Allergy/Intolerance Care Plan Storyboard
Storyboard: Physician Manages Allergy & Intolerance List; use case 5 above and 6. Adverse events list as 10 Purpose: To illustrate common practices in allergy management. Precondition: Dr. Patricia Primary is viewing the EMR of Patient Everyman. Dr. Primary has completed the subjective and objective portions of the visit and is now drawing together the findings into an impression of the patient. Dr. Primary has a referral relationship to an allergist, Dr. Richard Reaction. Activities: Dr. Primary identifies two findings that support the diagnosis of a *******: an itchy rash with linear patterns of distribution; and a potential exposure while walking in the woods prior to the rash. She then places ****** on the allergy list. She identifies two findings that support the diagnosis of spring pollen allergies: a history of sinus infections in a seasonal pattern and a family medical history of allergies. She also places the Spring Pollen Allergies on the allergy list and activates a care plan with anti-histamines as needed and a referral to an allergist, Dr. Reaction, for assessment of the Spring Pollen Allergies. Penicillin with a reaction of hives is also placed on the allergy list. The referral appointment for the allergy concern assessment is scheduled. When the allergist, Dr. Reaction, views the referral document for the Spring Pollen Allergies, he navigates from the allergy list to the respective diagnoses, findings, and care plans for each allergy in order to validate the data. He imports the data into his EMR system. He modifies and adds to the basic data in his EMR. These updates and additions include more detail on the symptoms and timelines related to the “Spring Pollen Allergies,” the family medical history of allergies, and more information on the penicillin allergy. He applies skin tests for multiple allergens, including spring pollen allergens and penicillin, and asks Mr. Everyman to return for readings on the tests. When Mr. Everyman returns, Dr. Reaction reads the tests, identifies the positive reactions to Pine Pollens, and updates the allergy list including revising the Spring Pollen Allergy and removing the penicillin allergy. Dr. Reaction returns the information to Dr. Primary in a referral report (consultants’ report) document along with recommended updates to the care plans. Dr. Primary reviews the recommendations from the allergist and adjusts the care plans to include a repeat visit by Mr. Everyman to discuss the recommendations. Dr. Primary also updates the allergies on the allergy list with more specific descriptions of the allergies and marks the penicillin allergy as obsolete. Post-condition: Mr. Everyman has progress notes, findings, impressions, referral documents, care plans, and a populated allergy list in the EMR that are captured in a manner that allows navigation from one related data item to the next. Specifically, the user is able to navigate from the current name of the allergy on the allergy list to the string of observations and treatment activities associated with management of that allergy over time. Additionally, the user is able to navigate from a data item to the allergy management programs supported by the data element.