Profiles & Operations Index > Profile: AllergyIntolerance

Profile: AllergyIntolerance

Canonical URL:http://ontariohealth.ca/fhir/StructureDefinition/ca-on-ps-profile-allergyintolerance

Simplifier project page: Allergy Intolerance (PS-ON)

Derived from: AllergyIntolerance (R4)

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work

Differential View

idΣ0..1string
id0..1string
extensionI0..*Extension
versionIdΣ0..1id
lastUpdatedΣ0..1instant
sourceΣ0..1uri
profileS Σ1..*canonical(StructureDefinition)
securityΣ0..*CodingBinding
tagΣ0..*Coding
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
abatement-datetimeI0..1Extension(dateTime)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
clinicalStatusΣ ?! I0..1CodeableConceptBinding
id0..1string
extensionI0..*Extension
HL7VerificationStatusΣ0..*CodingBinding
StatusCodeΣ0..*CodingBinding
textΣ0..1string
typeS Σ0..1codeBinding
categoryΣ0..*codeBinding
criticalityΣ0..1codeBinding
id0..1string
extensionI0..*Extension
codeAllergyCAS Σ0..*Coding (PS-ON)Binding
absentOrUnknownAllergyIntoleranceS Σ0..*Coding (PS-ON)Binding
textS Σ0..1string
id0..1string
extensionI0..*Extension
referenceS Σ I1..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
encounterI0..1Reference(Encounter)
onsetAgeAge
onsetPeriodPeriod
onsetRangeRange
onsetStringstring
onsetDateTimeS0..1dateTime
recordedDate0..1dateTime
recorderI0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
asserterΣ I0..1Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)
lastOccurrence0..1dateTime
note0..*Annotation
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
substance0..1CodeableConcept
id0..1string
extensionI0..*Extension
manifestationSCTCAS Σ0..*Coding (PS-ON)Binding
textS Σ0..1string
description0..1string
onset0..1dateTime
severityS0..1codeBinding
exposureRoute0..1CodeableConcept
note0..*Annotation

Hybrid View

idΣ0..1string
id0..1string
extensionI0..*Extension
versionIdΣ0..1id
lastUpdatedΣ0..1instant
sourceΣ0..1uri
profileS Σ1..*canonical(StructureDefinition)
securityΣ0..*CodingBinding
tagΣ0..*Coding
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
abatement-datetimeI0..1Extension(dateTime)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
clinicalStatusΣ ?! I0..1CodeableConceptBinding
id0..1string
extensionI0..*Extension
HL7VerificationStatusΣ0..*CodingBinding
StatusCodeΣ0..*CodingBinding
textΣ0..1string
typeS Σ0..1codeBinding
categoryΣ0..*codeBinding
criticalityΣ0..1codeBinding
id0..1string
extensionI0..*Extension
codeAllergyCAS Σ0..*Coding (PS-ON)Binding
absentOrUnknownAllergyIntoleranceS Σ0..*Coding (PS-ON)Binding
textS Σ0..1string
id0..1string
extensionI0..*Extension
referenceS Σ I1..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
encounterI0..1Reference(Encounter)
onsetAgeAge
onsetPeriodPeriod
onsetRangeRange
onsetStringstring
onsetDateTimeS0..1dateTime
recordedDate0..1dateTime
recorderI0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
asserterΣ I0..1Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)
lastOccurrence0..1dateTime
note0..*Annotation
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
substance0..1CodeableConcept
id0..1string
extensionI0..*Extension
manifestationSCTCAS Σ0..*Coding (PS-ON)Binding
textS Σ0..1string
description0..1string
onset0..1dateTime
severityS0..1codeBinding
exposureRoute0..1CodeableConcept
note0..*Annotation

Snapshot View

idΣ0..1string
id0..1string
extensionI0..*Extension
versionIdΣ0..1id
lastUpdatedΣ0..1instant
sourceΣ0..1uri
profileS Σ1..*canonical(StructureDefinition)
securityΣ0..*CodingBinding
tagΣ0..*Coding
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
abatement-datetimeI0..1Extension(dateTime)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
clinicalStatusΣ ?! I0..1CodeableConceptBinding
id0..1string
extensionI0..*Extension
HL7VerificationStatusΣ0..*CodingBinding
StatusCodeΣ0..*CodingBinding
textΣ0..1string
typeS Σ0..1codeBinding
categoryΣ0..*codeBinding
criticalityΣ0..1codeBinding
id0..1string
extensionI0..*Extension
codeAllergyCAS Σ0..*Coding (PS-ON)Binding
absentOrUnknownAllergyIntoleranceS Σ0..*Coding (PS-ON)Binding
textS Σ0..1string
id0..1string
extensionI0..*Extension
referenceS Σ I1..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
encounterI0..1Reference(Encounter)
onsetAgeAge
onsetPeriodPeriod
onsetRangeRange
onsetStringstring
onsetDateTimeS0..1dateTime
recordedDate0..1dateTime
recorderI0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
asserterΣ I0..1Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)
lastOccurrence0..1dateTime
note0..*Annotation
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
substance0..1CodeableConcept
id0..1string
extensionI0..*Extension
manifestationSCTCAS Σ0..*Coding (PS-ON)Binding
textS Σ0..1string
description0..1string
onset0..1dateTime
severityS0..1codeBinding
exposureRoute0..1CodeableConcept
note0..*Annotation

Table View

AllergyIntolerance..
AllergyIntolerance.meta1..
AllergyIntolerance.meta.profile1..
AllergyIntolerance.extensionExtension..1
AllergyIntolerance.verificationStatus..
AllergyIntolerance.verificationStatus.coding..
AllergyIntolerance.verificationStatus.coding..
AllergyIntolerance.verificationStatus.coding..
AllergyIntolerance.type..
AllergyIntolerance.criticality..
AllergyIntolerance.codeCodeable Concept (PS-ON)1..1
AllergyIntolerance.code.codingCoding (PS-ON)..
AllergyIntolerance.code.coding..
AllergyIntolerance.code.coding..
AllergyIntolerance.patientReference(Patient (PS-ON))..
AllergyIntolerance.patient.reference1..
AllergyIntolerance.onset[x]..
AllergyIntolerance.onsetDateTime..
AllergyIntolerance.reaction..
AllergyIntolerance.reaction.substance..
AllergyIntolerance.reaction.manifestationCodeable Concept (PS-ON)1..
AllergyIntolerance.reaction.manifestation.codingCoding (PS-ON)..
AllergyIntolerance.reaction.manifestation.coding..
AllergyIntolerance.reaction.onset..
AllergyIntolerance.reaction.severity..

JSON View

{
    "resourceType": "StructureDefinition",
    "id": "ca-on-ps-profile-allergyintolerance",
    "url": "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-ps-profile-allergyintolerance",
    "version": "0.10.0",
    "name": "AllergyIntolerancePSON",
    "title": "Allergy Intolerance (PS-ON)",
    "status": "active",
    "date": "2022-10-15T12:00:00+00:00",
    "publisher": "Ontario Health",
    "description": "This profile defines a set of constraints to the FHIR AllergyIntolerance resource for use in Ontario Patient Summaries (PS-ON).  It refines constraints applied to the AllergyIntollerance resource by the PS-CA project, which is informed by the constraints of the [AllergyIntolerance-UV-IPS profile](http://hl7.org/fhir/uv/ips/StructureDefinition-AllergyIntolerance-uv-ips.html) and the [Canadian Baseline Profile](http://build.fhir.org/ig/HL7-Canada/ca-baseline/branches/master/StructureDefinition-profile-allergyintolerance.html) to allow for cross-border and cross-jurisdiction sharing of Allergies and Intolerances. It documents the relevant allergies or intolerances (conditions) for a patient, describing the kind of reaction (e.g. rash, anaphylaxis,..); preferably the agents that cause it; and optionally the criticality and the certainty of the allergy.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "AllergyIntolerance",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/AllergyIntolerance",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "AllergyIntolerance.meta",
                "path": "AllergyIntolerance.meta",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "AllergyIntolerance.meta.profile",
                "path": "AllergyIntolerance.meta.profile",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "AllergyIntolerance.extension:abatement-datetime",
                "path": "AllergyIntolerance.extension",
                "sliceName": "abatement-datetime",
                "short": "Abatement datetime",
                "definition": "The date or estimated date that the condition resolved or went into remission.",
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "http://hl7.org/fhir/uv/ips/StructureDefinition/abatement-dateTime-uv-ips"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.verificationStatus.coding",
                "path": "AllergyIntolerance.verificationStatus.coding",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "pattern",
                            "path": "$this"
                        }
                    ],
                    "description": "Discriminated by value set",
                    "rules": "open"
                },
                "comment": "In the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed. While the IPS-UV specification considers this a MS element, some systems will not have a field directly representing verificationStatus; further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element using additional data from the system when developing the patient summary instance",
                "mustSupport": false
            },
            {
                "id": "AllergyIntolerance.verificationStatus.coding:HL7VerificationStatus",
                "path": "AllergyIntolerance.verificationStatus.coding",
                "sliceName": "HL7VerificationStatus",
                "short": "Required value set for AllergyIntolerance Verification Status.",
                "definition": "Code for an allergy or intolerance statement. Represents whether an allergy/intolerance is active or resolved (indicating no longer active).",
                "binding": {
                    "strength": "required",
                    "description": "HL7 required value set for AllergyIntolerance Verification Status.",
                    "valueSet": "http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1"
                }
            },
            {
                "id": "AllergyIntolerance.verificationStatus.coding:StatusCode",
                "path": "AllergyIntolerance.verificationStatus.coding",
                "sliceName": "StatusCode",
                "short": "Code for allergy or intolerance status",
                "definition": "Code for an allergy or intolerance statement. Represents whether an allergy/intolerance is active or resolved (indicating no longer active).",
                "binding": {
                    "strength": "required",
                    "description": "Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.",
                    "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/allergyintolerancestatuscode"
                }
            },
            {
                "id": "AllergyIntolerance.type",
                "path": "AllergyIntolerance.type",
                "mustSupport": true
            },
            {
                "id": "AllergyIntolerance.criticality",
                "path": "AllergyIntolerance.criticality",
                "comment": "While the IPS-UV specification considers this a MS element, some systems will not have a field directly representing the criticality of an allergy or intolerance, it may be possible for systems to populate the unable-to-assess code, however further feedback is required on whether these systems are expected to be able to demonstrate they can construct criticality when developing the patient summary instance",
                "mustSupport": false
            },
            {
                "id": "AllergyIntolerance.code",
                "path": "AllergyIntolerance.code",
                "short": "Concept - reference to a terminology or just text",
                "comment": "IPS-UV allows the supply of coding, text, or both. Use of the IPS-UV ValueSet is currently marked as preferred, work is underway to determine the pan-Canadian terminology that will be preferred and/or socialized for this element.  Until then, only the existing slices are put forward below. They are considered optional, meaning an implementer can still be conformant if they use another subset of codes from SNOMED CT, SNOMED CT CA or another Code System.",
                "min": 1,
                "max": "1",
                "type":  [
                    {
                        "code": "CodeableConcept",
                        "profile":  [
                            "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-ps-profile-codeableconcept"
                        ]
                    }
                ],
                "mustSupport": true,
                "binding": {
                    "extension":  [
                        {
                            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                            "valueString": "AllergyIntoleranceCode"
                        }
                    ],
                    "strength": "preferred",
                    "description": "Codes for allergic condition from the SNOMED CT Canadian edition value set",
                    "valueSet": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/substanceandpharmaceuticalbiologicproductcode"
                }
            },
            {
                "id": "AllergyIntolerance.code.coding",
                "path": "AllergyIntolerance.code.coding",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "pattern",
                            "path": "$this"
                        }
                    ],
                    "description": "Discriminated by the bound value set",
                    "rules": "open"
                },
                "mustSupport": true,
                "type":  [
                    {
                        "code": "Coding",
                        "profile":  [
                            "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-ps-profile-coding"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.code.coding:codeAllergyCA",
                "path": "AllergyIntolerance.code.coding",
                "sliceName": "codeAllergyCA",
                "short": "Optional slice for code for allergy or intolerance from the SNOMED CT CA code set",
                "definition": "Code for an allergy or intolerance statement that is selected from the SNOMED CT Canadian edition value set.",
                "mustSupport": true,
                "binding": {
                    "extension":  [
                        {
                            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                            "valueString": "codeAllergyCA"
                        }
                    ],
                    "strength": "required",
                    "description": "Codes for allergic condition from the SNOMED CT Canadian edition value set",
                    "valueSet": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/substanceandpharmaceuticalbiologicproductcode"
                }
            },
            {
                "id": "AllergyIntolerance.code.coding:absentOrUnknownAllergyIntolerance",
                "path": "AllergyIntolerance.code.coding",
                "sliceName": "absentOrUnknownAllergyIntolerance",
                "short": "Optional slice for code for absent or unknown allergy or intolerance",
                "definition": "Code for an allergy or intolerance statement (either a positive or a negated/excluded statement).  This describes a categorical negated statement (e.g., \"No known allergy\").",
                "comment": "The use of Null values in v3 implementations and SNOMED CT 716186003 (No known allergy) code are common in Canadian implementations - given the semantic equivilance to the codes no-allergy-info and no-known-allergies, Canadian implementers are encouraged to map to the IPS-UV value set (and provide the original source code as an alternate coding) when noting this concept in patient summaries.",
                "mustSupport": true,
                "binding": {
                    "extension":  [
                        {
                            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                            "valueString": "absentOrUnknownAllergy"
                        }
                    ],
                    "strength": "required",
                    "description": "negation/exclusion codes for reporting no known allergies or not available data.",
                    "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-allergies-uv-ips"
                }
            },
            {
                "id": "AllergyIntolerance.patient",
                "path": "AllergyIntolerance.patient",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-ps-profile-patient"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "AllergyIntolerance.patient.reference",
                "path": "AllergyIntolerance.patient.reference",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "AllergyIntolerance.onset[x]",
                "path": "AllergyIntolerance.onset[x]",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "type",
                            "path": "$this"
                        }
                    ],
                    "ordered": false,
                    "rules": "open"
                }
            },
            {
                "id": "AllergyIntolerance.onsetDateTime",
                "path": "AllergyIntolerance.onsetDateTime",
                "mustSupport": true
            },
            {
                "id": "AllergyIntolerance.reaction",
                "path": "AllergyIntolerance.reaction",
                "mustSupport": true
            },
            {
                "id": "AllergyIntolerance.reaction.substance",
                "path": "AllergyIntolerance.reaction.substance",
                "comment": "The IPS-UV does not consider this element MS, however some Canadian systems may capture allergen substances separately from allergyIntolerance.code. Further investigation is required to determine what approaches are in use by participating jurisdictions."
            },
            {
                "id": "AllergyIntolerance.reaction.manifestation",
                "path": "AllergyIntolerance.reaction.manifestation",
                "type":  [
                    {
                        "code": "CodeableConcept",
                        "profile":  [
                            "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-ps-profile-codeableconcept"
                        ]
                    }
                ],
                "min": 1,
                "mustSupport": true,
                "binding": {
                    "extension":  [
                        {
                            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                            "valueString": "manifestationSCTCA"
                        }
                    ],
                    "strength": "preferred",
                    "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode"
                }
            },
            {
                "id": "AllergyIntolerance.reaction.manifestation.coding",
                "path": "AllergyIntolerance.reaction.manifestation.coding",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "pattern",
                            "path": "$this"
                        }
                    ],
                    "description": "Discriminated by the bound value set",
                    "rules": "open"
                },
                "mustSupport": true,
                "type":  [
                    {
                        "code": "Coding",
                        "profile":  [
                            "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-ps-profile-coding"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.reaction.manifestation.coding:manifestationSCTCA",
                "path": "AllergyIntolerance.reaction.manifestation.coding",
                "sliceName": "manifestationSCTCA",
                "short": "Optional slice for representing code for the allergy or intolerance reaction manifestation from the SNOMED CT Canadian edition value set.",
                "definition": "Code for an allergy or intolerance reaction manifestation statement that is selected from the SNOMED CT Canadian edition value set.",
                "mustSupport": true,
                "binding": {
                    "extension":  [
                        {
                            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                            "valueString": "manifestationSCTCA"
                        }
                    ],
                    "strength": "required",
                    "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode"
                }
            },
            {
                "id": "AllergyIntolerance.reaction.onset",
                "path": "AllergyIntolerance.reaction.onset",
                "comment": "While IPS-UV considers this a MS element, some systems may not capture the onset of the reaction separate from the onset of the allergy. It should be sent if available but further feedback is required on whether these systems are still expected to be able to demonstrate they can construct it for the first release of the PS-ON specification."
            },
            {
                "id": "AllergyIntolerance.reaction.severity",
                "path": "AllergyIntolerance.reaction.severity",
                "mustSupport": true
            }
        ]
    }
}

Usage

The AllergyIntolerance Resource is used to populate entries in the Allergies and Intolerances section of a Patient Summary.

Notes

.id

  • Definition: Logical id of this artifact
  • used to uniquely identify the resource
  • if a persistent identity for the resource is not available to use when constructing the composition Bundle, a UUID SHOULD be used in this element (with a corresponding value in Bundle.entry.fullUrl)
  • Where .id is populated with a persistent identifier, consumers SHALL NOT expect to be able to resolve the resource and SHALL always use the version of the resource contained in the Bundle to render the composition.

.meta.profile

  • used to declare conformance to this profile
  • populate with a fixed value: http://ontariohealth.ca/fhir/StructureDefinition/ca-on-ps-profile-allergyintolerance|0.10.0

.meta.versionId

  • SHALL be populated by the Patient Summary Repository server
  • consuming systems can expect this element to be populated when retrieving patient summary instances from the repository
  • source systems do not need to populate this element prior to submission

.extension abatement-datetime

  • Note that while the MS flag is relaxed in the differential, it still shows in the renderer until the extension modeling is further corrected by IPS

.clinicalStatus

  • mustSupport element in international patient summary

.verificationStatus

  • SHOULD be used to convey the level of certainty about the allergy or intolerance in the entry where data is available
  • if not available in the generating system, set to "unconfirmed"
  • mustSupport element in international patient summary

.type

  • SHOULD be used to convey whether the entry is an allergy or an intolerance
  • mustSupport element in international patient summary

.criticality

  • SHOULD be used to convey the criticality of the allergy or intolerance (i.e. the seriousness)
  • mustSupport element in international patient summary

.code

  • SHALL be used to either:
    • identify the agent that causes the allergy or intolerance conveyed in the entry, or
    • to explicitly state that the patient has no known or unknown allergies when the allergy section in the patient summary does not contain an allergy or intolerance
  • in situations where an allergy or intolerance is present:
    • a description of the agent SHALL be provided in .text for display
    • a coded value SHOULD also be provided in .coding
  • in situations where an allergy or intolerance is not present, this SHALL be conveyed using .coding from the prescribed valueSet (absent-or-unknown-allergies-uv-ips)
    • in situations where the EMR cannot distinguish between no-known and no information about patient allergies, then the code for no information should be used. In the instance where a patient is KNOWN to have no allergies, the no-known code should be used.
  • the "codeAllergyCA" slice provides the preferred choice of terminology for this element in Ontario
  • mustSupport element in international patient summary

.patient

  • SHALL provide a .reference to the same Patient resource identified in Composition.subject
  • mustSupport element in international patient summary

.reaction.manifestation

  • used to convey the kind of reaction (e.g. rash, anaphylaxis, etc.)
  • the "manifestationSCTCA" slice provides the preferred choice of terminology for this element in Ontario
  • mustSupport element in international patient summary