GP Connect - Emergency Supply of Medications (ITK3)

Note: This specification was originally titled "Digital Medicines (DigiMeds)" and maintained by the PODAC Programme.

How to populate Allergies and adverse reactions

The Composition.section element is used to convey both HTML and the structrued FHIR elements contained within the payload.

More information can be found on:

The FHIR snippets below provides an example of how to populate the FHIR resources, and the respective HTML.

Allergy terminology

Allergy information can be represented in two different ways:

Using 'precoordinated' concepts i.e. expressing all the clinical ideas combined in a single code/field, such as 293584003 |Allergy to paracetamol (finding)| in SNOMED CT.
Using 'postcoordinated' concepts i.e. using separate codes/fields for each clinical idea, and linking them together outside of the chosen terminology - such as 609328004 |Allergic disposition (finding)| and 387517004 |Paracetamol (substance)| in SNOMED CT. In this example, separate codes are used to represent the reaction type and the causative agent respectively.

This specification chooses to represent allergy information using postcoordinated concepts, as in the latter example.

No known drug allergy

In the event that the patient does not have any known allergies, please use the SNOMED code:

409137002 | No known drug allergy (situation) |

<coding>
    <system value="http://snomed.info/sct"/>
    <code value="409137002"/>
    <display value="No known drug allergy"/>
</coding>

FHIR snippet (HTML)

Allergic to Paracetamol

An example using an Actual Medicinal Product (AMP).

<section>
    <title value="Allergies and adverse reactions"/>
    <code>
        <coding>
            <system value="http://snomed.info/sct"/>
            <code value="886921000000105"/>
            <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>Paracetamol 500mg tablets (A A H Pharmaceuticals Ltd)</td>
                    </tr>
                    <tr>
                        <th>Description of reaction</th>
                        <td>sample adverse event</td>
                    </tr>
                    <tr>
                        <th>Type of reaction</th>
                        <td>Allergy</td>
                    </tr>
                    <tr>
                        <th>Severity</th>
                        <td>Mild</td>
                    </tr>
                    <tr>
                        <th>Certainty</th>
                        <td>Confirmed</td>
                    </tr>
                    <tr>
                        <th>Date recorded</th>
                        <td>31 May 2020 21:53</td>
                    </tr>
                </tbody>
            </table>
        </div>
    </text>
    <entry>
        <reference value="urn:uuid:a9f3d7fc-4129-4f55-8757-c1b170ad6967"/>
    </entry>
</section>

No known drug allergy

<section>
    <title value="Allergies and Adverse Reactions"/>
    <code>
        <coding>
            <system value="http://snomed.info/sct"/>
            <code value="886921000000105"/>
            <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>No known drug allergy</td>
                    </tr>
                </tbody>
            </table>
        </div>
    </text>
    <!--Reference to Allergies List as the source of information for this section-->
    <entry>
        <reference value="urn:uuid:82d40ab3-6304-4620-8ba5-95234631dca6"/>
    </entry>
							</section>

Example HTML render

Allergic to Paracetamol

An example using an Actual Medicinal Product (AMP).

Allergies and adverse reactions

Causative agent	Paracetamol 500mg tablets (A A H Pharmaceuticals Ltd)
Description of reaction	sample adverse event
Type of reaction	Allergy
Severity	Mild
Certainty	Confirmed
Date recorded	31 May 2020 21:53

No known drug allergy

Allergies and adverse reactions

Causative agent	No known drug allergy

FHIR snippet (CareConnect-ITK-Allergy-List-1)

<List>
    <id value="a9f3d7fc-4129-4f55-8757-c1b170ad6967"/>
    <meta>
        <profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-ITK-Allergy-List-1"/>
    </meta>
    <identifier>
        <system value="https://tools.ietf.org/html/rfc4122"/>
        <value value="a9f3d7fc-4129-4f55-8757-c1b170ad6967"/>
    </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:e82a6a10-7409-4bc1-8f00-ec577ab1f7a8"/>
        <display value="SYKES, Ray"/>
    </subject>
    <encounter>
        <reference value="urn:uuid:f08e018b-9179-4569-9958-e7ba9750c0fe"/>
    </encounter>
    <source>
        <reference value="urn:uuid:e5eb2e11-2996-4046-bf35-22da98bd5fe0"/>
        <display value="SMITH, John (Mr)"/>
    </source>
    <entry>
        <item>
            <reference value="urn:uuid:e5e02a1b-098b-45de-812b-22586128d341"/>
        </item>
    </entry>
</List>

FHIR snippet (CareConnect-ITK-AllergyIntolerance-1)

Allergic to Paracetamol

An example using an Actual Medicinal Product (AMP).

<AllergyIntolerance>
    <id value="e5e02a1b-098b-45de-812b-22586128d341"/>
    <meta>
        <profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-ITK-AllergyIntolerance-1"/>
    </meta>
    <identifier>
        <system value="https://tools.ietf.org/html/rfc4122"/>
        <value value="262335c0-6ddd-4a1c-8409-e6bbcc230ee0"/>
    </identifier>
    <clinicalStatus value="active"/>
    <verificationStatus value="confirmed"/>
    <code>
        <coding>
            <system value="http://snomed.info/sct"/>
            <code value="382911000001102"/>
            <!--Added by chbe -->
            <display value="Paracetamol 500mg tablets (A A H Pharmaceuticals Ltd)"/>
        </coding>
    </code>
    <patient>
        <reference value="urn:uuid:e82a6a10-7409-4bc1-8f00-ec577ab1f7a8"/>
        <display value="SYKES, Ray"/>
    </patient>
    <assertedDate value="2020-05-31T21:53:00+01:00"/>
</AllergyIntolerance>

No known drug allergy

<AllergyIntolerance xmlns="http://hl7.org/fhir">
    <id value="d31bba78-4ae4-450c-9a5e-c6b33723dedb"/>
    <meta>
        <profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-ITK-AllergyIntolerance-1"/>
    </meta>
    <identifier>
        <system value="https://tools.ietf.org/html/rfc4122"/>
        <value value="d31bba78-4ae4-450c-9a5e-c6b33723dedb"/>
    </identifier>
    <clinicalStatus value="active"/>
    <verificationStatus value="unconfirmed"/>
    <category value="medication"/>
    <code>
        <coding>
            <system value="http://snomed.info/sct"/>
            <code value="409137002"/>
            <display value="No known drug allergy"/>
        </coding>
    </code>
    <patient>
        <reference value="urn:uuid:1ca429f3-6d18-42a4-9de9-b58eaed77c7f"/>
        <display value="THYME, Justin"/>
    </patient>
    <assertedDate value="2020-06-22T16:25:28Z"/>
</AllergyIntolerance>