Allergy & Intolerance

return to: Patient Care

Patient Care WGM Agenda

All Patient Care WGM agenda and minutes can be access from this link:

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

Allergy/Intolerance and Adverse Reaction Projects

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

• 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

Allergy/Intolerance Topic Scope Statement

• 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.

Ballot Reconciliation January 2013

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

C-CDA Examples

Questions are often raised regarding how certain demographic and clinical data should be represented using C-CDA templates.

Often there are disagreements on whether certain approaches in data representations are desirable, correct or constitute best practices.

Representation of allergy/intolerance and adverse reactions data in C-CDA Adverse Reaction Section and Entry templates is one such area where significant disagreements exist.

PCWG is collaborating with experts from Structured Document WG and other interested parties in developing:

• Guidelines on how best to represent allergy/intolerance and adverse reactions using C-CDA templates
• xml examples representing a variety of use cases

Link to C-CDA Example Task Force wiki page

The C-CDA Example Task Force is working on producing a number of xml examples to provide guidance on how different C-CDA templates can/should be used to exchange demographic and clinical data.

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

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:

Meeting Minutes

Allergy/Intolerance Project Conference Calls and Meeting Minutes

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

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