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FHIR Allergy Sample
Revision as of 18:34, 13 January 2014 by Angelo Kastroulis1 (talk | contribs) (→Erythromycin Allergy)
Contents
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"/>
</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><display value="Erythromycin 0.02 MG/MG Topical Gel"/> </coding>
<coding> <system value="http://snomed.info/sct"/>
<!--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><display value="Urticaria"/> </coding> <text value="Urticaria"/>
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"/>
</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><display value="Bactrim"/> </coding>
<coding> <system value="http://snomed.info/sct"/>
<!--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><display value="Tongue swelling"/> </coding> <text value="Tongue swelling"/>
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"/>
<!--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><display value="Anaphylaxis"/> </coding> <text value="Anaphylaxis reaction"/>
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>