Id1.3.6.1.4.1.19376.1.5.3.1.4.6Effective Date2020‑04‑16 12:29:45
Statusretired RetiredVersion Label
NameeHDSIAllergiesAndIntolerancesDisplay NameeHDSI Allergies And Intolerances
Description

Allergies and intolerances are special kinds of problems, and so are also recorded in the CDA <observation> element, with classCode='OBS'. They follow the same pattern as the problem entry, with exceptions noted below.

Parent Template

This is a specialization of the IHE PCC Problem Entry 1.3.6.1.4.1.19376.1.5.3.1.4.5 and of the CCD alert observation template 2.16.840.1.113883.10.20.1.18

ContextParent nodes of template element with id 1.3.6.1.4.1.19376.1.5.3.1.4.6
ClassificationCDA Entry Level Template
Open/ClosedOpen (other than defined elements are allowed)
Associated with
Associated with 5 concepts
IdNameData Set
epsos-dataelement-70draft Onset Date draft epSOS Data Set
epsos-dataelement-209draft Agent Code draft epSOS Data Set
epsos-dataelement-208draft Agent description draft epSOS Data Set
epsos-dataelement-68draft Allergy description draft epSOS Data Set
epsos-dataelement-69draft Allergy code draft epSOS Data Set
Used by / Uses
Used by 0 transactions and 3 templates, Uses 2 templates
Used by as NameVersion
1.3.6.1.4.1.19376.1.5.3.1.4.5.3Containmentretired Allergy and Intolerance Concern2013‑12‑20
1.3.6.1.4.1.19376.1.5.3.1.4.5.3Containmentretired Allergy and Intolerance Concern2019‑04‑08 13:59:03
1.3.6.1.4.1.19376.1.5.3.1.4.5.3Containmentretired eHDSI Allergy And Intolerance Concern2020‑04‑16 12:30:31
Uses as NameVersion
1.3.6.1.4.1.12559.11.10.1.3.1.3.7Containmentactive eHDSI ProblemDYNAMIC
1.3.6.1.4.1.19376.1.5.3.1.4.1Containmentretired eHDSI SeverityDYNAMIC
RelationshipVersion: template 1.3.6.1.4.1.19376.1.5.3.1.4.6 Allergies And Intolerances (2019‑02‑11 15:08:49)
Version: template 1.3.6.1.4.1.19376.1.5.3.1.4.6 Allergies And Intolerances (2013‑12‑20)
Specialization: template 2.16.840.1.113883.10.20.1.18 (DYNAMIC)
Specialization: template 1.3.6.1.4.1.19376.1.5.3.1.4.5 (DYNAMIC)
Example
Example
<observation classCode="OBS" moodCode="EVN" negationInd="false">
  <templateId root="2.16.840.1.113883.10.20.1.18"/>  <templateId root="2.16.840.1.113883.10.20.1.28"/>  <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.6"/>  <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5"/>  <id root=" " extension=" "/>  <!-- This is the code that shows what kind of allergy or intolerance derived from the eHDSIAdverseEventType Value Set-->
  <code code="" codeSystem="2.16.840.1.113883.6.96"/>  <text>
    <reference value=" "/>  </text>  <statusCode code="completed"/>  <effectiveTime>
    <low value=" "/>    <high value=" "/>  </effectiveTime>  <!-- value element is present only to indicate no known allergies, in all other cases is used for referenicng text in the narrative -->
  <value type="CD"/>  <!-- This is the allergen - the substance that caused the allergy -->
  <participant typeCode="CSM">
    <participantRole classCode="MANU">
      <playingEntity classCode="MMAT">
        <code code=" " codeSystem=" ">
          <originalText>
            <reference value="#substance"/>          </originalText>        </code>        <name/>      </playingEntity>    </participantRole>  </participant>  <!-- This is how the allergy manifests itself -->
  <entryRelationship typeCode="MFST">
    <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.6.1"/>    <!-- a problem entry -->
    <observation classCode="OBS" moodCode="EVN">
      <templateId root="2.16.840.1.113883.10.20.1.54"/>      <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5"/>      <!-- The code tells us that the observation is a symptom -->
      <code code="418799008" codeSystem="2.16.840.1.113883.6.96" displayName="Finding reported by subject or history provider" codeSystemName="SNOMED CT"/>      <text>
        <reference value="#manifest-1"/>      </text>      <statusCode code="completed"/>      <!-- The value tells us what the symptom (i.e. allergy manifestation) is -->
      <!-- This is where anaphylaxy or angiooedema will be coded -->
      <value type="CD" code=" " codeSystem=" " displayName=" " codeSystemName=" "/>    </observation>  </entryRelationship>  <!-- This is how the severity of the allergy is described (Optional)-->
  <entryRelationship typeCode="SUBJ" inversionInd="true">
    <observation classCode="OBS" moodCode="EVN">
      <templateId root="2.16.840.1.113883.10.20.1.55"/>      <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.1"/>      <!-- This code is from HL7 and indicates that the observation is about severity -->
      <code code="SEV" displayName="Severity" codeSystem="2.16.840.1.113883.5.4" codeSystemName="ActCode"/>      <text>
        <reference value="#severity-1"/>      </text>      <statusCode code="completed"/>      <!-- This code is from SNOMED, according to the epSOS value set-->
      <value type="CD" code="" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/>    </observation>  </entryRelationship></observation>
ItemDTCardConfDescriptionLabel
hl7:observation
R

This entry has a template identifier of 1.3.6.1.4.1.19376.1.5.3.1.4.6, and is a subtype of the Problem Entry, and so must also conform to the rules of the problem entry, which has the template identifier of 1.3.6.1.4.1.19376.1.5.3.1.4.5. These elements are required and shall be recorded exactly as shown above.

Note: the 1.3.6.1.4.1.19376.1.5.3.1.4.5 requires that also the template ID '2.16.840.1.113883.10.20.1.28' is included.

eHDSdotsnces
@classCode
cs1 … 1FOBS
@moodCode
cs1 … 1FEVN
@negationInd
bl0 … 1 
hl7:templateId
II.EPSOS1 … 1RIHE PCC Problem EntryeHDSdotsnces
@root
uid1 … 1F1.3.6.1.4.1.19376.1.5.3.1.4.5
hl7:templateId
II.EPSOS1 … 1RCCD Alert ObservationeHDSdotsnces
@root
uid1 … 1F2.16.840.1.113883.10.20.1.18
hl7:templateId
II.EPSOS1 … 1ReHDSdotsnces
@root
uid1 … 1F2.16.840.1.113883.10.20.1.28
hl7:templateId
II.EPSOS1 … 1ReHDSdotsnces
@root
uid1 … 1F1.3.6.1.4.1.19376.1.5.3.1.4.6
hl7:id
II.EPSOS0 … *ReHDSdotsnces
hl7:code
CD1 … 1R

The <code> element represents the kind of allergy observation made, to a drug, food or environmental agent, and whether it is an allergy, non-allergy intolerance, or unknown class of intolerance (not known to be allergy or intolerance). The <code> element of an allergy entry shall be provided, and a code and codeSystem attribute shall be present.

eHDSdotsnces
 
target
epsos-dataelement-69draft Allergy code draft epSOS Data Set
 CONF
The value of @code shall be drawn from value set 1.3.6.1.4.1.12559.11.10.1.3.1.42.18 eHDSIAdverseEventType (DYNAMIC)
hl7:text
ED1 … 1ReHDSdotsnces
 
target
epsos-dataelement-68draft Allergy description draft epSOS Data Set
hl7:reference
TEL1 … 1MeHDSdotsnces
@value
1 … 1RReference pointing to the narrative, typically #{label}-{generated-id}, e.g. #xxx-1
hl7:statusCode
CS1 … 1ReHDSdotsnces
@code
CONF0 … 1Fcompleted
hl7:effectiveTime
IVL_TS0 … 1ReHDSdotsnces
 
target
epsos-dataelement-70draft Onset Date draft epSOS Data Set
hl7:value
CD0 … *R

The value element shall be present in a coded or uncoded form. In both cases the type shall be set to xsi:type='CD'.
In the case of no information or known absence of allergies, one of the following codes from the eHDSIAbsentOrUnknownAllergy value set has to be used:

If one of these values is used, the participant used for indicating the allergy agent shall be omitted.
In all other cases it shall be in its uncoded form and may contain a <reference> to the <originalText> in the narrative where the allergy is described.

eHDSdotsnces
hl7:participant
0 … 1C

The substance that causes the allergy or intolerance should be specified in the <participant> structure.
This is the preferred way an allergy is supposed to be expressed.
However it is recognized that in some contexts a controlled vocabulary is used for describing the allergy to a substance; or for asserting known absence or unavailability of information.
In this case the <participant> structure shall be omitted.
The agent responsible for an allergy or adverse reaction is not always a manufactured material (for example, food allergies), nor is it necessarily consumed. The following constraints reflect limitations in the base CDA R2 specification, and should be used to represent any type of responsible agent, i.e., use playingEntity classCode = "MMAT" for all agents, manufactured or not.

eHDSdotsnces
@typeCode
cs1 … 1FCSM
 ConstraintIF the observation/value element is present and valued with a code indicating the known absence/no information on allergies THEN the observation/participant element used to describe the agent SHALL be omitted.
hl7:participantRole
1 … 1ReHDSdotsnces
@classCode
cs1 … 1FMANU
hl7:playingEntity
1 … 1ReHDSdotsnces
@classCode
cs1 … 1FMMAT
hl7:code
CD.EPSOS1 … 1RCode for the substance causing the allergy or intolerance.eHDSdotsnces
 
target
epsos-dataelement-209draft Agent Code draft epSOS Data Set
 CONF
The value of @code shall be drawn from value set 1.3.6.1.4.1.12559.11.10.1.3.1.42.19 eHDSIAllergenNoDrug (DYNAMIC)
or
The value of @code shall be drawn from value set 1.3.6.1.4.1.12559.11.10.1.3.1.42.24 eHDSIActiveIngredient (DYNAMIC)
hl7:name
PN0 … *RName for the substance causing the allergy or intolerance.eHDSdotsnces
 
target
epsos-dataelement-208draft Agent description draft epSOS Data Set
hl7:entryRelationship
0 … *R

An allergy entry can record the reactions that are manifestations of the allergy or intolerance as shown below. It uses a related entry (<entryRelationship>) that indicates the manifestations (typeCode='MFST') the reported allergy or intolerance. These are events that may occur, or have occurred in the past as a reaction to the allergy or intolerance<entryRelationship typeCode='MFST'>

The entry contained with this entry relationship is some sort of problem that is a manifestation of the allergy. It is recorded using the Problem Entry structure.


Contains 1.3.6.1.4.1.12559.11.10.1.3.1.3.7 eHDSI Problem (DYNAMIC)		eHDSdotsnces
@typeCode
cs1 … 1FMFST
hl7:entryRelationship
0 … 1R

An optional <entryRelationship> element may be present indicating the severity of the problem. If present, this <entryRelationship> element shall contain a severity observation conforming to the Severity entry template (1.3.6.1.4.1.19376.1.5.3.1.4.1).

The related statement is made about the severity of the condition, concern, or allergy). This observation is recorded inside an <entryRelationship> element occurring in the containing entry. The containing <entry> is the subject (typeCode='SUBJ') of this new observation, which is the inverse of the normal containment structure, thus inversionInd='true'.

The related statement is another event (moodCode='EVN') observing (<observation classCode='OBS'>) the severity of the (surrounding) related entry (e.g., a condition or allergy).


Contains 1.3.6.1.4.1.19376.1.5.3.1.4.1 eHDSI Severity (DYNAMIC)		eHDSdotsnces
@typeCode
cs1 … 1FSUBJ
 Example<!-- The encompasing condition or allergy observation -->
<observation classCode="COND" moodCode="EVN">
  <!-- ... -->
  <entryRelationship typeCode="SUBJ" inversionInd="true">
    <observation classCode="OBS" moodCode="EVN">
      <templateId root="2.16.840.1.113883.10.20.1.55"/>      <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.1"/>      <code code="SEV" displayName="Severity" codeSystem="2.16.840.1.113883.5.4" codeSystemName="ActCode"/>      <text>
        <reference value="#severity-2"/>      </text>      <statusCode code="completed"/>      <!-- This code is from SNOMED, according to the epSOS value set-->
      <value type="CD" code="" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/>    </observation>  </entryRelationship>  <!-- ... -->
</observation>