Download KWF_Comparison of allergies and intolerances

Comparison of allergies and intolerances data models
Aim: to study similarities and differences between data models proposed by various countries and standards development organizations to
record allergies and intolerances
Information sources: HL7 Patient Care Work Group (HL7PC), HL7 Structured Documents Work Group (HL7SD), UK NHS Connecting for Health
(UKCFH), UK Health & Social Care Information Centre (UKHSC), US Federal Health Information Model (FHIM), Canada Allergy Intolerance Draft
Model (CAN), EU epSOS Selection of code systems for the Master Value Catalogue document (EUEP), IHTSDO Allergic state – Immune
hypersensitivity disorder project document (IHTSDOPD)
Domain terms and definitions
Term
Hypersensitivity
Allergy
Pseudoallergy
Intolerance
Condition (used in
combination with
hypersensitivity, allergy,
pseudoallergy and intolerance)
Disposition (used in
combination with
hypersensitivity, allergy,
pseudoallergy and intolerance)
Definition
Objectively reproducible symptoms or signs initiated by
exposure to a defined stimulus at a dose tolerated by
normal persons
Allergy is a type of immune-mediated hypersensitivity in
which the immune response is generally directed towards
a foreign antigen and which results in tissue injury, which
is usually transient
A nonimmune hypersensitivity generally directed towards
a foreign substance, which results in tissue injury, which is
usually transient
A non-immunological adverse physiological sensitivity to a
substance. It may be manifested by an inability to endure,
withstand, absorb, or metabolize a substance (e.g.
lactose).
Can be a disposition or manifestation of such a disposition
Source
IHTSDOPD
The disposition or propensity for a reaction
IHTSDOPD
(modified)
comments
Similar to adverse sensitivity,
subsumes allergy,
pseudoallergy and intolerance
IHTSDOPD
IHTSDOPD
(modified)
considered a type of
intolerance in this document
HL7PC
IHTSDOPD
(modified)
Subsumes disposition and
reaction
Reaction (used in combination
with hypersensitivity, allergy,
pseudoallergy and intolerance)
Adverse reaction
The pathological process triggered by exposure to a
defined stimulus in a patient with such disposition
IHTSDOPD
(modified)
An undesirable physiological effect resulting from
exposure to a substance
HL7PC
Subsumes reactions due to
hypersensitivity, allergy,
pseudoallergy and intolerance
Overview
This analysis uses the HL7 Patient Care Work Group (HL7PC) model as the basis for comparison, because it is the most comprehensive and most
recent. The places where other models overlap with or differ from the HL7PC model are highlighted.
The centerpiece of the HL7PC model is the Adverse Sensitivity to Substances Record, which documents the hypersensitivity disposition of a
patient. Each hypersensitivity disposition may or may not be substantiated (or refuted) by one or more Adverse Reaction Record or Sensitivity
Test Record. The following tables show the data elements in each record. Only data elements that are specific to this use case are included.
Generic data elements such as date/time, patient and practitioner identifiers are omitted. Names of some data elements are modified for
readability. To simplify the comparison, the data elements allocated to related entities in the HL7PC UML model are incorporated into the 3
principle records. Highlighted in red are those data elements not found in the HL7PC model.
Adverse Sensitivity to Substances Record – documents disposition to adverse reactions
Data element
Substance
Sensitivity type
Certainty
Description
A substance is a physical material which can
mean a drug or biologic, food, chemical
agent, plants, animals, plastics etc.
indicates whether this sensitivity is of an
allergic nature or an intolerance to a
substance.
An allergy could be further categorized as:
Confirmed - via laboratory testing or
witnessed observation or other strong
evidence, or Suspected (Unconfirmed) Patient reported but not further verified by
Found in other models
all
comments
UKCFH, UKHSC, FHIM, CAN
UKCFH, UKHSC, CAN, FHIM
Certainty is not in the HL7PC UML
diagram but is mentioned in the
glossary appendix
clinical history, diagnostic testing or is
uncertain.
Criticality
The potential seriousness of a future
reaction. This represents a clinical judgment
about the worst case scenario for a future
reaction. It would be based on the severity of
past reactions, the dose and route of
exposure that produced past reactions, and
the life-threatening or organ system
threatening potential of the reaction type.
Criticality is an attribute of the allergic
condition, not the reaction(s).
Condition status
indicates the current status of the concern
Substance type
Drug, food, environment, vaccine etc.
Probability of recurrence Probability of the reaction (allergic, adverse,
intolerant) occurring
IsAbsolutelyContradindic
ated
FHIM
Not the same as severity of the
reaction, because a severe
reaction can be non-critical and
vice versa. A Boolean flag is
proposed, as gradation of
criticality is deemed implausible.
HL7SD, CAN, FHIM
FHIM,CAN
UKHSC
FHIM
Can this be rolled under
criticality?
Adverse Reaction Record – documents the observed effect resulting from exposure to a substance.
Data element
Substance
didNotOccurFlag
Reaction manifestation
Severity
Exposure type
Description
A substance is a physical material which can
mean a drug or biologic, food, chemical agent,
plants, animals, plastics etc.
indicates that, although the patient came in
contact with the substance, a reaction did not
occur.
indicates the specific adverse reaction that
occurred. Example: Rash, Hives
How severe the reaction was
how the exposure occurred. Example:
Vaccination, Prescription Administration,
Found in other models
all
comments
Can be used to document an
exception to sensitivity to a class
of drugs
all
HL7SD, UKHSC, CAN
Type of reaction
Observation method
Reliability
Accidental
Allergic reaction or intolerance
UKCFH
FHIM
FHIM
Sensitivity Test Record – document specific sensitivity test associated with an adverse sensitivity
Data element
Sensitivity test
Test result
Evidence supporting
categorization of type
of reaction
Description
Sensitivity test performed
Sensitivity test result
Results of immunological or other
investigations
Found in other models
UKCFH
UKCFH
UKCFH
comments
Can differentiate between
allergic and non-allergic reactions