Summary of notes from http://notes.openmrs.org/Design-Forum-2013-05-29
The allergy data model (added in 1.7) covers the fields we need for HL7 2.6 compatibility. The allergy UI in the legacy web application is basically a placeholder, and not worth preserving.
What developers need:
- Get list of allergies for a patient
- Add/remove allergies (remove distinct from soft-delete)
- check a med against the allergy list and get back some set of alerts
- check allergies when a new med is added
- check meds when a new allergy is added
- given an allergen, have the API suggest a broader group ("are you sure you didn't mean Penicillins instead of Amoxicillin?")
What users need:
- When ordering meds, show the list of allergies (and warn about contra-indications)
- Show allergies on patient summary (along with problem list and active orders)
- Maybe show some indication of allergies on dashboard
- Darius (not a doctor) thinks they should be listed in the header. Burke and Jonathan both say this is overkill.
- Add/Remove allergies
- ideally you'd want to be able to do this while writing an encounter note
Possible Allergens
Jonathan: you can define a short list of ~50 items that encompass 98% of what you'll see. (The following is from BWH.)
- Drugs
- ACE inhibitors
- Angiotensin receptor blockers
- Aspirin (note 2)
- Cephalosporins (for now, all generations. There is some controversy about whether third- and fourth-generation cephalosporins have any cross-reaction with penicillins)
- Erythromycins
- Fluoroquinolones
- G6PD-sensitive drugs (note 3)
- Heparins
- Iodinated contrast media
- Opiates (note 4)
- NSAIDs
- Penicillins
- Statins
- Sulfonamides (sulfa drugs)
- Foods
- Beef
- Caffeine
- Chocolate
- Dairy products
- Eggs
- Fish
- Milk Protein
- Peanuts
- Shellfish
- Soy
- Strawberries
- Wheat/gluten
- Environmentals
- Tape
- Bee stings
- Dust
- Latex
- Mold
- Pollen
- Ragweed
Burke says that to cover the long tail we need to support any concept whose class is Allergen, Med, or MedSet.
We should build a widget something like a searchable tree giving the "98% list" and also with a "choose from complete list" option. If you choose from the pick list, we can automatically infer the AllergyType (DRUG, FOOD, etc), otherwise the user has to choose it.
Possible values for Reactions
Short list of common reactions (but there's a long tail of uncommon ones):
- Anaphylaxis
- Anemia
- Angioedema
- Arrhythmia
- Bronchospasm
- Cough
- Diarrhea
- Dystonia
- Fever
- Flushing
- GI Upset
- Headaches
- Hepatotoxicity
- Hives
- Hypotension
- Itching
- Mental Status Change
- Musculoskeletal pain
- Myalgia
- Nausea
- Rash
- Renal toxicity
- Rigors
- Seizures
- Shortness of Breath
- Sneezing
- Swelling
- Thrombocytopenia
- Vomiting
- Wheezing
The UI should push you to this short list, but give you an option for "pick from whole list" (the complete list is probably concepts with class=Symptom, Finding, Symptom/Finding