Vision of the Summary Care Record within the NHS Care Records Service

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Vision of the Summary Care Record within the NHS
Care Records Service
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Early Adopters programme - Learning together
about information sharing

• Patients' perspective
• Clinicians' perspective

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Benefits case

• Effectively imparting vital information in urgent
  situations - medications, adverse reactions,
  allergies
• Additional content e.g. for people with complex
  needs

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Realising the benefits - clinical and business
change

• Initial work for general practice, initial
  benefits for secondary care?
• e.g. AE, OOH, LTCs, Community Pharmacy
• It's all in the exchange of information -
  clinical, accurate, necessary

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SCR and Allergies and Adverse Reactions (AARs)
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What are we trying to achieve with sharing
Allergies and Adverse Reactions?

• Reduction in the repeat exposure of drugs,
  substances and foods to a patient who has had a
  previous Allergy or Adverse Reaction (AARs) to a
  specific substance.
• E.g. by recording and sharing AARs
• Supporting the maintenance of a list of AARs in a
  system
• Providing trigger points for the working of
  clinical decision support systems This is where
  SNOMED CT comes in.

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Definitions and Exclusion

• Definitions
• An Adverse Reaction is defined as any undesirable
  or unwanted consequence of a preventative,
  diagnostic, or therapeutic procedure or regimen.
• Adverse Drug Reaction - A response to a
  pharmaceutical product which is noxious and
  unintended and which occurs at doses normally
  used in man for prophylaxis, diagnosis, or
  therapy of disease or for modification of
  physiological function.
• An Allergy is an acquired hypersensitivity caused
  by exposure to a particular antigen (allergen)
  resulting in a marked increase in reactivity to
  that antigen upon subsequent exposure.
• Allergic Drug Reaction (Allergic Response) A
  response to a pharmaceutical product to which an
  individual has become sensitised, in which
  histamine, serotonin and other vasoactive
  substances are released, in response to an immune
  system-mediated reaction.
• This causes systemic symptoms which can include
  pruritus, erythema, flushing, urticaria,
  angio-oedema, nausea, diarrhoea, vomiting,
  laryngeal oedema, bronchospasm, hypotension,
  cardiovascular collapse and death.
• Exclusions
• Contra-indications.

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With whom did we consult?

• Royal College of Physicians
• Consultation Exercise
• The Faculty of Pharmaceutical Medicine
• The British Society for Allergy and Clinical
  Immunology
• The British Pharmacological Society
• The Royal College of Physicians including the
  General Internal Medicine Committee Joint
  Standing Committee for Clinical Pharmacology and
  Therapeutics
• Medicines and Healthcare Regulatory Authority
• Royal College of Anaesthetists
• Royal College of Pathologists
• The Drugs Prescribing Section of the British
  Geriatrics Society
• Royal College of Nursing
• Royal College of Midwives
• National Patient Safety Agency

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Key Modelling Principle Event and Propensity
split

• Event
• Recording an Adverse Reaction or Allergic
  Response to a drug, substance or food
• The purpose of this entry is the recording of the
  clinical event. The structure of this record
  should be similar to the recording of any other
  event, with no restrictions. It should be
  possible to record severity and certainty about
  diagnoses as in any other consultation record.
• Propensity (or Condition)
• Recording a clinicians opinion about future risk
  of (or propensity to) an allergy or other adverse
  reaction if the patient is exposed to a substance
  
• These records make up the 'allergies and ADR
  list. The purpose of this kind of record is to
  alert the future care professional both from the
  record and through decision support software.

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Propensity and Event recording of information
Allergic Reaction to Amoxicillin
Allergy to Amoxicillin
Allergic reaction to peanut
Allergy to Peanut
Allergic reaction to peanut
Allergic reaction to peanut
Propensity to Adverse Reaction to Lisinopril
Adverse reaction to Lisinopril
AAR Propensity
AAR Event
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Propensity and Event
It is appropriate to have an AAR Propensity
record without having a AAR Event Record
Allergy to Amoxicillin
Immunological tests Hereditary conditions?
AAR Propensity
AAR Event
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Propensity and Event the AAR list
Allergic Reaction to Amoxicillin
Allergy to Amoxicillin
Allergic reaction to peanut
Allergic reaction to peanut
Allergy to Peanut
Allergic reaction to peanut
Propensity to Adverse Reaction to Lisinopril
Adverse reaction to Lisinopril
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Using SNOMED CT and HL7v3 Together

• What does SNOMED CT give to the representation of
  Allergies and Adverse reactions which Read 2
  and CTV3 do not?
• Post Coordination of allergy and causative
  agent
• Supports the allergy event/propensity split

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Allergy Propensity template
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Post Coordination of the Allergy and Causative
Agent
In SNOMED CT expressional grammar an example
would be
416098002 drug allergy 246075003
causative agent 387048002 nystatin
The expressions below would be represented by the
general HL7 Clinical Data (CD) pattern.
Or more simply put we combine two codes to create
an expression describing the AAR
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Examples
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What does this give us?

• The ability to describe large numbers of AARs
• Drugs
• Reactions to actually prescribed drugs (AMP-trade
  names, VMP-generic names)
• Reaction to classes of drugs e.g. Penicillins
• Drug ingredients
• Foods
• Substances
• Without duplication of content in SNOMED CT

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Challenges that SNOMED CT brings

• SNOMED CT is complex if different systems use
  SNOMED CT in different ways the interoperability
  may be compromised.
• SNOMED CT Context Model
• Findings Context used in restricted manner
• Subject Relationship Context non modified,
  always default (subject of the record)
• Temporal Context Default (current at specified
  time)
• Other available attributes
• Severity

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Findings Context and AAR
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Supporting Documentation Additional Credits

• SCG site http//www.connectingforhealth.nhs.uk/sys
  temsandservices/data/scg/publications
• E prescribing Team NHS CFH
• Ann Slee
• Pete Horsfield