Generated Narrative: ConceptMap R2-AllergyIntolerance-element-map-to-R5 Mapping from http://hl7.org/fhir/1.0 to http://hl7.org/fhir/5.0 Group 1 Mapping from http://hl7.org/fhir/StructureDefinition/AllergyIntolerance|1.0.2 to AllergyIntoleranceversion: 5.0.0) Source Concept Details Relationship Target Concept Details Comment Codes from http://hl7.org/fhir/StructureDefinition/AllergyIntolerance|1.0.2 Codes from AllergyIntolerance AllergyIntolerance.meta meta is broader than AllergyIntolerance.meta AllergyIntolerance.meta Element `AllergyIntolerance.meta` is mapped to FHIR R5 element `AllergyIntolerance.meta` as `SourceIsBroaderThanTarget`. The mappings for `AllergyIntolerance.meta` do not cover the following types: Meta. The mappings for `AllergyIntolerance.meta` do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId. AllergyIntolerance.implicitRules implicitRules is equivalent to AllergyIntolerance.implicitRules AllergyIntolerance.implicitRules Element `AllergyIntolerance.implicitRules` is mapped to FHIR R5 element `AllergyIntolerance.implicitRules` as `Equivalent`. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible. AllergyIntolerance.language language is equivalent to AllergyIntolerance.language AllergyIntolerance.language Element `AllergyIntolerance.language` is mapped to FHIR R5 element `AllergyIntolerance.language` as `Equivalent`. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). AllergyIntolerance.text text is broader than AllergyIntolerance.text AllergyIntolerance.text Element `AllergyIntolerance.text` is mapped to FHIR R5 element `AllergyIntolerance.text` as `SourceIsBroaderThanTarget`. The mappings for `AllergyIntolerance.text` do not cover the following types: Narrative. The mappings for `AllergyIntolerance.text` do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. AllergyIntolerance.contained contained is equivalent to AllergyIntolerance.contained AllergyIntolerance.contained Element `AllergyIntolerance.contained` is mapped to FHIR R5 element `AllergyIntolerance.contained` as `SourceIsBroaderThanTarget`. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. AllergyIntolerance.identifier identifier is broader than AllergyIntolerance.identifier AllergyIntolerance.identifier Element `AllergyIntolerance.identifier` is mapped to FHIR R5 element `AllergyIntolerance.identifier` as `SourceIsBroaderThanTarget`. The mappings for `AllergyIntolerance.identifier` do not cover the following types: Identifier. The mappings for `AllergyIntolerance.identifier` do not cover the following types based on type expansion: assigner, period, system, type, use, value. AllergyIntolerance.onset onset is equivalent to AllergyIntolerance.onset[x] AllergyIntolerance.onset[x] Element `AllergyIntolerance.onset` is mapped to FHIR R5 element `AllergyIntolerance.onset[x]` as `Equivalent`. The target context `AllergyIntolerance.onset[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `AllergyIntolerance`. AllergyIntolerance.recorder recorder is narrower than AllergyIntolerance.participant AllergyIntolerance.participant Element `AllergyIntolerance.recorder` is mapped to FHIR R5 element `AllergyIntolerance.participant` as `SourceIsNarrowerThanTarget`. AllergyIntolerance.patient patient is broader than AllergyIntolerance.patient AllergyIntolerance.patient Element `AllergyIntolerance.patient` is mapped to FHIR R5 element `AllergyIntolerance.patient` as `SourceIsBroaderThanTarget`. The mappings for `AllergyIntolerance.patient` do not cover the following types based on type expansion: display, reference. The standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `AllergyIntolerance.patient` with unmapped reference targets: Patient. AllergyIntolerance.reporter reporter is narrower than AllergyIntolerance.participant AllergyIntolerance.participant Element `AllergyIntolerance.reporter` is mapped to FHIR R5 element `AllergyIntolerance.participant` as `SourceIsNarrowerThanTarget`. The recorder takes repsonsibility for the content, but can reference the source from where they got it. AllergyIntolerance.substance substance is equivalent to AllergyIntolerance.code AllergyIntolerance.code Element `AllergyIntolerance.substance` is mapped to FHIR R5 element `AllergyIntolerance.code` as `Equivalent`. It is strongly recommended that the substance be coded with a terminology, where possible. For example, some terminologies used include RxNorm, SNOMED CT, DM+D, NDFRT, ICD-9, IDC-10, UNI, ATC and CPT. Plain text should only be used if there is no appropriate terminology available. Additional details about a substance can be specified in the text. AllergyIntolerance.status status is related to AllergyIntolerance.clinicalStatus AllergyIntolerance.clinicalStatus Element `AllergyIntolerance.status` is mapped to FHIR R5 element `AllergyIntolerance.clinicalStatus` as `RelatedTo`. Element `AllergyIntolerance.status` is mapped to FHIR R5 element `AllergyIntolerance.verificationStatus` as `RelatedTo`. The mappings for `AllergyIntolerance.status` do not allow expression of the necessary codes, per the bindings on the source and target. Decision support would typically raise alerts for 'Unconfirmed', 'Confirmed', and 'Resolved' and ignore a 'Refuted' reaction. In particular, 'Refuted' may be useful for reconciliation of the Adverse Reaction List. Some implementations may choose to make this field mandatory. is related to AllergyIntolerance.verificationStatus AllergyIntolerance.verificationStatus Element `AllergyIntolerance.status` is mapped to FHIR R5 element `AllergyIntolerance.clinicalStatus` as `RelatedTo`. Element `AllergyIntolerance.status` is mapped to FHIR R5 element `AllergyIntolerance.verificationStatus` as `RelatedTo`. The mappings for `AllergyIntolerance.status` do not allow expression of the necessary codes, per the bindings on the source and target. Decision support would typically raise alerts for 'Unconfirmed', 'Confirmed', and 'Resolved' and ignore a 'Refuted' reaction. In particular, 'Refuted' may be useful for reconciliation of the Adverse Reaction List. Some implementations may choose to make this field mandatory. AllergyIntolerance.criticality criticality is equivalent to AllergyIntolerance.criticality AllergyIntolerance.criticality Element `AllergyIntolerance.criticality` is mapped to FHIR R5 element `AllergyIntolerance.criticality` as `Equivalent`. The default criticality value for any propensity to an adverse reaction should be 'Low Risk', indicating at the very least a relative contraindication to deliberate or voluntary exposure to the Substance. 'High Risk' is flagged if the clinician has identified a propensity for a more serious or potentially life-threatening reaction, such as anaphylaxis, and implies an absolute contraindication to deliberate or voluntary exposure to the substance. If this element is missing, the criticality is unknown (though it may be known elsewhere). AllergyIntolerance.type type is broader than AllergyIntolerance.type AllergyIntolerance.type Element `AllergyIntolerance.type` is mapped to FHIR R5 element `AllergyIntolerance.type` as `SourceIsNarrowerThanTarget`. Allergic (typically immune-mediated) reactions have been traditionally regarded as an indicator for potential escalation to significant future risk. Contemporary knowledge suggests that some reactions previously thought to be immune-mediated are, in fact, non-immune, but in some cases can still pose a life threatening risk. It is acknowledged that many clinicians may not be in a position to distinguish the mechanism of a particular reaction. Often the term "allergy" is used rather generically and may overlap with the use of "intolerance" - in practice the boundaries between these two concepts may not be well-defined or understood. This data element is included nevertheless, because many legacy systems have captured this attribute. Immunologic testing may provide supporting evidence for the basis of the reaction and the causative substance, but no tests are 100% sensitive or specific for sensitivity to a particular substance. If, as is commonly the case, it is unclear whether the reaction is due to an allergy or an intolerance, then the type element should be omitted from the resource. AllergyIntolerance.category category is broader than AllergyIntolerance.category AllergyIntolerance.category Element `AllergyIntolerance.category` is mapped to FHIR R5 element `AllergyIntolerance.category` as `RelatedTo`. This data element has been included because it is currently being captured in some clinical systems. This data can be derived from the Substance where coding systems are used, and is effectively redundant in that situation. AllergyIntolerance.lastOccurence lastOccurence is equivalent to AllergyIntolerance.lastOccurrence AllergyIntolerance.lastOccurrence Element `AllergyIntolerance.lastOccurence` is mapped to FHIR R5 element `AllergyIntolerance.lastOccurrence` as `Equivalent`. This date may be replicated by one of the Onset of Reaction dates. Where a textual representation of the date of last occurrence is required e.g. 'In Childhood, '10 years ago' the Comment element should be used. AllergyIntolerance.note note is broader than AllergyIntolerance.note AllergyIntolerance.note Element `AllergyIntolerance.note` is mapped to FHIR R5 element `AllergyIntolerance.note` as `RelatedTo`. The mappings for `AllergyIntolerance.note` do not cover the following types: Annotation. The mappings for `AllergyIntolerance.note` do not cover the following types based on type expansion: author[x], text, time. For example: including reason for flagging a seriousness of 'High Risk'; and instructions related to future exposure or administration of the Substance, such as administration within an Intensive Care Unit or under corticosteroid cover. The notes should be related to an allergy or intolerance as a condition in general and not related to any particular episode of it. For episode notes and descriptions, use AllergyIntolerance.event.description and AllergyIntolerance.event.notes. AllergyIntolerance.reaction reaction is broader than AllergyIntolerance.reaction AllergyIntolerance.reaction Element `AllergyIntolerance.reaction` is mapped to FHIR R5 element `AllergyIntolerance.reaction` as `Equivalent`. AllergyIntolerance.reaction.substance substance is equivalent to AllergyIntolerance.reaction.substance AllergyIntolerance.reaction.substance Element `AllergyIntolerance.reaction.substance` is mapped to FHIR R5 element `AllergyIntolerance.reaction.substance` as `Equivalent`. Coding of the specific substance with a terminology capable of triggering decision support should be used wherever possible. The substance field allows for the use of a specific substance or a group or class of substances, for example "Penicillins". The specific substance field could be used for Amoxycillin. Duplication is acceptable when a specific substance has been recorded in the 'substance' field. AllergyIntolerance.reaction.manifestation manifestation is equivalent to AllergyIntolerance.reaction.manifestation AllergyIntolerance.reaction.manifestation Element `AllergyIntolerance.reaction.manifestation` is mapped to FHIR R5 element `AllergyIntolerance.reaction.manifestation` as `SourceIsNarrowerThanTarget`. Manifestation can be expressed as a single word, phrase or brief description. For example: nausea, rash or no reaction. It is preferable that manifestation should be coded with a terminology, where possible. The values entered here may be used to display on an application screen as part of a list of adverse reactions, as recommended in the UK NHS CUI guidelines. Terminologies commonly used include, but are not limited to, SNOMED CT or ICD10. AllergyIntolerance.reaction.description description is equivalent to AllergyIntolerance.reaction.description AllergyIntolerance.reaction.description Element `AllergyIntolerance.reaction.description` is mapped to FHIR R5 element `AllergyIntolerance.reaction.description` as `Equivalent`. Use the description to provide any details of a particular event of the occurred reaction such as circumstances, reaction specifics, what happened before/after. Information, related to the event, but not describing a particular care should be captured in the comment field. For example: at the age of four, the patient was given penicillin for strep throat and subsequently developed severe hives. AllergyIntolerance.reaction.onset onset is equivalent to AllergyIntolerance.reaction.onset AllergyIntolerance.reaction.onset Element `AllergyIntolerance.reaction.onset` is mapped to FHIR R5 element `AllergyIntolerance.reaction.onset` as `Equivalent`. AllergyIntolerance.reaction.severity severity is equivalent to AllergyIntolerance.reaction.severity AllergyIntolerance.reaction.severity Element `AllergyIntolerance.reaction.severity` is mapped to FHIR R5 element `AllergyIntolerance.reaction.severity` as `Equivalent`. It is acknowledged that this assessment is very subjective. There may be some some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions. AllergyIntolerance.reaction.exposureRoute exposureRoute is equivalent to AllergyIntolerance.reaction.exposureRoute AllergyIntolerance.reaction.exposureRoute Element `AllergyIntolerance.reaction.exposureRoute` is mapped to FHIR R5 element `AllergyIntolerance.reaction.exposureRoute` as `Equivalent`. Coding of the route of exposure with a terminology should be used wherever possible. AllergyIntolerance.reaction.note note is broader than AllergyIntolerance.reaction.note AllergyIntolerance.reaction.note Element `AllergyIntolerance.reaction.note` is mapped to FHIR R5 element `AllergyIntolerance.reaction.note` as `RelatedTo`. The mappings for `AllergyIntolerance.reaction.note` do not cover the following types: Annotation. The mappings for `AllergyIntolerance.reaction.note` do not cover the following types based on type expansion: author[x], text, time. Use this field to record information indirectly related to a particular event and not captured in the description. For example: Clinical records are no longer available, recorded based on information provided to the patient by her mother and her mother is deceased. Group 2 Mapping from http://hl7.org/fhir/StructureDefinition/AllergyIntolerance|1.0.2 to DSTU2: meta additional typesversion: 0.1.0) Source Code Relationship Target Code Comment AllergyIntolerance.meta (meta) is equivalent to Extension (DSTU2: meta additional types) Element `AllergyIntolerance.meta` is mapped to FHIR R5 element `AllergyIntolerance.meta` as `SourceIsBroaderThanTarget`. The mappings for `AllergyIntolerance.meta` do not cover the following types: Meta. The mappings for `AllergyIntolerance.meta` do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId. Group 3 Mapping from http://hl7.org/fhir/StructureDefinition/AllergyIntolerance|1.0.2 to DSTU2: text additional typesversion: 0.1.0) Source Code Relationship Target Code Comment AllergyIntolerance.text (text) is equivalent to Extension (DSTU2: text additional types) Element `AllergyIntolerance.text` is mapped to FHIR R5 element `AllergyIntolerance.text` as `SourceIsBroaderThanTarget`. The mappings for `AllergyIntolerance.text` do not cover the following types: Narrative. The mappings for `AllergyIntolerance.text` do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. Group 4 Mapping from http://hl7.org/fhir/StructureDefinition/AllergyIntolerance|1.0.2 to DSTU2: identifier additional typesversion: 0.1.0) Source Code Relationship Target Code Comment AllergyIntolerance.identifier (identifier) is equivalent to Extension (DSTU2: identifier additional types) Element `AllergyIntolerance.identifier` is mapped to FHIR R5 element `AllergyIntolerance.identifier` as `SourceIsBroaderThanTarget`. The mappings for `AllergyIntolerance.identifier` do not cover the following types: Identifier. The mappings for `AllergyIntolerance.identifier` do not cover the following types based on type expansion: assigner, period, system, type, use, value. Group 5 Mapping from http://hl7.org/fhir/StructureDefinition/AllergyIntolerance|1.0.2 to DSTU2: When recorded (new)version: 0.1.0) Source Code Relationship Target Code Comment AllergyIntolerance.recordedDate (recordedDate) is equivalent to Extension (DSTU2: When recorded (new)) Element `AllergyIntolerance.recordedDate` has a context of AllergyIntolerance based on following the parent source element upwards and mapping to `AllergyIntolerance`. Element `AllergyIntolerance.recordedDate` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). Group 6 Mapping from http://hl7.org/fhir/StructureDefinition/AllergyIntolerance|1.0.2 to DSTU2: active | unconfirmed | confirmed | inactive | resolved | refuted | entered-in-error additional codesversion: 0.1.0) Source Code Relationship Target Code Comment AllergyIntolerance.status (status) is broader than Extension (DSTU2: active | unconfirmed | confirmed | inactive | resolved | refuted | entered-in-error additional codes) Element `AllergyIntolerance.status` is mapped to FHIR R5 element `AllergyIntolerance.clinicalStatus` as `RelatedTo`. Element `AllergyIntolerance.status` is mapped to FHIR R5 element `AllergyIntolerance.verificationStatus` as `RelatedTo`. The mappings for `AllergyIntolerance.status` do not allow expression of the necessary codes, per the bindings on the source and target. Decision support would typically raise alerts for 'Unconfirmed', 'Confirmed', and 'Resolved' and ignore a 'Refuted' reaction. In particular, 'Refuted' may be useful for reconciliation of the Adverse Reaction List. Some implementations may choose to make this field mandatory. Group 7 Mapping from http://hl7.org/fhir/StructureDefinition/AllergyIntolerance|1.0.2 to DSTU2: typeversion: 0.1.0) Source Code Relationship Target Code Comment AllergyIntolerance.type (type) is equivalent to Extension (DSTU2: type) Element `AllergyIntolerance.type` is mapped to FHIR R5 element `AllergyIntolerance.type` as `SourceIsNarrowerThanTarget`. Allergic (typically immune-mediated) reactions have been traditionally regarded as an indicator for potential escalation to significant future risk. Contemporary knowledge suggests that some reactions previously thought to be immune-mediated are, in fact, non-immune, but in some cases can still pose a life threatening risk. It is acknowledged that many clinicians may not be in a position to distinguish the mechanism of a particular reaction. Often the term "allergy" is used rather generically and may overlap with the use of "intolerance" - in practice the boundaries between these two concepts may not be well-defined or understood. This data element is included nevertheless, because many legacy systems have captured this attribute. Immunologic testing may provide supporting evidence for the basis of the reaction and the causative substance, but no tests are 100% sensitive or specific for sensitivity to a particular substance. If, as is commonly the case, it is unclear whether the reaction is due to an allergy or an intolerance, then the type element should be omitted from the resource. Group 8 Mapping from http://hl7.org/fhir/StructureDefinition/AllergyIntolerance|1.0.2 to DSTU2: food | medication | environment | other - Category of Substanceversion: 0.1.0) Source Code Relationship Target Code Comment AllergyIntolerance.category (category) is equivalent to Extension (DSTU2: food | medication | environment | other - Category of Substance) Element `AllergyIntolerance.category` is mapped to FHIR R5 element `AllergyIntolerance.category` as `RelatedTo`. This data element has been included because it is currently being captured in some clinical systems. This data can be derived from the Substance where coding systems are used, and is effectively redundant in that situation. Group 9 Mapping from http://hl7.org/fhir/StructureDefinition/AllergyIntolerance|1.0.2 to DSTU2: note additional typesversion: 0.1.0) Source Code Relationship Target Code Comment AllergyIntolerance.note (note) is equivalent to Extension (DSTU2: note additional types) Element `AllergyIntolerance.note` is mapped to FHIR R5 element `AllergyIntolerance.note` as `RelatedTo`. The mappings for `AllergyIntolerance.note` do not cover the following types: Annotation. The mappings for `AllergyIntolerance.note` do not cover the following types based on type expansion: author[x], text, time. For example: including reason for flagging a seriousness of 'High Risk'; and instructions related to future exposure or administration of the Substance, such as administration within an Intensive Care Unit or under corticosteroid cover. The notes should be related to an allergy or intolerance as a condition in general and not related to any particular episode of it. For episode notes and descriptions, use AllergyIntolerance.event.description and AllergyIntolerance.event.notes. Group 10 Mapping from http://hl7.org/fhir/StructureDefinition/AllergyIntolerance|1.0.2 to DSTU2: unlikely | likely | confirmed - clinical certainty about the specific substance (new)version: 0.1.0) Source Code Relationship Target Code Comment AllergyIntolerance.reaction.certainty (certainty) is equivalent to Extension (DSTU2: unlikely | likely | confirmed - clinical certainty about the specific substance (new)) Element `AllergyIntolerance.reaction.certainty` has a context of AllergyIntolerance.reaction based on following the parent source element upwards and mapping to `AllergyIntolerance`. Element `AllergyIntolerance.reaction.certainty` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). Group 11 Mapping from http://hl7.org/fhir/StructureDefinition/AllergyIntolerance|1.0.2 to DSTU2: note additional typesversion: 0.1.0) Source Code Relationship Target Code Comment AllergyIntolerance.reaction.note (note) is equivalent to Extension (DSTU2: note additional types) Element `AllergyIntolerance.reaction.note` is mapped to FHIR R5 element `AllergyIntolerance.reaction.note` as `RelatedTo`. The mappings for `AllergyIntolerance.reaction.note` do not cover the following types: Annotation. The mappings for `AllergyIntolerance.reaction.note` do not cover the following types based on type expansion: author[x], text, time. Use this field to record information indirectly related to a particular event and not captured in the description. For example: Clinical records are no longer available, recorded based on information provided to the patient by her mother and her mother is deceased.
Cross-version mapping for FHIR DSTU2 AllergyIntolerance to FHIR R5 AllergyIntolerance
This ConceptMap represents cross-version mappings for elements from a FHIR DSTU2 AllergyIntolerance to FHIR R5.
Element `AllergyIntolerance.meta` is mapped to FHIR R5 element `AllergyIntolerance.meta` as `SourceIsBroaderThanTarget`. The mappings for `AllergyIntolerance.meta` do not cover the following types: Meta. The mappings for `AllergyIntolerance.meta` do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.
Element `AllergyIntolerance.implicitRules` is mapped to FHIR R5 element `AllergyIntolerance.implicitRules` as `Equivalent`. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible.
Element `AllergyIntolerance.language` is mapped to FHIR R5 element `AllergyIntolerance.language` as `Equivalent`. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Element `AllergyIntolerance.text` is mapped to FHIR R5 element `AllergyIntolerance.text` as `SourceIsBroaderThanTarget`. The mappings for `AllergyIntolerance.text` do not cover the following types: Narrative. The mappings for `AllergyIntolerance.text` do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.
Element `AllergyIntolerance.contained` is mapped to FHIR R5 element `AllergyIntolerance.contained` as `SourceIsBroaderThanTarget`. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.
Element `AllergyIntolerance.identifier` is mapped to FHIR R5 element `AllergyIntolerance.identifier` as `SourceIsBroaderThanTarget`. The mappings for `AllergyIntolerance.identifier` do not cover the following types: Identifier. The mappings for `AllergyIntolerance.identifier` do not cover the following types based on type expansion: assigner, period, system, type, use, value.
Element `AllergyIntolerance.onset` is mapped to FHIR R5 element `AllergyIntolerance.onset[x]` as `Equivalent`. The target context `AllergyIntolerance.onset[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `AllergyIntolerance`.
Element `AllergyIntolerance.recorder` is mapped to FHIR R5 element `AllergyIntolerance.participant` as `SourceIsNarrowerThanTarget`.
Element `AllergyIntolerance.patient` is mapped to FHIR R5 element `AllergyIntolerance.patient` as `SourceIsBroaderThanTarget`. The mappings for `AllergyIntolerance.patient` do not cover the following types based on type expansion: display, reference. The standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `AllergyIntolerance.patient` with unmapped reference targets: Patient.
Element `AllergyIntolerance.reporter` is mapped to FHIR R5 element `AllergyIntolerance.participant` as `SourceIsNarrowerThanTarget`. The recorder takes repsonsibility for the content, but can reference the source from where they got it.
Element `AllergyIntolerance.substance` is mapped to FHIR R5 element `AllergyIntolerance.code` as `Equivalent`. It is strongly recommended that the substance be coded with a terminology, where possible. For example, some terminologies used include RxNorm, SNOMED CT, DM+D, NDFRT, ICD-9, IDC-10, UNI, ATC and CPT. Plain text should only be used if there is no appropriate terminology available. Additional details about a substance can be specified in the text.
Element `AllergyIntolerance.status` is mapped to FHIR R5 element `AllergyIntolerance.clinicalStatus` as `RelatedTo`. Element `AllergyIntolerance.status` is mapped to FHIR R5 element `AllergyIntolerance.verificationStatus` as `RelatedTo`. The mappings for `AllergyIntolerance.status` do not allow expression of the necessary codes, per the bindings on the source and target. Decision support would typically raise alerts for 'Unconfirmed', 'Confirmed', and 'Resolved' and ignore a 'Refuted' reaction. In particular, 'Refuted' may be useful for reconciliation of the Adverse Reaction List. Some implementations may choose to make this field mandatory.
Element `AllergyIntolerance.criticality` is mapped to FHIR R5 element `AllergyIntolerance.criticality` as `Equivalent`. The default criticality value for any propensity to an adverse reaction should be 'Low Risk', indicating at the very least a relative contraindication to deliberate or voluntary exposure to the Substance. 'High Risk' is flagged if the clinician has identified a propensity for a more serious or potentially life-threatening reaction, such as anaphylaxis, and implies an absolute contraindication to deliberate or voluntary exposure to the substance. If this element is missing, the criticality is unknown (though it may be known elsewhere).
Element `AllergyIntolerance.type` is mapped to FHIR R5 element `AllergyIntolerance.type` as `SourceIsNarrowerThanTarget`. Allergic (typically immune-mediated) reactions have been traditionally regarded as an indicator for potential escalation to significant future risk. Contemporary knowledge suggests that some reactions previously thought to be immune-mediated are, in fact, non-immune, but in some cases can still pose a life threatening risk. It is acknowledged that many clinicians may not be in a position to distinguish the mechanism of a particular reaction. Often the term "allergy" is used rather generically and may overlap with the use of "intolerance" - in practice the boundaries between these two concepts may not be well-defined or understood. This data element is included nevertheless, because many legacy systems have captured this attribute. Immunologic testing may provide supporting evidence for the basis of the reaction and the causative substance, but no tests are 100% sensitive or specific for sensitivity to a particular substance. If, as is commonly the case, it is unclear whether the reaction is due to an allergy or an intolerance, then the type element should be omitted from the resource.
Element `AllergyIntolerance.category` is mapped to FHIR R5 element `AllergyIntolerance.category` as `RelatedTo`. This data element has been included because it is currently being captured in some clinical systems. This data can be derived from the Substance where coding systems are used, and is effectively redundant in that situation.
Element `AllergyIntolerance.lastOccurence` is mapped to FHIR R5 element `AllergyIntolerance.lastOccurrence` as `Equivalent`. This date may be replicated by one of the Onset of Reaction dates. Where a textual representation of the date of last occurrence is required e.g. 'In Childhood, '10 years ago' the Comment element should be used.
Element `AllergyIntolerance.note` is mapped to FHIR R5 element `AllergyIntolerance.note` as `RelatedTo`. The mappings for `AllergyIntolerance.note` do not cover the following types: Annotation. The mappings for `AllergyIntolerance.note` do not cover the following types based on type expansion: author[x], text, time. For example: including reason for flagging a seriousness of 'High Risk'; and instructions related to future exposure or administration of the Substance, such as administration within an Intensive Care Unit or under corticosteroid cover. The notes should be related to an allergy or intolerance as a condition in general and not related to any particular episode of it. For episode notes and descriptions, use AllergyIntolerance.event.description and AllergyIntolerance.event.notes.
Element `AllergyIntolerance.reaction` is mapped to FHIR R5 element `AllergyIntolerance.reaction` as `Equivalent`.
Element `AllergyIntolerance.reaction.substance` is mapped to FHIR R5 element `AllergyIntolerance.reaction.substance` as `Equivalent`. Coding of the specific substance with a terminology capable of triggering decision support should be used wherever possible. The substance field allows for the use of a specific substance or a group or class of substances, for example "Penicillins". The specific substance field could be used for Amoxycillin. Duplication is acceptable when a specific substance has been recorded in the 'substance' field.
Element `AllergyIntolerance.reaction.manifestation` is mapped to FHIR R5 element `AllergyIntolerance.reaction.manifestation` as `SourceIsNarrowerThanTarget`. Manifestation can be expressed as a single word, phrase or brief description. For example: nausea, rash or no reaction. It is preferable that manifestation should be coded with a terminology, where possible. The values entered here may be used to display on an application screen as part of a list of adverse reactions, as recommended in the UK NHS CUI guidelines. Terminologies commonly used include, but are not limited to, SNOMED CT or ICD10.
Element `AllergyIntolerance.reaction.description` is mapped to FHIR R5 element `AllergyIntolerance.reaction.description` as `Equivalent`. Use the description to provide any details of a particular event of the occurred reaction such as circumstances, reaction specifics, what happened before/after. Information, related to the event, but not describing a particular care should be captured in the comment field. For example: at the age of four, the patient was given penicillin for strep throat and subsequently developed severe hives.
Element `AllergyIntolerance.reaction.onset` is mapped to FHIR R5 element `AllergyIntolerance.reaction.onset` as `Equivalent`.
Element `AllergyIntolerance.reaction.severity` is mapped to FHIR R5 element `AllergyIntolerance.reaction.severity` as `Equivalent`. It is acknowledged that this assessment is very subjective. There may be some some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions.
Element `AllergyIntolerance.reaction.exposureRoute` is mapped to FHIR R5 element `AllergyIntolerance.reaction.exposureRoute` as `Equivalent`. Coding of the route of exposure with a terminology should be used wherever possible.
Element `AllergyIntolerance.reaction.note` is mapped to FHIR R5 element `AllergyIntolerance.reaction.note` as `RelatedTo`. The mappings for `AllergyIntolerance.reaction.note` do not cover the following types: Annotation. The mappings for `AllergyIntolerance.reaction.note` do not cover the following types based on type expansion: author[x], text, time. Use this field to record information indirectly related to a particular event and not captured in the description. For example: Clinical records are no longer available, recorded based on information provided to the patient by her mother and her mother is deceased.
Element `AllergyIntolerance.recordedDate` has a context of AllergyIntolerance based on following the parent source element upwards and mapping to `AllergyIntolerance`. Element `AllergyIntolerance.recordedDate` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).
Element `AllergyIntolerance.reaction.certainty` has a context of AllergyIntolerance.reaction based on following the parent source element upwards and mapping to `AllergyIntolerance`. Element `AllergyIntolerance.reaction.certainty` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).