PCC-2

Query Problems and Allergies

This section corresponds to Transaction PCC-2 of the IHE Patient Care Coordination Technical Framework. Transaction Query Problems and Allergies is used by the Clinical Data Consumer and Problem and Allergy Data Repository Actors.

Transaction Query Problems and Allergies uses the same pattern as transaction PCC-1. Therefore, the Referenced Standards and Interaction Diagrams sections also serve to document the standards and interactions used in this transaction. Information specific to this transaction is described in futher detail below in the section on Domain Content.

Use Case Roles

Clinical Data Consumer		Problem and Allergy Data Repository
Query Problems and Allergies

Actor

Clinical Data Consumer

Role

Requests a list of problems or allergies for a given patient matching a minimal set of selection criteria from the Problem and Allergy Repository.

Actor

Problem and Allergy Data Repository

Role

Returns problems or allergy entries for a given patient matching the selection criteria supplied by the Clinical Data Consumer.

Domain Content

This section lists the requirements specific to the Query Problems and Allergies transaction.

Note:

Implementors of a Problems and Allergies Data Repository Actor, or a Clinical Data Consumer Actor shall publish an HL7 Conformance Profile that indicates the vocabularies and code sets that they support for this transaction.

Get Care Record Profile Query

careProvisionCode

A Clinical Data Consumer may specify the following values from the HL7 ActCode vocabulary (2.16.840.1.113883.5.4) to obtain the observations listed in the table below.

Code	Returns	Template Id
MEDCCAT	All problem entries	Problem Entry
ALLGCAT	All allergies	Allergy and Intolerance Entry
CONDLIST	All Concern Entries	Concern Entry
PROBLIST	All Problem Concerns	Problem Concern
INTOLIST	All Allergy Concerns	Allergy and Intolerance Concern
RISKLIST	All Risks1	Concern Entry

Note 1: Risks are other concerns that may not be explicitly classified as problem or allergy concerns.

A Clinical Data Consumer Actor may make requests using other codes to obtain information about specific problem, allergy, or risk observations, however, the Problem and Allergy Data Repository Actor need not honor these codes.

One such set of codes that may be used are the problem codes listed in the Problem Entry, and reproduced in the table below.

Problem Codes

Code	Description
64572001	Condition
418799008	Symptom
404684003	Finding
409586006	Complaint
248536006	Functional limitation
55607006	Problem
282291009	Diagnosis

Another such set of codes that may be used are from the HL7 ObservationIntoleranceType vocabulary, as used in the Allergy and Intolerance Entry.

Additional codes for problems and allergies may be found in SNOMED CT (2.16.840.1.113883.6.96), ICD-9-CM diagnosis codes (2.16.840.1.113883.6.103), MEDCIN (2.16.840.1.113883.6.26), and in other controlled vocabularies.

Note:

The code value specified in the query may represent a code found in either the <code> or <value> elements of the <observation> element.

careProvisionReason

When careProvisionCode is set to INTOLIST, or ALLGCAT from the HL7 ActCode domain (see above), or other values specific to allergies and/or intolerances, the Clinical Data Consumer may specify the a code identifying a substance in the <value> element of the <careProvisionReason> element to refine the query to allergies to a particular substance. The <value> element shall contain a code from a controlled vocabulary that describes a substance. The Problem and Allergy Data Repository Actor need not honor these codes.

For Public Comment

Is this a correct use of careProvisionReason? If not, how could we query for an allergy to a specific substance? Only SNOMED-CT supports such a statement in a single post-coordinated code, which prevents use of NDC or RxNorm codes to identify the substance. Should we extend the parameterList to support specification of the drug using other codes?

Get Care Record Profile Response

A Problems and Allergies Data Repository Actor shall respond to a query request by returning clinical statements matching the query parameter returned within <pertinentInformation3> data elements.

The clinical statements that are returned for codes specified in the table above in the section on careProvisionCode shall conform to the template identifiers shown therein.

A Problems and Allergies Data Repository Actor may respond to query requests using other codes to return information about specific problem, allergy or risk observations. These observations shall conform to the Problem Entry or Allergy and Intolerance Entry