KjAllergyIntolerance

The KjAllergyIntolerance is used for registration of adverse drug reactions (Legemiddelreaksjon) or other allergies (Annen Allergi) that are critical in an emergency medical context.

The two types of AllergyIntolerance are separated on 'category':

DrugReaction (Legemiddelreaksjon), category=medication
OtherAllergen (Annen Allergi), category=environment/food/biologic

Adverse drug reactions can be reported on:

ATC (Anatomical Therapeutic Chemical Classification System).
Drug brand/trademark name.
Excipent (inactive substance) in the drug.
Active ingredient in the drug.

Profile elements

Note that for all FHIR elements which has coding, e.g. code.coding and reaction.manifestation.coding, we want coding.display to always be set for completeness sake as well as coding.code and coding.system.

https://simplifier.net/kjernejournalr4/kjallergyintolerance

Element	Description	Comment
id	Record id.	Id + meta.versionId is the unique identifier.
meta.versionId	Record version id.
clinicalStatus	Used for Status or Probability, see below.	Values can be active \| inactive
verificationStatus	Used for Status or Probability, see below.	Values can be refuted, confirmed, unconfirmed or entered-in-error.
verificationStatus.extension.Presumed	Boolean extension used to set Probability, see below.	Presumed will in R5 be added to the valueset for verificationStatus.
category	See description above, values can be food \| medication \| environment\| biologic	The value ‘medication’ shall be used for drug reactions, and typically ´environment´ is used for other allergies.
criticality	Values can be low \| high \| unable-to-assess	Norwegian text is Alvorlighetsgrad.
code.coding	Code for allergy.	Additional coding may be used for extra information. I.e. the ATC code for drug trade name (not userSelected).
code.coding.userSelected	If this coding was chosen directly by the user.	If more than one coding, userSelected shall indicate the main coding. See code example below.
code.extension.inactiveIngredient	Boolean extension if inactive ingredient (hjelpestoffreaksjon).
code.text	Other allergy if no proper code is found.
patient	Who the sensitivity is for.
onset	Estimated or actual date, date-time, or age when allergy or intolerance was identified.
recordedDate	Date when first version of the resource instance was recorded.
recorder	Who recorded the sensitivity first. Must always reference the original recorder of the resource.	Use contained reference.
note	Additional text not captured in other fields.
reaction.manifestation.coding	Type of reaction.
extension.sourceOfInformation	Source of information.
extension.updater	Who changed this version of the resource.	Use contained reference.
extension.updatedDateTime	When this version of the resource was changed.

Status

The status which the critical information record is in.

Status	Norwegian Text	Element Values	Comment
Active	Aktiv	clinicalStatus=active and verificationStatus is used for probability (below).	Use when the registration is active.
Refuted	Avkreftet	clinicalStatus=inactive and verificationStatus=refuted	Use when the allergy or reaction is refuted.
Deleted	Slettet	clinicalStatus=null and verificationStatus=entered-in-error	When an erroneous registration. Use the REST delete endpoint.
Inactive	Inaktiv	clinicalStatus=inactive and verificationStatus is used for probability.	Use to remove a duplicate registration.

Probability

Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.

Probability	Norwegian Text	Element Values
Probable	Sannsynlig	clinicalStatus=active and verificationStatus=unconfirmed and verificationStatus.extension.Presumed=true
Suspected	Mistenkt	clinicalStatus=active and verificationStatus=unconfirmed and verificationStatus.extension.Presumed=null or false
Confirmed	Bekreftet	clinicalStatus=active and and verificationStatus=confirmed and verificationStatus.extension.Presumed=null or false

The Presumed extension is set on verificationStatus the following way:

"verificationStatus": {
  "extension": [
    {
      "url": "http://nhn.no/kj/fhir/StructureDefinition/KjPresumed",
      "valueBoolean": true
    }
  ],
  "coding": [
    {
      "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
      "code": "unconfirmed",
      "display": "Unconfirmed"
    }
  ]
}

Examples

Category medication, coding ATC

{
  "resourceType": "AllergyIntolerance",
  "id": "be3e0de3-d4f1-4df7-b0c1-e723bc2cee7d",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2021-03-14T12:01:03.633+01:00",
    "profile": [ "http://nhn.no/kj/fhir/StructureDefinition/KjAllergyIntolerance" ]
  },
  "contained": [ {
    "resourceType": "PractitionerRole",
    "id": "recorderRef",
    "practitioner": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.4",
        "value": "222200063"
      },
      "display": "Fos Perez, Jack"
    },
    "organization": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.101",
        "value": "100100223"
      },
      "display": "Andeby Legevakt"
    },
    "code": [ {
      "coding": [ {
        "system": "http://nhn.no/kj/fhir/CodeSystem/CategoriesOfHealthProfessionals",
        "code": "LE",
        "display": "Lege"
      } ]
    } ]
  } ],
  "extension": [ {
    "url": "http://nhn.no/kj/fhir/StructureDefinition/KjSourceOfInformation",
    "valueCoding": {
      "system": "http://nhn.no/kj/fhir/CodeSystem/SourceOfInformation",
      "code": "2",
      "display": "Observert av registrerende helsepersonell"
    }
  } ],
  "clinicalStatus": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
      "code": "active",
      "display": "Active"
    } ]
  },
  "verificationStatus": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
      "code": "confirmed",
      "display": "Confirmed"
    } ]
  },
  "category": [ "medication" ],
  "criticality": "high",
  "code": {
    "coding": [ {
      "system": "http://nhn.no/kj/fhir/CodeSystem/ATC",
      "code": "J01CA",
      "display": "Penicilliner med utvidet spekter"
    } ]
  },
  "patient": {
    "reference": "Patient/13116900216"
  },
  "onsetDateTime": "2021-03-11T00:00:00+01:00",
  "recordedDate": "2021-03-14T12:01:03+01:00",
  "recorder": {
    "reference": "#recorderRef"
  },
  "note": [ {
    "text": "Akutt hevelse i tunge og svelg, tiltagende pusteproblemer, kvalme og abdominale smerter."
  } ],
  "reaction": [ {
    "manifestation": [ {
      "coding": [ {
        "system": "http://nhn.no/kj/fhir/CodeSystem/TypeOfReaction",
        "code": "1",
        "display": "Anafylaktisk reaksjon"
      } ]
    } ]
  } ]
}

Categori medication, coding DrugTradeName with ATC code

{
  "resourceType": "AllergyIntolerance",
  "id": "d1fa603b-f62b-4f22-b7fa-da2a7aba852d",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2021-04-06T15:19:01.355+02:00",
    "profile": [ "http://nhn.no/kj/fhir/StructureDefinition/KjAllergyIntolerance" ]
  },
  "contained": [ {
    "resourceType": "PractitionerRole",
    "id": "recorderRef",
    "practitioner": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.4",
        "value": "222200063"
      },
      "display": "Tandberg, Gard"
    },
    "organization": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.101",
        "value": "998570328"
      },
      "display": "Munkholmen Legesenter"
    },
    "code": [ {
      "coding": [ {
        "system": "http://nhn.no/kj/fhir/CodeSystem/CategoriesOfHealthProfessionals",
        "code": "LE",
        "display": "Lege"
      } ]
    } ]
  } ],
  "extension": [ {
    "url": "http://nhn.no/kj/fhir/StructureDefinition/KjSourceOfInformation",
    "valueCoding": {
      "system": "http://nhn.no/kj/fhir/CodeSystem/SourceOfInformation",
      "code": "5",
      "display": "Hentet fra tidligere journal"
    }
  } ],
  "clinicalStatus": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
      "code": "active",
      "display": "Active"
    } ]
  },
  "verificationStatus": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
      "code": "unconfirmed",
      "display": "Unconfirmed"
    } ]
  },
  "category": [ "medication" ],
  "criticality": "high",
  "code": {
    "extension": [ {
      "url": "http://nhn.no/kj/fhir/StructureDefinition/KjInactiveIngredient",
      "valueBoolean": true
    } ],
    "coding": [ {
      "system": "http://nhn.no/kj/fhir/CodeSystem/DrugTradeName",
      "code": "ID_D31A34B4-705F-44D6-8232-92A89CA921B1",
      "display": "Apocillin Tab",
      "userSelected": true
    }, {
      "system": "http://nhn.no/kj/fhir/CodeSystem/ATC",
      "code": "J01CE02",
      "display": "Fenoksymetylpenicillin",
      "userSelected": false
    } ]
  },
  "patient": {
    "reference": "Patient/01035500126"
  },
  "onsetDateTime": "2021-04-01T00:00:00+02:00",
  "recordedDate": "2021-04-06T15:19:01+02:00",
  "recorder": {
    "reference": "#recorderRef"
  },
  "note": [ {
    "text": "Fikk eksematøse reaksjoner som ble behandlet med lokale glukokortikoider pluss antihistaminer for behandling av urtikarielle reaksjoner."
  } ],
  "reaction": [ {
    "manifestation": [ {
      "coding": [ {
        "system": "http://nhn.no/kj/fhir/CodeSystem/TypeOfReaction",
        "code": "10",
        "display": "Alvorlig hudreaksjon"
      } ]
    } ]
  } ]
}

Category medication, coding DrugtradeName and reaction on inactive ingredient

{
  "resourceType": "AllergyIntolerance",
  "id": "d1fa603b-f62b-4f22-b7fa-da2a7aba852d",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2021-04-06T15:19:01.355+02:00",
    "profile": [ "http://nhn.no/kj/fhir/StructureDefinition/KjAllergyIntolerance" ]
  },
  "contained": [ {
    "resourceType": "PractitionerRole",
    "id": "recorderRef",
    "practitioner": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.4",
        "value": "222200063"
      },
      "display": "Tandberg, Gard"
    },
    "organization": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.101",
        "value": "998570328"
      },
      "display": "Munkholmen Legesenter"
    },
    "code": [ {
      "coding": [ {
        "system": "http://nhn.no/kj/fhir/CodeSystem/CategoriesOfHealthProfessionals",
        "code": "LE",
        "display": "Lege"
      } ]
    } ]
  } ],
  "extension": [ {
    "url": "http://nhn.no/kj/fhir/StructureDefinition/KjSourceOfInformation",
    "valueCoding": {
      "system": "http://nhn.no/kj/fhir/CodeSystem/SourceOfInformation",
      "code": "5",
      "display": "Hentet fra tidligere journal"
    }
  } ],
  "clinicalStatus": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
      "code": "active",
      "display": "Active"
    } ]
  },
  "verificationStatus": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
      "code": "unconfirmed",
      "display": "Unconfirmed"
    } ]
  },
  "category": [ "medication" ],
  "criticality": "high",
  "code": {
    "extension": [ {
      "url": "http://nhn.no/kj/fhir/StructureDefinition/KjInactiveIngredient",
      "valueBoolean": true
    } ],
    "coding": [ {
      "system": "http://nhn.no/kj/fhir/CodeSystem/DrugTradeName",
      "code": "ID_D31A34B4-705F-44D6-8232-92A89CA921B1",
      "display": "Apocillin Tab 660 mg"
    } ]
  },
  "patient": {
    "reference": "Patient/01035500126"
  },
  "onsetDateTime": "2021-04-01T00:00:00+02:00",
  "recordedDate": "2021-04-06T15:19:01+02:00",
  "recorder": {
    "reference": "#recorderRef"
  },
  "note": [ {
    "text": "Fikk eksematøse reaksjoner som ble behandlet med lokale glukokortikoider pluss antihistaminer for behandling av urtikarielle reaksjoner."
  } ],
  "reaction": [ {
    "manifestation": [ {
      "coding": [ {
        "system": "http://nhn.no/kj/fhir/CodeSystem/TypeOfReaction",
        "code": "10",
        "display": "Alvorlig hudreaksjon"
      } ]
    } ]
  } ]
}

Category medication, coding ActiveSubstance

{
  "resourceType": "AllergyIntolerance",
  "id": "b61a2de9-dc38-40ea-94ee-634c2e206706",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2021-04-06T15:09:19.583+02:00",
    "profile": [ "http://nhn.no/kj/fhir/StructureDefinition/KjAllergyIntolerance" ]
  },
  "contained": [ {
    "resourceType": "PractitionerRole",
    "id": "recorderRef",
    "practitioner": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.4",
        "value": "222200063"
      },
      "display": "Tandberg, Gard"
    },
    "organization": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.101",
        "value": "998570328"
      },
      "display": "Munkholmen Legesenter"
    },
    "code": [ {
      "coding": [ {
        "system": "http://nhn.no/kj/fhir/CodeSystem/CategoriesOfHealthProfessionals",
        "code": "LE",
        "display": "Lege"
      } ]
    } ]
  } ],
  "extension": [ {
    "url": "http://nhn.no/kj/fhir/StructureDefinition/KjSourceOfInformation",
    "valueCoding": {
      "system": "http://nhn.no/kj/fhir/CodeSystem/SourceOfInformation",
      "code": "1",
      "display": "Resultat av tester / analyser"
    }
  } ],
  "clinicalStatus": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
      "code": "active",
      "display": "Active"
    } ]
  },
  "verificationStatus": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
      "code": "confirmed",
      "display": "Confirmed"
    } ]
  },
  "category": [ "medication" ],
  "criticality": "high",
  "code": {
    "coding": [ {
      "system": "http://nhn.no/kj/fhir/CodeSystem/ActiveSubstance",
      "code": "ID_ECA56300-5E51-4152-913D-A2EA6E83AD72",
      "display": "Ibuprofen"
    } ]
  },
  "patient": {
    "reference": "Patient/01035500126"
  },
  "onsetAge": {
    "value": 50,
    "system": "http://unitsofmeasure.org",
    "code": "a"
  },
  "recordedDate": "2021-04-06T15:09:19+02:00",
  "recorder": {
    "reference": "#recorderRef"
  },
  "note": [ {
    "text": "Etter en hypersensivitetsreaksjon på et NSAID av immunologisk natur, bør pasienten aldri bruke et annet preparat som har en lignende kjemisk struktur. I dette tilfellet betyr det at pasienten skal unngå alle propionsyrederivater. Dersom man velger et preparat fra en annen gruppe, er det holdepunkter for at de mest COX-II spesifikke gir minst risiko for reaksjoner."
  } ],
  "reaction": [ {
    "manifestation": [ {
      "coding": [ {
        "system": "http://nhn.no/kj/fhir/CodeSystem/TypeOfReaction",
        "code": "1",
        "display": "Anafylaktisk reaksjon"
      } ]
    } ]
  } ]
}

Categori environment, coding OtherAllergen

{
  "resourceType": "AllergyIntolerance",
  "id": "5dfa2ca1-27cd-4c89-be74-bc7d1dffb006",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2021-04-06T15:20:24.117+02:00",
    "profile": [ "http://nhn.no/kj/fhir/StructureDefinition/KjAllergyIntolerance" ]
  },
  "contained": [ {
    "resourceType": "PractitionerRole",
    "id": "recorderRef",
    "practitioner": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.4",
        "value": "222200063"
      },
      "display": "Tandberg, Gard"
    },
    "organization": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.101",
        "value": "998570328"
      },
      "display": "Munkholmen Legesenter"
    },
    "code": [ {
      "coding": [ {
        "system": "http://nhn.no/kj/fhir/CodeSystem/CategoriesOfHealthProfessionals",
        "code": "LE",
        "display": "Lege"
      } ]
    } ]
  } ],
  "extension": [ {
    "url": "http://nhn.no/kj/fhir/StructureDefinition/KjSourceOfInformation",
    "valueCoding": {
      "system": "http://nhn.no/kj/fhir/CodeSystem/SourceOfInformation",
      "code": "7",
      "display": "Opplyst av ansvarlig behandler"
    }
  } ],
  "clinicalStatus": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
      "code": "active",
      "display": "Active"
    } ]
  },
  "verificationStatus": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
      "code": "confirmed",
      "display": "Confirmed"
    } ]
  },
  "category": [ "environment" ],
  "criticality": "high",
  "code": {
    "coding": [ {
      "system": "http://nhn.no/kj/fhir/CodeSystem/OtherAllergen",
      "code": "5",
      "display": "Fisk"
    } ]
  },
  "patient": {
    "reference": "Patient/01035500126"
  },
  "onsetAge": {
    "value": 2,
    "system": "http://unitsofmeasure.org",
    "code": "a"
  },
  "recordedDate": "2021-04-06T15:20:24+02:00",
  "recorder": {
    "reference": "#recorderRef"
  },
  "reaction": [ {
    "manifestation": [ {
      "coding": [ {
        "system": "http://nhn.no/kj/fhir/CodeSystem/TypeOfReaction",
        "code": "1",
        "display": "Anafylaktisk reaksjon"
      } ]
    } ]
  } ]
}
{
  "resourceType": "AllergyIntolerance",
  "id": "ed89cb10-5415-4676-bbd1-665019c5cdeb",
  "meta": {
    "versionId": "2",
    "lastUpdated": "2021-04-22T17:04:47.552+02:00",
    "profile": [ "http://nhn.no/kj/fhir/StructureDefinition/KjAllergyIntolerance" ]
  },
  "contained": [ {
    "resourceType": "PractitionerRole",
    "id": "updaterRef",
    "practitioner": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.4",
        "value": "222200063"
      },
      "display": "Tandberg, Gard"
    },
    "organization": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.101",
        "value": "986664203"
      },
      "display": "Sjøsiden Legesenter"
    },
    "code": [ {
      "coding": [ {
        "system": "http://nhn.no/kj/fhir/CodeSystem/CategoriesOfHealthProfessionals",
        "code": "LE",
        "display": "Lege"
      } ]
    } ]
  }, {
    "resourceType": "PractitionerRole",
    "id": "recorderRef",
    "practitioner": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.4",
        "value": "222200063"
      },
      "display": "Tandberg, Gard"
    },
    "organization": {
      "identifier": {
        "system": "urn:oid:2.16.578.1.12.4.1.4.101",
        "value": "998570328"
      },
      "display": "Munkholmen Legesenter"
    }
  } ],
  "extension": [ {
    "url": "http://nhn.no/kj/fhir/StructureDefinition/KjUpdater",
    "valueReference": {
      "reference": "#updaterRef"
    }
  }, {
    "url": "http://nhn.no/kj/fhir/StructureDefinition/KjUpdatedDateTime",
    "valueDateTime": "2021-04-22T17:04:47+02:00"
  }, {
    "url": "http://nhn.no/kj/fhir/StructureDefinition/KjSourceOfInformation",
    "valueCoding": {
      "system": "http://nhn.no/kj/fhir/CodeSystem/SourceOfInformation",
      "code": "3",
      "display": "Pasientens egne opplysninger"
    }
  } ],
  "clinicalStatus": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
      "code": "active",
      "display": "Active"
    } ]
  },
  "verificationStatus": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
      "code": "confirmed",
      "display": "Confirmed"
    } ]
  },
  "category": [ "environment" ],
  "criticality": "low",
  "code": {
    "coding": [ {
      "system": "http://nhn.no/kj/fhir/CodeSystem/OtherAllergen",
      "code": "15",
      "display": "Sellerirot- og pastinakk allergi "
    } ]
  },
  "patient": {
    "reference": "Patient/01035500126"
  },
  "onsetDateTime": "2021-04-07T00:00:00+02:00",
  "recordedDate": "2021-04-06T15:26:27+02:00",
  "recorder": {
    "reference": "#recorderRef"
  },
  "note": [ {
    "text": "Pasienten reagerer med kløe i munn og svelg ved inntak av sellerirot, samt magesmerter og diare. "
  } ],
  "reaction": [ {
    "manifestation": [ {
      "coding": [ {
        "system": "http://nhn.no/kj/fhir/CodeSystem/TypeOfReaction",
        "code": "13",
        "display": "Oppkast,  diaré, magesmerter"
      } ]
    } ]
  } ]
}