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Date

Thursday, January 9, 2020

Schedule
2nd Thursday of every month
Time: 20:00 UTC


Zoom Details

https://snomed.zoom.us/j/934143312

Meeting ID: 934-143-312

International numbers available: https://snomed.zoom.us/zoomconference?m=EochJjO8ozm1ZiDr_x9p-bFJCbIBwgqV


Objectives

  • See discussion items below:

Discussion items

ItemDescriptionOwnerNotesAction
1

Welcome and role call

  • Welcome and roll call
  • Introduction -
    • Dr. Maurits van Maaren
      • Chairman of Dutch Society of Allergy and Clinical Immunology
      • Allergist and immunologist Erasmus MC Rotterdam The Netherlands


2Progress in recruiting more specialty physicians to this group
  • See actions

I forwarded the following list of the goals of the Allergy/Hypersensitivity CRG as requested by Jane Millar (collaboration lead):

  1. Review legacy content for currency and accuracy
    1. Review of WAO/EAAACI definitions of allergy and hypersensitivity
      1. Are these still relevant?
      2. Need clarification of difference between hypersensitivity, nonallergic hypersensitivity and intolerance
      3. Should “allergy” specifically refer to immediate hypersensitivity?
    2. Review of content under Allergy to substance (finding) as to which sub concepts actually represent allergy vs. nonallergic hypersensitivity or intolerance.
  2. Suggest new content in order to represent current knowledge in the field of allergy and adverse reactions and to be consistent with the new ICD-11 chapter on allergies and hypersensitivity
  3. In addition to substances and allergy conditions, need review of other allergy content areas such as allergy tests, patch and other allergen extracts, desensitization procedures
  4. Provide input on development of subsets required for implementation of allergy-specific content in EHRs
  5. Provide guidance for developers of decision support
  6. Harmonize SNOMED content with HL-7/FHIR
  7. Should this group eventually take on clinical immunology?

I think we need to engage the following organizations/individuals. I based SNOMED’s allergy/hypersensitivity content on the nomenclature developed by the WAO?EAAACI close to 20 years ago. The lead author has since retired and I was told these organizations are no longer interested in nomenclature. I would like to reengage them in this area as there are aspects of the nomenclature that remain unclear. Several individuals I have spoken with and articles I have read have different takes on this but we need the support of these professional organizations to move forward.

  1. World Allergy Organization (WAO): president Ignacio J. Ansotegui, MD, PhD
  2. European Academy of Allergy, Asthma and Clinical Immunology (EAAACI): president Marek Jutel
  3. American Academy of Allergy, Asthma and Immunology: president David Lang (Russ Leftwitch the only allergist on our CRG other than myself is reaching out to Dr. Lang on our behalf)
  4. Individuals creating content for ICD-11: Luciana Kase Tano and Pascal Demoly (I have reached out them in the past and was told they were too busy to participate).
  5. Will also need to recruit some primary care providers in internal medicine, pediatrics and family practice

Russell Leftwich to reach out to AAAAI on our behalf


Natasha Krul has reached out to Dr. Maurits van Maaren


Marie-Alexandra Lambot to reach out to allergy specialists in Belgium

3Use of SNOMED substances vs Allergy to substance concepts among member countries of CMAGBruce GoldbergResults of survey summarized in column to the right
CountryUsing Allergy to substance?Using substance?Response

 Norway

Possibly in the futureX

In our national summary record, we are using concepts like fish, milk, egg etc to document past reactions to etc, i.e. the allergen as a separate information element. Our plan is to map this to SNOMED CT (partially done already) or use SNOMED CT as the base terminology. In that context, we won't use the precoordinated concepts. The national work on archetypes do not use the precoordinated concept. It is not decided yet exactly how allergic reactions/allergies will be documented in the Epic implementation in Mid-Norway. So there is a chance that the precoordinated concepts will be used.

 Denmark

??

 Denmark is presently not using the allergy concepts.

 The Netherlands

XX

 In the Netherlands we are using a few of the precoordinated allergies in our diagnosis list: allergy for insect venom, allergy to food, allergic contact dermatitis, occupational allergy, allergic inhalant dermatitis. Next to that we have 5 allergens reference sets where the allergy can be specified further.

 Australia

XX

 Both sets of concepts are in use.

  • We encourage vendors to implement the substance heirarchy for "recording allergens" which most already do. This ensures they get the best coverage / user experience available. Also any decision support is easier to trigger of this (not having to calculate the causative agent, though that's not a huge task)
  • The Allergy concepts (clinical findings) are also used when populating a generic problem list. However most systems have a dedicated Allergy recording module, where the agents are recorded.
  • We strongly discourage the use of anything but Clinical Findings/Situations in a problems field. As the intent is often ambiguous - is a record of "Amoxicillin" mean Allergy to, or Current medication ?

Sweden

XX

There is a recently published national specification for hypersensitivities which might influence provision of care (e.g. drug allergies, latex allergy). We use substance hierarchy concepts for the substance allergens. Hypersensitivity findings concepts are used for generic categorization similar to FHIR's AllergyIntolerance.category.

 USA

XX

Evidence of use of Allergy to X (finding) in several value sets (e.g., Allergy to Beta Blocker Therapy). Note: in other cases, value sets list the offending substances instead (e.g., Allergy/Intolerance Substance, Food).

UKX?

Although the direction of travel is towards post-coordinated expressions, and we have a 'draft for trial use' refset to support the Care Connect Allergy Intolerance FHIR profile: https://nhsconnect.github.io/CareConnectAPI/api_clinical_allergyintolerance.html, currently the 'allergy to xxx (finding)' concepts are what are predominantly used here.

CanadaPossibly in the futureX

Canada Health Infoway publishes a Canadian subset of more than 700 SNOMED CT codes for representing the specific non-drug allergen or other agent/substance to which the client has an allergic reaction. All cocepts are from the Substance hierarchy. We also have at least one Jurisdiction that is seeking to align to FHIR concepts for allergy where applicable and is also looking to leverage the IPS AllergyIntolerance value set which uses concepts from: all descendants of 762766007 | Edible substance (substance); all descendants of 406455002 | Allergen class (substance); all descendants of 425620007 | Metal (substance); all descendants of 373873005 | Pharmaceutical / biologic product (product). Note that the FHIR example terminology bindings for the http://hl7.org/fhir/ValueSet/allergyintolerance-code include codes from http://snomed.info/sct : where concept is-a 418038007 (Propensity to adverse reactions to substance), where concept is-a 267425008 (Lactose intolerance), where concept is-a 29736007 (Syndrome of carbohydrate intolerance), where concept is-a 340519003 (Lysine intolerance), where concept is-a 190753003 (Sucrose intolerance), where concept is-a 413427002 (Acquired fructose intolerance), where concept is-a 716186003 (No known allergy).

3PresentationDr. Maurits van Maaren
  • Efforts of Dutch Society of Allergy and Clinical Immunology to document allergy and adverse reactions in medical records
4Updates to SNOMED allergy content for Jan. 2020 releaseReview of recent updates to SNOMED substances and allergy to substance concepts
5Severity scale for anaphylaxisBruce Goldberg
  • Request from Netherlands (Natasha Krul) to add severity scale for anaphylaxis
6Allergy to animals
  • Update on when role chaining might be implemented in order to link organism derived substances to organisms


5Allergen and Allergy to substance refset for Belgium
  • List of allergen concepts currently missing from SNOMED provided
8Adjourn
  • AOB

Meeting Files

  File Modified
Microsoft Powerpoint Presentation Anaphylaxis Mueller grades.pptx 2020-Jan-06 by Bruce Goldberg
PNG File image2019-12-10_16-5-31.png 2020-Jan-06 by Bruce Goldberg
PNG File image2019-12-10_16-4-12.png 2020-Jan-06 by Bruce Goldberg
PNG File image2019-12-10_15-29-28.png 2020-Jan-06 by Bruce Goldberg
PNG File image2019-12-10_15-28-40.png 2020-Jan-06 by Bruce Goldberg
Microsoft Excel Spreadsheet Allergy to substance verification.xlsx 2020-Jan-06 by Bruce Goldberg
Microsoft Word Document Briefing note - Changes to the modeling of hypersensitivity_allergy and pseudoallergy content_final.docx 2020-Jan-06 by Bruce Goldberg
Microsoft Powerpoint Presentation Redesigning the allergy module of the electronic health 8-9-2018.pptx 2020-Jan-06 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy update.pptx 2020-Jan-06 by Bruce Goldberg
ZIP Archive Allergy to animals.zip 2020-Jan-06 by Bruce Goldberg
Microsoft Excel Spreadsheet Pollens_allergyto_to create_SIG20190906.xlsx 2020-Jan-06 by Bruce Goldberg
Microsoft Excel Spreadsheet Foods_allergyto_to create_SIG20190906.xlsx 2020-Jan-06 by Bruce Goldberg
Microsoft Excel Spreadsheet Drugs_allergyto_to create_SIG20190906.xlsx 2020-Jan-06 by Bruce Goldberg
Microsoft Excel Spreadsheet Other_allergyto_to create_SIG20190906.xlsx 2020-Jan-06 by Bruce Goldberg
Microsoft Excel Spreadsheet AnimalSubstances_SIG20190906.xlsx 2020-Jan-06 by Bruce Goldberg
Microsoft Excel Spreadsheet allergens for SIG (partial)_20190802.xlsx 2020-Jan-06 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy to animals.pptx 2020-Jan-06 by Bruce Goldberg
Microsoft Excel Spreadsheet DHD - Losse Allergenenlijst - Snomed.xlsx 2020-Jan-06 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy_Intolerance CRG bullet points.pptx 2020-Jan-06 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy SNOMED on FHIR.pptx 2020-Jan-06 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy to combination products, stereoisomers, bases.pptx 2020-Jan-06 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy to living organisms.pptx 2020-Jan-06 by Bruce Goldberg
Microsoft Word Document Feedback from FDB re retiring of substance groupers.docx 2020-Jan-06 by Bruce Goldberg
PDF File EHR_Editorial Annals of Allergy 6-2016.pdf 2020-Jan-06 by Bruce Goldberg
Microsoft Word Document SNOMED on FHIR.docx 2020-Jan-06 by Bruce Goldberg
Microsoft Powerpoint Presentation Alpha-gal allergy.pptx 2020-Jan-06 by Bruce Goldberg
PDF File HL7_XPARADIGM_ALLERGY_VS_R1_INFORM_2018AUG.pdf 2020-Jan-06 by Bruce Goldberg
Microsoft Excel Spreadsheet HL7_XPARADIGM_ALLERGY_VS_R1_I2_2018 May ALLERGY SUBSTANCES.xlsx 2020-Jan-06 by Bruce Goldberg
ZIP Archive HL7_XPARADIGM_ALLERGY_VS_R1_INFORM_2018AUG.zip 2020-Jan-06 by Bruce Goldberg
PDF File Drug+Allergy.pdf 2020-Jan-06 by Bruce Goldberg
Microsoft Word Document Allergy project plan for 2019.docx 2020-Jan-06 by Bruce Goldberg
Microsoft Word Document Allergy definition query for MSAC.docx 2020-Jan-06 by Bruce Goldberg
PDF File Drug-Book-web.pdf 2020-Jan-06 by Bruce Goldberg
PDF File nihms371252.pdf 2020-Jan-06 by Bruce Goldberg
Microsoft Excel Spreadsheet Pirson_Not_In_CSCT.xlsx 2020-Jan-06 by Bruce Goldberg
Microsoft Powerpoint Presentation Registratie allergieen en bijwerkingen AIOS dag Utrecht 1-11-2019.pptx 2020-Jan-09 by Bruce Goldberg


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