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Interoperable deployment of SNOMED CT in support of Electronic Health Record (EHR) The capture and exchange of adverse sensitivity data (which encompasses allergy, non-allergic hypersensitivity and intolerance) is inconsistent and fails to support interoperability across SNOMED International member realms.  This arises due to confusion regarding the scope and definition of adverse sensitivity data, uncertainty regarding the reference models for defining relevant data records and inconsistency in guidance for the appropriate value sets from SNOMED CT that should populate those records.   

Several Standards Development Organizations (SDOs) such as HL7 have also provided some general guidance to assist implementers, however specific guidance in using SNOMED CT is still lacking. 

Statement of the Problem

The capture and exchange of adverse sensitivity data varies across vary across EHRs. As an effect, much of this data is not interoperable across electronic systems. Confusion regarding the representation and definition of adverse sensitivity data within the EHR presents challenges to organizations that are trying to implement SNOMED CT for electronic data sharing. Further, this uncertainty limits the use of adverse sensitivity data for clinical decision support and longitudinal patient care records. The capture of allergy data must be clearly defined to support patient safety and a comprehensive health record.

Several Standards Development Organizations (SDOs), such as HL7, have provided some general guidance to assist implementers, however specific guidance in using SNOMED CT within this domain is lacking. 

Objective

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This implementation guide is intended to accelerate the consistent implementation of vocabulary with an emphasis on the use of SNOMED CT within the domain of adverse sensitivity and adverse reactions by:

• Extending previous SNOMED International work on definitions of adverse sensitivity
• Surveying and summarizing the relevant interoperability standards, 
• Advising the SNOMED International community regarding best practice deployment of allergy data within the EHR and identify identifying the SNOMED CT refsets (value sets) content that would constitute best practice for use in electronic health records.
• Addressing issues using SNOMED in day-to-day clinical practice
• Provide guidance in reconciling substances as allergens with clinical findings representing diseases and propensities as used in problem lists
• Leverage products and substances hierarchy for allergy decision support 

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• Fill the knowledge gap in the community of practice by providing authoritative guidance and reference sets that can be used consistently for the representation of:
• an allergy, non-allergic hypersensitivity, and intolerance 
• propensities and reactions
• the criticality of the allergic condition (i.e. the potential seriousness of a future reaction)
• the severity of a reaction 
• Provide guidance for the aggregation & analysis of reported adverse drug reactions (ADR) and sharing/interoperability of ADR reports

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Our The scope and approach was the followingof the work presented in this guide includes:

1. Review definitions and reference standard publications
2. Analyze relevant information models
   1. Review existing information models that are in scope, with special emphasis on HL7® FHIR® that has gained considerable momentum in recent years
   2. Create an inclusive model to harmonize the key data elements in the reviewed information models
3. Create exemplar use cases
   1. Describe the most common and important scenarios for capturing or exchanging adverse sensitivity information
   2. Illustrate how the information can be represented by using FHIR® and SNOMED CT concepts
4. Identify SNOMED CT reference sets
   1. Identify starter sets for large domains – most commonly used SNOMED CT concepts in clinical settings e.g., food allergens, adverse sensitivity reactions
   2. Identify value sets for specific data elements e.g., adverse sensitivity types, certainty, criticality, severity
5. Provide practical guidance of on the use of SNOMED CT in
   1. Allergy list
   2. Problem list
   3. Clinical decision support

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• Clinicians who are interested in understanding how SNOMED CT can support the clinical needs for data collection and acquisition within the field of Allergy, Hypersensitivity and Intolerance. 
• Information managers  who who are looking to learn how SNOMED CT can be integrated into health information models within the domain of Allergy, Hypersensitivity, and Intolerance to support the implementation of SNOMED CT and enhance data interoperability.
• Software developers who want to learn how to integrate SNOMED CT into software applications used in the domain of Allergy, Hypersensitivity, and Intolerance.

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This SNOMED CT Implementation guide and the underlying work has have been developed by the SNOMED International Clinical Reference Group for Allergies/Hypersensitivity. The Clinical Reference Group (CRG) is composed of experts in the field of Allergies/Hypersensitivity providing input from the community of practice to on the development, maintenance, and use of SNOMED CT in this specific domain. The CRG members have been instrumental in the development of this guide, providing their expertise, knowledge, and experience to ensure that it is accurate, up-to-date, and relevant to the needs of its intended audience. Their dedication and hard work have made this guide possible and SNOMED Internationalis is grateful for their contributions. This guide is a product of SNOMED International's ongoing commitment to improving healthcare through the use of high-quality, standardized clinical terminologies.

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This SNOMED CT Implementation Guide is designed to provide guidance for the use of SNOMED CT within the domain of allergies, hypersensitivity, and intolerance. The guide is organized into five main chapters:

• Chapter 1: Introduction - This chapter provides a background on the guide, including the objectives, scope, and target audience.
• Chapter 2: Clinical Use Cases - This chapter describes the key use cases that have motivated the creation of this guide and explains scenarios where implementation of SNOMED CT within this domain is needed.
• Chapter 3: Allergy Content in SNOMED CT - This chapter describes how SNOMED CT addresses the terminological needs within the domain of allergies, hypersensitivities, and intolerances. It also elaborates on relevant editorial policies and concept model rules established to ensure the quality of the content.
• Chapter 4: Information Model and Terminology Binding - This chapter introduces an inclusive information model that can be used within the field of allergies, hypersensitivities, and intolerances to facilitate the harmonization and interoperability of data within this domain. It also clarifies the bindings between the inclusive information model and SNOMED CT.
• Chapter 5: Technical Application - This chapter presents technical considerations related to the implementation of the inclusive model and provides practical examples, including the implementation of the inclusive model through HL7 FHIR.

Review

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