HL7 Patient Care Work Group
Allergy/Intolerance/Adverse Reaction Topic Sub-Group Meeting Minutes
Date: October 29, 2014
Phone Number: +1 770-657-9270
Participant Passcode: 943377
WEBEX: 197 520 889
Co-Chairs: Stephen Chu/Elaine Ayres
Name
Elaine Ayres
Stephen Chu
Kelly Verdin
Rob Hausam
Matt Graham
Emma Jones
Jay Lyle
Russ Leftwich
Scribe: Elaine Ayres
Present on October 29, 2014
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Agenda for October 29, 2014
1. Approve minutes of meetings:
2. Discussion of proposed AdverseReactionRisk FHIR Resource
a. Link to OpenEHR comments: http://wiki.hl7.org/images/6/6d/OpenEHR-FHIR-AdverseReactionRiskreview-summary_2014-10-09.pdf
3. Continue work with C-CDA harmonization
4. Other items?
5. Next meeting – Wednesday, November 12
Minutes for October 15:
Move: Russ/Stephen
Abstain: 1 Negative: 0 Approve: 6
The group discussed problem status vs. the allergy problem and appropriate concepts for the value sets. It
was noted that often an allergy list includes the morphologic presentation (as opposed to the condition).
Therefore a list might be rash, swelling, hives etc. The group discussed what should go on the list. It was
also noted that these terms should be crossed-mapped with ICD-10.
The FHIM group (Federal Health Information Management) did a study of system allergy lists. The study
included allergy lists from the VA, Intermountain Health and Kaiser Permanente and examined the
frequency of reaction/manifestation terms. (This is currently unpublished work but will be used to drive a
value set in VSAC for reaction terms). The top manifestation terms across systems in descending order was:
RASH
NAUSEA AND VOMITING
URTICARIA
ANAPHYLAXIS
HL7 Allergy and Intolerance Minutes
MUSCLE PAIN
DYSPNEA
NAUSEA
COUGH
SWELLING
DIARRHEA
PRURITUS
If a reaction has two manifestations it may lead to two different conditions. So for example, sulfa drugs may
cause nausea and vomiting and urticaria indicating the need to include two different conditions.
For an allergy problem – the problem is inactive until challenged. However the risk is always active.
The group then discussed the list of substance types – and agreed that the synthetic substance could be
removed.
FHIR resources for adverse reaction and allergy and intolerance and comparative analysis with the
proposed adverse reaction risk:
The group discussed the new combined resource as proposed by FHIR which combines the reaction and the
condition. The new combined resource is called the “AdverseReactionRisk” and the UML model is as
follows:
The group discussed if there was a need to represent an adverse reaction without the representation of the
condition. Russ noted that 80% of adverse reactions are situational and not the propensity to react related to
an individual. Rob noted that when there is an event, it may not be known what the causative substance is
until later. It was also noted that 50% of hives had no cause.
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HL7 Allergy and Intolerance Minutes
The group then discussed if an adverse reaction should be changed to an adverse event. In risk management
an adverse event could be anything including a fall, an incorrect drug and may or may not have an effect.
It was noted that the construct of a FHIR resource for adverse reaction will help clarify the discussion.
C-CDA Harmonization – postponed.
Problem Observation – proposed terms
Allergy Status Observation – proposed terms
Proposed terms for Table 117 – substance class
Agenda for November 12 , 2014
1. Summary of Substances Summit – November 5-7, 2014
2. Adverse reaction resource
3. C-CDA harmonization.
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