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Date
Thursday, July 8, 2021
Schedule
2nd Thursday of every month
Time: 18:30 UTC
Objectives
- To begin review, revision and completion of the allergy implemntation guide
Discussion items
| Item | Description | Owner | Notes | Action |
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| 0 | Reminder to record call |
| 1 | | |
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| 2 | Allergy implementation guide | | | |
| 3 | Protein contact dermatitis | | - The Dutch would like to create a concept for |Protein contact dermatitis| for their diagnosis thesaurus (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760939/) which they believe should be a child of 200847009 |Allergic contact dermatitis caused by food in contact with skin (disorder)|.
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| 4 | Question from the Netherlands | | The idea is to use a thesaurus with ‘clean’ diagnoses that have no additional information (so severe asthma’ or ‘food allergy caused by peanut’ have been replaced by ‘asthma’ and ‘food allergy’) the metadata are references sets with allergens, and classifications of severity. For most diagnoses we can use the SNOMED-codes for mild, moderate and severe but there are a few exceptions tot his. The exceptions are asthma, allergic rhinoconjunctivitis and a few more. For those specific diagnoses allergy specialists use specific classifications of severity, for example GINA is used for asthma and ARIA for allergic rhinoconjunctivitis. - To be able to exchange and register the information that the severity was registered using one of these classifications we need to create and OID, so that when the health care professionals registers ‘asthma’ for diagnosis, automatically a list of the GINA pops up. The receiver of that information also need to receive the info that the severity was coded by using GINA. The problem we are encountering now is that all these specific classifications do not have numeric codes, they just have display names like mild, moderate and severe, as opposed to SNOMED which uses numeric identifiers.
| I think most physicians in the U.S. document using ICD-10 CM. You can see the asthma and allergic rhinitis content by clicking on the links below https://icd10cmtool.cdc.gov/?fy=FY2021&q=asthma https://icd10cmtool.cdc.gov/?fy=FY2021&q=allergic%20rhinitis At my institution, we use an interface terminology which is created by physicians and which contains unique identifiers as well as maps to SNOMED and ICD-10 CM. If you download the Kaiser CMT donation files from NLM you can see what this looks like. I have attached a file with our asthma and allergic rhinitis diagnoses but it is old and contains ICD-9 rather than ICD-10 maps.
- What I can see in your file is that you have created new SNOMED codes for entitites like ‘severe ashtma’ and ‘controlled asthma’ etc which is the exact opposite of the way the allergy specialists want to do it over here haha. So although you have definitely answered my question, thank you very much, unfortunately we can not use your solution as an example for our solution the allergy specialist here want to avoid additions like severe and controlled to a term. They want ‘asthma’ and then additional information can be added like severe or controlled….
- SNOMED has severity qualifier values under 272141005 |Severities (qualifier value)|. One could create a dropdown with these severities and another dropdown with diagnoses such as asthma. Currently most severities of disorders are modeled as primitives and do not use the severity attribute with the severities qualifier values (except for 3 concepts) so even if your system supports postcoordination, SNOMED does not support that model.
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| 5 | EU Allergy Intolerance Information model | | There is a EU-funded initiative to create European health data models. Among them is an allergy model. The main critique of the current SNOMED allergy model in the hospital discharge report is that the concept of allergic condition to define the type of reaction should be replaced by the risk of reacting (propensity). This is augmented by the statement "that some patients will never have any manifestation of their allergy, as it will only have been detected by patch or prick test", which is of course correct.
| - Allergy Intolerance Information Model - v1.2.docx
- Allergic condition in SNOMED is a disjunctive grouper that means an allergic disease (i.e. something with a morphology and finding site such as allergic rhinitis.), an allergic disposition (propensity to develop symptoms on exposure to an allergen) and allergic reaction (the realization of an allergic disposition observed during a patient encounter upon allergen exposure).
- Also, when you say "that some patients will never have any manifestation of their allergy, as it will only have been detected by patch or prick test", this is incorrect. What you are describing is known as sensitization i.e. the exposure to and development of an immune response to an allergen. This should not be documented as an allergy but rather just as a test finding. Unfortunately many physicians do confuse a positive test result with allergy.
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| 4 | Adjourn | | | |
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