Joint openEHR/FHIR review of Allergy/Intolerance
Jul 11, 2014I previously announced that:
we’re going to do a joint review of the FHIR resources for Allergy/Intolerance (AllergyIntolerance and AdverseReaction), and the openEHR archetype for the equivalent content (openEHR-EHR-EVALUATION.adverse_reaction.v1). The review is going to be done on the openEHR CKM, on a newly prepared archetype that shows the essential content models of the existing archetypes and resources (they’re quite different)
Well, the review is now open on the openEHR CKM, and will close on 28th July. We invite all interested parties - clinicians, programmers, systems analysts, etc, to contribute to the review. Even if all you contribute is a list of what fields you presently support in your existing system, this is a valuable contribution.
This blog post has some further details to help the FHIR/HL7 community with this process.
The archetype that is being reviewed is the result of a thorough review of both the FHIR and openEHR content, informed by the HL7 Allergy DAM and the joint NHS/Microsoft CUI documents.
There are 3 sections below:
- Discussion of specific issues that arose during the editorial preparation
- Map between the review archetype and the existing FHIR resources
- Notes about the review process for the FHIR community
Specific Issues for the Review
1. Who is invited to participate
The review of this archetype is open to everyone, whether they are HL7 members, members of the openEHR community, the FHIR community, or otherwise unengaged. We would like as many people as possible to review the content. Although the content is primarily clinical, and for this reason clinical review is the main focus of this review, we are also very much interested in review from technical people (developers, analysts, standards folks), particularly in regard to whether there are obstacles in this design that would make it difficult to represent existing legacy content (whether in databases or some exchange format) using this logical model.
2. Split between AllergyIntolerance/AdverseReaction
The FHIR archetype is split into 2 parts; the AllergyIntolerance resource that represents the notification of a risk of reaction, and the AdverseReaction that describes specific past reactions. The allergy intolerance resource references 0..* past reactions. This means that you can describe an adverse reaction event without providing an overall assessment of risk.
This proposed archetype does not allow for this separability, and the reaction event details can only be used in the context of the evaluation/notification of the risk. The editorial team expects that there will be a need for an Adverse Event report content model, but that this will need a different content model to the one for reaction event details in this archetype.
This raises design questions about the other resources that currently use AdverseReaction. We are seeking comment about this issue, and there will be further discussion of this on the FHIR and Patient Care mailing lists.
3. Collapsing Exposure
The FHIR AdverseReaction allows for a single event with multiple possible causative agents. This archetype doesn’t. This is related to the previous issue, in that we are reporting issues with substances here, not reporting of Adverse Events. We are seeking comment as to whether existing systems do or should allow for multiple causative agents in the context of evaluating a propensity to a reaction.
4. Element Names
The names of the fields in the archetype are not valid FHIR element names. In the Archetype, these names have UI implications, where they do not necessarily do so in the FHIR resource. Reviewers should assume that the archetype field names will be converted to valid (and sometimes shorter) element names in the resulting FHIR resource, so extensive comment on this is not needed.
5. Core (or 80/20)
OpenEHR and FHIR have different models for extensibility. This influences the way that openEHR and FHIR handle assessment of core. This archetype includes some specific elements that were not part of the FHIR resources. Some of them may become core elements of the FHIR resources, while others might be relegated to extensions. We are interested in comment on this. In particular, we are seeking comment/input from both clinicians and technicians as to which fields in this archetype that existing systems support/collect/(could) populate, as this will help guide this decision.
6. Exposure Category
This is a common feature in many models, but the editorial team is not sure why, and proposes to remove it. We are interested in both clinical arguments for and against its presence, as well as input as to whether existing systems populate it, and if so, how.
Map between the review archetype and the existing FHIR resources
This table provides a basic map between the review archetype and the existing FHIR resources, to assist FHIR reviewers to make their comments.
| Open EHR | Existing FHIR Resources |
| Header | Scope and Use |
| Data: |
Substance
Status
Seriousness
Reaction Type
Comment
Reaction Event
Specific Substance
Certainty
Manifestation Details
Manifestation
Severity
Reaction Description
Onset of Reaction
Duration of Reaction
Severity of Reaction
Reaction Details
Duration of Exposure
Exposure Category
Initial Exposure
Exposure Description
Exposure Details
Clinical Management Description
Reporting Details
Multimedia
Information Source
| Reaction Comment | FHIR: |
AllergyIntolerance.substance (.code)
AllergyIntolerance.status
AllergyIntolerance.criticality
AllergyIntolerance.sensitivityType
n/a
AdverseReaction / AllergyIntolerance.reaction
AdverseReaction.exposure.substance
AdverseReaction.exposure.causalityExpectation
AdverseReaction.symptom
AdverseReaction.symptom.code
AdverseReaction.symptom.severity
n/a
AdverseReaction.date
n/a
n/a
AdverseReaction.extension
n/a (nearest is AdverseReaction.exposure.date)
AdverseReaction.exposure.type
AdverseReaction.exposure.date
n/a
AdverseReaction.exposure.extension
n/a
AdverseReaction.exposure.extension
n/a
~AdverseReaction.recorder + Provenance
n/a
|Protocol:
Date Recorded
Supporting Clinical Record Information
Reporting Details
Reaction Reported?
Report Comment Adverse Reaction Report
FHIR Record Provenance
Subject
Identifier
| Recorder | FHIR |
AllergyIntolerance.recordedDate
AllergyIntolerance.sensitivityTest + .extension
n/a
n/a
AllergyIntolerance.extension
AllergyIntolerance.subject
AllergyIntolerance.identifier
AllergyIntolerance.recorder
Note: all the fields labelled as “n/a” in the second column have no direct equivalent in FHIR. Maybe they should, or perhaps they should just be extensions? The fields that are directly mapped to extensions in the table above are where the archetype fields are openEHR extensibility points, and it wouldn’t make sense to define FHIR elements for them.
The following Resource contents have no direct equivalent in the new archetype. If you think they are still needed, you can make a comment about this in the general comments section of the review.
- AdverseReaction.identifier (not needed if event is not a separable model)
- AdverseReaction.didNotOccur (when would this be used?)
Notes about the review process for the FHIR community
We highly recommend that you read the HL7 Allergy and Intolerance DAM (http://wiki.hl7.org/images/1/1b/Allergy_and_Intolerance_INFORM_2013_MAY.pdf), and the MSCUI Allergies documentation (www.mscui.net/DesignGuide/DisplayingAllergies.aspx + www.mscui.net/DesignGuide/RecordingAllergies.aspx) prior to participating in the review.
Also, in the review, remember to review all 3 sections – Header, Data, and Protocol.
To sign up to participate in the review, Go to http://www.openehr.org/ckm/#. You’ll get this page:
Click on the Sign-up link on the top right:
Fill it out, and submit:
Then you get a confirmation Email:
Click on the Activate your account, and you get this:
Now, sign in (top right), and then find the FHIR/OpenEHR adverse reaction:
Double click on it, and you get this:
The content of the archetype is divided into 4 sections:
- Header: the scope, purpose, use etc for the archetype, along with a set of references
- Data: the core clinical content of the archetype
- Protocol: data elements that relate to how the evaluation was performed
- Reference Model: underlying content that isn’t important for the review process