Allergies
Allergies - Data Model
Patient Facing Services incorporates the GP Connect data model, this contains guidelines on how Providers need to populate each of the FHIR resources. It is advised to read the data model first, to understand how this is being populated by GP clinical systems.
The relevant profiles in the data model are as follows:
- Allergies - CareConnect-GPC-AllergyIntolerance-1
However, not all clinical information stored on GP systems may be safe to display for the end user (patients / citizens). This guide is intended to help Consumers understand what is clinically safe and useful to display via PFS from the GP Connect data model. Please see the PFS recommendations below.
PFS Recommendation
Safe to display to patient / citizen - With a safety rating of 'High', 'Medium' or 'Low'.
Useful to display to patient / citizen - With a recommendation of 'Recommended' or 'Not recommended'.
For example, the element 'Id’ has a safety rating of ‘High’, meaning it can be shown via Patient Facing Services (PFS). However, we believe it may not be useful to display 'Not Recommended' for the patient / citizen. It’s worth noting, there are elements that will have no meaning or have any merit in being displayed such as ‘Id’. For example, some elements are just entities that link data together.
For further information on the labelling please visit Data model labels used within this guidance.
| Element | Safe to display to patient / citizen | Useful to display to patient / citizen |
|---|---|---|
| id | ||
| meta.profile | ||
| extension[encounter] | ||
| extension[allergyEnd] | ||
| extension[allergyEnd].endDate | ||
| extension[allergyEnd].endReason | ||
| identifier | ||
| clinicalStatus | ||
| verificationStatus | ||
| type | ||
| category | ||
| criticality | ||
| code | ||
| patient | ||
| onset.DateTime | ||
| assertedDate | ||
| recorder | ||
| asserter | ||
| lastOccurence | ||
| note | ||
| reaction.manifestation | ||
| reaction.description | ||
| reaction.severity | ||
| reaction.exposureRoute |
Further Information
Note - Not every element will have further information. Further information is to simply give additional context and perspective to the element.
extension[allergyEnd]
Use with caution for PFS use
Further information
If the element is marked as ‘untrue’, it will likely be marked in error. In any case, this should not to be sent via PFS.
extension[allergyEnd].endDate
Use with caution for PFS use
Further information
There is a strong chance of this element being misunderstood by the end user (patient / citizen). This is not the date the patient has stopped being allergic (person ceasing to be allergic) but when it has been marked by clinical staff as ending. Additionally, the 'extension[allergyEnd].endReason' element must be populated alongside 'extension[allergyEnd].endDate' to give context to the end user, it is unsafe to only apply end date.
extension[allergyEnd].endReason
Use with caution for PFS use
Further information
Similar to 'extension[allergyEnd].endDate'. Furthermore, there is a strong chance of this being misunderstood by the end user (patient / citizen). The 'extension[allergyEnd].endReason' element must be populated alongside 'extension[allergyEnd].endDate', it is unsafe to only display the end date element.
clinicalStatus
Further information
The element is strongly advised to be supported by the 'extension[allergyEnd].endDate' and 'extension[allergyEnd].endReason'. It may also be used as a header. For example, for active allergies (in the allergy active list) and the other with ended allergies.
type
Use with caution for PFS use
Further information
The 'type' element classifies whether it’s an allergy or intolerance. There is an absence of a standard or set of rules for intolerance, sensitivity and how a life-threatening allergy is categorised. Whilst we support what GP clinical systems have in the records, categorising the difference between an allergy and an intolerance can be difficult, the majority of the time there is not enough data to understand the difference. Unless Consumers have a clear understanding of the data, a strong use case and address any risk of inconsistencies, then it is sensible to ignore this element for PFS.
category
Use with caution for PFS use
Further information
There are four ‘types’ of identified substance associated with allergies or intolerances. They are food, medication, biologic and environment. However, out of the four, only medication and environment are populated by the GP clinical systems.
The category provided is determined by the source system (GP clinical system). GP Connect advises where there is not a clear assertion by the clinician when recording an allergy and associated category. Categories are assigned based on whether the specified allergy will be used in prescribing and checking (medication) or not (environmental), however this recommendation is not monitored or enforced.
Unless the PFS has a strong use case to define allergies in this way and can convey the meaning clearly and safely to the user (patient / citizen), then it is not recommended to use this element.
code
Use with caution for PFS use
Further information
This element is a CodeableConcept. The element may include more than one code for the medication and/or more one text description. Consumers are strongly advised to use the original term text as the primary text displayed to the end user (patient / citizen). For more information on 'Processing data from a CodeableConcept', specifically section 'Original term text' then please visit -
onset.DateTime
Further information
It is advised to represent the most clinically relevant date which is ‘onset[x]’. However, if secondary dates are used such as ‘assertedDate’, then it should be made clear that these are additional dates. They should not be presented in the same priority as the clinically relevant date (‘onset[x]’).
assertedDate
Use with caution for PFS use
Further information
It is advised to represent the most clinically relevant date which is ‘onset[x]’. However, if secondary dates are used such as ‘assertedDate’, then it should be made clear that these are additional dates. They should not be presented in the same priority as the clinically relevant date (‘onset[x]’).
lastOccurence
Use with caution for PFS use
Further information
Not all GP clinical systems support 'lastOccurence'. For some patients this will not be populated. It is advised to be shown only if populated to avoid confusion and potential wasted real estate of the user interface.
reaction
Further information
Reaction may not be supported by all GP clinical systems. It is currently rare that reaction data is populated.