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Scenario 1.1: Documentation of an adverse reaction to a drug substance
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Healthcare providers should be able to accurately record the details of a patient's adverse reaction to a drug substance. This information includes the drug substance involved, routes of administration, dosage, signs, and symptoms produced by the reaction, time frames, etc., allowing for clear and consistent documentation and communication between healthcare providers. This can improve patient care by facilitating a more accurate understanding of the reaction and facilitating the identification of potential risk factors. Additionally, the use of SNOMED CT can support research and data analysis on adverse drug reactions
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A review of the systems fails to reveal any other causes, and the physician believes that the patient may be having an urticarial reaction to penicillin. He has lingering uncertainty about this and tells the patient to stop the penicillin and employ diphenhydramine for relief. He schedules him back in a week for follow-up and when recording his note for the visit, he adds to his assessment in the problem list: “Moderate urticarial reaction, possible penicillin allergy”.
A week later, the patient returns for follow-up with the itching and rash entirely resolved. He reports that the reaction subsided within days after stopping the penicillin. The physician adds “Penicillin allergy probable: moderate reaction of hives; criticality unable-to-assess” to the allergy list.
Scenario 1.2: Documentation of drug allergy in the allergy list and use as alert to provider
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Several years later, the patient from scenario 1.1, who has since received an aortic valve replacement, is seeing another physician within the organization for consultation on antibiotic prophylaxis for an upcoming dental procedure. The second physician decides that a penicillin-class antibiotic is appropriate for the patient.
When the physician creates an order for amoxicillin 2 g orally as a single dose and commits to the electronic prescription, an alert appears, which requires a response by the physician warning him of an allergy history to penicillin. The substance-based alert is generated by the EHR drug-disease interactions software, which uses the Allergy list as a reference. As the patient has not received penicillin class antibiotics for several years, the physician decides to refer the patient to an allergy specialist for clarification of current status of penicillin allergy.
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SNOMED CT can be used to document drug allergies in the allergy list and serve as an alert to providers. This will allow providers to quickly and accurately identify drugs that a patient may be allergic to. SNOMED CT is used to identify potential allergy triggers in the patient's medical history and assist providers in determining the safest and most effective treatment options
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Scenario 1.3: Documentation of a food intolerance
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Healthcare providers should be able to record the details of a patient's food intolerance accurately. This information includes the type of food, examination results, signs, and symptoms produced by the intolerance, time frames, etc., allowing for clear and consistent documentation and communication between healthcare providers. This can improve patient care by facilitating a more accurate understanding of intolerance events and facilitating the identification of potential risk factors. Additionally, the use of SNOMED CT can support research and data analysis on food intolerance.
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A 34-year-old female is seen by her primary care provider for complaints of abdominal pain, bloating and change in bowel habits within hours or a few days after ingesting whole wheat bread. In addition, she complains of feeling tired but denies itching rash or wheezing. Those complaints are entered as observations in the EHR. Due to a family history of celiac disease, tissue transglutaminase IgG and IgA are ordered which are negative. The patient is also referred to a gastroenterologist, who performs an endoscopic biopsy, which is negative for celiac disease. (Both of these examination results can be recorded in the EHR as a FHIR observation using LOINC codes). The patient is advised to avoid wheat and gluten containing products. An encounter diagnosis of moderate wheat intolerance is documented in the patient’s health record and wheat is entered in the patient’s “allergy” list. |
Scenario 1.4: Documentation of animal allergy
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Healthcare providers should be able to record the details of a patient's animal accurately. This information includes the type of animal, exposure, examination results, signs and symptoms produced by the allergy, time frames, etc., allowing for clear and consistent documentation and communication between healthcare providers. This can improve patient care by facilitating a more accurate understanding of intolerance events and facilitating the identification of potential risk factors. Additionally, the use of SNOMED CT can support research and data analysis on animal allergy.
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A physician sees a patient for the first time in clinic for routine outpatient care. The patient tells the physician that he has begun to experience asthma symptoms. The physician runs some blood tests and a series of skin tests, which demonstrate an intense reaction to the house dust mite, Dermatophagoides farinae protein with high IgE antibody levels. The patient confirms that his wheezing occurs primarily at home, especially while lying in bed at night. The physician opens the allergy record and documents the allergic propensity to Dermatophagoides farinae protein, criticality and severity of low in the EHR allergy list. |
Scenario 1.5: Documentation of allergy to non-medicinal substance cross-reacting with a pharmaceutical
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SNOMED CT can be used to document non-medicinal substance allergies in the allergy list, which can cross-react with ingredients of medications and serve as an alert to providers. This will allow providers to quickly and accurately identify drugsa patient may be allergic to based on previously recorded allergies to non-medicinal ingredients. SNOMED CT is used to identify potential allergy triggers in the patient's medical history and assist providers in determining the safest and most effective treatment options for the patient.
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A patient’s mother reports to their child’s physician that the child reacts violently to eating peanuts with symptoms that include generalized hives, wheezing and hypotension requiring use of epinephrine for resuscitation. The physician obtains a blood test which documents high levels of IgE antibody against the Arachis h2 peanut protein which is found in unrefined peanut oil (Arachis oil) - the sensitizing agent for clinical peanut allergy. Ara h2 is associated with a risk of severe reactions to peanut. The physician records a peanut allergy in the EHR with anaphylaxis, hives and wheezing as reaction symptoms, records a criticality of high and reaction severity of ‘severe’.
Years later, the youngster is seen by a dermatologist for treatment of acne. As part of the plan of care, the physician enters an electronic prescription for Isotretinoin capsules. When the physician commits the order, the EHR software runs allergy cross checking and issues a high priority alert that the capsules contain peanut oil that is not highly refined and therefore may potentially include peanut protein and are contraindicated for the patient. The physician cancels the order and chooses an alternative preparation.
Scenario 1.6: Documentation of allergic reaction to other non-medicinal substances
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Healthcare providers should be able to record allergic reactions to other non-medicinal substances accurately. This information includes the type of non-medicinal substance, examination results, signs, and symptoms produced by the reaction, time frames, etc., allowing for clear and consistent documentation and communication between healthcare providers. This can improve patient care by facilitating a more accurate understanding of allergic reactions and facilitating the identification of potential risk factors. Additionally, the use of SNOMED CT can support research and data analysis on allergic reactions.
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A licensed nurse presents to her personal physician for recurring problems of a generalized rash and itching. She works in an intensive care unit and is constantly handling chemicals, disinfectants, assisting in surgical procedures and performing catheter cares for her patients. As a part of the health history, she noticed that she had an eruption on her hands after handling latex catheters. Additionally, she reports a serious allergic reaction to papaya in the past and has been careful in the fruits she eats as a consequence. The clinician suspects a latex allergy cross-reacting with foodstuffs and orders IgE testing for Hevea latex antibody. The serology testing is strongly positive and the clinician advises the nurse of his findings with warnings about other foods, which may cross react. While documenting the clinical encounter, he records a latex allergy in the allergy list. The EHR software supports selection of foods, chemicals and animal biological products as substances, which may be identified as source substances for an entry onto the allergy list or for recording of an adverse reaction. |
Scenario 1.7: Documentation of ‘No Known Allergies’
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Healthcare providers should be able to record when a patient reports that he has no allergy history, with the data and time of the report
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Use Case 2: Sharing of Information Related to Allergy, Hypersensitivity, and Intolerance
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