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 Allergies ver6.pdf
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 (clinical 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 (clinical note 3)
- Heparins
- Iodinated contrast media
- Opiates (clinical 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.
Jonathan's clinical notes:
1. Regardless of whether these are true biochemical allergies, almost all clinicians lump together all drugs that are hazardous to an individual patient, and they are commonly if incorrectly known as "allergies" because that's the word the patients know and hear. So we are including major intolerance groups in this list.
2. Products specifically containing aspirin
3. Drugs to be flagged and avoided in patients with G6PD deficiency, such as aspirin, dapsone, etc. Note that aspirin itself actually is a member of three of the groups listed here.
4. There are technically three different groups of opiates for allergy purposes, but most of the ones used fall into the phenanthrene group (codeine, oxycodone, morphine, hydromorphone, etc.). The outliers are fentanyl, meperidine, methadone and propoxyphene -- but there's still some cross-reactivity.
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