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Difference between revisions of "FHIR Allergy Sample"

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[[Category: CDA_to_FHIR_Samples_Group]]
 
[[Category: CDA_to_FHIR_Samples_Group]]

Revision as of 18:35, 13 January 2014

A FHIR Representation of the Patient with allergies to different substances CDA Sample (from CDA Template Example Task Force)

The CDA sample follows this structure: 

<component>
  <section>
     <text /> <- I put this aside for the moment
     Erythromycin Allergy
     Bactrim Allergy
     Peanut Allergy
     Cat Dander Allergy
  </section>
</component>

TODO: -section.text? -bundling the resources

Atom List and Allergy Section List

<feed xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://www.w3.org/2005/Atom">
   <title>A sample FHIR bundle</title>
   <id>urn:uuid:07bff130-7c7e-11e3-baa7-0800200c9a66</id>
   
   <updated>2014-01-10T09:00:00-08:00</updated>     <!-- Time the bundle was built -->
   
   <!-- Author is required by the Atom spec. FHIR doesn't use it. The CDA Sample does not indicate the name-->
   <author>
       <name>Author's name</name>
   </author>
   <!-- This tag specifies unambiguously that this is a FHIR document bundle. If it's a document, we'll need a composition. Since the CDA sample is intended to illustrate a section as part of a document, the composition is ommitted from this sample.-->
   <category  term="http://hl7.org/fhir/tag/document" scheme="http://hl7.org/fhir/tag" />
   
   <entry>
       <title>ALLERGIES AND ADVERSE REACTIONS</title>
       <id>cid:24082b69-e29d-498f-afd9-8f400a5d2eb9</id>
       <updated>2014-01-10T09:00:00-08:00</updated>
       <content type="text/xml">
           <List xmlns="http://hl7.org/fhir">
               <text>
                   <status value="generated" />
                   <div xmlns="http://www.w3.org/1999/xhtml">List of Allergies</div>
               </text>
               <entry>
                   <item>
                       <reference value="cid:e429d29a-7214-4bbc-98f1-dca7dedebe41"/>
                       <display value="Anapylaxis Reaction to Peanuts"/>
                   </item>
               </entry>
               <entry>
                   <item>
                       <reference value="cid:5155592a-8a55-4585-8105-08c2f04debda"/>
                       <display value="Urticaria Reaction to Erythromycin"/>
                   </item>
               </entry>
               <entry>
                   <item>
                       <reference value="cid:1aed348b-0c93-434f-aaf5-9b41d6304a61"/>
                       <display value="Eye Swelling Reaction to Cat Dander"/>
                   </item>
               </entry>
               <entry>
                   <item>
                       <reference value="141ff36a-9256-4153-b421-a8f1da62f719"/>
                       <display value="Tongue Swelling Reaction to Bactrim"/>
                   </item>
               </entry>
           </List>
       </content>
   </entry>

   <!-- Subject (Patient) -->
   <entry>
       <title>The Patient</title>
       <id>cid:3f134db0-7a32-11e3-981f-0800200c9a66</id>
       <updated>2014-01-10T09:00:00-08:00</updated>
       
       <content type="text/xml">
           <Patient xmlns="http://hl7.org/fhir">
               <text>
                   <status value="generated"/>
                   <div xmlns="http://www.w3.org/1999/xhtml">Patient Name</div>
               </text>
               <!-- Not specified in the CDA Sample -->
           </Patient>
       </content>
   </entry>
   
   <!-- Author (Practitioner) -->
   <entry>
       <title>The document author - Doctor Dave</title>
       <id>cid:0bdcc9f2-f7f0-4805-8bf4-2e24538dbe5f</id>
       <updated>2014-01-10T09:00:00-08:00</updated>
       
       <content type="text/xml">
           <Practitioner xmlns="http://hl7.org/fhir">
               <identifier>
                   <system value ="urn:oid:2.16.840.1.113883.4.6" />
                   <value value="66778899" />
               </identifier>
               <!-- No other details of Practitioner are provided in the CDA Sample -->
           </Practitioner>
       </content>
   </entry>

Erythromycin Allergy

   <entry>
       <title>Urticaria Reaction to Erythromycin</title>
       <id>cid:5155592a-8a55-4585-8105-08c2f04debda</id>
       <updated>2014-01-10T09:00:00-08:00</updated>
       <content type="text/xml">
           
           <AllergyIntolerance xmlns="http://hl7.org/fhir">
               
               <contained>
                   <Medication id="med1">
                       <name value="Bactrim" />
                       
                           <coding>
                               <!--RxNorm-->
                               <system value="urn:2.16.840.1.113883.6.88"/>
                               
                               <display value="Erythromycin 0.02 MG/MG Topical Gel"/>
                           </coding>
                       
                   </Medication>
               </contained>
               
               <contained>
                   <AdverseReaction id="react1">
                       
                       <text>
                           <div xmlns="http://www.w3.org/1999/xhtml">Urticaria</div>
                       </text>
                       
                       <!--Can't do high/low-->
                           <!--<effectiveTime>
                          <low value="199512011205-0800"/>
                          <high value="199512020835-0800"/>
                          </effectiveTime>-->
                       <reactionDate value="1995-12-01T12:05:00-08:00"/>
                       
                       <subject>
                           <reference value="cid:3f134db0-7a32-11e3-981f-0800200c9a66" />
                       </subject>
                       
                       <didNotOccurFlag value ="false" />
                       
                       <recorder>
                           <reference value="cid:0bdcc9f2-f7f0-4805-8bf4-2e24538dbe5f" />
                       </recorder>
                       
                       <symptom>
                           
                               <coding>
                                   <system value="http://snomed.info/sct"/>
                                   
                                   <display value="Urticaria"/>
                               </coding>
                               <text value="Urticaria"/>
                           
                           <!--In this case, the cda sample severity is code="6736007" displayName="moderate"-->
                           <!--There doesn't seem to be a way to describe the severity of the allergy, just the reaction-->
                           <severity value="moderate"/>
                       </symptom>
                   </AdverseReaction>
               </contained>
               
               
               <!--CDA Note: not sure which (I took from the observation/id) entry/act/id... or entry/act/entryRelationship/observation/id. entry/act describes the id for the allergy act... entry/act/entryrelationship/obsevation is the actual allergy -->
               <identifier>
                   <value value="urn:uuid:4ffd3420-0f60-425c-aaca-6255c8d8c890" />
               </identifier>
               
               <!--Drug allergy-->
               <identifier>
                   <label value ="Drug allergy" />
                   <system value="http://snomed.info/sct"/>
                   <value value="416098002"/>
               </identifier>
               
               <!--Severe == high?-->
               <!--CDA Note: the CDA differentiates from the severity of the reaction and the severity of the allergy... but I don't see a FHIR equivalent.-->
               <criticality value="high" />
               
               <!--CDA Note: we're inferring a bit here (because of snomed food allergy code)-->
               <sensitivityType value="allergy" />
               
               <!--Act.effectivetime-->
               <recordedDate value="1998-05-01T11:45:00-08:00"/>
               
               <!--CDA Note: entry/act/statuscode denotes that the allergy is active and needs to be monitored. it doesn't really map 1:1 to confirmed-->
               <status value="confirmed" />
               
               <subject>
                   <reference value="cid:3f134db0-7a32-11e3-981f-0800200c9a66" />
               </subject>
               
               <!--CDA Note: the author of the act-->
               <recorder>
                   <reference value="cid:0bdcc9f2-f7f0-4805-8bf4-2e24538dbe5f" />
               </recorder>  
               
               <substance>
                   <reference value="#med1"/>
                   <display value="Bactrim"/>
               </substance>
               
               
               <reaction>
                   <reference value="#react1"/>
                   <display value="Urticaria"/>
               </reaction>
               
               <sensitivityTest></sensitivityTest>
               
           </AllergyIntolerance>
       </content>
   </entry>

Bactrim Allergy

   <entry>
       <title>Tongue Swelling Reaction to Bactrim</title>
       <id>cid:141ff36a-9256-4153-b421-a8f1da62f719</id>
       <updated>2014-01-10T09:00:00-08:00</updated>
       <content type="text/xml">
           <AllergyIntolerance xmlns="http://hl7.org/fhir">
               <contained>
                   <Medication id="med1">
                       <name value="Bactrim" />
                       
                           <coding>
                               <!--RxNorm-->
                               <system value="urn:2.16.840.1.113883.6.88"/>
                               
                               <display value="Bactrim"/>
                           </coding>
                       
                   </Medication>
               </contained>
               
               <contained>
                   <AdverseReaction id="react1">
                       
                       <text>
                           <div xmlns="http://www.w3.org/1999/xhtml">Tongue swelling</div>
                       </text>
                       
                       <!--cda entry/act/entryrelationship/observation/entryrelationship[severity]/observation/effectivetime -->
                       <!--<effectiveTime>
                                <low value="19921001"/>
                                <high value="19921001"/>
                        </effectiveTime>-->
                       <!--Chose the low time-->
                       <reactionDate value="1992-10-01"/>
                       
                       <subject>
                           <reference value="cid:0bdcc9f2-f7f0-4805-8bf4-2e24538dbe5f" />
                       </subject>
                       
                       <didNotOccurFlag value ="false" />
                       
                       <recorder>
                           <reference value="cid:0bdcc9f2-f7f0-4805-8bf4-2e24538dbe5f" />
                       </recorder>
                       
                       <symptom>
                           
                               <coding>
                                   <system value="http://snomed.info/sct"/>
                                   
                                   <display value="Tongue swelling"/>
                               </coding>
                               <text value="Tongue swelling"/>
                           
                           <!--CDA tongue swelling observation.entryrelationship.observation.value [severity]. In this case, the cda sample severity is code="371923003" displayName="Mild to moderate"-->
                           <severity value="moderate"/>
                       </symptom>
                   </AdverseReaction>
               </contained>
               
               
               <!--CDA Note: not sure which (I took from the observation/id) entry/act/id... or entry/act/entryRelationship/observation/id. entry/act describes the id for the allergy act... entry/act/entryrelationship/obsevation is the actual allergy -->
               <identifier>
                   <value value="urn:uuid:4ffd3420-0f60-425c-aaca-6255c8d8c890" />
               </identifier>
               
               <!--Drug allergy-->
               <identifier>
                   <label value ="Drug allergy" />
                   <system value="http://snomed.info/sct"/>
                   <value value="416098002"/>
               </identifier>
               
               <!--Is this what we should map to criticality?-->
               <!--CDA Note: the CDA differentiates from the severity of the reaction and the severity of the allergy... but I don't see a FHIR equivalent.-->
               <!--<value xsi:type="CD" code="371924009" displayName="Moderate to severe" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/>-->
               <criticality value="severe" />
               
               <!--CDA Note: we're inferring a bit here (because of snomed drug allergy code)-->
               <sensitivityType value="allergy" />
               
               <!--Act.effectivetime-->
               <recordedDate value="2008-08-01T09:15:00-08:00"/>
               
               <!--CDA Note: entry/act/statuscode denotes that the allergy is active and needs to be monitored. it doesn't really map 1:1 to confirmed-->
               <status value="confirmed" />
               
               <subject>
                   <reference value="cid:0bdcc9f2-f7f0-4805-8bf4-2e24538dbe5f" />
               </subject>
               
               <!--CDA Note: the author of the act-->
               <recorder>
                   <reference value="cid:0bdcc9f2-f7f0-4805-8bf4-2e24538dbe5f" />
               </recorder>
               
               <substance>
                   <reference value="#med1"/>
                   <display value="Bactrim"/>
               </substance>
               
               <reaction>
                   <reference value="#react1"/>
                   <display value="Tongue swelling"/>
               </reaction>
               
               <sensitivityTest></sensitivityTest>
               
           </AllergyIntolerance>
       </content>
   </entry>

Peanut Allergy

   <entry>
       <title>Anapylaxis Reaction to Peanuts</title>
       <id>cid:e429d29a-7214-4bbc-98f1-dca7dedebe41</id>
       <updated>2014-01-10T09:00:00-08:00</updated>
       <content type="text/xml">
           <AllergyIntolerance xmlns="http://hl7.org/fhir">
               
               <contained>
                   <Substance id="sub1">
                       <text>
                           <status value="generated"/>
                           <div xmlns="http://www.w3.org/1999/xhtml">Peanut</div>
                       </text>
                       <type>
                           <coding>
                               <!--UNII-->
                               <system value="urn:oid:2.16.840.1.113883.4.9"/>
                               
                               <display value="PEANUT"/>
                           </coding>
                       </type>
                   </Substance>
               </contained>
               
               <contained>
                   <AdverseReaction id="react1">
                       <text>
                           <div xmlns="http://www.w3.org/1999/xhtml">Anaphylaxis Reaction</div>
                       </text>
                       
                       <!--effective time of CDA allergy observation. Not exactly when you noticed the allergy.. but when you noticed the reaction-->
                       <reactionDate value="1988"/>
                       
                       <subject>
                           <reference value="cid:3f134db0-7a32-11e3-981f-0800200c9a66" />
                       </subject>
                       
                       <didNotOccurFlag value ="false" />
                       
                       <recorder>
                           <reference value="cid:0bdcc9f2-f7f0-4805-8bf4-2e24538dbe5f" />
                       </recorder>
                       
                       <symptom>
                           
                               <coding>
                                   <system value="http://snomed.info/id"/>
                                   
                                   <display value="Anaphylaxis"/>
                               </coding>
                               <text value="Anaphylaxis reaction"/>
                           
                           <!--CDA alaphylaxis observation.entryrelationship.observation.value [severity]. In this case, the cda sample severity is "Severe" (snomed 24484000)-->
                           <severity value="severe"/>
                       </symptom>

                   </AdverseReaction>
               </contained>
               
               !--CDA Note: not sure which (I took from the observation/id) entry/act/id... or entry/act/entryRelationship/observation/id. entry/act describes the id for the allergy act... entry/act/entryrelationship/obsevation is the actual allergy -->
               <identifier>
                   <value value="urn:uuid:e70b70c6-48d2-47af-8138-9470ed249bab" />
               </identifier>
               
               <!--Food allergy-->
               <identifier>
                   <label value ="Food Allergy" />
                   <system value="http://snomed.info/sct"/>
                   <value value="414285001"/>
               </identifier>
               
               <!--Severe == high?-->
               <!--CDA Note: the CDA differentiates from the severity of the reaction and the severity of the allergy... but I don't see a FHIR equivalent.-->
               <criticality value="high" />
               
               <!--CDA Note: we're inferring a bit here (because of snomed food allergy code)-->
               <sensitivityType value="allergy" />
               
               <!--Act.effectivetime-->
               <recordedDate value="1998-05-01T11:45:00-08:00"/>
               
               <!--CDA Note: entry/act/statuscode denotes that the allergy is active and needs to be monitored. it doesn't really map 1:1 to confirmed-->
               <status value="confirmed" />
               
               <subject>
                   <reference value="cid:3f134db0-7a32-11e3-981f-0800200c9a66" />
               </subject>
               
               <!--CDA Note: the author of the act-->
               <recorder>
                   <reference value="cid:0bdcc9f2-f7f0-4805-8bf4-2e24538dbe5f" />
               </recorder>  
               
               <substance>
                   <reference value="#sub1"/>
                   <display value="Peanut"/>
               </substance>
               
               
               <reaction>
                   <reference value="#react1"/>
                   <display value="Anapylaxis"/>
               </reaction>
               
               <sensitivityTest></sensitivityTest>
               
           </AllergyIntolerance>
       </content>
   </entry>

Cat Dander Allergy

   <entry>
       <title>Eye Swelling Reaction to Cat Dander</title>
       <id>cid:1aed348b-0c93-434f-aaf5-9b41d6304a61</id>
       <updated>2014-01-10T09:00:00-08:00</updated>
       <content type="text/xml">
             <AllergyIntolerance xmlns="http://hl7.org/fhir">
               
               <!--Cat dander substance (entry.act.entryRelationship.observation.participant.participantRole[classCode="MANU"].playingEntity[classCode="MMAT"].code
                    Note too, that entry.act.entryRelationship.observation.effectiveTime.low indicates allergy onset, and I can't seem to find a place to map that... Adverse Reaction seems to have a time that indicates when the reaction occurred.-->
               <contained>
                   <Substance id="sub1">
                       <text>
                           <status value="generated"/>
                           <div xmlns="http://www.w3.org/1999/xhtml">Cat Dander</div>
                       </text>
                       <type>
                           <coding>
                               <system value="urn:oid:2.16.840.1.113883.4.9"/>
                               
                               <display value="Felis catus dander"/>
                           </coding>
                       </type>
                   </Substance>
                   
                   <!--Note that there does not seem an appropriate place to put entry.act.entryRelationship.observation.entryRelationship[typeCode="SUBJ"] (describing the severity of the allergy) SEE note at criticality node below-->
                   
               </contained>
               
               <!--Eye Swelling Reaction (entry.act.entryRelationship.observation.entryRelationship[typeCode="MFST"].observation)-->
               <contained>
                   <AdverseReaction id="react1">
                       <text>
                           <div xmlns="http://www.w3.org/1999/xhtml">Eye swelling reaction</div>
                       </text>
                       
                       <!--A reaction to cat dander was observed for 3 days in January 2009. We don't seem to have an equivalent way of representing it.-->
                       <!--<effectiveTime>
                            <low value="20090116"/>
                            <high value="2009019"/>
                          </effectiveTime>-->
                       <reactionDate value="2009-01-16"/> <!--Since there's no way to do effectiveTime.low/high that I can see, I took the low'\-->
                       
                       <!--Making a safe assumption-->
                       <subject>
                           <reference value="cid:0bdcc9f2-f7f0-4805-8bf4-2e24538dbe5f" />
                       </subject>
                       
                       <!--Node CDA negation indicators, so...-->
                       <didNotOccurFlag value ="false" />
                       
                       <!--Since there's no other author specified, we'll go up the tree until we find one... and that's at entry.act.author-->
                       <recorder>
                           <reference value="cid:0bdcc9f2-f7f0-4805-8bf4-2e24538dbe5f" />
                       </recorder>
                       
                       <!--why not in identifier?-->
                       <symptom>
                           
                           <coding>
                               <system value="http://snomed.info/sct"/>
                               
                               <display value="Eye swelling"/>
                           </coding>
                           <text value="Eye swelling"/>                           
                           
                           <!--entryrelationship[typeCode="SUBJ"].observation.value == 255604002 [mild severity]-->
                           <severity value="mild"/>
                       </symptom>
                   </AdverseReaction>
               </contained>
               
               <!--CDA entry. should both act.id and entry.act.entryRelationship.observation.id be mapped?-->
               <!--I took act.id entry/act describes the id for the allergy act... entry/act/entryrelationship/obsevation is the actual allergy-->
               <identifier>
                   <value value="urn:uuid:dd8f01c9-fb0d-4744-aeda-75e7f208dca7" />
               </identifier>
               
               <!--Allergy to substance (entry.act.entryRelationship.observation.value)-->
               <identifier>
                   <label value ="Allergy to substance" />
                   <system value="http://snomed.info/sct"/>
                   <value value="419199007"/>
               </identifier>
               
               <!--the CDA differentiates from the severity of the reaction and the severity of the allergy... but I don't see a FHIR equivalent.-->
               <criticality value="" />
               
               <!--we're inferring a bit here (because of snomed allergy code)-->
               <sensitivityType value="allergy" />
               
               <!--entry.act.effectivetime.low-->
               <recordedDate value="1998-05-01T11:45:00-08:00"/>
               
               <!--CDA Note: entry.act.statuscode="active" denotes that the allergy is active and needs to be monitored. It doesn't seem to really map 1:1 to confirmed-->
               <status value="confirmed" />
               
               <subject>
                   <reference value="cid:0bdcc9f2-f7f0-4805-8bf4-2e24538dbe5f" />
               </subject>
               
               <!--CDA Note: the author of the act... in this case the same author of this entire section-->
               <recorder>
                   <reference value="cid:0bdcc9f2-f7f0-4805-8bf4-2e24538dbe5f" />
               </recorder>
               
               <substance>
                   <reference value="#sub1"/>
                   <display value="Cat Dander"/>
               </substance>
               
               <reaction>
                   <reference value="#react1"/>
                   <display value="Eye swelling"/>
               </reaction>
               
               <sensitivityTest></sensitivityTest>
               
           </AllergyIntolerance>
       </content>
   </entry>


</feed>

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