| Substance (Non-Medication) |
Description
Non-pharmacologic agent believed to cause a harmful or undesired physiologic response following exposure.
Examples include but are not limited to latex, eggs, pollen, and peanuts.
| Submitted By: John D'Amore
/ Diameter Health
|
| Data Element Information |
| Rationale for Separate Consideration |
The data elements of drug class and medications do not cover all related allergies to clinical care. Latex will affect the use of products in the provisions of healthcare. Eggs may affect the selection of certain vaccines. Contrast media is important in the provision of specific imaging procedures. |
| Use Case Description(s) |
| Use Case Description |
Non-medication allergies are important in the provision of clinical care. They may affect the selection of healthcare products used in services (e.g. latex for glove use and contrast media in imaging procedures) as well as the selection of specific medication or immunization therapies (e.g. egg allergies in vaccine selection and dust, mold or pollen for allergy medication selection). In addition, this data element could include food allergies, which may affect food service preparation for inpatient or custodial facilities. |
| Estimated number of stakeholders capturing, accessing using or exchanging
|
It is estimated that the over 4,000 hospitals as well as the vast majority of ambulatory care settings already record, capture and transmit information related to non-medication allergies. |
| Healthcare Aims |
- Improving patient experience of care (quality and/or satisfaction)
- Improving the health of populations
|
| Maturity of Use and Technical Specifications for Data Element |
| Applicable Standard(s) |
SNOMED Substance Hierarchy. This code system is already referenced in the C-CDA Implementation Guidance (see conformance CONF:1098-16324). It is already support in the Value Set Authority Center through value set "Substance Reactant for Intolerance" (https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1010.1/expansion) . This information is also supported in FHIR http://hl7.org/fhir/us/core/stu1/ValueSet-us-core-substance-sct.html
https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1010.1/expansion
|
| Additional Specifications |
C-CDA 2.1
FHIR US Core Allergy Intolerance Profile (http://hl7.org/fhir/us/core/stu1/ValueSet-us-core-substance-sct.html)
|
| Current Use |
Extensively used in production environments |
| Supporting Artifacts |
This data is in support of the advancement of non-medication allergies for inclusion in the United States Core Data for Interoperability under the Data Class of Allergies and Intolerances.
As part of a research project sponsored by the National Committee of Quality Assurance (NCQA) and a regional health information exchange in New York, Diameter Health was requested to examine data included in clinical documents, such as C-CDA, for 474 distinct facilities in 2020. These clinical documents are shared through health information exchange with other healthcare organizations routinely, in part to fulfill requirements for use of certified health information technology to record and transmit data related to USCDI. These facilities represented a mix of ambulatory care, inpatient and post-acute settings in New York. The project was sponsored as part of the emerging program for Data Aggregator Validation (DAV) launched by NCQA (https://www.ncqa.org/programs/data-and-information-technology/hit-and-data-certification/hedis-compliance-audit-certification/data-aggregator-validation/). These comments represent the perspective of Diameter Health and are not meant to represent the opinions, perspectives or policy of any other organization.
Over the data analysis of 474 organizations, over 80% of organizations recorded substance and food allergies in some patient records. The most common allergies were: latex, contrast media, shellfish, adhesive tape, dust, tree nuts, eggs, bees, pollen and peanuts. UNII and SNOMED were often used for these allergy observations in addition to free text, locally developed coding systems and other national vocabularies. In addition, prior work by HL7 has also profiled the frequency of allergies, which also includes non-medication allergies (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=482)
Diameter Health works with over 20 health information exchanges nationally as well as an array of health plans, health information technology vendors and governmental entities. The findings shared as part of this research supports observations from other clients.
While these allergies are commonly recorded, they are not currently part of the USCDI since they do not qualify as medication or drug class allergies. Diameter Health supports the addition of a new data element (or alternatively an expansion of existing elements) for the inclusion of this data in the USCDI. We believe that the recording and transmission of this information will improve patient safety as well as clinical decision making. We believe that the data from the field shows that this information is already widely recorded and exchanged among healthcare organizations. Please feel welcome to reach out if it would be helpful to share more details or to answer questions regarding this comment.
|
| Number of organizations/individuals with which this data element has been electronically exchanged
|
5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders. |
| Supporting Artifacts |
This data is in support of the advancement of non-medication allergies for inclusion in the United States Core Data for Interoperability under the Data Class of Allergies and Intolerances.
As part of a research project sponsored by the National Committee of Quality Assurance (NCQA) and a regional health information exchange in New York, Diameter Health was requested to examine data included in clinical documents, such as C-CDA, for 474 distinct facilities in 2020. These clinical documents are shared through health information exchange with other healthcare organizations routinely, in part to fulfill requirements for use of certified health information technology to record and transmit data related to USCDI. These facilities represented a mix of ambulatory care, inpatient and post-acute settings in New York. The project was sponsored as part of the emerging program for Data Aggregator Validation (DAV) launched by NCQA (https://www.ncqa.org/programs/data-and-information-technology/hit-and-data-certification/hedis-compliance-audit-certification/data-aggregator-validation/). These comments represent the perspective of Diameter Health and are not meant to represent the opinions, perspectives or policy of any other organization.
Over the data analysis of 474 organizations, over 80% of organizations recorded substance and food allergies in some patient records. The most common allergies were: latex, contrast media, shellfish, adhesive tape, dust, tree nuts, eggs, bees, pollen and peanuts. UNII and SNOMED were often used for these allergy observations in addition to free text, locally developed coding systems and other national vocabularies. In addition, prior work by HL7 has also profiled the frequency of allergies, which also includes non-medication allergies (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=482)
Diameter Health works with over 20 health information exchanges nationally as well as an array of health plans, health information technology vendors and governmental entities. The findings shared as part of this research supports observations from other clients.
While these allergies are commonly recorded, they are not currently part of the USCDI since they do not qualify as medication or drug class allergies. Diameter Health supports the addition of a new data element (or alternatively an expansion of existing elements) for the inclusion of this data in the USCDI. We believe that the recording and transmission of this information will improve patient safety as well as clinical decision making. We believe that the data from the field shows that this information is already widely recorded and exchanged among healthcare organizations. Please feel welcome to reach out if it would be helpful to share more details or to answer questions regarding this comment.
|
| Potential Challenges |
| Restrictions on Standardization (e.g. proprietary code) |
None |
| Restrictions on Use (e.g. licensing, user fees) |
None |
| Privacy and Security Concerns |
None |
| Estimate of Overall Burden |
Adding this data element will add modest overhead for terminology support. While many systems already support terminologies like SNOMED and UNII that can record non-medication allergies, some track this information as free text (e.g. "Latex" rather than a reference to the specific SNOMED code). Clinicians routinely record and transmit this information today since it is important in the provision of safe and effective patient care. |
| Other Implementation Challenges |
None |
|
Submitted by hswmin on 2023-04-14
Allergies and Intolerances: Substance (Non-Medication)
The Texas Health Informatics Alliance (THIA) Policy and Standards Working Group supports the proposal for substance (non-medication). This has been very frustrating for nurses. Some organizations have determined that having the unit PharmD is vital to the success of this effort, which is very costly. Moreover, allergies are currently part of free-text search and the proposed standard would make these into an actual code that is much easier for medical professionals.