AllergyIntolerance Guidance

The recording of allergy and intolerance information in patient records is a major component of communicating the effects of external substances and compounds on patient health.


Introduction

General Overview of Resource

Note: Guidance replicated from that published for GPConnect.

The allergy and intolerance concept is broad and multi-dimensional:

  • the causation of allergy and intolerance may be linked to specific medications or pharmaceuticals or substances (biological or chemical) in the environment
  • the weight and significance that may be attached to recorded allergy or intolerance is affected by a number of factors including the certainty, the severity of the reaction and the likelihood of occurrence
  • allergies and intolerances may be linked to other clinical events, such as diagnostic tests that confirm the presence of the allergy or intolerance or linked to instances of illness caused by the allergy or intolerance
  • allergies and intolerances may be dynamic and evolving, increasing in severity over time, recurrent or perhaps only active and observed within defined periods.

The recording and handling of allergy and intolerance information has an important role to play in patient safety, not only with regard to clinical decision making, but also in the realm of prescribing decision support, where the presence of allergy information linked to causative agents can trigger automated alerts and restrictions when prescribing.

Given the complexity and depth of the allergy and intolerance domain there are significant differences and variations in the implementation of the allergy and intolerance concept across participating systems in terms of structure, terminology and the linkages between terminology and decision support. These differences limit the current interoperability of allergies and intolerances.

The AllergyIntolerance resource aims to improve the interoperability of allergies and intolerances through convergence towards a standardised structure and common terminology.

The clinical importance of allergy and intolerance information coupled with the variability of implementations across participating systems means that there is a need for clear guidance on the utilisation of the AllergyIntolerance resource by both providers and consumers.

Transformation Overview

The following sections provide details on the properties that differ when comparing


Base AllergyIntolerance Diff Table

Source: https://www.hl7.org/fhir/R4/allergyintolerance.html#tabs-diff

Element Changes
AllergyIntolerance.clinicalStatus Type changed from code to CodeableConcept.
Change value set from http://hl7.org/fhir/ValueSet/allergy-clinical-status to http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1
AllergyIntolerance.verificationStatus Min Cardinality changed from 1 to 0.
Type changed from code to CodeableConcept.
Change value set from http://hl7.org/fhir/ValueSet/allergy-verification-status to http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1
AllergyIntolerance.type Change value set from http://hl7.org/fhir/ValueSet/allergy-intolerance-type to http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1
AllergyIntolerance.category Change value set from http://hl7.org/fhir/ValueSet/allergy-intolerance-category to http://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1
AllergyIntolerance.criticality Change value set from http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality to http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1
AllergyIntolerance.encounter Added Element
AllergyIntolerance.recordedDate Renamed from assertedDate to recordedDate
AllergyIntolerance.recorder Type Reference: Added Target Types PractitionerRole, RelatedPerson
AllergyIntolerance.asserter Type Reference: Added Target Type PractitionerRole
AllergyIntolerance.reaction.severity Change value set from http://hl7.org/fhir/ValueSet/reaction-event-severity to http://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1


CareConnect to UKCore AllergyIntolerance Diff table

Element Changes
AllergyIntolerance.extension:encounter Moved to new resource element AllergyIntolerance.encounter
AllergyIntolerance.extension:allergyEnd Renamed from AllergyIntolerance.extension.allergyEnd to AllergyIntolerance.extension.allergyIntoleranceEnd Change profle from Extension-CareConnect-AllergyIntoleranceEnd-1 to Extension-UKCore-AllergyIntoleranceEnd
AllergyIntolerance.extension:evidence Change profle from Extension-CareConnect-Evidence-1 to Extension-UKCore-Evidence
AllergyIntolerance.identifier.system Min cardinality changed from 0 to 1
AllergyIntolerance.identifier.value Min cardinality changed from 0 to 1
AllergyIntolerance.identifier.assigner Change profile from CareConnect-Organization-1 to UKCore-Organization
AllergyIntolerance.verificationStatus Change profile from CareConnect-AllergyVerificationStatus-1 to (base) http://hl7.org/fhir/ValueSet/allergyintolerance-verification
AllergyIntolerance.code.coding Slicing removed
AllergyIntolerance.code.coding:snomedCT Removed.
Not required. (Covered by AllergyIntolerance.code, and cardinalify was 0..*)
AllergyIntolerance.code Min cardinality changed from 0 to 1ValueSet changed from to 'Care Connect Allergy Code' to UKCoreAllergyCode.
AllergyIntolerance.patient Change profile from CareConnect-Patient-1 to UKCore-Patient
AllergyIntolerance.onset[x] Remove mustSupport = true
AllergyIntolerance.assertedDate Min cardinality changed from 0 to 1
AllergyIntolerance.patient.identifier.assigner Change profile from Orgnanization to UKCore-Organization
AllergyIntolerance.recorder Change profile from {CareConnect-Patient-1, CareConnect-Practitioner-1} to {UKCore-Practitioner, UKCore-PractitionerRole, UKCore-Patient, UKCore-RelatedPerson}
AllergyIntolerance.recorder.identifier.assigner Change profile from Orgnanization to UKCore-Organization
AllergyIntolerance.asserter Change profile from {RelatedPerson, CareConnect-Patient-1, CareConnect-Practitioner-1} to {UKCore-Patient, UKCore-RelatedPerson, UKCore-Practitioner, UKCore-PractitionerRole}
AllergyIntolerance.asserter.identifier.assigner Change profile from Orgnanization to UKCore-Organization
AllergyIntolerance.note.author[x] Change profile from {RelatedPerson, CareConnect-Patient-1, CareConnect-Practitioner-1} to {UKCore-Practitioner, UKCore-Organization, UKCore-Patient, UKCore-RelatedPerson}
AllergyIntolerance.reaction.substance.coding Slicing removed
AllergyIntolerance.reaction.substance.coding:snomedCT Removed.
Not required. (Covered by AllergyIntolerance.reaction.substance, and cardinalify was 0..*)
AllergyIntolerance.reaction.substance Change profile from (base) http://hl7.org/fhir/ValueSet/substance-code to UKCore-AllergySubstance
AllergyIntolerance.reaction.manifestation Change profile from CareConnect-AllergyManifestation-1 to UKCore-AllergyManifestation
AllergyIntolerance.reaction.manifestation.coding Slicing removed
AllergyIntolerance.reaction.manifestation.coding:snomedCT Removed. Not required. (Covered by AllergyIntolerance.reaction.manifestation, and cardinalify was 0..*)
AllergyIntolerance.reaction.severity Change profile from CareConnect-ReactionEventSeverit to (base) http://hl7.org/fhir/ValueSet/reaction-event-severity
AllergyIntolerance.reaction.exposureRoute Slicing removed
AllergyIntolerance.reaction.exposureRoute.coding Removed. Not required. (Covered by AllergyIntolerance.reaction.exposureRoute, and cardinalify was 0..*)
AllergyIntolerance.reaction.note.author[x] Change profile from {RelatedPerson, CareConnect-Patient-1, CareConnect-Practitioner-1} to {UKCore-Practitioner, UKCore-Organization, UKCore-Patient, UKCore-RelatedPerson}


Extensions

TODO


Element position changes

TODO


Element type changes

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Element slices

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Element binding changes

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Element target profile changes

TODO