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January 9, 2020 Allergy CRG meeting agenda

January 9, 2020 Allergy CRG meeting agenda

2020-Jan-09

 

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

 

Invitees:

Apologies

 

 

 

 

Objectives

  • See discussion items below:

Discussion items

Item

Description

Owner

Notes

Action

Item

Description

Owner

Notes

Action

1

Welcome and role call

@Bruce Goldberg

  • 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

 

2

Progress in recruiting more specialty physicians to this group

@Bruce Goldberg

  • 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

@Former user (Deleted) to reach out to AAAAI on our behalf

@Natasha Krul (Unlicensed) has reached out to Dr. Maurits van Maaren

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

3

Use of SNOMED substances vs Allergy to substance concepts among member countries of CMAG

@Bruce Goldberg

Results of survey summarized in column to the right

Country

Using Allergy to substance?

Using substance?

Response

 Norway

Possibly in the future

X

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

X

X

 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

X

X

 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

X

X

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

X

X

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).

UK

X

?

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.

Canada

Possibly in the future

X

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).

3

Presentation

Dr. Maurits van Maaren

  • Efforts of Dutch Society of Allergy and Clinical Immunology to document allergy and adverse reactions in medical records

4

Updates to SNOMED allergy content for Jan. 2020 release

@Former user (Deleted) , @Farzaneh Ashrafi

Review of recent updates to SNOMED substances and allergy to substance concepts

 

5

Severity scale for anaphylaxis

@Bruce Goldberg

  • Request from Netherlands (@Natasha Krul (Unlicensed)) to add severity scale for anaphylaxis

6

Allergy to animals

@Yongsheng Gao

  • Update on when role chaining might be implemented in order to link organism derived substances to organisms

 

5

Allergen and Allergy to substance refset for Belgium

@Bruce Goldberg, @Marie-Alexandra Lambot

  • List of allergen concepts currently missing from SNOMED provided

 

8

Adjourn

@Bruce Goldberg, All

  • 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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