Representing Patient Allergies and Intolerances; Medications

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Type Standard / Implementation Specification Standards Process Maturity Implementation Maturity Adoption Level Federally required Cost Test Tool Availability
Standard
Final
Production
Rating 4
Yes
Free
N/A
Standard
Final
Production
Rating 3
No
Free
N/A
Emerging Standard
In Development
Pilot
Feedback Requested
No
Free
No
Limitations, Dependencies, and Preconditions for Consideration
Applicable Value Set(s) and Starter Set(s)
  • When a medication allergy necessitates capture by medication class, SNOMED CT® should be used.
  • MED-RT is meant to replace the VA's NDF-RT with is being sunsetted in 2018.  It has the capability to represent medication classes for use as an allergen category, and currently requires MeSH terms for medication classes.
  • RxNorm: Refers to the RxNorm source specifically (and not to other sources that are included with the RxNorm download).

Comment

Links and descriptions are lacking.

You link to RX Norm, but not to the value set.  How hard would it be to include https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1010.7/expansion

Similarly, for SNOMED CT.  You've identified 327,000 codes, but not much else.  At the very least you could identify the appropriate heirarchies.

Need to include appropriate SNOMED specifics

The Consideration: "When a medication allergy necessitates capture by medication class, SNOMED CT® should be used." would mean the use of a specific SNOMED CT subset that are descendants of  Pharmaceutical / biologic product (product) [373873005]. As a change from NDFRT this recommendation should also have specifications regarding the concern about consistency among the members of a drug class concept.

Also, it is VERY confusing that the SNOMED CT consideration noted above does not align with the SNOMED CT "starter Set" noted on the right - this set of "disorders" is a completely different thing than the substance-type recommendations every where else in this part of the ISA. This is extremely problematic and as a condition-type concept should not be used here at all. That is not to say that implementers should not consider using disorders to also represent allergies, but the ISA has consistently appropriately said that the best way to represent an allergy/intolerance reactant is using a concept that is a substance, not a condition. Don't change this.

Consider including MED-RT to represent classes of medications

MED-RT is an emerging standard that allows for representing classes of medications.  This has already been added under "Representing Patient Medications".  Shouldn't this also be added here for representing allergies to a class of medication? 

Class Medication Allergen - Suggest SNOMED CT Substance Hierarch

Strong support SNOMED CT as replacement to NDF-RT which is no longer supported.  In past modeling, have recommended the "substance" domain in lieu of the listed "product" domain as the "class" substance contains relationships to related medication ingredient substances.  For example, current NDF-RT N0000011281 "Penicillins" spans RXCUI 7986 within RxNorm.  RXCUI 7986 also spans SNOMED CT 373270004 "Penicillin -class of antibiotic- (substance)," and 6369005 "Penicillin -class of antibiotic- (product)" - the "substance" value has links to the ingredient "children" that would be expected to span the class, such as "amoxicillin". The "product" hierarchy does not have a direct path to member "ingredient" based concepts.. instead, it links to a product concept such as "product containing amoxicillin".

Pharmacy HIT Collaborative's Comments on ONC's Proposed 2018 ISA

The Pharmacy HIT Collaborative supports using RxNorm and SNOMED CT; however, we ask for clarification as to why MED-RT (formerly NDF-RT) has been removed as a standard/implementation specification, as it was included in the final 2017 ISA and is currently included under “Representing Patient Medications.” We recommend that it be returned.   

Agree - MED-RT should be the…

Agree - MED-RT should be the preferred class specification. It is tied to RxNorm and reasonably sized.