2. Most Negatives
Persuasive; PC to clarify document: 10, 11, 14, 16, 17, 21, 40, 42, 43, 50, 51, 55, 60, 71
Need clarification from submitter: 2, 5, 9, 12, 18, 19, 20, 44, 54 (i.e., we may agree, but need to clarify what is being proposed)

3. Questions Cutoff: Vaccines Synonymy (86) Not recommended.
62: 99% sounds ok
93: What’s listed here
Meds vs Foods Pick a statistically defensible target.
Vaccines
Mostly questions, not answers Will consult CDC.
63: RxNorm best for use case
Synonymy (86) Not recommended.
Guidance: include or not Yes, include, with guidance.
Class definitions Open, but probably stay the course.

4. Cross-reactive class definition
Cerner supports the recommendations of SNOMED CT for food and environmental allergens, and RxNorm for substances (IN) and mixtures (MIN). We also accept the adoption of SNOMED CT (substance hierarchy) as the interim choice for allergen drug classes due to its broad international reach; however, we consider the use of NDF-RT/MED-RT to be acceptable as well because of its historical support and existing use among many stakeholders. We agree with the considerations outlined in Section 3, and supports the Patient Care Work Group continuing to review other choices (e.g., G-SRS, IDMP) as they become available.
If an allergy class does not specifically identify the constituent members, it is subject to individual and inconsistent interpretation. For example, in one system, the opioid analgesic class may have propoxyphene as a member, whereas another system may include propoxyphene in the methadone derivatives class. Sharing allergy information between these systems would result in a false negative warning in the receiving system if propoxyphene is prescribed, and a false positive warning for hydrocodone. Information sharing is increased, but the quality and ultimate utility of the shared information poses a risk to the patient, and artificially reduces the available treatment choices.
Allergy classes can be broadly identified as structural (e.g., sulfonamides), functional (e.g., NSAIDS), and structural + functional (sulfonamide antibiotics). For example, celecoxib may be placed in both the sulfonamide and NSAID classes. How this is handled within each system, and how the clinical decision support functions may vary.