Harmful or undesired physiological responses associated with exposure to a substance.

Data Element

Substance (Non-Medication)

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.

Applicable Vocabulary Standard(s)

Applicable Standards
  • Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®) U.S. Edition, March 2023 Release


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.

Level 2 Data Class: Allergies and Intolerances

Level 2 Data Element: Substance (Non-Medication)

While IMO agrees that documentation of non-medication allergies is important in clinical care, we do have concerns regarding maturity and use of the technical specifications cited to support the proposed Level 2 data element submissions in this data class.

The following technical specifications are cited to support the proposed level 2 data elements in the Allergies and Intolerances data class:

  • C-CDA Implementation Guidance Conformance (CONF:1098-16324), for Substance or Device Allergy - Intolerance Observation (V2)
  • FHIR US Core Allergy Intolerance Profile: (v1.0.0: STU based on FHIR R3).
  • FHIR US Core Resource Profile: USCore AllergyIntolerance (v5.0.0 Preview CI Build)

The C-CDA specification for Substance or Device Allergy is not widely implemented and therefore does not meet the requirement as a Level 2 data element. The value set referenced in the specification, Substance Reactant for Intolerance OID: 2.16.840.1.113762.1.4.1010.1 is poorly curated. This value set contains over 47,000 codes, includes active pharmaceutical ingredients (single and multiple ingredient drugs and mix of branded and non-proprietary names), drugs used in veterinary medicine to include Ivermectin (Heartgard Plus) and Chlorhexidine Gluconate (Vet One), as well as codes for non-medications.

Neither FHIR technical specification meets the critiera for a Level 1 or Level 2 data element as they have not been implemented in production environments. The FHIR R3 US Core Allergy Intolerance Profile references the value set, Substance Other Than Clinical Drug OID: 2.16.840.1.113762.1.4.1010.9. This value set is poorly curated, contains over 21,000 codes that include codes for antibodies, antigens and amino acids in addition to relevant content for non-medications.  It is also worth noting that the v5.0.0 FHIR AllergyIntolerance profile references an entirely different value set Common substances for allergy and intolerance documentation including refutations OID: 2.16.840.1.113762.1.4.1186.8 which includes substances, medications, and food.   

IMO does not support the inclusion of Level 2 data elements (Substance (Non-Medication), Substance (Food)) in the Allergies and Intolerances Data Class in USCDI V3 as currently proposed. 

IMO does not support the inclusion of Level 2 data elements (Substance (Non-Medication), Substance (Food)) in the Allergies and Intolerances Data Class in USCDI V3 as currently proposed. 

Log in or register to post comments