Transfer of Care R4 Hackathon Implementation Guide

This guidance is under active development by NHS England and content may be added or updated on a regular basis.

Allergies and adverse reactions

The Allergies and adverse reactions section carries information about the patient's allergies and adverse reactions. PRSB Elements should be formatted as subheadings in any HTML sent. This table should be used in conjunction with the section on constructing clinical coded structures for further information on constructing and coding allergy lists.

Section Description Card. MRO* FHIR Target and Guidance
Allergies and adverse reactions The details of any known allergies, intolerances or adverse reactions. 1 only M Carried in the CodeableConcept of Composition.section.code FHIR element. ValueSet UKCoreCompositionSectionCode
PRSB Element Description Card. MRO* FHIR Target and Guidance
Causative agent The agent such as food, drug or substances that has caused or may cause an allergy, intolerance or adverse reaction in this patient. 1 only M Text and a SNOMED CT concept carried in the CodeableConcept of AllergyIntolerance.code FHIR element. For further information on coding causative agent see Allergy List(Causative agent)
Reaction details cluster
Description of reaction A description of the manifestation of the allergic or adverse reaction experienced by the patient. For example, skin rash. 0 to 1 O Text and if coding is available carried in the CodeableConcept of the AllergyIntolerance.reaction.manifestation FHIR element. If no coding available use AllergyIntolerance.reaction.description FHIR element. For further information on reaction details see Allergy List (Description of reaction)
Date recorded The date that the reaction was clinically recorded/asserted. This will often equate to the date of onset of the reaction, but this may not be wholly clear from source data. 0 to 1 R The date that the reaction was clinically recorded/asserted. Text and carried in AllergyIntolerance.assertedDate FHIR element.
Severity A description of the severity of the reaction 0 to 1 O Text and if coding is available carried in the CodeableConcept of the AllergyIntolerance.reaction.severity FHIR element. For further information on severity see Allergy List(severity)
Certainty A description of the certainty that the stated causative agent caused the allergic or adverse reaction. 0 to 1 O Text and if coding is used available carried in the Code of AllergyIntolerance.verificationStatus FHIR element. For further information on certainty see Allergy List (Certainty)
Comment Any additional comment or clarification about the adverse reaction. 0 to 1 R Free text
End of Reaction details cluster
Type of reaction The type of reaction experienced by the patient (allergic, adverse, intolerance) 0 to 1 O Text and if coding is available carried in Code of AllergyIntolerance.type FHIR element. For further information on certainty see Allergy List (Type of reaction)
Evidence Results of investigations that confirmed the certainty of the diagnosis. Examples might include results of skin prick allergy tests 0 to 1 O Free text. Note: structured FHIR Diagnostic Reports are not currently supported in Transfer of Care. An attachment such as a pdf of a laboratory report may be included with a link as evidence. See section on Use of Attachments
Date first experienced When the reaction was first experienced. May be a date or partial date (e.g. year) or text (e.g. during childhood) 0 to 1 O Free text and AllergyIntolerance.onset[x] FHIR element. For further information see Allergy List (Date first experienced)
* M=Mandatory R=Required O=Optional

Example Allergies and Adverse Reactions Section

{
    "resourceType": "Composition",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Composition"
        ]
    },
    "status": "final",
    "type": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "373942005",
                "display": "Discharge summary"
            }
        ]
    },
    "subject": {
        "reference": "urn:uuid:31686b67-9f20-4644-9a54-193d2f91de57"
    },
    "encounter": {
        "reference": "urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a"
    },
    "date": "2015-02-17T10:00:00+00:00",
    "author":  [
        {
            "reference": "urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc"
        }
    ],
    "title": "Cardiology Service Discharge Summary",
    "section":  [
        {
            "title": "Allergies and adverse reactions",
            "code": {
                "coding":  [
                    {
                        "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                        "code": "allergies-and-adverse-reaction",
                        "display": "Allergies and adverse reactions"
                    }
                ]
            },
            "text": {
                "status": "additional",
                "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Causative agent</th><td>Penicillin -class of antibiotic-</td></tr><tr><th>Description of reaction</th><td>Eruption due to drug</td></tr><tr><th>Date recorded</th><td>12 February 2015</td></tr><tr><th>Severity</th><td>Mild</td></tr><tr><th>Certainty</th><td>Certain</td></tr><tr><th>Comment</th><td>No swelling</td></tr></tbody></table></div>"
            },
            "entry":  [
                {
                    "reference": "urn:uuid:95e8f8d0-dfc3-4c72-a9dc-7ba1ccd1fab4"
                }
            ]
        }
    ]
}
<Composition xmlns="http://hl7.org/fhir">
    <!--   optional elements removed for readability   -->
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Composition" />
    </meta>
    <status value="final" />
    <type>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="373942005" />
            <display value="Discharge summary" />
        </coding>
    </type>
    <subject>
        <reference value="urn:uuid:31686b67-9f20-4644-9a54-193d2f91de57" />
    </subject>
    <encounter>
        <reference value="urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a" />
    </encounter>
    <date value="2015-02-17T10:00:00+00:00" />
    <author>
        <reference value="urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc" />
    </author>
    <title value="Cardiology Service Discharge Summary" />
    <section>
        <title value="Allergies and adverse reactions" />
        <code>
            <coding>
                <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                <code value="allergies-and-adverse-reaction" />
                <display value="Allergies and adverse reactions" />
            </coding>
        </code>
        <text>
            <status value="additional" />
            <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Causative agent</th><td>Penicillin -class of antibiotic-</td></tr><tr><th>Description of reaction</th><td>Eruption due to drug</td></tr><tr><th>Date recorded</th><td>12 February 2015</td></tr><tr><th>Severity</th><td>Mild</td></tr><tr><th>Certainty</th><td>Certain</td></tr><tr><th>Comment</th><td>No swelling</td></tr></tbody></table></div>
        </text>
        <entry>
            <reference value="urn:uuid:95e8f8d0-dfc3-4c72-a9dc-7ba1ccd1fab4" />
        </entry>
    </section>
</Composition>

Example Coded Resources

This text section should be linked to a UKCore-List profiled resource. E.g.

{
    "resourceType": "List",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-List"
        ]
    },
    "identifier":  [
        {
            "system": "https://tools.ietf.org/html/rfc4122",
            "value": "6ee0967d-aaa7-411a-9398-518c089ce3a1"
        }
    ],
    "status": "current",
    "mode": "snapshot",
    "code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "886921000000105",
                "display": "Allergies and adverse reactions"
            }
        ]
    },
    "subject": {
        "reference": "urn:uuid:31686b67-9f20-4644-9a54-193d2f91de57"
    },
    "encounter": {
        "reference": "urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a"
    },
    "source": {
        "reference": "urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc"
    },
    "entry":  [
        {
            "item": {
                "reference": "urn:uuid:9a1c380c-e8b0-4814-aefc-ee69d39b1079"
            }
        }
    ]
}
<List xmlns="http://hl7.org/fhir">
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-List" />
    </meta>
    <identifier>
        <system value="https://tools.ietf.org/html/rfc4122" />
        <value value="6ee0967d-aaa7-411a-9398-518c089ce3a1" />
    </identifier>
    <status value="current" />
    <mode value="snapshot" />
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="886921000000105" />
            <display value="Allergies and adverse reactions" />
        </coding>
    </code>
    <subject>
        <reference value="urn:uuid:31686b67-9f20-4644-9a54-193d2f91de57" />
    </subject>
    <encounter>
        <reference value="urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a" />
    </encounter>
    <source>
        <reference value="urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc" />
    </source>
    <entry>
        <item>
            <reference value="urn:uuid:9a1c380c-e8b0-4814-aefc-ee69d39b1079" />
        </item>
    </entry>
</List>


This list linked to a UKCore-AllergyIntolerance profiled resource. E.g.

{
    "resourceType": "AllergyIntolerance",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-AllergyIntolerance"
        ]
    },
    "identifier":  [
        {
            "system": "https://tools.ietf.org/html/rfc4122",
            "value": "06d65f0f-117a-43c6-84ea-f28c3bd664a2"
        }
    ],
    "clinicalStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
                "code": "active"
            }
        ]
    },
    "verificationStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
                "code": "confirmed"
            }
        ]
    },
    "category":  [
        "medication"
    ],
    "code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "373270004",
                "display": "Penicillin antibacterial"
            }
        ]
    },
    "patient": {
        "reference": "urn:uuid:31686b67-9f20-4644-9a54-193d2f91de57"
    },
    "recordedDate": "2015-02-12",
    "reaction":  [
        {
            "manifestation":  [
                {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "28926001",
                            "display": "Eruption due to drug"
                        }
                    ]
                }
            ],
            "severity": "mild"
        }
    ]
}
<AllergyIntolerance xmlns="http://hl7.org/fhir">
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-AllergyIntolerance" />
    </meta>
    <identifier>
        <system value="https://tools.ietf.org/html/rfc4122" />
        <value value="06d65f0f-117a-43c6-84ea-f28c3bd664a2" />
    </identifier>
    <clinicalStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical" />
            <code value="active" />
        </coding>
    </clinicalStatus>
    <verificationStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification" />
            <code value="confirmed" />
        </coding>
    </verificationStatus>
    <category value="medication" />
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="373270004" />
            <display value="Penicillin antibacterial" />
        </coding>
    </code>
    <patient>
        <reference value="urn:uuid:31686b67-9f20-4644-9a54-193d2f91de57" />
    </patient>
    <recordedDate value="2015-02-12" />
    <reaction>
        <manifestation>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="28926001" />
                <display value="Eruption due to drug" />
            </coding>
        </manifestation>
        <severity value="mild" />
    </reaction>
</AllergyIntolerance>
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