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
Context
Parent nodes of template element with id 1.3.6.1.4.1.19376.1.5.3.1.4.6
<observationclassCode="OBS"moodCode="EVN"negationInd="false"> <templateIdroot="2.16.840.1.113883.10.20.1.18"/><templateIdroot="2.16.840.1.113883.10.20.1.28"/><templateIdroot="1.3.6.1.4.1.19376.1.5.3.1.4.6"/><templateIdroot="1.3.6.1.4.1.19376.1.5.3.1.4.5"/><idroot=""extension=""/><!-- This is the code that shows what kind of allergy or intolerance derived from the
epSOSAdverseEventType Value Set--> <codecode=""codeSystem="2.16.840.1.113883.6.96"/><text> <referencevalue=""/></text><statusCodecode="completed"/><effectiveTime> <lowvalue=""/><highvalue=""/></effectiveTime><!-- value element is present only to indicate no known allergies, in all other cases
is used for referenicng text in the narrative --> <valuexsi:type="CD"/><!-- This is the allergen - the substance that caused the allergy --> <participanttypeCode="CSM"> <participantRoleclassCode="MANU"> <playingEntityclassCode="MMAT"> <codecode=""codeSystem=""> <originalText> <referencevalue="#substance"/></originalText></code><name/></playingEntity></participantRole></participant><!-- This is how the allergy manifests itself --> <entryRelationshiptypeCode="MFST"> <templateIdroot="1.3.6.1.4.1.19376.1.5.3.1.4.6.1"/><!-- a problem entry --> <observationclassCode="OBS"moodCode="EVN"> <templateIdroot="2.16.840.1.113883.10.20.1.54"/><templateIdroot="1.3.6.1.4.1.19376.1.5.3.1.4.5"/><!-- The code tells us that the observation is a symptom --> <codecode="418799008"codeSystem="2.16.840.1.113883.6.96"displayName="Finding reported by subject or history provider"codeSystemName="SNOMED CT"/><text> <referencevalue="#manifest-1"/></text><statusCodecode="completed"/><!-- The value tells us what the symptom (i.e. allergy manifestation) is --> <!-- This is where anaphylaxy or angiooedema will be coded --> <valuexsi:type="CD"code=""codeSystem=""displayName=""codeSystemName=""/></observation></entryRelationship><!-- This is how the severity of the allergy is described (Optional)--> <entryRelationshiptypeCode="SUBJ"inversionInd="true"> <observationclassCode="OBS"moodCode="EVN"> <templateIdroot="2.16.840.1.113883.10.20.1.55"/><templateIdroot="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 --> <codecode="SEV"displayName="Severity"codeSystem="2.16.840.1.113883.5.4"codeSystemName="ActCode"/><text> <referencevalue="#severity-1"/></text><statusCodecode="completed"/><!-- This code is from SNOMED, according to the epSOS value set--> <valuexsi:type="CD"code=""codeSystem="2.16.840.1.113883.6.96"codeSystemName="SNOMED CT"/></observation></entryRelationship></observation>
epsos-issue-275: Change the Cardinality of the id and text elements according to the IHE PCC (Feedback needed)
Item
DT
Card
Conf
Description
Label
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.
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.
The value element shall be present in a coded or uncoded form. In both cases the type
shall be set to xsi:type='CD'. The coded form shall be used to indicate "No known
allergy" (code='716186003' codeSystem='2.16.840.1.113883.6.96' codeSystemName='SNOMED
CT'). 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.
(Entnce)
hl7:participant
0 … *
C
The substance that causes the allergy or intolerance shall be specified in the <participant>
structure.
The <code> element shall be present. It may contain a code and codeSystem attribute
to indicate the code for the substance causing the allergy or intolerance. It shall
contain a <reference> to the <originalText> in the narrative where the substance is
named.
Conditional: Omit if Observation.value is SNOMED-CT 716186003 No known allergy
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.
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.
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).
<!-- The encompasing condition or allergy observation --> <observationclassCode="COND"moodCode="EVN"> <!-- ... --> <entryRelationshiptypeCode="SUBJ"inversionInd="true"> <observationclassCode="OBS"moodCode="EVN"> <templateIdroot="2.16.840.1.113883.10.20.1.55"/><templateIdroot="1.3.6.1.4.1.19376.1.5.3.1.4.1"/><codecode="SEV"displayName="Severity"codeSystem="2.16.840.1.113883.5.4"codeSystemName="ActCode"/><text> <referencevalue="#severity-2"/></text><statusCodecode="completed"/><!-- This code is from SNOMED, according to the epSOS value set--> <valuexsi:type="CD"code=""codeSystem="2.16.840.1.113883.6.96"codeSystemName="SNOMED CT"/></observation></entryRelationship><!-- ... --> </observation>