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The FHIR AllergyIntolerance base resource has example bindings to SNOMED CT for the element AllergyIntolerance.code as well as elements reaction.substance, reaction.manifestation, and reaction.exposureRoute. All example value sets are though very broad and likely not very precise in determining the set of relevant concepts, see table below. For each data element, the number of concepts that are in the Global Patient Set (GPS) is shown here. The GPS is a special SNOMED CT subset that can be used globally with minimal restriction and at no cost.
FHIR element | SNOMED CT value set | Corresponding ECL | # concepts (in GPS version 2020-7-31) |
---|---|---|---|
AllergyIntolerance.code | https://www.hl7.org/fhir/valueset-allergyintolerance-code.html | If recording is based on substances and products and specifies the type of reaction in "type": <<105590001 | Substance (substance) | OR <<373873005 | Pharmaceutical / biologic product (product) | OR If recording is based on finding concepts precoordinating the type of reaction : <<418038007 |Propensity to adverse reactions to substance| OR When using precoordianted Situation concepts to represent the absence of an allergic propensity <<716186003 |No known allergy|[1] | 51133 (1157) |
AllergyIntolerance. reaction.substance | <<105590001 | Substance (substance) | OR <<373873005 | Pharmaceutical / biologic product (product) | | 49763 (1132) | |
AllergyIntolerance. reaction.manifestation | <<404684003 |Clinical finding| | 114493 (12135) | |
AllergyIntolerance. reaction.exposureRoute | <<284009009 |Route of administration value| | 163 (20) |
Since the SNOMED CT value sets in this category usually include a large number of concepts, implementers often ask for lists of most frequently used concepts to facilitate implementation (e.g., building picklists to assist data entry). These frequently-used subsets are sometimes called “starter sets”. Examples of starter sets are:
Source | Name of value set | Steward | Number of concepts |
---|---|---|---|
Value Set Authority Center (VSAC), NLM[2] | Common dietary substances for allergy and intolerance documentation | HL7 Patient Care Workgroup | 127 |
Value Set Authority Center (VSAC), NLM | Common drug classes for allergy and intolerance documentation | HL7 Patient Care Workgroup | 42 |
Value Set Authority Center (VSAC), NLM | Common environmental substances for allergy and intolerance documentation | HL7 Patient Care Workgroup | 15 |
Value Set Authority Center (VSAC), NLM | Common substances for allergy and intolerance documentation including refutations | HL7 Patient Care Workgroup | 747 (also includes RxNorm entities) |
Value Set Authority Center (VSAC), NLM | Food Allergen | Partners Healthcare | 518 |
HL7 | Allergy intolerance substance condition (GPS) – IPS[3] | FHIR GPS IG | 784 |
HL7 | Allergy Reaction (GPS) - IPS[4] | FHIR GPS IG | 31 |
eHealth Digital Service Infrastructure (eHDSI) | IPS Allergy or Intolerance Conditions[5] | epSOS | 15 |
eHealth Digital Service Infrastructure (eHDSI) | eHDSIAllergenNoDrug[6] | epSOS | 158 |
eHealth Digital Service Infrastructure (eHDSI) | eHDSIAdverseEventType[7] | epSOS | 10 |
Qualifier and/or modifier value sets
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It was assessed that there was a good match between the HL7 required value set and the SNOMED CT << 272141005 |Severities (qualifier value)| subhierarchy.
HL7 Code | HL7 Display | Suggested SNOMED CT concept |
severe | Severe | 24484000 |Severe (severity modifier) (qualifier value)| |
moderate | Moderate | 6736007 |Moderate (severity modifier) (qualifier value)| |
mild | Mild | 255604002 |Mild (qualifier value)| |
AllergyIntolerance.Type
The group's suggested approach here is to use concepts taken from <<609433001 |Hypersensitivity disposition (finding)|unless an actual immune mediated hypersensitivity has been proven e.g., by testing. See section 6.1.1 Allergy list for a further discussion of the rationale behind this approach.
HL7 Code | HL7 Display | Suggested SNOMED CT concept |
allergy | Allergy | 609433001 |Hypersensitivity disposition (finding)| |
intolerance | Intolerance | 782197009 |Intolerance to substance (finding)| |
For other required value sets in the FHIR AllergyIntolerance resource there were issues ranging from some concepts in the FHIR value set lacked a corresponding SNOMED CT concept to differences in the underlying ontology making mapping complicated and likely less useful. For more details about mapping FHIR value sets to SNOMED CT, refer to the discussion of the SNOMED on FHIR Workgroup.[8]
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