MyHealtheVet PHR FHIR API
0.3.9-current - ci-build United States of America flag

MyHealtheVet PHR FHIR API, published by VA Digital Services. This guide is not an authorized publication; it is the continuous build for version 0.3.9-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/department-of-veterans-affairs/mhv-fhir-phr-mapping/ and changes regularly. See the Directory of published versions

Resource Profile: VA MHV PHR Allergy and Intolerance

Official URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/VA.MHV.PHR.allergyIntolerance Version: 0.3.9-current
Standards status: Trial-use Maturity Level: 4 Computable Name: MHVallergyIntolerance

A profile on the AllergyIntolerance resource for MHV PHR exposing Allergies using FHIR API.

  • based on US-Core for AllergyIntolerance Resource profile
  • patient is a reference to this patient
  • a clinicalStatus is active when not entered-in-error
  • a verificationStatus may be entered-in-error
  • a code.text which tells you what the patient is allergic to
  • category only medication, food, and/or environment
  • identifier will hold the record identifier from Vista
  • recordedDate may hold the observed time
  • extension[observedHistoric] will hold observed vs historical
  • recorder may have an extension alternate-reference that points to an Organization resource identifying the VAMC where the allergy was first recorded
    • the Organization.name is a friendly name populated from MHV internal table
  • reaction.manifestation may have .text
    • may have .coding from VUID or SNOMED-CT
  • note.text will hold comments
    • note.time will hold the date of the comment
  • no other elements are populated

Should search for entries that do not have verificationStatus=entered-in-error (might also work to look for only active)

GET {path}/AllergyIntolerance?patient={patient}&verification-status:not=entered-in-error

Usage:

Formal Views of Profile Content

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

This structure is derived from USCoreAllergyIntolerance

NameFlagsCard.TypeDescription & Constraintsdoco
.. AllergyIntolerance 0..* USCoreAllergyIntolerance Allergy or Intolerance (generally: Risk of adverse reaction to a substance)
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... observedHistoric S 0..1 code Allergy Observed vs Historic
URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/allergyObservedHistoric
Binding: Allergy Observed vs Historic ValueSet (preferred)
... Slices for identifier 1..* Identifier External ids for this item
Slice: Unordered, Open by pattern:use
.... identifier:recordIdentifier 0..1 Identifier External ids for this item
..... use 1..1 code usual | official | temp | secondary | old (If known)
Required Pattern: official
..... system C 0..1 uri `http://va.gov/systems/` | {intoleranceCondition.recordIdentifier.namespaceId}
HDRid-startswithoid: ID system must start with http://va.gov/systems/ The next would be the {idSourceTable}
..... value 0..1 string {intoleranceCondition.recordIdentifier.identity}
.... identifier:TOid 0..1 Identifier External ids for this item
..... use 1..1 code usual | official | temp | secondary | old (If known)
Required Pattern: usual
..... system C 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
..... value 0..1 string `AllergyTO` | `.` | {intoleranceCondition.recordIdentifier.identity}
... clinicalStatus 0..1 CodeableConcept active | inactive | resolved
... verificationStatus 0..1 CodeableConcept May indicate entered-in-error
... category S 0..* code food | medication | environment | biologic
Binding: Subset of allergy intolerance category (required)
... criticality 0..0
... code
.... coding 0..0
.... text 1..1 string Plain text representation of the concept
... patient 1..1 Reference(US Core Patient Profile) Who the sensitivity is for
... encounter 0..0
... onset[x] 0..0
... recordedDate S 0..1 dateTime Date first version of the resource instance was recorded
... recorder S 0..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) {c} Who recorded the sensitivity
.... Slices for extension Content/Rules for all slices
..... visn 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... value[x] 1..1 Reference(Organization) {c} Value of extension
.... display S 0..1 string Text alternative for the resource
... asserter 0..0
... lastOccurrence 0..0
... note S 0..* Annotation Additional text not captured in other fields
.... author[x] 0..0
.... time S 0..1 dateTime When the annotation was made
.... text S 1..1 markdown The annotation - text content (as markdown)
... reaction
.... substance 0..0
.... manifestation 1..1 CodeableConcept Clinical symptoms/signs associated with the Event
..... coding
...... system 0..1 uri Identity of the terminology system
...... code 0..1 code Symbol in syntax defined by the system
..... text 0..1 string Plain text representation of the concept
.... description 0..0
.... onset 0..0
.... severity 0..0
.... exposureRoute 0..0
.... note 0..0

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
AllergyIntolerance.categoryrequiredAllergyCategoryVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/AllergyCategoryVS
from this IG

Constraints

IdGradePath(s)DetailsRequirements
HDRid-startswithoiderrorAllergyIntolerance.identifier:recordIdentifier.systemID system must start with http://va.gov/systems/ The next would be the {idSourceTable}
: value.startsWith('http://va.gov/systems/')
TOid-startswithoiderrorAllergyIntolerance.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')
NameFlagsCard.TypeDescription & Constraintsdoco
.. AllergyIntolerance C 0..* USCoreAllergyIntolerance 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
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... observedHistoric S 0..1 code Allergy Observed vs Historic
URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/allergyObservedHistoric
Binding: Allergy Observed vs Historic ValueSet (preferred)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 1..* Identifier External ids for this item
Slice: Unordered, Open by pattern:use
.... identifier:recordIdentifier Σ 0..1 Identifier External ids for this item
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: official
..... system ΣC 0..1 uri `http://va.gov/systems/` | {intoleranceCondition.recordIdentifier.namespaceId}
HDRid-startswithoid: ID system must start with http://va.gov/systems/ The next would be the {idSourceTable}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string {intoleranceCondition.recordIdentifier.identity}
Example General: 123456
.... identifier:TOid Σ 0..1 Identifier External ids for this item
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `AllergyTO` | `.` | {intoleranceCondition.recordIdentifier.identity}
Example General: 123456
... clinicalStatus ?!SΣC 0..1 CodeableConcept active | inactive | resolved
Binding: AllergyIntoleranceClinicalStatusCodes (required)
... verificationStatus ?!SΣC 0..1 CodeableConcept May indicate entered-in-error
Binding: AllergyIntoleranceVerificationStatusCodes (required)
... category SΣ 0..* code food | medication | environment | biologic
Binding: Subset of allergy intolerance category (required)
... code SΣ 1..1 CodeableConcept Code that identifies the allergy or intolerance
Binding: Common substances for allergy and intolerance documentation including refutations . (extensible)
.... text Σ 1..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(US Core Patient Profile) Who the sensitivity is for
... recordedDate S 0..1 dateTime Date first version of the resource instance was recorded
... recorder S 0..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) {c} Who recorded the sensitivity
.... Slices for extension Content/Rules for all slices
..... visn 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/alternate-reference"
...... value[x] 1..1 Reference(Organization) {c} Value of extension
.... display SΣ 0..1 string Text alternative for the resource
... note S 0..* Annotation Additional text not captured in other fields
.... time SΣ 0..1 dateTime When the annotation was made
.... text SΣ 1..1 markdown The annotation - text content (as markdown)
... reaction S 0..* BackboneElement Adverse Reaction Events linked to exposure to substance
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... manifestation S 1..1 CodeableConcept Clinical symptoms/signs associated with the Event
Binding: SNOMEDCTClinicalFindings (extensible)
..... text Σ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
AllergyIntolerance.identifier:recordIdentifier.userequiredPattern: official
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
AllergyIntolerance.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
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.categoryrequiredAllergyCategoryVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/AllergyCategoryVS
from this IG
AllergyIntolerance.codeextensibleCommon substances for allergy and intolerance documentation including refutations .
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

Constraints

IdGradePath(s)DetailsRequirements
HDRid-startswithoiderrorAllergyIntolerance.identifier:recordIdentifier.systemID system must start with http://va.gov/systems/ The next would be the {idSourceTable}
: value.startsWith('http://va.gov/systems/')
TOid-startswithoiderrorAllergyIntolerance.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')
NameFlagsCard.TypeDescription & Constraintsdoco
.. AllergyIntolerance C 0..* USCoreAllergyIntolerance 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
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... observedHistoric S 0..1 code Allergy Observed vs Historic
URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/allergyObservedHistoric
Binding: Allergy Observed vs Historic ValueSet (preferred)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 1..* Identifier External ids for this item
Slice: Unordered, Open by pattern:use
.... identifier:recordIdentifier Σ 0..1 Identifier External ids for this item
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: official
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system ΣC 0..1 uri `http://va.gov/systems/` | {intoleranceCondition.recordIdentifier.namespaceId}
HDRid-startswithoid: ID system must start with http://va.gov/systems/ The next would be the {idSourceTable}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string {intoleranceCondition.recordIdentifier.identity}
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:TOid Σ 0..1 Identifier External ids for this item
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `AllergyTO` | `.` | {intoleranceCondition.recordIdentifier.identity}
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... clinicalStatus ?!SΣC 0..1 CodeableConcept active | inactive | resolved
Binding: AllergyIntoleranceClinicalStatusCodes (required)
... verificationStatus ?!SΣC 0..1 CodeableConcept May indicate entered-in-error
Binding: AllergyIntoleranceVerificationStatusCodes (required)
... type Σ 0..1 code allergy | intolerance - Underlying mechanism (if known)
Binding: AllergyIntoleranceType (required): Identification of the underlying physiological mechanism for a Reaction Risk.

... category SΣ 0..* code food | medication | environment | biologic
Binding: Subset of allergy intolerance category (required)
... code SΣ 1..1 CodeableConcept Code that identifies the allergy or intolerance
Binding: Common substances for allergy and intolerance documentation including refutations . (extensible)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... text Σ 1..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(US Core Patient Profile) Who the sensitivity is for
... recordedDate S 0..1 dateTime Date first version of the resource instance was recorded
... recorder S 0..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) {c} Who recorded the sensitivity
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... visn 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/alternate-reference"
...... value[x] 1..1 Reference(Organization) {c} Value of extension
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display SΣ 0..1 string Text alternative for the resource
... note S 0..* Annotation Additional text not captured in other fields
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... time SΣ 0..1 dateTime When the annotation was made
.... text SΣ 1..1 markdown The annotation - text content (as markdown)
... reaction S 0..* BackboneElement Adverse Reaction Events linked to exposure to substance
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... manifestation S 1..1 CodeableConcept Clinical symptoms/signs associated with the Event
Binding: SNOMEDCTClinicalFindings (extensible)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ 0..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 0..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 0..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text Σ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
AllergyIntolerance.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
AllergyIntolerance.identifier:recordIdentifier.userequiredPattern: official
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
AllergyIntolerance.identifier:recordIdentifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
AllergyIntolerance.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
AllergyIntolerance.identifier:TOid.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
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.typerequiredAllergyIntoleranceType
http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1
from the FHIR Standard
AllergyIntolerance.categoryrequiredAllergyCategoryVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/AllergyCategoryVS
from this IG
AllergyIntolerance.codeextensibleCommon substances for allergy and intolerance documentation including refutations .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1186.8
AllergyIntolerance.recorder.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
AllergyIntolerance.reaction.manifestationextensibleSNOMEDCTClinicalFindings
http://hl7.org/fhir/ValueSet/clinical-findings
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
HDRid-startswithoiderrorAllergyIntolerance.identifier:recordIdentifier.systemID system must start with http://va.gov/systems/ The next would be the {idSourceTable}
: value.startsWith('http://va.gov/systems/')
TOid-startswithoiderrorAllergyIntolerance.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

This structure is derived from USCoreAllergyIntolerance

Summary

Mandatory: 2 elements(2 nested mandatory elements)
Must-Support: 8 elements
Prohibited: 13 elements

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of AllergyIntolerance.identifier

Maturity: 4

Differential View

This structure is derived from USCoreAllergyIntolerance

NameFlagsCard.TypeDescription & Constraintsdoco
.. AllergyIntolerance 0..* USCoreAllergyIntolerance Allergy or Intolerance (generally: Risk of adverse reaction to a substance)
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... observedHistoric S 0..1 code Allergy Observed vs Historic
URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/allergyObservedHistoric
Binding: Allergy Observed vs Historic ValueSet (preferred)
... Slices for identifier 1..* Identifier External ids for this item
Slice: Unordered, Open by pattern:use
.... identifier:recordIdentifier 0..1 Identifier External ids for this item
..... use 1..1 code usual | official | temp | secondary | old (If known)
Required Pattern: official
..... system C 0..1 uri `http://va.gov/systems/` | {intoleranceCondition.recordIdentifier.namespaceId}
HDRid-startswithoid: ID system must start with http://va.gov/systems/ The next would be the {idSourceTable}
..... value 0..1 string {intoleranceCondition.recordIdentifier.identity}
.... identifier:TOid 0..1 Identifier External ids for this item
..... use 1..1 code usual | official | temp | secondary | old (If known)
Required Pattern: usual
..... system C 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
..... value 0..1 string `AllergyTO` | `.` | {intoleranceCondition.recordIdentifier.identity}
... clinicalStatus 0..1 CodeableConcept active | inactive | resolved
... verificationStatus 0..1 CodeableConcept May indicate entered-in-error
... category S 0..* code food | medication | environment | biologic
Binding: Subset of allergy intolerance category (required)
... criticality 0..0
... code
.... coding 0..0
.... text 1..1 string Plain text representation of the concept
... patient 1..1 Reference(US Core Patient Profile) Who the sensitivity is for
... encounter 0..0
... onset[x] 0..0
... recordedDate S 0..1 dateTime Date first version of the resource instance was recorded
... recorder S 0..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) {c} Who recorded the sensitivity
.... Slices for extension Content/Rules for all slices
..... visn 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... value[x] 1..1 Reference(Organization) {c} Value of extension
.... display S 0..1 string Text alternative for the resource
... asserter 0..0
... lastOccurrence 0..0
... note S 0..* Annotation Additional text not captured in other fields
.... author[x] 0..0
.... time S 0..1 dateTime When the annotation was made
.... text S 1..1 markdown The annotation - text content (as markdown)
... reaction
.... substance 0..0
.... manifestation 1..1 CodeableConcept Clinical symptoms/signs associated with the Event
..... coding
...... system 0..1 uri Identity of the terminology system
...... code 0..1 code Symbol in syntax defined by the system
..... text 0..1 string Plain text representation of the concept
.... description 0..0
.... onset 0..0
.... severity 0..0
.... exposureRoute 0..0
.... note 0..0

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
AllergyIntolerance.categoryrequiredAllergyCategoryVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/AllergyCategoryVS
from this IG

Constraints

IdGradePath(s)DetailsRequirements
HDRid-startswithoiderrorAllergyIntolerance.identifier:recordIdentifier.systemID system must start with http://va.gov/systems/ The next would be the {idSourceTable}
: value.startsWith('http://va.gov/systems/')
TOid-startswithoiderrorAllergyIntolerance.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. AllergyIntolerance C 0..* USCoreAllergyIntolerance 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
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... observedHistoric S 0..1 code Allergy Observed vs Historic
URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/allergyObservedHistoric
Binding: Allergy Observed vs Historic ValueSet (preferred)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 1..* Identifier External ids for this item
Slice: Unordered, Open by pattern:use
.... identifier:recordIdentifier Σ 0..1 Identifier External ids for this item
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: official
..... system ΣC 0..1 uri `http://va.gov/systems/` | {intoleranceCondition.recordIdentifier.namespaceId}
HDRid-startswithoid: ID system must start with http://va.gov/systems/ The next would be the {idSourceTable}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string {intoleranceCondition.recordIdentifier.identity}
Example General: 123456
.... identifier:TOid Σ 0..1 Identifier External ids for this item
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `AllergyTO` | `.` | {intoleranceCondition.recordIdentifier.identity}
Example General: 123456
... clinicalStatus ?!SΣC 0..1 CodeableConcept active | inactive | resolved
Binding: AllergyIntoleranceClinicalStatusCodes (required)
... verificationStatus ?!SΣC 0..1 CodeableConcept May indicate entered-in-error
Binding: AllergyIntoleranceVerificationStatusCodes (required)
... category SΣ 0..* code food | medication | environment | biologic
Binding: Subset of allergy intolerance category (required)
... code SΣ 1..1 CodeableConcept Code that identifies the allergy or intolerance
Binding: Common substances for allergy and intolerance documentation including refutations . (extensible)
.... text Σ 1..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(US Core Patient Profile) Who the sensitivity is for
... recordedDate S 0..1 dateTime Date first version of the resource instance was recorded
... recorder S 0..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) {c} Who recorded the sensitivity
.... Slices for extension Content/Rules for all slices
..... visn 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/alternate-reference"
...... value[x] 1..1 Reference(Organization) {c} Value of extension
.... display SΣ 0..1 string Text alternative for the resource
... note S 0..* Annotation Additional text not captured in other fields
.... time SΣ 0..1 dateTime When the annotation was made
.... text SΣ 1..1 markdown The annotation - text content (as markdown)
... reaction S 0..* BackboneElement Adverse Reaction Events linked to exposure to substance
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... manifestation S 1..1 CodeableConcept Clinical symptoms/signs associated with the Event
Binding: SNOMEDCTClinicalFindings (extensible)
..... text Σ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
AllergyIntolerance.identifier:recordIdentifier.userequiredPattern: official
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
AllergyIntolerance.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
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.categoryrequiredAllergyCategoryVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/AllergyCategoryVS
from this IG
AllergyIntolerance.codeextensibleCommon substances for allergy and intolerance documentation including refutations .
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

Constraints

IdGradePath(s)DetailsRequirements
HDRid-startswithoiderrorAllergyIntolerance.identifier:recordIdentifier.systemID system must start with http://va.gov/systems/ The next would be the {idSourceTable}
: value.startsWith('http://va.gov/systems/')
TOid-startswithoiderrorAllergyIntolerance.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. AllergyIntolerance C 0..* USCoreAllergyIntolerance 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
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... observedHistoric S 0..1 code Allergy Observed vs Historic
URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/allergyObservedHistoric
Binding: Allergy Observed vs Historic ValueSet (preferred)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 1..* Identifier External ids for this item
Slice: Unordered, Open by pattern:use
.... identifier:recordIdentifier Σ 0..1 Identifier External ids for this item
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: official
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system ΣC 0..1 uri `http://va.gov/systems/` | {intoleranceCondition.recordIdentifier.namespaceId}
HDRid-startswithoid: ID system must start with http://va.gov/systems/ The next would be the {idSourceTable}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string {intoleranceCondition.recordIdentifier.identity}
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:TOid Σ 0..1 Identifier External ids for this item
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `AllergyTO` | `.` | {intoleranceCondition.recordIdentifier.identity}
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... clinicalStatus ?!SΣC 0..1 CodeableConcept active | inactive | resolved
Binding: AllergyIntoleranceClinicalStatusCodes (required)
... verificationStatus ?!SΣC 0..1 CodeableConcept May indicate entered-in-error
Binding: AllergyIntoleranceVerificationStatusCodes (required)
... type Σ 0..1 code allergy | intolerance - Underlying mechanism (if known)
Binding: AllergyIntoleranceType (required): Identification of the underlying physiological mechanism for a Reaction Risk.

... category SΣ 0..* code food | medication | environment | biologic
Binding: Subset of allergy intolerance category (required)
... code SΣ 1..1 CodeableConcept Code that identifies the allergy or intolerance
Binding: Common substances for allergy and intolerance documentation including refutations . (extensible)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... text Σ 1..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(US Core Patient Profile) Who the sensitivity is for
... recordedDate S 0..1 dateTime Date first version of the resource instance was recorded
... recorder S 0..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) {c} Who recorded the sensitivity
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... visn 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/alternate-reference"
...... value[x] 1..1 Reference(Organization) {c} Value of extension
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display SΣ 0..1 string Text alternative for the resource
... note S 0..* Annotation Additional text not captured in other fields
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... time SΣ 0..1 dateTime When the annotation was made
.... text SΣ 1..1 markdown The annotation - text content (as markdown)
... reaction S 0..* BackboneElement Adverse Reaction Events linked to exposure to substance
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... manifestation S 1..1 CodeableConcept Clinical symptoms/signs associated with the Event
Binding: SNOMEDCTClinicalFindings (extensible)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ 0..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 0..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 0..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text Σ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
AllergyIntolerance.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
AllergyIntolerance.identifier:recordIdentifier.userequiredPattern: official
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
AllergyIntolerance.identifier:recordIdentifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
AllergyIntolerance.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
AllergyIntolerance.identifier:TOid.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
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.typerequiredAllergyIntoleranceType
http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1
from the FHIR Standard
AllergyIntolerance.categoryrequiredAllergyCategoryVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/AllergyCategoryVS
from this IG
AllergyIntolerance.codeextensibleCommon substances for allergy and intolerance documentation including refutations .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1186.8
AllergyIntolerance.recorder.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
AllergyIntolerance.reaction.manifestationextensibleSNOMEDCTClinicalFindings
http://hl7.org/fhir/ValueSet/clinical-findings
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
HDRid-startswithoiderrorAllergyIntolerance.identifier:recordIdentifier.systemID system must start with http://va.gov/systems/ The next would be the {idSourceTable}
: value.startsWith('http://va.gov/systems/')
TOid-startswithoiderrorAllergyIntolerance.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

This structure is derived from USCoreAllergyIntolerance

Summary

Mandatory: 2 elements(2 nested mandatory elements)
Must-Support: 8 elements
Prohibited: 13 elements

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of AllergyIntolerance.identifier

Maturity: 4

 

Other representations of profile: CSV, Excel, Schematron

Notes:

  • The mock example
  • Received from HDR
  • maps to intoleranceConditions schema.
  • mapping to HDR
  • Vivian Allergy 120.8
  • Should be based on US-Core for AllergyIntolerance Resource profile
  • should have meta.profile set to https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/VA.MHV.PHR.allergyIntolerance to indicate the intent to be compliant with this profile
  • identifier
    • seems most of the time there is a intoleranceCondition.recordIdentifier.namespaceId. this should be used if it is provided
    • else there is an typical TOid slice with the value prefix of AllergyTO.
  • Using active and entered-in-error to support normal resource lifecycle.
    • a verificationStatus will be set to entered-in-error when status is E
    • a clinicalStatus will be set to active if the status is F
    • Thus query needs to look for entries NOT marked entered-in-error
  • a code.text which tells you what the patient is allergic to
  • category derived from .allergyType
    • D -> #medication
    • F -> #food
    • O -> #environment
    • multiple codes are multiple category - for example: DF -> both #medication and #food
  • reaction.reaction.code seems to be a number
    • if it is a 7 digit number, then it is a VUID and system=urn:oid:2.16.840.1.113883.6.233
    • else it is likely a SNOMED
  • informationSourceCategory contains one of two values
    • OBSERVED shall be mapped to extension[observedHistoric].valueCode=o
    • HISTORICAL shall be mapped to extension[observedHistoric].valueCode=h
  • facilityIdentifier is where the allergy was first recorded (The VISN number).
    • logical to put this into .recorder, but that doesn't support a Organization reference
    • use alternate-reference extension on the recorder, with a Organization holding the facilityIdentifier.
      • http://hl7.org/fhir/R4/StructureDefinition/alternate-reference
    • populate the Organization.name from internal MHV table that is manually managed to hold human readable names given a DNS style identifier that we get in the HDR feed.
    • contained Organization
      • if changed to not contained, in order to support _include, we must define a search parameter against alternate-reference so that can be used in search _include.
  • do not map drugClass
  • confirmed vs unconfirmed
    • Vista has a "VERIFIED" but this does not come thru HDR.
  • Confirmed that the .reaction.code is not the same thing as .code and should not be recorded as such. (as seen in example from Lighthouse) - 2024-08-09

Business Rules

  • Ignore those without a facility
  • Ignore those without an id
  • no hold period