| Package | ForgePatientChart.0830 |
| Type | StructureDefinition |
| Id | Id |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=ForgePatientChart.0830@0.1.0&canonical=http://telus.com/fhir/patientChart/StructureDefinition/profile-allergyIntolerance-patientchart |
| Url | http://telus.com/fhir/patientChart/StructureDefinition/profile-allergyIntolerance-patientchart |
| Status | draft |
| Date | 2022-01-17T19:14:20.2817728+00:00 |
| Name | AllergyIntolerance |
| Title | Allergy Intolerence Patient Chart |
| Experimental | False |
| Authority | hl7 |
| Type | AllergyIntolerance |
| Kind | resource |
No resources found
| ValueSet | |
https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct  | Canadian Clinical Drug Data Set-CCDD |
| http://hl7.org/fhir/uv/ips/ValueSet/allergy-reaction-gps-uv-ips | Allergy Reaction (GPS) - IPS |
| https://fhir.infoway-inforoute.ca/ValueSet/allergyintolerancestatuscode | Allergy/Intolerance Status Code |
| http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-allergies-uv-ips | Absent or Unknown Allergies - IPS |
FHIR{
"resourceType" : "StructureDefinition",
"id" : "profile-allergyIntolerance-patientchart",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2022-08-12T16:24:06.3656853+00:00"
},
"url" : "http://telus.com/fhir/patientChart/StructureDefinition/profile-allergyIntolerance-patientchart",
"name" : "AllergyIntolerance",
"title" : "Allergy Intolerence Patient Chart",
"status" : "draft",
"date" : "2022-01-17T19:14:20.2817728+00:00",
"fhirVersion" : "4.0.1",
"mapping" : [
{
"identity" : "rim",
"uri" : "http://hl7.org/v3",
"name" : "RIM Mapping"
},
{
"identity" : "w5",
"uri" : "http://hl7.org/fhir/fivews",
"name" : "FiveWs Pattern Mapping"
},
{
"identity" : "v2",
"uri" : "http://hl7.org/v2",
"name" : "HL7 v2 Mapping"
}
],
"kind" : "resource",
"abstract" : false,
"type" : "AllergyIntolerance",
"baseDefinition" : "http://hl7.org/fhir/StructureDefinition/AllergyIntolerance",
"derivation" : "constraint",
"differential" : {
"element" : [
{
"id" : "AllergyIntolerance",
"path" : "AllergyIntolerance",
"comment" : "Usage Note: The allergy record is the most current state; the reactions captured may include all past reactions or only the most current, depending on the use case.\r\n\r\nConformance Rule: If NullFlavor is used then the following elements SHOULD NOT be populated:\r\n\r\nAllergyIntolerance.clinicalStatus\r\nAllergyIntolerance.verificationStatus\r\nAllergyIntolerance.type\r\nAllergyIntolerance.category\r\nAllergyIntolerance.criticality\r\nand other allergy related elements.\r\n\r\nSubstances include, but are not limited to: a therapeutic substance administered correctly at an appropriate dosage for the individual; food; material derived from plants or animals; or venom from insect stings.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.id",
"path" : "AllergyIntolerance.id",
"comment" : "Usage Note: This will usually be a GUID that is assigned by the sending application.\r\n\r\nThe only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.meta",
"path" : "AllergyIntolerance.meta",
"comment" : "**Confirm usage of last updated",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.meta.lastUpdated",
"path" : "AllergyIntolerance.meta.lastUpdated",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.meta.source",
"path" : "AllergyIntolerance.meta.source",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.meta.profile",
"path" : "AllergyIntolerance.meta.profile",
"comment" : "Usage: May be used for validatiing a message instance against this profile. This will be determined by each implementation.\r\n\r\nIt is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.",
"max" : "1",
"fixedCanonical" : "http://telus.com/fhir/StructureDefinition/profile-allergyIntolerance-patientchart",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.text",
"path" : "AllergyIntolerance.text",
"comment" : "Conformance Rule: This must be formatted, as closely as possible what was presented to the user in the originating system and must include all clinical data. \r\n\r\nCA Core - not supported\r\n\r\nContained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.identifier",
"path" : "AllergyIntolerance.identifier",
"definition" : "Business identifiers assigned to this AllergyIntolerance by the performer or other systems which remain constant as the resource is updated and propagates from server to server"
},
{
"id" : "AllergyIntolerance.clinicalStatus",
"path" : "AllergyIntolerance.clinicalStatus",
"definition" : "The most current clinical status of the allergy or intolerance.",
"comment" : "Conformance Rule: Sending systems must minimally support both active and inactive and resolved (specialization of inactive) where possible. Conformance Rule: Receiving systems must consume all values and map to the best of their ability to their current model.\r\nConformance Rule: Sending systems must send local codings when mapping has occurred.\r\nConformance Rule: The clinical status must be empty when the verification status is \"entered-in-error\"\r\nTBD Conformance Rule: 11/24 - If the sending EMR \"treats\" the allergy as active, this should be populated. \r\n \r\nEMRAPI: API supports current (active) allergies and \"inactive\" \r\nCHR : supports active and inactive (also have verificaiton status confirmed, unconfirmed, resolved, refuted)\r\nMA: MA doesn't support the concept of active or inactive. eg The concept of refute is present; if not refuted it is assumed to be active\r\nPSS: If listed in CPP it is active and should show up in CurrentAllergies in API. \r\nNote: Refuted is a subset of Inactive but cannot be represented here. \r\nPSS - another issue - can be on the patient list, but patient no longer has a reaction. Is this resolved? Is this active? Leave as active with severity = no reaction?\r\nChallenge: Clinical status and verificationStatus are bundled differently than in FHIR. What mappings are safe/make sense. Clinical input is required to determine the safe mappings.\r\n\r\nPS-CA - must support \r\nPS - ON - not supported - Jim - If not present, the receiving system may have to make a decision - eg assume active\r\n\r\n\r\nRefer to [discussion](extensibility.html#Special-Case) if clincalStatus is missing data.\nThe data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.",
"mustSupport" : true,
"binding" : {
"strength" : "required",
"valueSet" : "https://fhir.infoway-inforoute.ca/ValueSet/allergyintolerancestatuscode"
}
},
{
"id" : "AllergyIntolerance.clinicalStatus.coding",
"path" : "AllergyIntolerance.clinicalStatus.coding",
"min" : 1,
"max" : "1",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.clinicalStatus.coding.system",
"path" : "AllergyIntolerance.clinicalStatus.coding.system",
"min" : 1,
"fixedUri" : "http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.clinicalStatus.coding.code",
"path" : "AllergyIntolerance.clinicalStatus.coding.code",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.clinicalStatus.coding.userSelected",
"path" : "AllergyIntolerance.clinicalStatus.coding.userSelected",
"comment" : "Conformance Rule: When encoding any coded value in FHIR, set user selectted field = true IF the code system that is being sent is the same as the code system that is being used internally. This may be a local code or a standard code such as ICD-9.\r\n\r\nAmongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.clinicalStatus.text",
"path" : "AllergyIntolerance.clinicalStatus.text",
"comment" : "Conformance Rule: This must be sent if the user could see this value in the soruce system. \r\n\r\nVery often the text is the same as a displayName of one of the codings.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.verificationStatus",
"path" : "AllergyIntolerance.verificationStatus",
"comment" : "EMRAPI: verificationStatus: system, code, display, text, descriptor\r\n***FDG/TELUS clinical group - reviewed and we will NOT use the CA-Core Allergy Status Codes \r\n\r\nConformance Rule: If verification status is entered in error, the clinical status must not be populated.\r\n\r\nNov 24 - Further discussion required. PSS - this is not a dropdown in PSS - this is multiple fields in PSS. eg - How is text handled if this is confirmed/refuted? Do we represent text of several data points? If refuted, journal view, allergy disappears from CPP allergy box. De-active an allergy, severity choice = no reaction. If changed to no reaction it remains in allergy box with strikethrough. May refute because entered in error. PSS change is a possibility. Refuted status in PSS is a separate concept from confirmed/unconfirmed. PSS has suspected and confirmed as one field. Refuted is handled separately. Problem - an allergy can move through states; in most cases, the current state is of interest. \r\n\r\n\r\nMA - Mapping: FHIR-->MA \r\nunconfirmed-->unconfirmed, suspect, and all other status' not specified here. \r\nconfirmed-->confirmed \r\nrefuted-->refuted \r\nentered in error-->erroneous\r\n\r\nPS-CA - not supported\r\nPS-ON - not supported\r\n\r\nThe data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.verificationStatus.coding",
"path" : "AllergyIntolerance.verificationStatus.coding",
"mustSupport" : true,
"binding" : {
"strength" : "preferred",
"description" : "StatusCode",
"valueSet" : "https://fhir.infoway-inforoute.ca/ValueSet/allergyintolerancestatuscode"
}
},
{
"id" : "AllergyIntolerance.verificationStatus.coding.system",
"path" : "AllergyIntolerance.verificationStatus.coding.system",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.verificationStatus.coding.code",
"path" : "AllergyIntolerance.verificationStatus.coding.code",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.verificationStatus.text",
"path" : "AllergyIntolerance.verificationStatus.text",
"comment" : "Core-CA - 0..1\r\n\r\nVery often the text is the same as a displayName of one of the codings.",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.type",
"path" : "AllergyIntolerance.type",
"comment" : "Conformance Rule: Unless this is very clear, omit this element as it is often very difficult to distinguish\r\n\r\nFHIR>MA \r\nAllergy-> drug allergy, non-drug allergy \r\nIntollerance-> drug intollerance, non-drug intollerance\r\n\r\nFHIR->PSS \r\nallergy->allergy\r\nintollerance->side-effect, exagerated effect, other.\r\n JK - we will not add an intolerence value as this is too vague. Default is allergy. \r\n\r\nEMRAPI: ReactionType (codeable concept; system,code,display,text,descriptor)\r\n\r\nFHIR-> CHR\r\nallergy -> allergy\r\nintolerance - intolerance\r\n\r\nFHIR->MS\r\nReactionType not supported, look in reaction for text\r\n\r\nAllergic (typically immune-mediated) reactions have been traditionally regarded as an indicator for potential escalation to significant future risk. Contemporary knowledge suggests that some reactions previously thought to be immune-mediated are, in fact, non-immune, but in some cases can still pose a life threatening risk. It is acknowledged that many clinicians might not be in a position to distinguish the mechanism of a particular reaction. Often the term \"allergy\" is used rather generically and may overlap with the use of \"intolerance\" - in practice the boundaries between these two concepts might not be well-defined or understood. This data element is included nevertheless, because many legacy systems have captured this attribute. Immunologic testing may provide supporting evidence for the basis of the reaction and the causative substance, but no tests are 100% sensitive or specific for sensitivity to a particular substance. If, as is commonly the case, it is unclear whether the reaction is due to an allergy or an intolerance, then the type element should be omitted from the resource.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.category",
"path" : "AllergyIntolerance.category",
"comment" : "Conformance Rule: This must always be present for \"medication\" allergies. If non-medication, this must be populated when value is known\r\nConformance Rule: The only supported use case for more than one category is \"medication\" and \"biologic\". Other combinations are disallowed. \r\n\r\nEMRAPI: Codeable concept (system, code, display, text, descriptor)\r\nThis data element has been included because it is currently being captured in some clinical systems. This data can be derived from the substance where coding systems are used, and is effectively redundant in that situation. When searching on category, consider the implications of AllergyIntolerance resources without a category. For example, when searching on category = medication, medication allergies that don't have a category valued will not be returned. Refer to [search](search.html) for more information on how to search category with a :missing modifier to get allergies that don't have a category. Additionally, category should be used with caution because category can be subjective based on the sender.",
"max" : "2",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.criticality",
"path" : "AllergyIntolerance.criticality",
"comment" : "Usage Note: This conveys the current state. Criticality can change over time, eg bee stings.\r\n\r\nConformance Rule: FDG - Sending systems are not expected to support this as this is often recorded in the source system in Reaction.severity event. If sending systems support criticality separately than reaction.severity, this will be sent. \r\n\r\nConformance Rule: If a value of \"high\" can be determined via logic (eg recorded as life-threatening or severe) this must be populated for patient safety purposes. should we do this??? we do not want to send data that is not captured. (TBC from dicussion 11/03 on IPS)\r\n\r\nConformance Rule: As this data is crucial for patient safety this should be mapped into the receiving system such that this data is visible to the user when looking at the allergy record. \r\n\r\nThe default criticality value for any propensity to an adverse reaction should be 'Low Risk', indicating at the very least a relative contraindication to deliberate or voluntary exposure to the substance. 'High Risk' is flagged if the clinician has identified a propensity for a more serious or potentially life-threatening reaction, such as anaphylaxis, and implies an absolute contraindication to deliberate or voluntary exposure to the substance. If this element is missing, the criticality is unknown (though it may be known elsewhere). Systems that capture a severity at the condition level are actually representing the concept of criticality whereas the severity documented at the reaction level is representing the true reaction severity. Existing systems that are capturing both condition criticality and reaction severity may use the term \"severity\" to represent both. Criticality is the worst it could be in the future (i.e. situation-agnostic) whereas severity is situation-dependent.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code",
"path" : "AllergyIntolerance.code",
"comment" : "Usage Notes: This could be used at a higher level to record allergies at the medication class, eg \"penicillin\" where a substance might be amoxicillin. Another example: Allergy code = codeine (offending agent) and the Reaction.substance may be Tylenol 3.\r\nUsage Note: If the same alllergy code is documented several times the the POS, it must be sent multiple times.\r\n\r\nUsage Note: 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.\r\n\r\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content.\r\n\r\nConformance Rule: The local code must always be sent for codified values. Additionally, where known the code from the target system must be sent\r\n\r\nEMRAPI: SubstanceCode (system,code,display are all required)\r\nPS-CA: - AllergyintolerancesubstanceconditionGPS (required)\r\nPS-ON: https://fhir.infoway-inforoute.ca/ValueSet/AllergicCondition (required)\r\n\r\nIt is strongly recommended that this element be populated using a terminology, where possible. For example, some terminologies used include RxNorm, SNOMED CT, DM+D, NDFRT, ICD-9, IDC-10, UNII, and ATC. Plain text should only be used if there is no appropriate terminology available. Additional details can be specified in the text.\r\rWhen a substance or product code is specified for the 'code' element, the \"default\" semantic context is that this is a positive statement of an allergy or intolerance (depending on the value of the 'type' element, if present) condition to the specified substance/product. In the corresponding SNOMED CT allergy model, the specified substance/product is the target (destination) of the \"Causative agent\" relationship.\r\rThe 'substanceExposureRisk' extension is available as a structured and more flexible alternative to the 'code' element for making positive or negative allergy or intolerance statements. This extension provides the capability to make \"no known allergy\" (or \"no risk of adverse reaction\") statements regarding any coded substance/product (including cases when a pre-coordinated \"no allergy to x\" concept for that substance/product does not exist). If the 'substanceExposureRisk' extension is present, the AllergyIntolerance.code element SHALL be omitted.",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding",
"path" : "AllergyIntolerance.code.coding",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "system"
}
],
"rules" : "open"
},
"comment" : "EMRAPI: substance code\r\n\r\nMA: urn:telus:emr:ma:*:codetable:allergy-substance\r\nPSS: urn:telus:emr:pss:*:codetable:allergy-code\r\nMS: Vigilance -- they identify DIN's and General codes (GEN)\r\n\r\nConformance Rule: For Medication allergies, a CCDD code must be used if possible. \r\nConformance Rule: The local code must always be sent when available in addition to the CCDD code. \r\nJIM - CCDD is missing drug class - do we use a knowledge base code set? \r\nAnne - is there a standardized set for drug class? Infoway...\r\nJim/Travis: Representative DIN - allergies CAN be recorded in some systems, they are encoded. Can't tell the difference between an actual DIN and DIN coded because that was the best that can be done.\r\n\r\nCodes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding.system",
"path" : "AllergyIntolerance.code.coding.system",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding.code",
"path" : "AllergyIntolerance.code.coding.code",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding:Medication",
"path" : "AllergyIntolerance.code.coding",
"sliceName" : "Medication",
"comment" : "Alignment: Not used in Core-CA, PS-ON or PS-CA\r\n\r\nCodes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"max" : "1",
"mustSupport" : true,
"binding" : {
"strength" : "preferred",
"valueSet" : "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct"
}
},
{
"id" : "AllergyIntolerance.code.coding:Medication.system",
"path" : "AllergyIntolerance.code.coding.system",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding:Medication.code",
"path" : "AllergyIntolerance.code.coding.code",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding:Medication.display",
"path" : "AllergyIntolerance.code.coding.display",
"comment" : "Usage Note: This is not necessary when sending CCDD codes for medication allergies",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding:LocalCode",
"path" : "AllergyIntolerance.code.coding",
"sliceName" : "LocalCode",
"comment" : "Usage Note: The local code should always be sent where known as it may be helpful to receiving EMRs who may understand the code\r\nAlignment: This is not identified in Core-CA, PS-ON or PS-CA \r\n\r\nCodes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"max" : "1",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding:LocalCode.system",
"path" : "AllergyIntolerance.code.coding.system",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding:LocalCode.code",
"path" : "AllergyIntolerance.code.coding.code",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding:LocalCode.userSelected",
"path" : "AllergyIntolerance.code.coding.userSelected",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding:codeAllergyCA",
"path" : "AllergyIntolerance.code.coding",
"sliceName" : "codeAllergyCA",
"comment" : "Usage Note: SNOMED codes - can be included where known but required for PS-ON and PS-CA. This must be provided where possible. EMRs are expected to map from the local code into this codeset. As at July 2022 it is DRAFT\r\n\r\nAlignment - PS-ON - https://tgateway.infoway-inforoute.ca/singlesubset.html?id=2.16.840.1.113883.2.20.3.483&versionid=20220228\r\nAlignment - PS-CA - https://tgateway.infoway-inforoute.ca/singlesubset.html?id=2.16.840.1.113883.2.20.3.483&versionid=20220228\r\nAlignment - Core-CA - example binding\r\n\r\n\r\nCodes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"max" : "1",
"mustSupport" : true,
"binding" : {
"strength" : "required",
"valueSet" : "https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode"
}
},
{
"id" : "AllergyIntolerance.code.coding:codeAllergyCA.system",
"path" : "AllergyIntolerance.code.coding.system",
"min" : 1,
"fixedUri" : "http://snomed.info/sct",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding:codeAllergyCA.code",
"path" : "AllergyIntolerance.code.coding.code",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding:AbsentOrUnknownAllergyIntolerance",
"path" : "AllergyIntolerance.code.coding",
"sliceName" : "AbsentOrUnknownAllergyIntolerance",
"comment" : "Alignment: PS-CA, PS-ON and Core-CA all support \r\n\r\nCodes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"max" : "1",
"mustSupport" : true,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-allergies-uv-ips"
}
},
{
"id" : "AllergyIntolerance.code.coding:AbsentOrUnknownAllergyIntolerance.system",
"path" : "AllergyIntolerance.code.coding.system",
"min" : 1,
"fixedUri" : "http://hl7.org/fhir/uv/ips/CodeSystem/absent-unknown-uv-ips",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.coding:AbsentOrUnknownAllergyIntolerance.code",
"path" : "AllergyIntolerance.code.coding.code",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.code.text",
"path" : "AllergyIntolerance.code.text",
"comment" : "Usage: This must be displayed to the user\r\n\r\nVery often the text is the same as a displayName of one of the codings.",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.patient",
"path" : "AllergyIntolerance.patient",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.patient.reference",
"path" : "AllergyIntolerance.patient.reference",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.patient.display",
"path" : "AllergyIntolerance.patient.display",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.encounter",
"path" : "AllergyIntolerance.encounter",
"comment" : "Usage Note: If data is definitively tied to an encounter in the EMR, this reference should be sent. If there is no definitive reference, this should not be derived using date or other data points.\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"mustSupport" : false
},
{
"id" : "AllergyIntolerance.onset[x]",
"path" : "AllergyIntolerance.onset[x]",
"comment" : "Usage Note: This should only be sent when there is a clear mapping to this date.\r\nAlignment: Not supported in Core-CA, PS-ON or PS-CA\r\n\r\nEMRAPI: Date or DateFD. String is not supported in the API, Requested by OMD CDSS as Lifestage; EMRs in Ontario have to support this (codified value). **May need to extend to a code.\r\n\r\nNOTE: There is only one date in the API and one date in MA. Which is the best date to support? \r\nMA: Patient Chart --> Allg --> add new --> pick type--> Date of Reaction",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.recordedDate",
"path" : "AllergyIntolerance.recordedDate",
"comment" : "Usage Note: This date is the original date from the from the originating system. This is the clinically relevant date.\r\n\r\nEMRAPI: not supported\r\nMA: Allergen-->Date of Reported, MS: CreateDate - FDG to follow up",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.recorder",
"path" : "AllergyIntolerance.recorder",
"comment" : "DISCUSSION: FDG - DO WE NEED THIS DATA? Role is important, reference a practitoiner? non-clinician practitioner, Name, Billing ID? Licence\r\nEMR API: not supported\r\nMA: Patient Chart --> Allg --> add new --> pick type--> Likey not Recorded by, choose physician, patient, pharmacist, etc\r\n\r\nAlignment: not supported in PS-ON or PS-CA\r\n\r\nPSS: who entered into chart, user initials - \r\n\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.recorder.reference",
"path" : "AllergyIntolerance.recorder.reference",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.recorder.display",
"path" : "AllergyIntolerance.recorder.display",
"comment" : "Usage Note: This is a user-friendly textual representation of the reference that should be used in the narrative. This will be the name of the recorder.\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.asserter",
"path" : "AllergyIntolerance.asserter",
"comment" : "Usage Rule: If practitioner role is specified, only a role code is mandatory \r\nUsage Rule: Currently, there is no support for RelatedPerson in some EMRs\r\nPS-ON: This is must support in Ontario Patient Summary; not supported in Core-CA\r\n\r\nThe recorder takes responsibility for the content, but can reference the source from where they got it.\r\nMA (current user, patient, provider values) \r\nMA: Physician (role only), patient, pharmacist (role only), DPIC values - on issue list\r\nMS: \r\nCHR: Patient, related person, practitioner (reported by) - select box but no option to provide further information\r\nPSS: Allergy.reportedby - values current user, patient, provider (not on main screen; more info, dropdown). Select box - can enter further information on provider only\r\n\r\nEMRAPI: not supported",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.asserter.reference",
"path" : "AllergyIntolerance.asserter.reference",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.asserter.display",
"path" : "AllergyIntolerance.asserter.display",
"comment" : "Usage Note: This is a textual representation of the reference that should be used in the narrative\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.lastOccurrence",
"path" : "AllergyIntolerance.lastOccurrence",
"comment" : "Usage Note: This may be sent when there is a clear mapping from the sending EMR\r\nEMRAPI: not supported\r\nMapping exists for PSS; absent for the other EMRs\r\nPS-ON and Core CA: not supported\r\n\r\nThis date may be replicated by one of the Onset of Reaction dates. Where a textual representation of the date of last occurrence is required e.g. 'In Childhood, '10 years ago' the Comment element should be used.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.note",
"path" : "AllergyIntolerance.note",
"comment" : "Usage Note: These notes represent the latest state of the allergy that in an EMR is displayed in a CPP. Reaction events/episodic notes can be sent in addition to this information and will be captured in reaction section.\r\n\r\nEMRAPI: Notes - Descriptor (string) -- TBC - what is the definition for this?\r\nMA: note section in the allergy task\r\nCHR: single comment for documented allergy, rather than a specific occurrence\r\nPSS: short details + long details; each captured as a separate note. \r\nPS-ON and Core-CA: not supported \r\n\r\nFor example: including reason for flagging a seriousness of 'High Risk'; and instructions related to future exposure or administration of the substance, such as administration within an Intensive Care Unit or under corticosteroid cover. The notes should be related to an allergy or intolerance as a condition in general and not related to any particular episode of it. For episode notes and descriptions, use AllergyIntolerance.event.description and AllergyIntolerance.event.notes.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.note.author[x]",
"path" : "AllergyIntolerance.note.author[x]",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.note.time",
"path" : "AllergyIntolerance.note.time",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.note.text",
"path" : "AllergyIntolerance.note.text",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction",
"path" : "AllergyIntolerance.reaction",
"comment" : "Usage Note: Some of the EMRs edit an allergy state which results in an updated record with a single reaction. Other EMRs (eg PSS) can have multiple allergy events; these are summarized for the display in the CPP.\r\nUsage Note: There could be multiple reactions in a record; receiving systems must look at the most current reaction (based on onset date) to see the latest reaction notes. The allergy.notes will capture what is displayed in the CPP \r\nUsage Note: If the EMR enters a value of \"no reaction\", eg where a person used to react and no longer does. (eg penicillin allergy as a child and this has resolved in adulthood a reaction section is not necessary and the clinical status on this record is \"resolved\". Other than this use case, severity is captured at the reaction level and a reaction section will always be present. \r\nUsage Note: When sending the IPS, or for most referrals only the latest reaction will be included. If referring to an allergist, or for full patient chart extracts, all reactions will be sent.\r\nUsage Rule: If there is no manifestation recorded in the EMR and there is no severity recorded, reaction is not included. Example: Sulfa or Penicillin will often not have a recorded reaction/manifestation.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.substance",
"path" : "AllergyIntolerance.reaction.substance",
"comment" : "The IPS-UV does not consider this element Must Support, 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.\r\n\r\nCoding of the specific substance (or pharmaceutical product) with a terminology capable of triggering decision support should be used wherever possible. The 'code' element allows for the use of a specific substance or pharmaceutical product, or a group or class of substances. In the case of an allergy or intolerance to a class of substances, (for example, \"penicillins\"), the 'reaction.substance' element could be used to code the specific substance that was identified as having caused the reaction (for example, \"amoxycillin\"). Duplication of the value in the 'code' and 'reaction.substance' elements is acceptable when a specific substance has been recorded in 'code'.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.substance.coding",
"path" : "AllergyIntolerance.reaction.substance.coding",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "system"
}
],
"rules" : "open"
},
"max" : "1",
"binding" : {
"strength" : "required",
"valueSet" : "https://fhir.infoway-inforoute.ca/ValueSet/nondrugallergencode"
}
},
{
"id" : "AllergyIntolerance.reaction.manifestation",
"path" : "AllergyIntolerance.reaction.manifestation",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "coding.code"
}
],
"rules" : "open"
},
"comment" : "Usage Note: Text is mandatory; if not specified in the sending system, this may be populated with the display value that was displayed to the user. Text may contain supplemental data, by example, the display may be \"Contact dermatitis (disorder)\" and the text may be \"on left finger\". Exporting systems must always send the display name when available.\r\n\r\nMA: HL7\r\nPSS: urn:telus:emr:pss:*:codetable:allergy-reaction-type\r\nMS: N/A\r\nEMRAPI: ReactionType\r\n\r\nPS-CA - must support the same two value sets as identiied in PS-ON\r\nPS-ON - two slices 1) AllergyReactionGpsUvIps (required) - not supported 2) ManifestationSCTCA https://fhir.infoway-inforoute.ca/ValueSet/ClinicalFinding (required) - not supported - SNOMED\r\n\r\nManifestation can be expressed as a single word, phrase or brief description. For example: nausea, rash or no reaction. It is preferable that manifestation should be coded with a terminology, where possible. The values entered here may be used to display on an application screen as part of a list of adverse reactions, as recommended in the UK NHS CUI guidelines. Terminologies commonly used include, but are not limited to, SNOMED CT or ICD10.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.manifestation.coding",
"path" : "AllergyIntolerance.reaction.manifestation.coding",
"comment" : "***Anne - update differentiator in slice; both are SNOMED\r\nUsage: A local code will be converted where possible into a SNOMED code. If the EMR has not stored a code, text must be present. If the text is an exact match to a code descriptor, then coding must be sent. Example: anaphylaxis \r\n\r\nCodes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.manifestation.coding.system",
"path" : "AllergyIntolerance.reaction.manifestation.coding.system",
"min" : 1
},
{
"id" : "AllergyIntolerance.reaction.manifestation.coding.code",
"path" : "AllergyIntolerance.reaction.manifestation.coding.code",
"min" : 1
},
{
"id" : "AllergyIntolerance.reaction.manifestation.text",
"path" : "AllergyIntolerance.reaction.manifestation.text",
"comment" : "Usage Note: This is populated by EMRs who capture notes on a per reaction basis. \r\nConformance Rule: this must be populated if the EMR has a textual value in addition to a code\r\nExample: EMRs may support a code of \"other\" and this allows them to convey meaningful information.\r\n\r\nPSS: Maps to radio button desciption +short description text. If the severity description is not mild, moderate, severe, concatenate the radio button description and the severity description\r\n\r\nVery often the text is the same as a displayName of one of the codings.",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.manifestation:ReactionManifestationGPS",
"path" : "AllergyIntolerance.reaction.manifestation",
"sliceName" : "ReactionManifestationGPS",
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/uv/ips/ValueSet/allergy-reaction-gps-uv-ips"
}
},
{
"id" : "AllergyIntolerance.reaction.manifestation:ReactionManifestationGPS.coding",
"path" : "AllergyIntolerance.reaction.manifestation.coding",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.manifestation:ReactionManifestationGPS.coding.system",
"path" : "AllergyIntolerance.reaction.manifestation.coding.system",
"min" : 1,
"fixedUri" : "http://snomed.info/sct",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.manifestation:ReactionManifestationGPS.coding.code",
"path" : "AllergyIntolerance.reaction.manifestation.coding.code",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.manifestation:ReactionManifestationGPS.coding.display",
"path" : "AllergyIntolerance.reaction.manifestation.coding.display",
"mustSupport" : true,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/uv/ips/ValueSet/allergy-reaction-gps-uv-ips"
}
},
{
"id" : "AllergyIntolerance.reaction.manifestation:ReactionManifestationGPS.text",
"path" : "AllergyIntolerance.reaction.manifestation.text",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.manifestation:manifestationSCTCA",
"path" : "AllergyIntolerance.reaction.manifestation",
"sliceName" : "manifestationSCTCA",
"comment" : "Usage Note: This aligns with PS-ON. \r\n\r\nManifestation can be expressed as a single word, phrase or brief description. For example: nausea, rash or no reaction. It is preferable that manifestation should be coded with a terminology, where possible. The values entered here may be used to display on an application screen as part of a list of adverse reactions, as recommended in the UK NHS CUI guidelines. Terminologies commonly used include, but are not limited to, SNOMED CT or ICD10.",
"mustSupport" : true,
"binding" : {
"strength" : "required",
"valueSet" : "https://fhir.infoway-inforoute.ca/ValueSet/ClinicalFinding"
}
},
{
"id" : "AllergyIntolerance.reaction.manifestation:manifestationSCTCA.coding",
"path" : "AllergyIntolerance.reaction.manifestation.coding",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.manifestation:manifestationSCTCA.coding.system",
"path" : "AllergyIntolerance.reaction.manifestation.coding.system",
"min" : 1,
"fixedUri" : "http://snomed.info/sct",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.manifestation:manifestationSCTCA.coding.code",
"path" : "AllergyIntolerance.reaction.manifestation.coding.code",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.manifestation:manifestationSCTCA.coding.display",
"path" : "AllergyIntolerance.reaction.manifestation.coding.display",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.manifestation:manifestationSCTCA.text",
"path" : "AllergyIntolerance.reaction.manifestation.text",
"min" : 1,
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.description",
"path" : "AllergyIntolerance.reaction.description",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.onset",
"path" : "AllergyIntolerance.reaction.onset",
"comment" : "Usage: Note: If the EMR is able to send this, they should include this data. It is recognized that this may be challenging and therefore some allowance may be given during conformance and will not be point of failure for conformance testing.\r\n\r\nEMRAPI: There is only one date in the EMR API; which is the allergy date, NOT The reaction date \r\nMA: Patient Chart --> Allg --> add new --> pick type--> Date of Reaction\r\nPSS: Date of first reaction and date of latest change \r\nCHR: Date of first reaction\r\n\r\n\r\nCore-CA: not supported; this suggests that it can be ignored if received.?\r\nPS-CA - not supported\r\nPS-ON - not supported",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.severity",
"path" : "AllergyIntolerance.reaction.severity",
"comment" : "Usage Note: For \"unknown\" severity or \"no reaction\", this can be entered in text. In both cases there is no severity code included. When mapping, if the wording is different it is recommended that the text that the doctor saw (eg life threatening) is included as AllergyIntolerance.reaction.description.\r\n\r\nEMRAPI: not supported\r\nPS-ON - mustSupport (Nov 24)\r\nPS-CA - not supported (Nov 24)\r\n\r\nRefer to EMR-FHIR mappings; require clinical input - there are not exact mappings out of the EMRs, as per example below. \r\nFHIR-->PSS\r\nmild --> minor \r\nmoderate --> major \r\nsevere --> life threatening\r\nin addition, \"no reaction\" code is supported in PSS. You cannot enter an allergy without a reaction; you can enter it as another reaction and later downgrade it to \"no reaction\". \r\n\r\n \r\nCHR: severe, moderate, mild - in addition, they have \"unknown\" and \"no reaction\"\r\n\r\n\r\nIt is acknowledged that this assessment is very subjective. There may be some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions.",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.exposureRoute",
"path" : "AllergyIntolerance.reaction.exposureRoute",
"comment" : "Conformance Rule: This will not be supported as the source systems do not capture it in a reliable/safe manner\r\nEMRAPI: Not Supported\r\nCore-CA: not supported\r\n\r\n\r\nCoding of the route of exposure with a terminology should be used wherever possible.",
"binding" : {
"strength" : "preferred",
"valueSet" : "https://fhir.infoway-inforoute.ca/ValueSet/routeofadministration"
}
},
{
"id" : "AllergyIntolerance.reaction.note",
"path" : "AllergyIntolerance.reaction.note",
"comment" : "Alignment: ON-PS does not include this as MustSupport. PS-ON is aligned with the IPS and PS-CA \r\nAllergyIntolerance profiles, neither of which have AllergyIntolerance.note as MustSupport. In addition, neither US-Core \r\nnor CA-Baseline have AllergyIntolerance.note as MustSupport.\r\n\r\nUse this field to record information indirectly related to a particular event and not captured in the description. For example: Clinical records are no longer available, recorded based on information provided to the patient by her mother and her mother is deceased."
},
{
"id" : "AllergyIntolerance.reaction.note.author[x]",
"path" : "AllergyIntolerance.reaction.note.author[x]",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.note.time",
"path" : "AllergyIntolerance.reaction.note.time",
"mustSupport" : true
},
{
"id" : "AllergyIntolerance.reaction.note.text",
"path" : "AllergyIntolerance.reaction.note.text",
"mustSupport" : true
}
]
},
"text" : {
}
}
XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.