1. Allergy discussion
I want to throw something else into the mix - recording of allergies using 'Allergy to X' as a concept from the Clinical Findings hierarchy. We discussed this at our recent Implementation SIG call, where Netherlands seems to be using the pre-coordinated allergy findings list from SNOMED CT directly, as opposed to using the allergen to record the allergy. For various reasons (excessive pre-coordination, linking to decision support, etc), I think recording the allergen is probably more useful/sensible. But looks like Netherlands feels otherwise. What has been your experience about this?

2. SNOMED CT v20130731 91936005|Allergy to penicillin(finding)|
IS_A=Propensity to adverse reactions(disorder)
Causative agent= |Penicllin-class of antibiotic(substance)|
Has definitional manifestation= |Allergic reaction to drug(disorder)|
User guide permits:
|Penicillin – class of antibiotic(substance)| OR
|Penicillin –class of antibiotic(pharmaceutical/biological product)|

3. Jay>>>I want to throw something else into the mix - recording of allergies using 'Allergy to X' as a concept from the Clinical Findings hierarchy. We discussed this at our recent Implementation SIG call, where Netherlands seems to be using the pre-coordinated allergy findings list from SNOMED CT directly, as opposed to using the allergen to record the allergy. For various reasons (excessive pre-coordination, linking to decision support, etc), I think recording the allergen is probably more useful/sensible. But looks like Netherlands feels otherwise. What has been your experience about this?
Jim>>>Extensive discussion at editorial level several years ago converged on understanding that an “Allergy list” record was an assertion of a propensity to allergic reaction to a substance, as opposed to the clinical assertion that might be made during an encounter that the patient is experiencing a situation of an (current) allergic reaction. From this the allergy modelling was revised to allow distinction between these two different situations. US realm modelling of allergy list records has evolved accordingly.
Interoperation standards were published recently regarding CDAR2 compliance for modelling of allergy list for the US realm. The US is employing RxNORM as the realm specific medication standard. Severity is to be post-coordinated within the report.
Allergy discussion

4. CDA2 IHE Consolidation

5. CDA2 IHE Consolidation “Allergy to codeine 30mg/ml”
<observation classCode="OBS" moodCode="EVN">
<!-- allergy observation template -->
<templateId root=" "/>
<id root="4adc1020-7b14-11db-9fe c9a66"/>
<code code="ASSERTION" codeSystem=" "/>
<statusCode code="completed"/>
<effectiveTime>
<low value=" "/>
</effectiveTime>
<value xsi:type="CD" code=" "
displayName="Propensity to adverse reactions to drug"
codeSystem=" " codeSystemName="SNOMED CT">
<originalText>
<reference value="#reaction2"/>
</originalText>
</value>
<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code code="763049" displayName="Codeine 30mg/ml" codeSystem=" "
codeSystemName="RxNorm">
</code>
</playingEntity>
</participantRole>
</participant>
</observation>

6. CDA2 IHE Consolidation “Allergy to codeine with nausea”
<observation classCode="OBS" moodCode="EVN">
<templateId root=" "/>
<!-- Reaction observation template -->
<id root="4adc1020-7b14-11db-9fe c9a64"/>
<code nullFlavor="NA"/>
<text>
<reference value="#reaction1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value=" "/>
<high value=" "/>
</effectiveTime>
<value xsi:type="CD" code=" " codeSystem=" " codesystemName=SNOMED CT  
displayName="Nausea"/>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<!-- ** Severity observation ** -->
<templateId root=" "/>
....
</observation>
</entryRelationship> </observation>

7. CDA2 IHE Consolidation “Allergy to codeine with severe nausea” SNOMED CT value set specified for severity
<observation classCode="OBS" moodCode="EVN">
<templateId root=" "/>
<!-- Reaction observation template -->
<id root="4adc1020-7b14-11db-9fe c9a64"/>
<code nullFlavor="NA"/>
<text>
<reference value="#reaction1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value=" "/>
<high value=" "/>
</effectiveTime>
<value xsi:type="CD" code=" " codeSystem=" " codesystemName=SNOMED CT  
displayName="Nausea"/>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<!-- ** Severity observation ** -->
<templateId root=" "/>
....
</observation>
</entryRelationship> </observation>

8. US Realm MU Stage 2 Compliance Model “Allergy list: Reacts to penicillin with severe hives”
Allergies Section (Allergy list)
IS_A=Propensity to adverse reactions(disorder)
Causative agent=RxNORM7689|Penicillins|
Has manifestation= |Weal(disorder)|
Severity= |Severe(qualifier)|