferences
  • CPS.1.7.3 Manage Consents and Authorizations
  • CPS.2 Support externally-sourced Information
  • CPS.2.5 Support Patient-Originated Data
  • CPS.2.6 Support Patient Health Data Derived from Administrative and Financial Data and Documentation
  • CPS.2.8 Support Medical Device Originated Data
  • CPS.2.9 Support Data and Documentation from External Sources for the Adverse Events domain.
  • CPS.3.3 Support for Standard Care Plans, Guidelines, Protocols
  • CPS.3.4 Support for Context-Sensitive Care Plans, Guidelines, Protocols
  • CPS.3.6 Support Self-Care
  • CPS.3.7 Capture Guidelines and Standards from External Sources
  • CPS.3.10 Support for Identification of Potential Problems and Trends
  • CPS.3.1 Support Other Encounter and Episode of Care Documentation (e.g., for Nutritionists)
  • CPS.4.2.1 Support for Medication Interaction and Allergy Checking
  • CPS.4.2.2 Support for Patient-Specific Dosing and Warnings
  • CPS.4.2.5 Support for Medication Reconciliation (instead, apply this concept to Nutritionals)
  • CPS.4.6 Support for Referrals (perhaps applying this concept to Nutritional assessments, reconciliations, referrals, care coordination, reporting, et cetera)
  • CPS.7 Support Future Care
  • CPS.8 Support Patient Education & Communication (including all of its child-functions)
  • CPS.9 Support Care Coordination & Reporting (including all of its child-functions)
  • POP Population Health (perhaps some of its child-functions)
  • AS.8.1 Support Rules-Driven Clinical Coding (replace “clinical” with “nutritional” coding)



 

8.2    Mobile Health Standards for SHIFT

8.3    Vocabulary Standards for SHIFT

8.3.1        Dental

8.3.2        Immunizations

8.3.3        (Other)



9       Appendix C: References


10        Appendix: xxxxx

11         


 [CW1]Wanted to make sure we can communicate with different suppliers, mainly food vendors in my case, in order to capture ingredient and nutrient information.


 [CW2]I wanted to call out local, state, and national providers of education since I hope some of this will become a national set of standards that the USA or other countries can adopt.


yyyyyyyyyyyyyyyyy



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