Food consistency AND Dysphagia in SNOMED CT

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Considering our discussion on September 17 re the proposed terms for food texture and fluid consistency to accommodate the IDDSI adoption in many countries. Discussion about the construct or universality of the IDDSI adoption is not germain. While IDDSI is not embraced universally, there is significant adoption around the world. Inclusion of a term in SNOMED-CT, or any other terminology for that matter, only describes a practice; it does not mandate a practice. It will be helpful to those many practitioners who will be adopting IDDSI to have availability of concepts needed to describe IDDSI.

I was chair of NCPROC when the IDDSI terms were presented for inclusion in the NCPT. We did remove ampersands, hyphens, etc when constructing the terms for the NCPT following guidance for SNOMED-CT Editorial Guide. I appreciated at the time that the color and level designations would be difficult, if not impossible complications, to include in SNOMED-CT. While these designations will be included in the food service operations workflows, they are probably not clinically essential. Clinically, adoption of IDDSI would be supported by a diet manual and policy/procedure which would offer complete definition of a term such as Soft bite sized food in the context of that food service operation. In terms of clinical data aggregation, Soft bite sized food would be a preferred search term due to its specificity vs Level X or a color. In organizations that don’t adopt IDDSI, they may have a different definition of Pureed food than IDDSI; but still need the term to describe their care. Definition in SNOMED-CT for any of these terms should be simple and true: a food texture modification used in the management of dysphagia and a fluid consistency modification used in the management of dysphagia.

SNOMED-CT currently may have some of the needed descriptors (NCPT concepts minus level and color) for adoption of IDDSI. Variations of these descriptor concepts can be found in several hierarchies: (findings) (substance) (regime/therapy). According to current editorial guidance, these descriptor concepts probably do not belong in the (substance) and (findings) hierarchies. Texture is not a chemical constituent nor is food; a diet is not a patient observation. That is another day’s discussion. The terms in NCPT are interventions, a regime/therapy for the individual client or a procedure if applied to general clinical practice. Currently diets exist only in the regime/therapy hierarchy. These observations are summarized in the following table:

Random notes: (editorial inconsistencies affecting food and diet content development)

Mildly, moderately,and extremely are used in many concepts throughout SNOMED-CT but are not in the Qualifier value hierarchy while Slightly is.

Pureed diet would seem to be the singular fully defined diet. It has a Using substance (attribute) Liquidized food. The correct Using substance (attribute) should be Pureed food.

Texture modified diet (regime/therapy) vs Modified texture diet (finding), are these really different concepts? Or was the wording rearranged to facilitate placement in different hierarchies?

That all said, it is clear that SNOMED-CT has had a difficult time accommodating the complexity and subtlety of food and diet concepts. Placement seems rather haphazard; this is probably due to the fact that many food and diet concepts predate editorial guidance. I am proposing the concepts in the right hand column be adopted as this seems most consistent with current diet concepts and their placement.

Due to the recognized importance/essentiality of food and diet in healthcare, not being able to accommodate concepts to support this role is untenable.