Allergy & Intolerance

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Allergy/Intolerance Project Meeting Minutes

Allergy/Intolerance Project Conference Calls and Meeting Minutes

• Spiro_DailyMed (2016-09-27)

Allergy/Intolerance and Adverse Reaction Projects

The Allergy/Intolerance and Adverse Reaction topic comprises a number of phases:

• Allergy and Intolerance Substance Value Set(s)Definition Informative Document

• HL7 FHIR Allergy and Intolerance Resource: http://www.hl7.org/fhir/allergyintolerance.html

• Allergy/Intolerance Domain Analysis phase, which aimed at producing a Domain Analysis Model (DAM)

• Allergy/Intolerance and Adverse Reaction clinical model development phase, which aims at producing of a set of HL7 clinical models DSTU to support exchanges of allergy/intolerance and adverse reaction information

• Implementation guide - project scope yet to be defined

• Harmonization of Allergy and Intolerance concepts in V3, C-CDA R1.1, C-CDA R2.0 and FHIR

Food substance sub-project

Food Substances Sub Group Project

Drug substance sub-project

Allergy & Intolerance Drug Sub-project

Document for ballot

Leadership (project co-leads)

Elaine Ayres

Russ Leftwich

Stephen Chu

Allergy/Intolerance Topic Scope Statements

• Allergy and Intolerance Substance Value Sets 2016 DRAFT

• Final Project Scope Statement Project 881 (2012-4-30)

• Allergy/Intolerance Topic Draft Project Scope Statement (2011-11-09)

• Allergy/Intolerance Topic withddrawal - ANSI (2012-04-06)

Current work: Create an Allergy and Intolerance Domain Analysis Model and Clinical Models (DSTU).

Project 881 (Domain Analysis Model) and Project 1004 (Clinical Models) This is a work in progress. See HL7 Ballot site for existing specification.

This topic covers all interactions related to clinically recorded adverse reactions, including:

• Recording adverse reactions
• Revising existing adverse reaction records
• Retrieving a patient's adverse reaction records

These transactions are not intended for reporting adverse reactions (as managed by Individual Case Safety Reports). Rather, these transactions are intended to be recorded as part of a patient's electronic health record. They supplement allergy and intolerance records for circumstances where it is not clear whether an allergy or intolerance exists. These interactions are crafted to support a 'request-based' architecture in which messages are sent from a point of service (POS) such as a clinic, pharmacy, etc. to a central drug information system (DIS). These messages are phrased as requests because the DIS reserves the right to refuse all requests. Reasons might include the presence of contraindications such as drug-drug interactions or duplicate therapy, as well as more mundane issues such as lack of permission, lack of recorded patient consent, etc.

Allergy/Intolerance Topic DSTU

The current "Allergy/Intolerance" topic DSTU expires in June 2012. The "Allergy/Intolerance" project group after some discussion recommends that application to HL7 publishing committee for a 12-month extension of the current DSTU should be considered as the best option forward. The 12-month extension will allow the group with time to perform proper DAM development and to determine how best the current DSTU may be modified and/or extended to meet updated, new requirements.

The following is DSTU extension guidance provided by HL7 HQ:

DSTU extension guidance is offered at the TSC wiki page under TSC Process Guidance, at: http://hl7t3f.org/wiki/index.php?title=DSTU_Publishing_Guidance, where requesting extensions to DSTU should use criteria determined in the TSC’s conference call 2009-03-09:

“Sufficient justification should be provided to describe effort in progress to move the standard towards a normative ballot, such as evidence of current trial activity, if they have a credible expectation that a normative document will be produced within a requested timeframe, given that trials are currently underway. The request must include the length of time required to extend the DSTU, including conclusion of the pilot and subsequent balloting activity...If you send the completed form to me (LynnL) I can put it on the TSC agenda.”

Domain Analysis Model (DAM)

Allergy/Intolerance DAM project is completed.

This is the artefact produced by the project:

• Allergy and Intolerance DAM V1 2013 MAY (2012-5-16)

Ballot reconciliation is complete for this DAM as of May 8, 2013. Final Domain Analysis Model will be published with changes.

To help with harmonization with FHIR resources, a recent (2014-10-30) discussion thread regarding Adverse Event v Adverse Reaction (to substance) v Propensity to Adverse Reaction (to substance) has emerged.

Ballot Reconciliation January 2013

• Allergy and Intolerance Ballot Reconciliation as of 2013-2-23)

Harmonization Activities and Related Materials

• CDA and Allergy/Intolerance & Adverse Reaction: Issues, Harmonization and Examples

• HL7 - openEHR Harmonization

Allergy/Intolerance and Adverse Reaction Projects: Document Collection

The Allergy/Intolerance and Adverse Reaction projects produced a number of artefacts which can be accessed through the following links:

C-CDA Terminology Analysis for DAM and C-CDA r1.1 Harmonization Project:Terminology Analysis - Elaine Ayres June 2014

Presentations

• Proposal To Address Medications, Allergies Disparities In Final Rule MU Stage 2 (2012-10-03) Powerpoint.

• Allergy/Intolerance Concept Model Slides - Andre Boudreau (2012-02-03) updated 2012-01-03 Powerpoint.

• Allergy/Intolerance Concept Discussion Slides - Andre Boudreau (2011-12-20) updated 2012-01-03 Powerpoint.

• Allergy/Intolerance Topic Slides from Russ Leftwich, MD (2011-12-20) Powerpoint in PDF format.

• Canadian model on Allergy & Intolerance (2011-07-19) Powerpoint in PDF format.

• Use Case - shown at working group meeting in Cologne Powerpoint.

2012 Use Cases and Storyboards

• Reported Food Intolerance (2012-4-17)
• Allergy List (2012-5-8)
• Allergy Not Asked (2012-7-11)
• Immunizations (2012-7-26)
• Allergy to Latex (2012-7-26)
• Medication Reaction (2012-7-11)
• Misattribution of Allergy to Nickel Knee Implant (2012-7-26)
• New Food Allergy (2012-4-17)
• No Known History of Allergy (2012-7-11)
• Unable to Determine Triggering Agent (2012-7-11)
• Patient PHR List (2012-10-9)
• Reported Preference(2012-10-9)

2013 Use Cases and Storyboards

• Allergy List Reconciliation(2013-02-26)

Updated Allergy and Intolerance Glossary

• Allergy and Intolerance Glossary (2013-2-25)

Past Use Cases and Storyboards

• Allergy/Intolerance Topic Use Cases and Storyboard Summary (2011-08-30)
• From the old Ballot??
• Revised Draft 2007-May-23

Models

• Patient Care RMIM as of Jan 2007
• Patient Care RMIM as of May 2, 2007
• Updated Model as of May 22, 2007

Links to Other Relevant Projects

Structured Document WG: CDA Implementation Guilde Project on Clinical Oncology Treatment Plan and Summary:

http://wiki.hl7.org/index.php?title=Clinical_Oncology_Treatment_Plan_and_Summary

Discussions

Current discussion on topic

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