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Becky GradlAcademy of Nutrition and Dietetics
Sandy Miller
Sue Kent
Daniel Vreeman
Della DunbarDM&A
Gay Dolin
James Allain
Jenna NortonNIDDK
Leslye RauthIHS
Margaret DittloffJunum
Sandy Pagan
Julia Skapik
Laura Heermann

Multiple Chronic Conditions (MCC) eCare Plan Overview

  • Goal is to create a comprehensive shared care plan (or working towards one)
  • This care plan would be to share across multiple settings of care for people with multiple chronic conditions
  • Looking at how can they shift from disease specific care plans (or provider specific care plans) to a comprehensive care plan
  • Project is creating both an implementation guide (IG) and an application
  • This is a dynamic care plan intending to leverage the FHIR care plan resource
  • Initial goal is to pull information from existing EHR care plans 
  • Hoping to have a draft IG pulled together in September 2020, but not balloting until September 2022
  • The HL7 confluence project page is here: Multiple Chronic Conditions (MCC) eCare Plan
  • To join the listserv and follow the project, sign up here:

NutritionOrder discussion

  • The description states "A request to supply a diet, formula feeding (enteral) or oral nutritional supplement to a patient/resident." so it seems only appropriate for inpatient or in a residential setting with the word "supply" in the description
  • Margaret was involved in the initial design and build of the resource and thinks we can loosen some of the requirements fairly easily to make NutritionOrder work for an outpatient setting
  • The sticking point is there is a need in an inpatient setting that you only have 1 active oral diet at one time, thus the oralDiet element is constrained to 0..1; if necessary, this could be changed for outpatient
  • The type field under oralDiet could still be made up of multiple diet types strung together
  • The definition is a problem because of the supply part
  • The resource was modeled after the request pattern (it is the only resource still named order), but was supposed to be fixed up to match Service Request; it did not become part of service request like other resources did because of the need for detailed elements specific to nutrition
    • there might be some outstanding trackers related to this
  • The modifiers the MCC eCare Plan team is looking to use are:
    • Limit sodium in diet
    • Moderate protein in diet
    • Limit fats in diet
    • Limit cholesterol in diet
    • Limit phosphorus in diet
    • Limit potassium in diet
  • There are terminology codes the Academy of Nutrition and Dietetics has with its nutrition care process terminology (NCPT) that have been mapped to SNOMED, so you will see modified protein, with children of of increased or decreased; these could be used for the modifiers
  • In 2018, Margaret did a proof of concept with care plan and NutritionOrder for HIMSS interop showcase
  • There is there a written report out from January 2019 connectathon care plan work with Dave Carlson; Infor (Corey Spears) was also involved in this
    • The Academy of Nutrition and Dietetics created NutritionOrder as an activity in a CarePlan