Allergy and Intolerance Decisions to Date for C-CDA R1.1 Review with Patient Care WG

Allergy and Intolerance Decisions to Date for C-CDA R1.1 Review with Patient Care WG As of October 1, 2014

1. Name for Table 117 a. Current: Allergy/Adverse Event Type Value Set b. New: Allergy and Intolerance Type Value Set (approved by PC on 7/16/14) 2. Table of values entitled Allergy and Intolerance Category will reflect codes for representation of an allergy, an intolerance or if the type is undetermined. Grid under development. Need to determine impact on current value set codes. 3. Allergy and Intolerance Criticality Value Set (FHIR – put in G-FORGE))

a) Code for HIGH - Definition: Exposure to substance may result in a life threatening or organ system threatening outcome. b) Code for LOW – Definition: Exposure to substance unlikely to result in a life threatening or organ system threatening outcome. c) Unable to Determine – Definition: Unable to assess with information available. d) Unknown – Definition: A proper value is applicable but it is not known.

SNOMED-CT: request for finding/condition HIGH use “Allergy and intolerance condition of high criticality” need a preferred term? LOW use “Allergy and intolerance condition of low criticality” need preferred term? Unable to determine use “Unable to determine allergy and intolerance condition of criticality” need preferred term “Allergy and intolerance condition of undetermined criticality” (UNK) – a proper value is not known

LOINC REQUESTS as of September 3, 2014  Code 48756-2 LOINC code for the section in C-CDA for Allergies and Intolerances. Display name Allergies, Adverse Reactions and Alerts – o Can the refine to Allergies and Intolerances or retire the code. o New code for Allergies and Intolerances o New code for Alerts. o Actual LOINC code has the correct definition (Resolved) o Look at actual concept definition o Alerts is a leftover from HITSP – make a DSTU comment  LOINC code for criticality observation – o What is the criticality of the allergy and/or intolerance condition? OK o Display name: Allergy and/or intolerance condition criticality observation.  Reaction Observation (already exists) o What is the adverse reaction?  Severity Observation (OK –need to request)Should be specific to allergy and intolerance severity? o What is the severity of the adverse reaction? o NOTE C-CDA currently uses SEV code (HL7 code system)  REPLACE with three SNOMED-CT Concepts o Allergy and Non-Allergy Intolerance to a substance . Allergy to substance . Intolerance (non-allergic) to a substance  Code clarifies the act of making an observation NOTE that QRDA for adverse event and intolerance? These are not the same. Allergy is a subtype of intolerance.  Synonyms available for other realms? (see Stephen Chu’s e-mail)

OID for criticality observation value set: 2.16.840.1.113883.13.275 OID for allergy and intolerance types: 2.16.840.1.113883.13.274

Substance Type Allergy? Intolerance? Undetermined? Value Set Drug Name Code– Allergy Code – Code – allergy or RxNORM - to named drug? Intolerance to intolerance to a named deal with both named drug? drug? brand and generic Or realm specific Drug Ingredient Code – Allergy Code- Code – allergy or RxNORM or to drug Intolerance to intolerance to drug UNII ingredient? drug ingredient? ingredient? Drug Class Code – Allergy Code- Code – allergy or NDFRT including to drug class? Intolerance to intolerance to drug vaccines drug iclass? class? Food Code – Allergy Code- Code – allergy or UNII, to food? Intolerance to intolerance to food? SNOMED-CT, food? LANGUAL Devices Code – Allergy Code- Code – allergy or ?? to device? Intolerance to intolerance to device? device? Environmental Code – Allergy Code- Code – allergy or UNII, substance to an Intolerance to an intolerance to an SNOMED-CT, environmental environmental environmental substance? substance? substance? Biologics Code – Allergy Code- Code – allergy or to a biologic? Intolerance to a intolerance to a biologic? biologic? Blood Products Code – Allergy Code- Code – allergy or to blood Intolerance to intolerance to blood products? blood products? products? Synthetic Code – Allergy Code- Code – allergy or Substances to a synthetic Intolerance to a intolerance a synthetic substance? synthetic substance? substance?