{
"description": "This profile represents the constraints applied to the AllergyIntolerance resource by the PS-CA project, which is informed by the constraints of the [AllergyIntolerance IPS-UV profile](http://hl7.org/fhir/uv/ips/StructureDefinition-AllergyIntolerance-uv-ips.html) and the [Canadian Baseline Profile](http://build.fhir.org/ig/HL7-Canada/ca-baseline/branches/master/StructureDefinition-profile-allergyintolerance.html) to allow for cross-border and cross-jurisdiction sharing of Allergies and Intolerances. It documents the relevant allergies or intolerances (conditions) for a patient, describing the kind of reaction (e.g. rash, anaphylaxis,..); preferably the agents that cause it; and optionally the criticality and the certainty of the allergy.",
"_filename": "structuredefinition-profile-allergyintolerance-ca-ps.json",
"package_name": "ca.infoway.io.psca",
"date": "2024-04-09T00:00:00-08:00",
"derivation": "constraint",
"publisher": null,
"fhirVersion": "4.0.1",
"name": "AllergyIntolerancePSCA",
"abstract": false,
"copyright": "Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy).",
"type": "AllergyIntolerance",
"experimental": "false",
"resourceType": "StructureDefinition",
"title": "Allergy Intolerance (PS-CA)",
"package_version": "2.0.0-DFT-Ballot-alpha-1",
"status": "draft",
"id": "60344d57-6abb-441d-9983-4cc0a0c08b8d",
"kind": "resource",
"url": "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/allergyintolerance-ca-ps",
"version": null,
"differential": {
"element": [ {
"id": "AllergyIntolerance.extension",
"path": "AllergyIntolerance.extension",
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
}
}, {
"id": "AllergyIntolerance.extension:abatement",
"max": "1",
"path": "AllergyIntolerance.extension",
"type": [ {
"code": "Extension",
"profile": [ "http://hl7.org/fhir/StructureDefinition/allergyintolerance-abatement" ]
} ],
"sliceName": "abatement"
}, {
"id": "AllergyIntolerance.clinicalStatus",
"path": "AllergyIntolerance.clinicalStatus",
"comment": "IPS-UV no longer flags this as a Must Support Element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.\n\nFHIR Base Note: This element is a modifier element with a required vocabulary binding in the base FHIR specification.\n\nIPS-UV Note: In the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed."
}, {
"id": "AllergyIntolerance.clinicalStatus.coding",
"min": 1,
"path": "AllergyIntolerance.clinicalStatus.coding",
"comment": "Many Canadian systems currently use the [AllergyIntoleranceStatusCode](https://tgateway.infoway-inforoute.ca/vs/allergyintolerancestatuscode) value set comprised of SNOMED CT codes. Additionally, some Canadian systems that have implemented HL7 V3 are currently using [HL7 v3 Value Set ActStatus](http://hl7.org/fhir/R4/v3/ActStatus/vs.html). Both can be mapped and provided as additional codings to the required FHIR AllergyIntolerance clinicalStatus codes. The element is sliced to express the required population of at least the HL7AllergyIntoleranceClinicalStatus slice since it is a required coding.",
"slicing": {
"rules": "open",
"description": "Discriminated by the bound value set",
"discriminator": [ {
"path": "$this",
"type": "pattern"
} ]
}
}, {
"id": "AllergyIntolerance.clinicalStatus.coding:HL7AllergyIntoleranceClinicalStatus",
"max": "1",
"min": 1,
"path": "AllergyIntolerance.clinicalStatus.coding",
"short": "Required value set for AllergyIntolerance Clinical Status.",
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/allergyintolerance-clinical",
"description": "HL7 required value set for AllergyIntolerance Clinical Status."
},
"sliceName": "HL7AllergyIntoleranceClinicalStatus",
"definition": "The clinical status of an allergy or intolerance."
}, {
"id": "AllergyIntolerance.clincalStatus.coding:statusCodeSCTCA",
"path": "AllergyIntolerance.clinicalStatus.coding",
"short": "Code for allergy or intolerance status",
"binding": {
"strength": "required",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/allergyintolerancestatuscode",
"description": "Represents whether an allergy/intolerance is “active” or resolved (indicating no longer active)."
},
"comment": "This value set combines concepts that can be mapped to clinical status as well as verification status concepts. Implementers are expected to utilize concept maps to ensure the code captured in the source is appropriately mapped to the correct allergy intolerance element.",
"sliceName": "statusCodeSCTCA",
"definition": "Code for an allergy or intolerance statement. Represents whether an allergy/intolerance is active or resolved (indicating no longer active)."
}, {
"id": "AllergyIntolerance.clincalStatus.coding:ActStatusCodeV3",
"path": "AllergyIntolerance.clinicalStatus.coding",
"short": "HL7 V3 ActStatus code",
"binding": {
"strength": "required",
"valueSet": "http://terminology.hl7.org/ValueSet/v3-ActStatus",
"description": "Represents an ActStatus code used by systems implementing HL7 V3."
},
"sliceName": "ActStatusCodeV3",
"definition": "Codes representing the defined possible states of an Act, as defined by the Act class state machine."
}, {
"id": "AllergyIntolerance.verificationStatus",
"path": "AllergyIntolerance.verificationStatus",
"comment": "IPS-UV no longer flags this as a Must Support Element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.\n\nFHIR Base Note: This element is a modifier element with a required vocabulary binding in the base FHIR specification.\n\nIPS-UV Note: In the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed."
}, {
"id": "AllergyIntolerance.verificationStatus.coding",
"min": 1,
"path": "AllergyIntolerance.verificationStatus.coding",
"comment": "Many Canadian systems currently use the [AllergyIntoleranceStatusCode](https://tgateway.infoway-inforoute.ca/vs/allergyintolerancestatuscode) value set comprised of SNOMED CT codes that can be mapped and provided as additional codings to the required FHIR AllergyIntolerance-verification codes. The element is sliced to express the required population of at least the HL7VerificationStatus slice since it is a required coding.",
"slicing": {
"rules": "open",
"description": "Discriminated by the bound value set",
"discriminator": [ {
"path": "$this",
"type": "pattern"
} ]
}
}, {
"id": "AllergyIntolerance.verificationStatus.coding:HL7VerificationStatus",
"min": 1,
"path": "AllergyIntolerance.verificationStatus.coding",
"short": "Required value set for AllergyIntolerance Verification Status.",
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/allergyintolerance-verification",
"description": "HL7 required value set for AllergyIntolerance Verification Status."
},
"sliceName": "HL7VerificationStatus",
"definition": "Code for an allergy or intolerance statement. Represents whether an allergy/intolerance is active or resolved (indicating no longer active)."
}, {
"id": "AllergyIntolerance.verificationStatus.coding:statusCodeSCTCA",
"path": "AllergyIntolerance.verificationStatus.coding",
"short": "Code for allergy or intolerance status",
"binding": {
"strength": "required",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/allergyintolerancestatuscode",
"description": "Represents whether an allergy/intolerance is “active” or resolved (indicating no longer active)."
},
"comment": "This value set combines concepts that can be mapped to clinical status as well as verification status concepts. Implementers are expected to utilize concept maps to ensure the code captured in the source is appropriately mapped to the correct allergy intolerance element.",
"sliceName": "statusCodeSCTCA",
"definition": "Code for an allergy or intolerance statement. Represents whether an allergy/intolerance is active or resolved but also includes values like confirmed present and refuted"
}, {
"id": "AllergyIntolerance.type",
"path": "AllergyIntolerance.type",
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content."
}, {
"path": "AllergyIntolerance.code",
"min": 1,
"short": "Concept - reference to a terminology or just text",
"type": [ {
"code": "CodeableConcept",
"profile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" ]
} ],
"mustSupport": true,
"binding": {
"strength": "preferred",
"valueSet": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/substanceandpharmaceuticalbiologicproductcode",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AllergyIntoleranceCode"
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding",
"extension": [ {
"url": "purpose",
"valueCode": "candidate"
}, {
"url": "valueSet",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/hc-CCDD"
}, {
"url": "documentation",
"valueMarkdown": "Canadian Clinical Drug Data Set providing codes for identification of medications and medical devices in Canada. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding",
"extension": [ {
"url": "purpose",
"valueCode": "candidate"
}, {
"url": "valueSet",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/LicensedNaturalHealthProducts"
}, {
"url": "documentation",
"valueMarkdown": "All concepts represented in the Licensed Natural Health Products Database. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding",
"extension": [ {
"url": "purpose",
"valueCode": "candidate"
}, {
"url": "valueSet",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/ICD10CA"
}, {
"url": "documentation",
"valueMarkdown": "Any code from ICD-10 CA. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding",
"extension": [ {
"url": "purpose",
"valueCode": "candidate"
}, {
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-allergies-uv-ips"
}, {
"url": "documentation",
"valueMarkdown": "Negation/exclusion codes for reporting no known allergies or not available data."
} ]
} ],
"description": "Codes for that combine substance and pharmaceuticalbiologicproduct value sets from the SNOMED CT Canadian edition"
},
"max": "1",
"id": "AllergyIntolerance.code",
"comment": "Many Canadian implementations use codes from either SNOMED CT and the SNOMED CT Canada Extension to describe this concept, while others may still be using localized code systems or text descriptions. The AllergyIntoleranceSubstanceCondition - IPS ValueSet contains codes that are subsumed within the SNOMED CT CA SubstanceAndPharmaceuticalBiologicProductCode ValueSet that is preferred for this element.\n\n See additionalBinding extension.\r\n\r\n Future releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content."
}, {
"id": "AllergyIntolerance.patient",
"path": "AllergyIntolerance.patient",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" ]
} ],
"mustSupport": true
}, {
"id": "AllergyIntolerance.patient.reference",
"min": 1,
"path": "AllergyIntolerance.patient.reference",
"mustSupport": true
}, {
"id": "AllergyIntolerance.onset[x]",
"path": "AllergyIntolerance.onset[x]",
"slicing": {
"rules": "open",
"ordered": false,
"discriminator": [ {
"path": "$this",
"type": "type"
} ]
}
}, {
"id": "AllergyIntolerance.onsetDateTime",
"path": "AllergyIntolerance.onsetDateTime",
"mustSupport": true
}, {
"id": "AllergyIntolerance.reaction",
"path": "AllergyIntolerance.reaction",
"mustSupport": true
}, {
"id": "AllergyIntolerance.reaction.substance",
"path": "AllergyIntolerance.reaction.substance",
"comment": "The IPS-UV does not consider this element Must Support, however some Canadian systems may capture allergen substances separately from AllergyIntolerance.code. Further investigation is required to determine what approaches are in use by participating jurisdictions."
}, {
"id": "AllergyIntolerance.reaction.manifestation",
"path": "AllergyIntolerance.reaction.manifestation",
"type": [ {
"code": "CodeableConcept",
"profile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" ]
} ],
"binding": {
"strength": "preferred",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ReactionManifestationCode"
} ],
"description": "Codes for the allergy or intolerance reaction manifestation from the SNOMED CT Canadian edition value set"
},
"comment": "Future releases of PS-CA may require use of coded entries. In this release, however, implementers that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content. \r\n See guidance in Missing Data Expectations section in the Profiling Conventions page of the guide for cases where the system wants to convey that the manifestation is",
"mustSupport": true
}, {
"id": "AllergyIntolerance.reaction.severity",
"path": "AllergyIntolerance.reaction.severity",
"comment": "The IPS-UV flags AllergyIntolerance.reaction.severity as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated that the element may not be supported by the majority of systems today. Senders are encouraged to include this element in generated Patient Summary documents when available. Receivers are encouraged to process and display the data when it is present, as it may contain clinically relevant information such as life-threatening reactions. Vendors should expect that some jurisdictions may elevate this element to Must Support within their local implementations."
} ]
},
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/AllergyIntolerance"
}