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First NameLast NameOrganizationE-mailVoteCommentDispositionsResponse
GabrielaGonzalezCHCANYSggonzalez@chcanys.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
SharonHewnerUB School of Nursinghewner@buffalo.edu• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
AlTaylorHHS/ONCalbert.taylor@hhs.gov• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
Amy FreimanCHCANYSafreiman@chcanys.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
SarahDeSilveyYale University, School of Nursing, UVM Larner College of Medsarah.desilvey@med.uvm.edu• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
RebeccaMillerMichigan Health Information Network Shared Services (MiHIN)rebecca.miller@mihin.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
DonnaPertelAcademy of Nutrition and Dieteticsdpertel@eatright.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
SuzanneTamangStanford Center for Population Health Sciencesstamang@stanford.edu• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
MariaBasso LipaniMount Sinai Health Systemmaria.bassolipani@mountsinai.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
TerrenceO'MalleyPartners HealthCare System, Inctomalley@mgh.harvard.edu• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
JoniGeppertMinnesota Department of Healthjoni.geppert@state.mn.us• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
KarieNicholasWA Association for Community Healthknicholas@wacommunityhealth.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
AnitaLiCommunity Health Care Association of New York Stateali@chcanys.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
JamesMeyersLA DHS SDOH Consultantjimmeyersdrph@gmail.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
JulieDoolingAHIMAjulie.dooling@ahima.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
DonnaRuggAHIMAdonna.rugg@ahima.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
NatalieDillonBlue Cross Blue Shield Kansas Citynatalie.dillon@bluekc.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
Michelle AguirreEOIPAmichelle@eoipa.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
NedMossmanOCHINmossmann@ochin.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
LawrenceSimonBlue Cross and Blue Shieldlawrence.simon@bcbsla.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
LoriPetersenAlliance for Better Healthlori.petersen@abhealth.us• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
ScottBrownADVault, Inc.sbrown@advaultinc.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
GeorgeDixonAllscriptsgeorge.dixon@allscripts.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
Carrie BeckComagine Health (QIO)cbeck@comagine.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
LauriWrightUniversity of North Floridal.wright@unf.edu• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
MelindaBenedictBaptist Hospital JacksonvillembtheRD@gmail.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
MelindaBenedictBaptist Hospital JacksonvillembtheRD@gmail.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
AldenBergeronPoverelloabergeron@poverello.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
BeckyGradlAcademy of Nutrition and Dieteticsbgradl@eatright.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
DavidBucciferroFoothold TechnologyDavid@footholdtechnology.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
Jennifer SpearHumanajspear1@humana.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
SethBlumenthalAmerican Medical Associationseth.blumenthal@ama-assn.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
MylesBlackwellHealth Leadsmblackwell@healthleadsusa.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
KellyDavisonRegistered memberkelly.davison@gmail.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
RachelRiddifordDayton Children's Hospitalriddifordr@childrensdayton.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
BarbaraGordonIdaho State Universitygordbarb@isu.edu• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
RichardShewardChildren’s HealthWatch, Boston Medical Centerrichard.sheward@bmc.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
HeatherHartline-GraftonFood Research and Action Centerhhartline-grafton@frac.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
CatherineLuuHealthifycatherine@healthify.us• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
KennethSalyardsSAMHSAkenneth.salyards@samhsa.hhs.gov• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
NanceShatzkinBronx RHIOnance@shatzkinsystems.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
LeslyeRauthMember of Academy of Nutrition and Dietetics leslye.rauth@ihs.gov• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
LeslyeRauthMember of Academy of Nutrition and Dietetics leslye.rauth@ihs.gov• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
CarlaNelsonGreater New York Hospital Associationcnelson@gnyha.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
KarenSmithKAREN L SMITH,MD, PAksmith@karensmithmd.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
JuliaKyleTrinity Healthjulia.kyle@trinity-health.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
ChristiePeckElsevier Clinical Solutionsc.peck@elsevier.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
RuthWettaCerner CorporationRuth.Wetta@Cerner.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
PalomaLuisiNYSDOHpaloma.luisi@health.ny.gov• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
MariaMoenADVault, Inc.mmoen@advaultinc.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
AJPetersonNetsmartapeterson@ntst.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
MaryMillerUnited Way of South Hampton Roadsmmiller@unitedwayshr.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
KerryGoetzNIHgoetzke@nei.nih.gov• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
VictoriaTiaseANIvtiase@nyp.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
JanePirsigAlliance from Strong Families & Communitiesjpirsig@alliance1.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
MICHELLEAHMEDSouthwest Washington ACHmichelle.ahmed@southwestach.org• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
SafiyyahOkoyeJohns Hopkins Bloomberg School of Public Healthsokoye1@jhmi.edu• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
AlyssaCrawfordMathematicaacrawford@mathematica-mpr.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
DougBachHDConsultDoug.m.Bach@gmail.com• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
GraceGaoSt Catherine Universityggao912@stkate.edu• Yes: A Yes vote does not necessarily mean that the deliverable is the ideal one from the perspective of the Committed Member, but that it is better to move forward than to block the deliverable.
LucyJohns MPHHealth Care Planniljohns@metacosmos.org• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.Please put "illiteracy" in the parking lot for future discussion concerning whether a factor for food insecurity and need for intervention if present. Otherwise, comprehensive and thoughtful work that will undoubtedly advance reporting, understanding, and patient care. Thanks!AcceptedLanguage communication preference and level of proficiency is already a standardized data element in CDA (proficiencyLevel). This notion of proficiency has not been addressed yet in FHIR. This should be entered as a change request for Person, Patient, and RelatedPerson. For the Gravity Project, Use Case #1 indicates in the assumptions that the patient was a high school or greater level literacy and comprehsenion level.
AngelaPetrielloUnite Usangela@uniteus.com• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.Comments submitted by UniteUs have been addressed and assigned dispositions based on communications received from Michaela FerrariAcknowledgedThank you, Angela!
MichaelaFerrariUnite Usmichaela@uniteus.com• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.Thank you for the opportunity to review all of the great work the Gravity Project has done to define and standardize food- and nutrition-related data elements. We compared your Food Security Master with our own food assistance-related assessments, outcomes, and service categories. In general, your master list is incredibly comprehensive and includes more standardized tools than UU clients currently use. We went ahead and voted "yes" through your online form - this is such exciting work! One thing we wanted to note is that in addition to documenting service outcomes, we also include "assessment questions" when food assistance services are requested that are meant to identify any existing services that a client receives and gather information to determine eligibility for other services. Our "outcomes" largely overlap with the "interventions" you have defined. However, one of the types of outcomes we document that we didn't see in your list of interventions is a lack of eligibility for services, which would be determined after a screening. This makes sense not to include as an intervention, but could be helpful to collect generally. Please let us know if you have any questions about the suggestion above, and thank you again for the opportunity to review!AcceptedEligibility and enrollment is an identified need. Phase II of the Gravity Project will address working with Regenstrief to create a LOINC® panel for this information. In Gravity Use Case #2 we will be considering the work already being undertaken in DaVinci use cases around eligilbity and enrollment.
ShelbyKleinNew Jersey Innovation Institute (NJII)shelby.klein@njii.com• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.Very comprehensive. Thank you for the work.AcknowledgedThank you, Shelby!
MariannaWetherillUniversity of Oklahoma Health Sciences Center marianna-wetherill@ouhsc.edu• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.I do not see any CPT codes for dietitian interactions (assessment, education, counseling, etc). While many professionals contribute to the care that is provided to those who are food insecure, a dietitian’s work is central to identifying and addressing food insecurity and the nutrition CPT codes should be considered for inclusion. MNT CPT® Code Descriptors 97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes 97803 Reassessment and intervention, individual, face-to-face with the patient, each 15 minutes 97804 Group (2 or more individual[s]), each 30 minutes AcceptedWe have created a separate Intervention tab in the Master File for the relevant CPT/HCPCS billing codes that include the codes for medical nutrtion therapy.
ConstantinaPapoutsakisAcademy of Nutrition and Dieteticscpapoutsakis@eatright.org• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.Food insecurity is associated with poor nutritional health. As the reversal of food insecurity and improvement of nutritional health are at the core of services provided by dietitians, it would seem quite important to include CPT codes that are approved for use of RDNs interventions. AcceptedWe have created a separate Intervention tab in the Master File for the relevant CPT/HCPCS billing codes that include the codes for medical nutrtion therapy.
AlexVillaHealthifyalex@healthify.us• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.Below are a few items I noticed while reviewing the materials that predominantly related to organization and presentation: 1. The interventions definitions are all written in a different tense and with different subjects. This makes it hard to understand the framework as you read through all of them as a group. Not to mention having the Intervention Framework as an image of text followed by a list of examples is not very conducive to readability. I would reformat this into a table like the rest of the page. 2. The master spreadsheet is very hard to follow and could used some clean up if you expect people to further review it by hand (as opposed to this being an import file for a software application). As a basic example, the Screening Questions table (the third tab) has a collection of columns that have no values in them (see L through O). However, the "Answer Concept" column indicates in many cases questions that should be categorized into these columns somehow (ie. Yes/No should be a boolean type question, I believe). Overall, these tables could be improved by more clearly separating object types and referring to object types where it makes sense in other tables. For example, Interventions Planned-Completed should pull from a list of options of Intervention Types that is on it's own tab. This would allow people to more easily learn what the intervention types are and a reference to that table from this larger table can tell you as the reader where to find more. 3. On the summary spreadsheet there are 21 programs in the program summary but only 13 program definitions. It does note some programs include other programs in column C but I still think every program isn't covered by the definitions. I think this is simply representative of further feedback like that noted in #2. For me to assess this I had to flip back and forth to gauge which program/definition was related based on their name. I think use of references/formulas through out these spreadsheets (ie. typing "=" and then the cell it should refer to) would make this much easier to follow and update. Those are my initial thoughts on the review of this work. Thank you for the opportunity to provide feedback.1. Acknowledged 2. Accepted 3. Accepted1. We are currently awaiting response from submitter to clarify the comment with examples so we can discuss further and reconcile. 2. The master list format will be reviewed and updated for improvements for the next phase of Gravity. 3. The program definitions summary has been updated for completeness.
WilliamSwanAcademy of Nutrition and DieteticsTABILLOS@GMAIL.COM• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.I would restore/include CPT codes for dietitian interactions: 97802 Medical nutrition therapy initial assessment... , 97803 Medical nutrition therapy reassessment... , an possibly 97804 Medical nutrition therapy group... . There is an increasing presence of dietitian nutritionists in primary care settings where these interventions are likely to occur in order to address food insecurity as part of the care plan. It would be very useful to have these data points.AcceptedWe have created a separate Intervention tab in the Master File for the relevant CPT/HCPCS billing codes that include the codes for medical nutrtion therapy.
JosieRiggallCommunity-University Health Care Centerjosie.riggall@gmail.com• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.Food insecurity is closely tied to poor nutrition. Registered Dietitians (RDs) play a crucial role in assessing and addressing nutritional status and food insecurity. Therefore, it's essential to include CPT codes for Medical Nutrition Therapy by RDs.AcceptedWe have created a separate Intervention tab in the Master File for the relevant CPT/HCPCS billing codes that include the codes for medical nutrtion therapy.
Donna GjesvoldAcademy of Nutrition & Dietetic, Hennepin Healthcaredonna.gjesvold@hcmed.org• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.Please include Medical Nutrition Therapy (MNT) CPT codes 97802, 97803, and 97804 in all of the Interventions (ID#'s I-9 through I-143) on the Master List as these activities are occurring routinely during care provided by Registered Dietitian Nutritionists under the umbrella of these 3 CPT billing codes for MNT. The interventions listed are standard work and central to high quality nutrition care, so including these CPT codes in the Master List is essential to capturing the work that is already being done to address food insecurity. Thank you.AcceptedWe have created a separate Intervention tab in the Master File for the relevant CPT/HCPCS billing codes that include the codes for medical nutrtion therapy.
SaraArmsonLOINC, Regenstrief Institutesarmson@regenstrief.org• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.Suggestion for revision of this document: There are tools that use the same question. If the question and answer choices are the same, the LOINC code will be the same. In future revisions, I recommend listing the LOINC code where ever applicable. Example: LOINC 88122-7 “Within the past 12 months we worried whether our food would run out before we got money to buy more” (pronouns “I” and “you” are also acceptable) should be applied in the following tools, AHC, US household food security, SWYC, AAFP. Suggestion for further discussion: Survey questions in this domain (and similar domains) are often similar or overlapping, but have enough distinction to be considered unique questions. For example, this document includes several ways to ask if meals were skipped due to food insecurity, see US household food security, FIES-SM, HFSSM, USDA Youth. If these data standards will be used for work flows and data aggregation, what are some practical solutions for handling similar, but not quite the same, observations? (From a LOINC perspective, we have some tools that help “roll-up” data, and this community’s input will help us adapt these tools for SDH data.)Accepted1. The Screening Tool Master List has been updated to add the missing LOINC® codes. 2. The Gravity Project team will engage with Regenstrief to address this concern in an upcoming phase of the project.
BenAtkinsonAuburn School Districtbatkinson@auburn.wednet.edu• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.Food Insecurity is a condition that can definitely addressed by many clinicians and workers in many setttings, but the Registered Dietitian is the worker that typically handles these issues and has specific training and expertise also. I ask the Gravity Project group to please add the CPT codes that will allow dietitians to document and communicate about food insecurity. This should increase interoperability around the topic of food insecurity. The relevant CPT codes are: 97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes 97803 Reassessment and intervention, individual, face-to-face with the patient, each 15 minutes 97804 Group (2 or more individual[s]), each 30 minutes. Thanks so much for the hard work done by this group!AcceptedWe have created a separate Intervention tab in the Master File for the relevant CPT/HCPCS billing codes that include the codes for medical nutrtion therapy.
MaryKenneyHealthifymary@healthify.us• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.Outstanding questions: 1.- Why don’t all the programs listed in “Program Summary” appear in the “Program Definitions” tab? 1.- Why are programs that are included in Interventions (e.g. “food and nutrition voucher”) missing from the Program Summary and Program Definitions tabs? 2.- What does “community resource network” mean? I noticed some typos throughout (e.g. "referal", "socioecomonic", "snakc") - not a big deal but would recommend running spell check!1 Accepted 2 Accepted1. The program definitions summary has been updated for completeness. 2. Added "community resource network" definition to the program defintions table.
Alissa WassungGod's Love We Deliver, Inc./Food Is Medicine Coalitionawassung@glwd.org• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.Thank you for your incredible work on this project. I broadly agree with the Master List elements, with the following comments and necessary changes: 1.) Necessary change: the Medically Tailored Meal definition should be modified to fit the Food Is Medicine Coalition definition, which is: “Medically tailored meals are delivered to individuals living with severe illness through a referral from a medical professional or healthcare plan. Meal plans are tailored to the medical needs of the recipient by a Registered Dietitian Nutritionist (RDN), and are designed to improve health outcomes, lower cost of care and increase patient satisfaction.” (http://www.fimcoalition.org/our-model) 2.) I understand that we are not attaching the HCPCS code for Home-Delivered Meals (S5170) to Medically Tailored Meals, because we hope to have a distinct HCPCS code in the near future. MTM are currently recorded under the S5170 code. 3.) Line 125 on the Intervention Sheet: “Provision of medically tailored meals (child of 1-66)”; There should not be an age limit for this service. 4.) The current Food Insecurity focus of Gravity precludes measures that assess or diagnose malnutrition, though the interventions that may be provided to address this condition are similar or the same to those provided to address Food Insecurity. 5.) I would defer to the Academy of Nutrition and Dietetics on this, but I don’t see medical nutrition therapy detailed on the list of Interventions. This service should be included as discrete from nutrition counseling. Here are the CPT codes: • 97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes • 97803 Re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes • 97804 Group (2 or more individuals), each 30 minutes Thank you 1. Acknowledged 2. Acknowledged 3. Acknowledged 4. Acknowledged 5. Accepted1. Medically Tailored Meals definition from FIMC concepts have been integrated into the Gravity defintion. 2. The S5170 HCPCS codes are included in the new Intervention CPT/HCPCS tab in the Master List. 3. The note in ( ) refers to the relationsihp of this concept in SNOMED CT indicating that it will be a child of "Provision of Food" (I-66) when these concepts are submitted to SNOMED CT. 4. Yes, both Food Insecurity and Malnutrition can co-occur which may result in overlap interventions. 5. We have created a separate Intervention tab in the Master File for the relevant CPT/HCPCS billing codes that include the codes for medical nutrtion therapy.
EricJahnAlexandria Consulting LLCeric@alexandriaconsulting.com• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.I would like to see this taxonomy formalized as a linked open vocabulary. (W3C OWL; and submitted to something like schema. org). a linkeda vocabularyAcknowledgedThank you, Eric!
EricGuroffHealthifyeguroff@healthify.us• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.There are some elements of this that still are a bit confusing and inconsistent across the reference document. For example, the Reference document's "Program Summary" and "Program Definitions" tabs do not have the same numbers of Programs, so I don't feel I understand the clear definition of all elements being proposed. Before finalizing, it would be helpful to make sure there is an accurate reference document with clear documentation of the schema and individual element definitions. Nonetheless, I am encouraged by the progress and thank everyone for there work on this.AcceptedThe program definitions summary has been updated for completeness.
PriyankaSurioASTHOpsurio@astho.org• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.I saw only a few items on safe food and water and think there could be value in connecting with environmental health directors or informatics directors. I haven't been able to be as fully involved due to capacity, but ASTHO has a few outlets we could use to promote this more widely and/or to gather feedback, specifically around sources or screening tools used if that would be helpful. To that point, do you have an idea of how many state health agencies have contributed their comments to this?AcknowledgedSafe food is an aspect of quality but the tools that currently exist do not assess this well. Quality is one aspect of the definition of food insecurity. As of this consensus voting period, Gravity had nearly 80 federal, state and local agency registered members who have participated in community meetings.
Moniquevan BerkumAMAmonique.vanberkum@ama-assn.org• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.ADMIN NOTE TO READER: This field includes extensive comments that may not all show onscreen. To view, double-click this field and use the down arrow to view the entire text. Overall, the project deliverables are moving in a very positive direction. This is a challenging task and the Master List provides a good starting point for the types of data elements that the community feels are needed for the Food Insecurity Domain. However, many of the data elements will require further disambiguation (e.g., with human-readable definitions) before they can be converted to “machine-readable structured representations” (e.g., FHIR artifacts bound to code system codes). Additionally, it will be important to continue to set and understand expectations for this structured data (e.g., related to interoperability, algorithmic capabilities, etc.). With the continued success of the project in mind, a bit more detailed feedback is provided in an email sent today (12/05/2019) which contains the following documents: 1. Gravity_Master_List_Feedback_AMA_20191205 – Provides a few high-level comments/suggestions. 1-1. Diagnosis -Rows D-1 through D-5 have “Food insecurity” in Column D but then specify some additional SNOMED and/or ICD codes. It is not clear whether the additional columns are simply attempts to map the “Food insecurity” data element to code system codes or whether the additional codes are intended to represent additional, more granular “Food insecurity” data elements 1-2 General - Many data elements require further disambiguation (e.g., human-readable definitions) 1-3 Addressed in the spreadsheet review below 1-4 Placement of ( ) for Interventions 2. Food Security MASTER_AMA_20191204.xlsx – Provides specific feedback on some of the data elements in the Master List 2a. Screening -Comment applies to many items on this list: The ambiguity of the subject of these questions (e.g., we, the household, I/we, my child/the children, etc. as opposed to clearly being the patient) will pose problems (raised in a previously submitted document - Gravity_FI_Screening_Tool_Feedback_20191030.pdf). To make observations/assessments based on these questionnaires, this ambiguity as to the subject will need to be addressed. Structured representation of this data may require; additional questions to resolve ambiguity, developing novel solutions, or accepting and agreeing to compromises to the integrity of the data (specifically that the "true subject" of the data may not be known). - 2b. Screening Hunger Vital Signs Risk Score -1) Although these data elements can be derived from screening questions and their answers, the S-3 rows are not really screening questions. They represent the assessment/observation of “Food insecurity risk” (aka Food insecurity present) or “No food insecurity risk” (aka Food insecurity absent). These assessments are theoretically made based on two previously answered HVS questions. 2) The separate concern as to whether the two HVS questions can correctly arrive at the assessment made by rows S-3 was presented in a prior submitted document - Gravity_FI_Screening_Tool_Feedback_20191030.pdf. 3) Finally, under the revised definitions, “At risk for food insecurity” now falls into the category of “Food insecurity”. Ideally, the whole notion of “at risk for” in the context of "Food insecurity" needs to go way and be replace by another term (i.e., mild food insecurity). This would avoid the problem that “At risk for X condition” is not a kind of “X condition” (e.g., “At risk for Cancer” is not a kind of “Cancer”). 2c. Goals G2, G5, G6 - Per FHIR a Goal is "A Goal in health care services delivery is generally an expressed desired health state to be achieved by a subject of care (or family/group) over a period or at a specific point of time. ". These are not health states. As discussed in the previously submitted document (see row 8), these seem to be goals that specific intervention(s)/procedure(s) happen in the future. These desired interventions/procedures can be represented using the FHIR Service Request Resource which allows a specified Intent (e.g., proposal or plan) and Occurrence period during which the intended intervention should happen. Therefore, creating these separately as Goals seems redundant. 2d. Goals - G3 -“Decrease in severity of food insecurity” is a reasonable goal for the patient. However, confirming a “Decrease in severity of food insecurity” for the population will involve analysis of the data of individuals to make inferences about a population. This would not be a data element in the EHR. 2e. Goals - G4 -As per the Notes statement, confirming a “Decline in prevalence of food insecurity” will involve analysis of the data of individuals to make inferences about a population. This would not be a data element in the EHR. 2f. Diagnosis - Food Insecurity - The SNOMED code 733423003 |Food insecurity (finding)| has a Text Definition: “The state of being uncertain about future access to nutritionally adequate and affordable foods.” However, this concept is a child of 424924007 |Community resource finding (finding)| which seems to imply that “Food insecurity” is ONLY due to “living in a food desert” as opposed to representing a patient state of “Uncertain, limited, or unstable access to food that is: sufficient in quantity; adequate in nutritional quality; culturally acceptable; safe and acquired in socially acceptable ways”. The latter definition, which reflects the patient state, may be caused by something other than "Community resource issues". To reflect the intended meaning of the Gravity defintion, the SNOMED code should probably be placed in a different hierarchy. 2g Diagnosis -1) Is the data element being suggested by this row "Food insecurity", “Insufficient food supply” or “Food insecurity due to insufficient food supply”? 2) The selected SNOMED code 706875005 |Insufficient food supply (finding)| is a child of 424924007 |Community resource finding (finding)| which seems to imply that it is due to “living in a food desert” and therefore not due to other causes such as inadequate money to buy food”. The code may need a Text definition added in SNOMED to clarify its meaning and how it is different from 733423003 |Food insecurity (finding)|. Depending on its text definition, it may also need to be placed in a different hierarchy. 2h.Diagnosis - Nutrition Imparied 2 SNOMED CT Concepts - Seems out of scope. “Nutrition impaired due to limited access to healthful foods” is not a type of “Food insecurity” it is a physical condition that is caused by an SDOH finding (i.e., food insecurity). There will be many of these types of conditions (e.g., many of the subtypes of 300893006 |Nutritional finding (finding)|in SNOMED could be rooted in a SDOH problem) but they are outside of the scope of SDOH. They are separate concepts that might reference SDOH concepts as their cause. The actual SDOH concepts should be the only ones in scope. 2i. Diagnosis - Patient noncompliance -Seems out of scope for the same reasons provided for D-3 and D-4. This is “noncompliance with dietary regimen” because of an SDOH. The SDOH (e.g., food insecurity, low income, etc.) should be in scope and out of scope data elements like “noncompliance with dietary regimen” when due to an SDOH can reference the appropriate SDOH as their cause. 2j. Interventions- Counseling - Many of the counseling terms seem to be about counseling for medical conditions that might result from food insecurity. These seem out of scope. For example, many of the counseling interventions are interventions for obesity (e.g., “Counseling about nutrition using stimulus control strategy”) as opposed to interventions for “Food insecurity” (e.g., “Education about SNAP”). The number of interventions for conditions caused by “Food insecurity” is significant and intervetnions of this type should be out of scope. 2k. Interventions - Medically Tailored Meals Education and Nutrition Educations - ? Ambigous need definition1-1 Acknowledged 1-2 Acknowledged 1-4 Acknowledged 2a, 2g, 2h, 2i 2j Acknowledged 2b, 2c, 2d, 2e, 2f, 2k Accepted 1-1. Concepts were included as diagnoses if they were fully or partially (more granular or more general) related to Food Insecurity 1-2. Work to develop or refine data element definitions will be continued in a subsequent phase. 1-4. We will work with SNOMED during the submission process to align with best practices. 2a. The assumption in all cases is that the interviewee is the patient, except in the case of the full USDA 18 tool where the child would be the subject of child questions. There is work to be done in terms of identifying the needs of the household. 2b. We will work with Regenstrief to address coding of summary assessments. 2c. Goal type changed to organization 2d. Goal type changed to patient 2e. Goal type changed to organization 2f. We will propose a definition change to SNOMED International to align with Gravity community definition and work with SNOMED to review heirarchy placement. 2g. We will propose a defintion to SNOMED and, depending on the defintion, suggest different hierarchy placement if appropriate. 2h. The logic is if x represents the concept, you can be food insecure without x. However, if x is present, then you are always food insecure. Example: you can be food insecure without being nutrition impaired due to limited access to healthful food. However, if limited access to healthful foods you are, by our Gravity definition, always food insecure. 2i. The logic is if x represents the concept. you can be food insecure without x. However, if x is present, then you are always food insecure. 2j. The assumption in all cases is that food insecurity and/or the diagnoses suggested, are the "reason for" and not medical conditions that may be associated. We chose to not include secondary diagnoses in our modeling at this time. Education addresses knowledge deficit and counseling addresses behavior change. 2k. We are working with SNOMED to change the education definition. In addition, FIMC has revised the definition of medically tailored meals in another consensus comment and we will update accordingly.
LisaNelsonMaxMDLNelson@max.md• Yes with Comment: If a consensus process attracts significant comments through Yes With Comment votes, it is expected that the comments will be addressed in a future revision of the deliverable.I e-mailed a copy of the Master List with annotations and comments to be taken into consideration during the final review. These comments are influenced by having had some time to begin the FHIR modeling that will need to be supported by value sets that result from this work. 1. Screening - Hunger Vital Signs Risk Score - This data element should not be in the Screening Panel. It is a separate Assessment Observation and should be a separate LOINC coded Concept. Recommend LOINC remove this concept from the panel. 2, Screening - Multiple Screeners with questions that include (I/We) (you or members of your household) - More thought needed on how to address a question where the subject of the question is a household or group of people rather than a single person (the patient). What if you live with people who are not family members? The question does not make it clear what is being assessed. Also, need to clarify and standardize the possible reasons for no answer, i.e. I chose not to answer, refused, don't know, etc. Recommend clarifying the subject of the question before establishing a coded concept for this question 3. Screening - S11, S13, S14, S17, S18, S23, S28, S29, S30, S31, S32, ,S34, S41 - Need very specific guidance on how to use temporal coding for this question. 4. Screening - S12, S19, S25, S39, S40 - Need to decide if a subquestion will use a new coded concept or if this will use the same coding in each panel where it is used. 5. Diagnosis 'Insufficient food supply/lack of adequate food' -This is an observation made about an area or a region, not about a person. Clarify this concept has to do with the notion of a "Food Desert" where a geographical area does not have a sufficient supply of nutritious, safe, culturally acceptable food. 6. Diagnosis ' Nutrition imparied and noncomplicance concepts - This is a nutrition related Assessment Observation, not a SDOH related Assessment Observation. Category should be Nutrition not Social History 7. Diagnosis 'Food insecurity severity levels' - These are differing levels of severity of food insecurity. Add more specific definitions for each. 8. Goals - G2, G5, G6 - This is not a health goal, G4 - Out of scope 1. Acknowledged 2. Acknowledged 3. Acknowledged 4. Acknowledged 5. Acknowledged 6. Acknowledged 7. Accepted 8. Accepted1. Assumption in all cases is that the interviewee is the patient. Except in the case of the full USDA 18 tool where the child would be the subject of child questions. There is work to be done in terms of identifying the needs of the household. 2. Ww will work with Regenstrief to address coding of summary assessments. 3. This is a limitation of the current representation of concept in LOINC® since temporality is not its own discrete term. 4. The owner of the screening tool will need to work with LOINC® to insure the concepts are assigned codes correctly. 5. Will propose a defintion to SNOMED to clarify that this term refers to an individual. 6. There terms include components of both SDOH and nutrition. 7. We added definitions to "Severity level food insecurity" diagnoses in the Master List. 8. Goals changed to organization
DebbiePetitpainAcademy of Nutrition and Dietetics Foundationdepetitpain@eatright.org• Abstain: A member declined to vote.
EmilyParmenterContra Costa Health Servicesemily.parmenter@cchealth.org• Abstain: A member declined to vote.
Penni HernandezSNOMED Internationalphe@ihtsdo.org• Abstain: A member declined to vote.
Suzy RoySNOMED Internationalsro@snomed.org• Abstain: A member declined to vote.
MattSmithAunt Berthamsmith@auntbertha.come• Abstain: A member declined to vote.
BellaKirchnerAunt Berthabkirchner@auntbertha.com• Abstain: A member declined to vote.
DavidHaddickPSYCHeANALYTICS, Inc.dave@psycheanalytics.com• Abstain: A member declined to vote.
KimberlyGraorAfia Inckgraor@afiahealth.com• Abstain: A member declined to vote.
SeanMiklesUNC-Chapel Hillsmikles@med.unc.edu• Abstain: A member declined to vote.
NadineSahyounUniversity of Marylandnsahyoun@umd.edu• Abstain: A member declined to vote.
KellyDavisonCHIMAkelly.davison@echima.ca• Abstain: A member declined to vote.
PhilSmithWily Fox Technologiespsmith@wilyfox.com• Abstain: A member declined to vote.
AlyaNadjiIndependence Blue Crossalya.nadji@ibx.com• Abstain: A member declined to vote.
MichaelKlinkmanUniversity of Michiganmklinkma@umich.edu• Abstain: A member declined to vote.
DeniseChapelDenise Chapel Nutritional Services dba/DCNSdenise.chapel@cdph.ca.gov• Abstain: A member declined to vote.
AnaGallegoDohmhAgallego1@health.nyc.gov• Abstain: A member declined to vote.
AndrewHamiltonAllianceChicagoahamilton@alliancechicago.org• Abstain: A member declined to vote.
LeslieKelly HallEngaging Patient Strategylesliekellyhall@outlook.com• Abstain: A member declined to vote.
ShawnTerrellACLShawn.Terrell@acl.hhs.gov• Abstain: A member declined to vote.