Inpatient EHR Allergies - hmislk/hmis GitHub Wiki

Inpatient EHR — Allergies

The allergies panel records drug and substance allergies for a patient in the context of their inpatient admission. Recorded allergies are displayed prominently on the Admission Profile Dashboard and are checked each time a medication is prescribed.

Entry point: Admission Profile Dashboard → Admission Panel → Manage Allergies
Controller: BhtEditController.navigateToManageAllergies()
Data type: ClinicalFindingValue with clinicalFindingValueType = PatientAllergy

Viewing Allergies

The Admission Profile Dashboard shows all recorded allergies as amber warning badges in the Allergies panel (Column 1). Each badge displays:

  • The drug/substance name (itemValue.name)
  • A free-text reaction note (stringValue), if recorded

If no allergies are recorded, the panel shows "No known allergies".

Adding an Allergy

  1. From the Admission Profile, click Manage Allergies.
  2. Search for the drug or substance using the autocomplete field. Allergies are recorded at the VTM (Virtual Therapeutic Moiety) level — search for the generic substance, not a branded product.
  3. Optionally enter a reaction description in the notes field.
  4. Click Add.

The new allergy is saved as a ClinicalFindingValue record linked to the patient and the current admission.

Allergy Check at Prescribing

When a prescriber adds a ward medication, encounter medication, or patient medication, the system automatically checks the newly selected drug against all recorded allergies:

  • VTM-level match — if the prescribed drug's VTM (item.vtm) matches the VTM of any recorded allergen, an alert fires
  • Direct match — if the prescribed item itself exactly matches a recorded allergen, an alert fires

When a match is found, a yellow ALLERGY ALERT growl notification is displayed:

ALLERGY ALERT: [Drug Name] matches recorded allergy: [Allergen Name]

The prescriber can still save the medication — the alert is advisory, not a hard block. The alert is visible to any user on the same session screen.

This check runs in InpatientClinicalDataController.getAllergyWarning(), called from:

  • addAdmissionWardMedicine() — ward medications added from the ward medications page
  • addEncounterMedicine() — medications added within a clinical assessment encounter
  • addPatientMedicine() — medications added to the patient-level medicine list

Implementation note: VTM-level allergy checking was implemented in Issue #20831. A planned upgrade (Issue #20832) will extend checks to ATC class, VMP, and AMP levels.

Removing an Allergy

From the Manage Allergies page, each recorded allergy has a Remove button. Removed allergies are retired (soft-deleted) and will no longer appear in the active allergy list or trigger alerts.

Allergy Data Persistence

Allergies are stored at the patient level (not the admission level), meaning allergies recorded during one admission persist across future admissions for the same patient. The patientAllergies list on the Admission Profile reflects all active allergies for that patient regardless of when they were first recorded.

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