US Core Implementation Guide
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US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 8.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

Resource Profile: US Core AllergyIntolerance Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance Version: 8.0.0
Standards status: Trial-use Computable Name: USCoreAllergyIntolerance
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.5

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core AllergyIntolerance Profile inherits from the FHIR AllergyIntolerance resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the AllergyIntolerance resource to record, search, and fetch allergies/adverse reactions associated with a patient. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

Example Usage Scenarios:

The following are example usage scenarios for the US Core AllergyIntolerance profile:

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each AllergyIntolerance Must Have:

  1. a clinical status of the allergy (e.g., active or resolved)*
  2. a code that tells you what the patient is allergic to
  3. a patient

*This element has the following constraints: SHALL be present if verification status is not "entered-in-error" and SHALL NOT be present if verification Status is "entered-in-error".

Each AllergyIntolerance Must Support:

  1. a verification status
  2. a reaction manifestation

Profile Specific Implementation Guidance:

  • No Known Allergies may be represented using the US Core-AllergyIntolerance profile with the appropriate negation code in AllergyIntolerence.code and the appropriate verification status in AllergyIntolerance.verificationStatus.

    If a patient has not been asked about their allergies, this would be represented as:

    • AllergyIntolerance.code = "1631000175102" (Patient not asked (contextual qualifier) (qualifier value))

    • AllergyIntolerance.verificationStatus = "unconfirmed" or empty (in other words, then element omitted)

    If a patient has been asked, but has indicated they have no known allergies, this would be represented as:

    • AllergyIntolerance.code = "716186003" (No known allergy (situation))

    • AllergyIntolerance.verificationStatus = "confirmed"

Usage:

Changes since version 7.0.0:

  • No changes

    • Formal Views of Profile Content

    Description of Profiles, Differentials, Snapshots and how the different presentations work.

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. AllergyIntolerance C 0..* AllergyIntolerance Allergy or Intolerance (generally: Risk of adverse reaction to a substance)
    ait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error.
    ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    dom-6: A resource should have narrative for robust management
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ele-1: All FHIR elements must have a @value or children
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... clinicalStatus ?!SΣC 0..1 CodeableConcept active | inactive | resolved
    Binding: AllergyIntoleranceClinicalStatusCodes (required)
    ele-1: All FHIR elements must have a @value or children
    ... verificationStatus ?!SΣC 0..1 CodeableConcept unconfirmed | confirmed | refuted | entered-in-error
    Binding: AllergyIntoleranceVerificationStatusCodes (required)
    ele-1: All FHIR elements must have a @value or children
    ... code SΣ 1..1 CodeableConcept Code that identifies the allergy or intolerance
    Binding: Common substances for allergy and intolerance documentation including refutations . (extensible)
    ele-1: All FHIR elements must have a @value or children
    ... patient SΣ 1..1 Reference(US Core Patient Profile) Who the sensitivity is for
    ele-1: All FHIR elements must have a @value or children
    ... reaction S 0..* BackboneElement Adverse Reaction Events linked to exposure to substance
    ele-1: All FHIR elements must have a @value or children
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... manifestation S 1..* CodeableConcept Clinical symptoms/signs associated with the Event
    Binding: SNOMEDCTClinicalFindings (extensible)
    ele-1: All FHIR elements must have a @value or children

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    AllergyIntolerance.clinicalStatusrequiredAllergyIntoleranceClinicalStatusCodes
    http://hl7.org/fhir/ValueSet/allergyintolerance-clinical
    from the FHIR Standard
    AllergyIntolerance.verificationStatusrequiredAllergyIntoleranceVerificationStatusCodes
    http://hl7.org/fhir/ValueSet/allergyintolerance-verification
    from the FHIR Standard
    AllergyIntolerance.codeextensibleCommonSubstancesForAllergyAndIntoleranceDocumentationIncludingRefutations .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1186.8
    AllergyIntolerance.reaction.manifestationextensibleSNOMEDCTClinicalFindings
    http://hl7.org/fhir/ValueSet/clinical-findings
    from the FHIR Standard

     

    Other representations of profile: CSV, Excel, Schematron

    Notes:

    Quick Start

    Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

    • See the Scopes Format section for a description of the SMART scopes syntax.
    • See the Search Syntax section for a description of the US Core search syntax.
    • See the General Requirements section for additional rules and expectations when a Server requires status parameters.
    • See the General Guidance section for additional guidance on searching for multiple patients.

    US Core Scopes

    Servers providing access to allergy and intolerance data SHALL support these US Core SMART Scopes:

    Mandatory Search Parameters:

    The following search parameters and search parameter combinations SHALL be supported:

    1. SHALL support searching for all allergies for a patient using the patient search parameter:

      GET [base]/AllergyIntolerance?patient={Type/}[id]

      Example:

      1. GET [base]/AllergyIntolerance?patient=1137192

      Implementation Notes: Fetches a bundle of all AllergyIntolerance resources for the specified patient (how to search by reference)

    Optional Search Parameters:

    The following search parameter combinations SHOULD be supported:

    1. SHOULD support searching using the combination of the patient and clinical-status search parameters:

      GET [base]/AllergyIntolerance?patient={Type/}[id]&clinical-status={system|}[code]

      Example:

      1. GET [base]/AllergyIntolerance?patient=[id]&clinical-status=http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical|active

      Implementation Notes: Fetches a bundle of all AllergyIntolerance resources for the specified patient and status code. This will not return any "entered in error" resources because of the conditional presence of the clinicalStatus element. (how to search by reference and how to search by token)