Representing Patient Allergies and Intolerances; Medications

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Standard	RxNorm	Final	Production		Yes	Free	N/A
Standard	SNOMED CT® U.S. Edition	Final	Production		Yes	Free	N/A
Standard	National Drug Code (NDC)	Final	Production	Feedback Requested	No	Free
Emerging Standard	Medication Reference Terminology (MED-RT)	Final	Pilot	Feedback Requested	No	Free	No

Limitations, Dependencies, and Preconditions for Consideration	Applicable Value Set(s) and Starter Set(s)
When a medication allergy necessitates capture by medication class, SNOMED CT U.S. Edition should be used. MED-RT replaces VA's NDF-RT, which was sunsetted in 2018. MED-RT has the capability to represent medication classes for use as an allergen category, and currently requires MeSH terms for medication classes. RxNorm: Refers to the RxNorm source specifically (and not to other sources that are included with the RxNorm download).	Representing Medication: Clinical Drug Ingredient (2.16.840.1.113762.1.4.1010.7) (RxNorm ingredient codes) Representing Drug Classes for Allergy and Intolerance documentation: Pharmaceutical / biologic product (product) (SNOMED CT U.S. Edition 373873005) is the parent to pharmaceutical/biologic class hierarchy Medication drug class for allergen intolerance SCT (2.16.840.1.113762.1.4.1114.14) Representing Adverse Reactions/Intolerances: Propensity to adverse reactions to drug (disorder) (SNOMED CT U.S. Edition 419511003) is parent to: Drug Allergy (disorder) (SNOMED CT U.S. Edition 416098002) and child terms/codes

Limitations, Dependencies, and Preconditions for Consideration

Applicable Value Set(s) and Starter Set(s)

When a medication allergy necessitates capture by medication class, SNOMED CT U.S. Edition should be used.
MED-RT replaces VA's NDF-RT, which was sunsetted in 2018. MED-RT has the capability to represent medication classes for use as an allergen category, and currently requires MeSH terms for medication classes.
RxNorm: Refers to the RxNorm source specifically (and not to other sources that are included with the RxNorm download).

Representing Medication:

Clinical Drug Ingredient (2.16.840.1.113762.1.4.1010.7) (RxNorm ingredient codes)

Representing Drug Classes for Allergy and Intolerance documentation:

Pharmaceutical / biologic product (product) (SNOMED CT U.S. Edition 373873005) is the parent to pharmaceutical/biologic class hierarchy
Medication drug class for allergen intolerance SCT (2.16.840.1.113762.1.4.1114.14)

Representing Adverse Reactions/Intolerances:

Propensity to adverse reactions to drug (disorder) (SNOMED CT U.S. Edition 419511003) is parent to:
- Drug Allergy (disorder) (SNOMED CT U.S. Edition 416098002) and child terms/codes

Comment

Submitted by cmcdonald on 2018-10-01

Agree - MED-RT should be the…

Agree - MED-RT should be the preferred class specification. It is tied to RxNorm and reasonably sized.

Submitted by rmcclure on 2017-12-20

Need to include appropriate SNOMED specifics

The Consideration: "When a medication allergy necessitates capture by medication class, SNOMED CT® should be used." would mean the use of a specific SNOMED CT subset that are descendants of Pharmaceutical / biologic product (product) [373873005]. As a change from NDFRT this recommendation should also have specifications regarding the concern about consistency among the members of a drug class concept.

Also, it is VERY confusing that the SNOMED CT consideration noted above does not align with the SNOMED CT "starter Set" noted on the right - this set of "disorders" is a completely different thing than the substance-type recommendations every where else in this part of the ISA. This is extremely problematic and as a condition-type concept should not be used here at all. That is not to say that implementers should not consider using disorders to also represent allergies, but the ISA has consistently appropriately said that the best way to represent an allergy/intolerance reactant is using a concept that is a substance, not a condition. Don't change this.

Submitted by kwboone on 2017-11-20

Links and descriptions are lacking.

You link to RX Norm, but not to the value set. How hard would it be to include https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1010.7/expansion

Similarly, for SNOMED CT. You've identified 327,000 codes, but not much else. At the very least you could identify the appropriate heirarchies.

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Representing Patient Allergies and Intolerances; Medications

Comment

Agree - MED-RT should be the…

Need to include appropriate SNOMED specifics

Links and descriptions are lacking.

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