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Drug allergy checking in Gentu, idea map

How MIMS Drug Allergy Alert works from the user's side, drawn as the two moments it touches. Rough on purpose. Read with the source note in the PRD-006 project. Questions for the design are marked Q. Frame 9 is Tam's proposal to group the allergens into one alert. Corrected 22 Oct against PRD-006 v8: prescribing is never blocked, a clean check shows nothing, the uncoded notice lives in the sidebar.

Same ingredient Same class Cross-sensitivity Could not check No match, with disclaimer

Moment 1. Recording the allergy

The check only works on allergies MIMS can recognise. Whatever gets recorded here sets what the prescriber sees later. Two pick lists feed it.

1Add allergy · patient file › Allergies
⌕ ceph|
CephalosporinsClass
CefalexinIngredient
Cephalexin (SNOMED 387253001)SNOMED
Keflex 250 mg CapsulesProduct
Searches MIMS by product, ingredient, keyword, or SNOMED code and term. Four kinds of allergen come back.
PenicillinsNSAIDsSulfonamidesOpioidsCephalosporinsStatins+8
Rash, 2019
CancelSave allergy
MIMS: GET allergens · GET allergyclasses
Q1 Which kind to steer people to. A class catches the most (penicillins covers Curam, amoxicillin, and cross-reacts to cephalosporins). A product catches the least. Q2 Does the Gentu pick list (2016 SNOMED) get replaced by this search, or mapped to it? That is PRD-008.
2The allergy that cannot be checked · existing records

Allergies

Penicillins · class · rashCheckable
“penicillin?” · free text, 2017Not coded
Shellfish · free textNot a drug
1 allergy cannot be checked by MIMS

“penicillin?” is free text. Match it to a MIMS allergen so prescribing checks can see it.

Match to MIMS allergen
Q3 Who does the matching, and when: the doctor at the next consult, reception in bulk, or a one-off migration? Baseline today: 20.5% of patients with an allergy have it coded. Q4 Does a not-coded allergy show in the prescribing sidebar as a standing notice (PRD-006 says yes)?

Moment 2. Prescribing

One call: the patient's coded allergens against every medicine on the script. Three kinds of match come back, plus a list of anything MIMS could not check. There is no severity. MIMS says so itself.

3Same ingredient · the strongest match
Selected medicationAspro Clear 300 mg Effervescent Tablets, 30
Allergies on fileAspirin (ingredient)
Allergy · Aspirin × Aspro Clear Same ingredient

Aspro Clear contains aspirin, which is documented as this patient's allergen.

⌄ Ingredients, class and references
✕ Dismiss✓ Acknowledge
CancelPrescribe
MIMS: allergyType = same ingredient · summaryStatement · MoleculeName · references
PRD-006 says prescribing is never blocked, so this is drawn passive, with the red of the strongest match. Q5 is the PRD's Q6, Rory with Daryl: which alerts need acknowledgement and is an override reason captured. With no severity, acknowledgement would apply to every alert, which may be too much friction.
4Same class
Selected medicationCuram Duo 500/125 Tablets, 10
Allergies on filePenicillins (class)
Allergy · Penicillins × Curam Duo Same class

Curam Duo contains amoxicillin, a penicillin. The patient's documented allergy is to the penicillin class.

⌄ Ingredients, class and references
✕ Dismiss✓ Acknowledge
CancelPrescribe
MIMS: allergyType = same allergy class
Q6 Is "same class" weaker than "same ingredient"? Clinically a class allergy is often the more cautious record, so this may deserve the same weight as 3. The ladder is a design call, not a MIMS one.
5Cross-sensitivity · inferred from literature
Selected medicationKeflex 250 mg Capsules, 20
Allergies on filePenicillins (class)
Possible allergy · Penicillins × Keflex Cross-sensitivity

Cefalexin is a cephalosporin. Cross-reaction with penicillin allergy is reported in the literature.

⌄ References (international)
✕ Dismiss✓ Acknowledge
CancelPrescribe
MIMS: allergyType = cross sensitivity · references[]
Q7 This is the one that will fire most often and annoy most. Penicillin to cephalosporin cross-reaction is low in practice. Passive inline, like Michael's Moderate, or quieter still?
6Could not check · PRD-006 Q8: a sidebar notice, not an interrupting alert
Selected medicationAmoxicillin 500 mg Capsules, 20
Allergies on file“penicillin?” (free text)
Prescribing dialog: no alert, no confirmation. The check found nothing it could check against.
Sidebar · Allergies

1 of this patient's allergies is not coded and was not checked. Match it

CancelPrescribe
Gentu-side: a free-text allergy is never sent · MIMS unrecognized[] covers bad ids and inactive SNOMED codes
PRD-006 Q8, answered at the Triad review: the notice lives in the sidebar, shown when the check finds no conflict and the patient has uncoded allergies. Wording is Daryl's to approve (Q12). Q8 here, the PRD's Q11, yours: when exactly it shows, whether alongside a conflict alert too, and whether it also covers coded allergies MIMS did not recognise.
7No match · PRD-006: shows nothing, as DDI does
Selected medicationRosuvastatin 10 mg Tablets, 30
Allergies on filePenicillins (class)
No alert, no confirmation, no extra step. Daryl's advice on DDI, carried over as a PRD trade-off.
CancelPrescribe
MIMS: noAllergyDisclaimer, required by MIMS · PRD-006 Q13, Brendan: where does it show if a clean check shows nothing
Q9 is the PRD's Q13. MIMS requires its absence disclaimer, and the PRD shows nothing on a clean check. Once per session, in MIMS settings, behind an info icon, or does the DDI precedent already answer it? The tension with "not-checked must never look like clean" is carried by frame 6's sidebar notice, not by this screen.
9Grouped: one alert per medicine, every matching allergen inside it · Tam's proposal, 22 Oct
Selected medicationAugmentin Duo Forte 875/125 Tablets, 10
Allergies on file (6)Penicillins · Amoxicillin · Cephalosporins · Sulfonamides · Codeine · Latex
Allergy · 3 of 6 allergens match Augmentin Duo Forte Grouped
Amoxicillin · Augmentin contains amoxicillinSame ingredient
Penicillins · amoxicillin is a penicillinSame class
Cephalosporins · cross-reaction reported with penicillinsCross-sensitivity
⌄ Ingredients, classes and references · 3 allergens did not match
✕ Dismiss all✓ Acknowledge all
CancelPrescribe
MIMS: allergies[] holds one entry per allergen and medicine pair · the grouping is Gentu's
Why grouped. Inline alerts stack one per allergen. Six allergens would be six callouts for one decision, and the Prescribe button leaves the screen. 38% of patients with an allergy have two or more. Q10 The group takes the colour of its strongest match (red, from the same-ingredient row). Prescribing is never blocked, per the PRD. Right? Q11 Strongest first, or in the order the allergies are on file? Q12 On a script with several medicines, one group per medicine, or one group for the script?
8What MIMS sends, what Gentu adds
From MIMS, verbatimMatch type (3 kinds) · summary sentence · allergen and medicine with ingredient names and class · references · the two disclaimers · unrecognised ids
Gentu authorsThe title line · the weight of each match type · acknowledge and override · the not-coded notice · the no-match wording · what to log
The one fact that changes the design. Drug-drug alerts arrive tiered (severe, moderate, minor, with documentation levels). Drug-allergy alerts do not. The only differentiation MIMS gives is the kind of match. Reusing the drug-drug severity ladder here has nothing to feed it, so the ladder, if there is one, is ours to decide and to defend.
Not covered by MIMS at all: excipients and delivery systems. Non-drug allergies (shellfish, latex) never go to the check.