June 8, 2014 – C-CDA Harmonization Efforts with Patient Care WG
Issues:
1. Update to LOINC Code
2. Adverse Reaction vs. Propensity to Adverse Reaction
a. Intolerance complete?
3. Relationship of substances to reactions
4. Severity codes – review existing
5. Criticality concepts – need to establish
C-CDA – DSTU R 1.1
Allergy - Intolerance Observation
[observation: templateId 2.16.840.1.113883.10.20.22.4.7 (open)]
Allergy Problem Act
[act: templateId 2.16.840.1.113883.10.20.22.4.30 (open)]
5. SHALL contain exactly one [1..1] code (CONF:7477).
a. This code SHALL contain exactly one [1..1] @code="48765-2" Allergies, adverse
reactions, alerts (CodeSystem: LOINC 2.16.840.1.113883.6.1 STATIC)
(CONF:19158). (NOTE THAT THIS CODE HAS BEEN UPDATED)
6. SHALL contain exactly one [1..1] statusCode (CONF:7485).
a. This statusCode SHALL contain exactly one [1..1] @code, which SHALL be
selected from ValueSet ProblemAct statusCode (what is this?)
2.16.840.1.113883.11.20.9.19 STATIC 2011-09-09 (CONF:19086).
Allergy Section entry template
BELOW is the current value set:
Value Set: Allergy/Adverse Event Type 2.16.840.1.113883.3.88.12.3221.6.2 DYNAMIC
Concept
Code
Concept Name
Preferred
Concept Name
1
Code System OID
Code System
Name
419199007
416098002
59037007
414285001
235719002
420134006
419511003
418471000
418038007
Allergy to
substance
(disorder)
Drug allergy
(disorder)
Drug
intolerance
(disorder)
Food allergy
(disorder)
Food
intolerance
(disorder)
Propensity to
adverse
reactions
(disorder)
Propensity to
adverse
reactions to
drug
(disorder)
Propensity to
adverse
reactions to
food
(disorder)
Propensity to
adverse
reactions to
substance
(disorder)
allergy to
substance
2.16.840.1.113883.6.96
SNOMED-CT
drug allergy
2.16.840.1.113883.6.96
SNOMED-CT
drug
intolerance
2.16.840.1.113883.6.96
SNOMED-CT
food allergy
2.16.840.1.113883.6.96
SNOMED-CT
food
intolerance
2.16.840.1.113883.6.96
SNOMED-CT
propensity
to adverse
reactions
2.16.840.1.113883.6.96
SNOMED-CT
propensity
to adverse
reactions to
drug
2.16.840.1.113883.6.96
SNOMED-CT
propensity
to adverse
reactions to
food
2.16.840.1.113883.6.96
SNOMED-CT
propensity
to adverse
reactions to
substance
2.16.840.1.113883.6.96
SNOMED-CT
Hierarchy of Value Set concepts:
1. Disease
a. Propensity to adverse reactions
i. Hypersensitivity disposition
ii. Propensity to adverse reaction to a substance
1. Allergy to a substance (**two parents)
a. Drug Allergy**
b. Food Allergy**
2. Propensity to adverse reaction to a drug
a. Drug Allergy**
b. Drug Intolerance
3. Propensity to an adverse reaction to food
a. Food Allergy**
b. Food Intolerance
Note alternate hierarchy:
1. Disease
2
a. Complication
i. Adverse Reaction
1. Adverse reaction to substance
a. Allergic reaction to drugs
b. Allergic reaction to food
c. ………
2. Hypersensitivity reaction
Allergy to Substance:
3
Drug Allergy
Drug Intolerance
4
Food Allergy
Food Intolerance (Disorder)
5
Food Intolerance (Finding)
Propensity to Adverse Reactions
6
Propensity to Adverse Reactions to Drug
7
Propensity to Adverse Reactions Food
Propensity to Adverse Reaction to a Substance
8
Other Concepts Not in Value Set:
1. Reaction Observation – Is there a value set?
No specific list – need to select from the disease or syndrome hierarchy.
2. Severity Observation – is there a value set?
From C-CDA S& I Guide – Page 88
On Severity
While I showed the severity template above in the context of a reaction, the Consolidated CDA
allows that it can also be used for allergies themselves. And I note that it doesn’t forbid it from
being used in problems, it just didn’t suggest it. I’m suggesting it. Severity is simply a special kind
of annotation on a problem, allergy, or reaction. Don’t expect it to be present, or supported by
all systems, but if you have it, be kind and share it with others.
9
3. Criticality – no concepts
4. Adverse Reaction – SNOMED TERMS
10
Adverse Reaction to Substance
? Add Intolerance Reaction to Substance??
11
Allergic reaction to Substance
12