We may need to look at this within the context of the edible substance hierarchy to do this 762766007 |Edible substance (substance)| and then once this is in the approved hierarchy apply this to how we classify Nutrient intake of interest is that this has the following has the following children all of which are not yet fully specified terms and appear to address some of the complexity we have been re litigating in our meeting
226465004 |Drinks (substance)|
255620007 |Foods (substance)|
229979003 |General food and drink types (substance)|
440551000124102 |Bioactive substance (substance)|
735252001 |Protein and protein derivatives (substance)|
59533004 |Food additive (substance)|
Not sure that helps but if we were to work on sorting out these terms we could then use these "edible substances" as part of Dietary, oral and Nutrient intake.
Let me know what you think and how we can work on making the above more usable and fully specified
Thanks,
Nathan
ps will repost this in the discussion forum, sign up as watching get notified when others post and share thoughts asyncronously prior to next meeting
I'm concerned that looking to the substances may not yield the insight we need. For instance, "Water (substance)" is not included as an edible substance, yet "Drinks (substance)" are. We don't really have a good way of knowing who made that decision (or any other decisions about the substances hierarchy) or why. "Drinks" in SNOMED subsumes "Alcoholic beverages" and "Beverage whitener", but not "Medical beverage". I think reorganizing these substances could be a whole separate project, but may not be in the current scope of the CPG.
Piggybacking on my example from earlier today:
NCPT has the terms:
Carbohydrate intake
Total estimated carbohydrate intake
Total carbohydrate from diet
Total carbohydrate from enteral nutrition
Total carbohydrate from parenteral nutrition
Total carbohydrate from intravenous fluids
As terms are included in NCPT based upon the requests of users of the language and approved by content experts, we assume that they have utility in nutrition practice.
My thinking is that we need to figure out how to represent this in a useable way in SNOMED.
In the currently published edition of SNOMED, here is the hierarchy:
Endocrine, nutritional and metabolic observable
Nutritional observable
Dietary intake
Nutrient intake
Dietary carbohydrate intake
There are not currently terms in SNOMED representing:
Any total carbohydrate intake
carbohydrate from any route other than oral
So, we need to know:
1.Where does "Total..." go?
I would suggest that "Total" concepts reside under "Nutrient intake". In the current edition, that would be problematic because "Nutrient intake" is subsumed by "Dietary intake". Our request to change that has already been implemented for the next edition, so this is a good possibility
Endocrine, nutritional and metabolic observable
Nutritional observable
Nutrient intake
Total estimated carbohydrate intake (new)
Dietary intake
Dietary carbohydrate intake
2. Where do the intake by route terms go?
Under previous editors, we have been disallowed from making terms that only serve the purpose of organizing other terms. I will need to follow up with Penni to see if that is still the case. Due to this, I wonder if we would be able to create terms like "Dietary intake" (i.e. Parenteral intake, Enteral intake, etc.) in order to create build the hierarchy like this:
Nutrition observable
Nutrient Intake
Enteral intake (new)
Total carbohydrate from enteral nutrition (new)
Parenteral intake (new)
Total carbohydrate from parenteral nutrition (new)
Or it would end up looking more like this:
Nutrition observable
Nutrient Intake
Total carbohydrate from oral nutrition (new)
Dietary carbohydrate intake
Total carbohydrate from enteral nutrition (new)
Total carbohydrate from parenteral nutrition (new)
Total carbohydrate from intravenous fluids (new)
I need to understand the consensus of the CPG before I start submitting these terms so that I can make sure we use Penni's time productively, and then return to the CPG to discuss her feedback.
Great to initiate dialogue. Look we do not need to work on normalizing ALL the details of the substances within the substance field. However they are there and terms we can use to better define what we are trying to do.
You raised a number of issues let me try respond to each in order,
Water is not an edible substance and this could be for a number of reasons,
Water can be given via IV, used as flushes and other means
It appears that it is defined in terms of its molecular structure i.e. as H20 This does not mean it cannot be added as a Drink or Substance , These terms are not fully defined or specified and by making use of them we will, help with the definition but also ensure consistency in our logic
Medical beverages are not subsumed by Drinks in Snomed as these are different products and fall under a different hierachy. i.e. not under the edible substance hierarchy but either the pharmaceutical/biological product hierarchy OR by a medicinal product defined by therapeutic role such as a calorific agent or carbohydrate supplement In short there are may ways to define supplements and each definition would depend on the context with which we are referring to them e.g as a supplement a patient is having as part of their diet history vs a supplement prescribed to meet an identified energy deficit Now I am not suggesting that we need to re-organize items within the substance hierarchy, just that we make use of the ones that are there and make sense to help us define what we are working on. i.e making the links to better define the terminology we are putting in place
Re Carbohydrate intake and how to represent this in a meaningful way within SNOMED
Where does "Total..." go?
Total is not an observable entity it is a qualifier value it could go here somewhere
Or
This is I guess the point I am trying to make, it is not a list where we need totals under the Nutrient intake. There are better ways to model totals and values
The Nutrient intake is an observable that carbohydrate has been eaten, there is no scope to record how much this is where you need a quantifiable value and also why any total would be a quantifiable value
In terms of the route can be defined in the description of the food being eaten e.g. assuming a beverage is not consumed intravenously
This can be done in the diet order for a oral nutritional supplement (e.g. ensure) as part of setting the procedure or regimen therapy
by qualifying the route of administration such as part of a diet order
This will obviously be determined by how the patient is able to cope with the various consistencies of food observed
Or based on the notes captured in previous assessments
Look running out of time here and the Carbohydrate from any other route than oral could be a bit more tricky to calculate however I am assuming this is so you can record it as an observable entity or clinical finding
I need to spend some more time on the discussion above; nonetheless, need to put out what I've been thinking since 2/18 call. And I don't want to get too far ahead of the conversation and I want to see if I'm following along
First"dietary'" is an old term that refers to anything having to do with diet or obtaining nutrition and was used BEFORE enteral and parental were reliable routes to provide nutrition. In that regard I have always considered oral enteral and parenteral to all be dietary. My mind translates dietary intake into nutrition intake.
Nutritional observable
Nutrition intake
Meal, food group, food, drink, ONS, infant or enteral formula (manufactured and homemade), nutrient (micro, macro, water), bioactive substance, breast milk, lipid emulsion, etc which can be further differentiated by route of intake noting that some may have multiple routes of intake.
Note there is no SNOMED-CT concept for meal or percent meal consumption, everything else listed is a substance. There is a qualifier value of Non-standard dietary quantity per unit time which cane up when I searched portion/day
Not any editorial guidance about what attributes an observable entity should have. It seems to me that the Nutritional observable Nutrition intake would need to have at least 2 attributes: substance and qualifier value (quantity) or multiple qualifier values (substance, frequency, route). Note here that enteral and oral are qualifier values and parenteral is not but rather a navigational concept . Total (qualifier value) grams (qualifier value) daily (qualifier value) carbohydrate (substance) intake is a nutrition intake seems to be a fairly straight forward concept construction.
I guess my point is that before we put juice intake in a hierarchy we need to understand what the concept juice intake looks like to be fully defined.
I feel like we may have bitten off a little more than we can chew in this format. For now, can we limit our discussion to the utility of the substance hierarchy for informing how we go forward? My concern is that the current organization of the substance hierarchy isn't going to provide us a lot of insight on how to proceed. Can you let me know ways in which you think it can? Does anyone else have opinions on this topic?
Bill,
I"m not sure that is how we define "dietary" in the NCPT. Let me follow up with Donna so I can get the correct verbiage.
With regards to precoordinating route and "total" The following term was approved by SNOMED:
FSN: Total estimated oral fluid intake (observable entity) Definition: The approximate intake in one day of all fluid consumed orally.
I'll follow up with our editor for fresh guidance on navigational concepts.
I wish it did, but NCPT does not define 'dietary' and there are no terms with the word 'dietary' in them. The original task force defined diagnoses essentially using the 3 routes--'oral food and beverage intake' (later shortened to oral intake), 'enteral intake,' and 'parenteral intake'.
Indeed OED is the NCPT source dictionary. Based on how health professionals utilize the 3 routes to document intake nowadays, the word 'dietary' feels dated and not useful. We could/should consider discussing removing the word 'dietary' entirely.
We had initiated a discussion regarding the hierarchy of dietary terms within SNOMED. Now within SNOMED different core concepts there is some interplay between Nutritional findings and Dietary intake.
I guess the point I have been trying to make is that where things fall on the hierarchy are not as important as the context with which we are using the NCPT terms we are trying to map too. I.e are we looking at qualifying dietary and therefore nutrient intake based on observation or looking to record a NCPT diagnosis based on finding
At our last meeting we were trying to define how to quantify beverages and whether oral nutritional supplements would be described as a beverage / medicinal product or in terms of its nutrient content. I was only trying to point out that there were many different ways to tackle defining this but to do so we needed to be clear about what context we were using when trying to decide the hierarchy.
Lee we do not need to dive into resolving the substance hierarchy but appreciate that if the purpose of recording beverage intake is to help determine nutrient intake in SNOMED CT we could get very detailed by making use of
Substance hierarchy - to record what was eaten (i.e. food type, state (i.e. texture and thickness))
Substance hierarchy- to define the nutrients within what was eaten
Qualifier value hierarchy - to quantify of food eaten and the amount of nutrients consumed
Alternatively at a higher level, and probably what we need to focus on is that we can make use of observable entities to record a subjective interpretation of this intake.
In this regard, Tina I would agree that the term "dietary" is very open to interpretation and potentially something that needs remediation, to help remove some confusion. We may need to look at replacing diet and dietary with nutrition and nutritional wherever possible. The only area where we may want to keep diet is for diet orders or as a measure of intake.
How we define diets is another issue these would be a procedure of treatment within hospital setting (e.g. provide patient high protein diet 710925007 |Provision of food (procedure)|). However we also need to use these diets as a subjective means to quantify intake e.g. a patient is on a high protein diet and eating 1/3 of their meals. 410173005 |Dietary regime assessment (procedure)|
To do define these this we would need to use the pharmaceutical and substance hierarchy's to define diet types
Anyway I hope that helps us resolve the issue at hand.
There are allot more and we need to appreciate that we need to try be consistent and appreciate the context with which we are looking at a term to help us determine what SNOMED terms to use to define this. I had wanted to try put things in context and had been trying to conceptualize a grid to help us appreciate how we can utilize the different hierarchies within SNOMED to define some of the topics we were talking about. I have put this below and hope we can bear it in mind as we work through things moving forward.
In this regard, Tina I would agree that the term "dietary" is very open to interpretation and potentially something that needs remediation, to help remove some confusion. We may need to look at replacing diet and dietary with nutrition and nutritional wherever possible. The only area where we may want to keep diet is for diet orders or as a measure of intake.
I am not a nutrition expert as you know but if this terms are synonymous, can I ask you to consider leaving dietary/diet as synonyms to ensure that people can find what they have previously used but then can be encouraged to think in the new way. If they are not synonymous, then your conclusion should not be to replace but to add - but leave this to you
Nutrition observable is just that: the observation. Any judgement associated with the observable becomes (finding).
Energy is an inherent characteristic of macronutrients and EtOH; so I think energy should be treated similarly to micronutrients. There is a current concept |dietary caloric intake (observable entity)| with energy intake as a synonym. Here oral, enteral, and parenteral as the qualifier rather than dietary makes a lot of sense. This of course brings up 2 trains of thought.
First, "dietary" really is jargon used by care team members and typically only is used to refer to meal service operations. I would not object to having "dietary' as a synonym for the reason Jane offered. But really needs to be replaced with oral,enteral parenteral, nutrition or nutritional as appropriate.
Next brings me to parenteral. Enteral, oral and as near as I can tell all possible routes for medication administration are qualifier values except for parenteral. Parenteral as an attribute seems to be associated with a procedure as a navigation concept or intended site. Neither of these concepts would seem to be useful in defining the delivery of parenteral nutrition. Not sure what needs to be done here?
Now to some NCPT quirkiness. Beverage intake becomes fluid intake. Under fluid intake we have liquid meal replacement: beverage=fluid=liquid. NCPT does not use the perm drink or drinks. On reference sheet there is liquid meal replacement or supplement but on the list of terms it becomes simply liquid meal replacement. Of course industry refers to them as oral nutrition supplements avoiding the legal morass of "meal replacement" as a health claim. FDA as Nathan shared refers to dietary supplements, which goes off on that whole discussion again. And of course some oral nutrition supplements can and are used for as enteral feeding formula (so is formula different from beverage=fluid=liquid/). Messy for sure as we try to limit ourselves to existing NCPT and not rewrite NCPT. Not sure how we can expect SNOMED-CT to be clear if we're not really that clear in our own definitions.
Next up is meal. There is no SNOMED-CT concept for meal. On the NCPT ref sheet for Food intake it lists Other: % total meal eaten (percent). This term does not appear on the terms list, I suspect this has to do with the move to get rid of "other" terms. But no place seems to have been found for % total meal eaten, which I would offer that in clinical practice is by far and away the most commonly reported meal consumption data used not only by dietitians but others on the care team especially nurses and providers. We need to find a place in NCPT for this term and it needs to be Nutrition observable in SNOMED-CT.
FYI: NCPT does not refer to oral intake but rather food intake, which only describes nutrition taken orally.
Thanks for all the good discussion, helping me to get a grasp. Seems like it should be cleaner process but lots of cleanup to be done on both sides seems likely.
14 Comments
Nathan Billing
Nathan Billing
All,
Penni had shared this https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/DietarySupplements/ucm381189.htm which is a useful term. I think internationally "Beverage" , like Bill had mentioned is a social construct. Beverage looking at the FDA definitiion appears to be any nutrient containing liquid that is NOT a dietary supplement.
We may need to look at this within the context of the edible substance hierarchy to do this 762766007 |Edible substance (substance)| and then once this is in the approved hierarchy apply this to how we classify Nutrient intake of interest is that this has the following has the following children all of which are not yet fully specified terms and appear to address some of the complexity we have been re litigating in our meeting
Not sure that helps but if we were to work on sorting out these terms we could then use these "edible substances" as part of Dietary, oral and Nutrient intake.
Let me know what you think and how we can work on making the above more usable and fully specified
Thanks,
Nathan
ps will repost this in the discussion forum, sign up as watching get notified when others post and share thoughts asyncronously prior to next meeting
Lee Unangst
Nathan,
I'm concerned that looking to the substances may not yield the insight we need. For instance, "Water (substance)" is not included as an edible substance, yet "Drinks (substance)" are. We don't really have a good way of knowing who made that decision (or any other decisions about the substances hierarchy) or why. "Drinks" in SNOMED subsumes "Alcoholic beverages" and "Beverage whitener", but not "Medical beverage". I think reorganizing these substances could be a whole separate project, but may not be in the current scope of the CPG.
Piggybacking on my example from earlier today:
NCPT has the terms:
As terms are included in NCPT based upon the requests of users of the language and approved by content experts, we assume that they have utility in nutrition practice.
My thinking is that we need to figure out how to represent this in a useable way in SNOMED.
In the currently published edition of SNOMED, here is the hierarchy:
There are not currently terms in SNOMED representing:
So, we need to know:
1.Where does "Total..." go?
I would suggest that "Total" concepts reside under "Nutrient intake". In the current edition, that would be problematic because "Nutrient intake" is subsumed by "Dietary intake". Our request to change that has already been implemented for the next edition, so this is a good possibility
2. Where do the intake by route terms go?
Under previous editors, we have been disallowed from making terms that only serve the purpose of organizing other terms. I will need to follow up with Penni to see if that is still the case. Due to this, I wonder if we would be able to create terms like "Dietary intake" (i.e. Parenteral intake, Enteral intake, etc.) in order to create build the hierarchy like this:
Or it would end up looking more like this:
I need to understand the consensus of the CPG before I start submitting these terms so that I can make sure we use Penni's time productively, and then return to the CPG to discuss her feedback.
Thanks,
Lee
Nathan Billing
Lee,
Great to initiate dialogue. Look we do not need to work on normalizing ALL the details of the substances within the substance field. However they are there and terms we can use to better define what we are trying to do.
You raised a number of issues let me try respond to each in order,
This does not mean it cannot be added as a Drink or Substance ,
These terms are not fully defined or specified and by making use of them we will, help with the definition but also ensure consistency in our logic
Medical beverages are not subsumed by Drinks in Snomed as these are different products and fall under a different hierachy. i.e. not under the edible substance hierarchy but either the pharmaceutical/biological product hierarchy
OR by a medicinal product defined by therapeutic role such as a calorific agent or carbohydrate supplement
In short there are may ways to define supplements and each definition would depend on the context with which we are referring to them e.g as a supplement a patient is having as part of their diet history vs a supplement prescribed to meet an identified energy deficit
Now I am not suggesting that we need to re-organize items within the substance hierarchy, just that we make use of the ones that are there and make sense to help us define what we are working on. i.e making the links to better define the terminology we are putting in place
Where does "Total..." go?
Total is not an observable entity it is a qualifier value it could go here somewhere
This is I guess the point I am trying to make, it is not a list where we need totals under the Nutrient intake. There are better ways to model totals and values
In terms of the route can be defined in the description of the food being eaten e.g. assuming a beverage is not consumed intravenously
This can be done in the diet order for a oral nutritional supplement (e.g. ensure) as part of setting the procedure or regimen therapy
This will obviously be determined by how the patient is able to cope with the various consistencies of food observed
Or based on the notes captured in previous assessments
Look running out of time here and the Carbohydrate from any other route than oral could be a bit more tricky to calculate however I am assuming this is so you can record it as an observable entity or clinical finding
Hope that makes sense and helps
Regards,
Nathan
William Swan
I need to spend some more time on the discussion above; nonetheless, need to put out what I've been thinking since 2/18 call. And I don't want to get too far ahead of the conversation and I want to see if I'm following along
First"dietary'" is an old term that refers to anything having to do with diet or obtaining nutrition and was used BEFORE enteral and parental were reliable routes to provide nutrition. In that regard I have always considered oral enteral and parenteral to all be dietary. My mind translates dietary intake into nutrition intake.
Nutritional observable
Nutrition intake
Meal, food group, food, drink, ONS, infant or enteral formula (manufactured and homemade), nutrient (micro, macro, water), bioactive substance, breast milk, lipid emulsion, etc which can be further differentiated by route of intake noting that some may have multiple routes of intake.
Note there is no SNOMED-CT concept for meal or percent meal consumption, everything else listed is a substance. There is a qualifier value of Non-standard dietary quantity per unit time which cane up when I searched portion/day
Not any editorial guidance about what attributes an observable entity should have. It seems to me that the Nutritional observable Nutrition intake would need to have at least 2 attributes: substance and qualifier value (quantity) or multiple qualifier values (substance, frequency, route). Note here that enteral and oral are qualifier values and parenteral is not but rather a navigational concept
. Total (qualifier value) grams (qualifier value) daily (qualifier value) carbohydrate (substance) intake is a nutrition intake seems to be a fairly straight forward concept construction.
I guess my point is that before we put juice intake in a hierarchy we need to understand what the concept juice intake looks like to be fully defined.
Lee Unangst
Nathan,
I feel like we may have bitten off a little more than we can chew in this format. For now, can we limit our discussion to the utility of the substance hierarchy for informing how we go forward? My concern is that the current organization of the substance hierarchy isn't going to provide us a lot of insight on how to proceed. Can you let me know ways in which you think it can? Does anyone else have opinions on this topic?
Bill,
Donna Pertel
Lee and all,
I wish it did, but NCPT does not define 'dietary' and there are no terms with the word 'dietary' in them. The original task force defined diagnoses essentially using the 3 routes--'oral food and beverage intake' (later shortened to oral intake), 'enteral intake,' and 'parenteral intake'.
Donna
Donna Pertel
Looking at the Oxford English Dictionary (OED), the NCPT source dictionary, dietary/diet is defined:
Dietary--Of or pertaining to diet, of the nature of a diet
Diet--Prescribed course of food, restricted in kind or limited in quantity, esp. for medical or penal reasons; regimen
Donna
Constantina Papoutsakis
Thank you, Donna.
Indeed OED is the NCPT source dictionary. Based on how health professionals utilize the 3 routes to document intake nowadays, the word 'dietary' feels dated and not useful. We could/should consider discussing removing the word 'dietary' entirely.
Thoughts?
Constantina Papoutsakis
Nathan, please let us know if you found Donna.s remarks as persuasive. Many thanks, Tina
Nathan Billing
Tina,
We had initiated a discussion regarding the hierarchy of dietary terms within SNOMED. Now within SNOMED different core concepts there is some interplay between Nutritional findings and Dietary intake.
I guess the point I have been trying to make is that where things fall on the hierarchy are not as important as the context with which we are using the NCPT terms we are trying to map too. I.e are we looking at qualifying dietary and therefore nutrient intake based on observation or looking to record a NCPT diagnosis based on finding
At our last meeting we were trying to define how to quantify beverages and whether oral nutritional supplements would be described as a beverage / medicinal product or in terms of its nutrient content. I was only trying to point out that there were many different ways to tackle defining this but to do so we needed to be clear about what context we were using when trying to decide the hierarchy.
Lee we do not need to dive into resolving the substance hierarchy but appreciate that if the purpose of recording beverage intake is to help determine nutrient intake in SNOMED CT we could get very detailed by making use of
Alternatively at a higher level, and probably what we need to focus on is that we can make use of observable entities to record a subjective interpretation of this intake.
In this regard, Tina I would agree that the term "dietary" is very open to interpretation and potentially something that needs remediation, to help remove some confusion. We may need to look at replacing diet and dietary with nutrition and nutritional wherever possible. The only area where we may want to keep diet is for diet orders or as a measure of intake.
How we define diets is another issue these would be a procedure of treatment within hospital setting (e.g. provide patient high protein diet 710925007 |Provision of food (procedure)|). However we also need to use these diets as a subjective means to quantify intake e.g. a patient is on a high protein diet and eating 1/3 of their meals. 410173005 |Dietary regime assessment (procedure)|
To do define these this we would need to use the pharmaceutical and substance hierarchy's to define diet types
Anyway I hope that helps us resolve the issue at hand.
There are allot more and we need to appreciate that we need to try be consistent and appreciate the context with which we are looking at a term to help us determine what SNOMED terms to use to define this. I had wanted to try put things in context and had been trying to conceptualize a grid to help us appreciate how we can utilize the different hierarchies within SNOMED to define some of the topics we were talking about. I have put this below and hope we can bear it in mind as we work through things moving forward.
Lyn Lloyd
Thanks Nathan . I agree with your comment :
In this regard, Tina I would agree that the term "dietary" is very open to interpretation and potentially something that needs remediation, to help remove some confusion. We may need to look at replacing diet and dietary with nutrition and nutritional wherever possible. The only area where we may want to keep diet is for diet orders or as a measure of intake.
Jane Millar
HI everyone
I am not a nutrition expert as you know but if this terms are synonymous, can I ask you to consider leaving dietary/diet as synonyms to ensure that people can find what they have previously used but then can be encouraged to think in the new way. If they are not synonymous, then your conclusion should not be to replace but to add - but leave this to you
Jane
William Swan
Hi all,
My thoughts are evolving with this discussion
Nutrition observable is just that: the observation. Any judgement associated with the observable becomes (finding).
Energy is an inherent characteristic of macronutrients and EtOH; so I think energy should be treated similarly to micronutrients. There is a current concept |dietary caloric intake (observable entity)| with energy intake as a synonym. Here oral, enteral, and parenteral as the qualifier rather than dietary makes a lot of sense. This of course brings up 2 trains of thought.
First, "dietary" really is jargon used by care team members and typically only is used to refer to meal service operations. I would not object to having "dietary' as a synonym for the reason Jane offered. But really needs to be replaced with oral,enteral parenteral, nutrition or nutritional as appropriate.
Next brings me to parenteral. Enteral, oral and as near as I can tell all possible routes for medication administration are qualifier values except for parenteral. Parenteral as an attribute seems to be associated with a procedure as a navigation concept or intended site. Neither of these concepts would seem to be useful in defining the delivery of parenteral nutrition. Not sure what needs to be done here?
Now to some NCPT quirkiness. Beverage intake becomes fluid intake. Under fluid intake we have liquid meal replacement: beverage=fluid=liquid. NCPT does not use the perm drink or drinks. On reference sheet there is liquid meal replacement or supplement but on the list of terms it becomes simply liquid meal replacement. Of course industry refers to them as oral nutrition supplements avoiding the legal morass of "meal replacement" as a health claim. FDA as Nathan shared refers to dietary supplements, which goes off on that whole discussion again. And of course some oral nutrition supplements can and are used for as enteral feeding formula (so is formula different from beverage=fluid=liquid/). Messy for sure as we try to limit ourselves to existing NCPT and not rewrite NCPT. Not sure how we can expect SNOMED-CT to be clear if we're not really that clear in our own definitions.
Next up is meal. There is no SNOMED-CT concept for meal. On the NCPT ref sheet for Food intake it lists Other: % total meal eaten (percent). This term does not appear on the terms list, I suspect this has to do with the move to get rid of "other" terms. But no place seems to have been found for % total meal eaten, which I would offer that in clinical practice is by far and away the most commonly reported meal consumption data used not only by dietitians but others on the care team especially nurses and providers. We need to find a place in NCPT for this term and it needs to be Nutrition observable in SNOMED-CT.
FYI: NCPT does not refer to oral intake but rather food intake, which only describes nutrition taken orally.
Thanks for all the good discussion, helping me to get a grasp. Seems like it should be cleaner process but lots of cleanup to be done on both sides seems likely.