Allergies, DDI & med reconciliation

Allergies, drug interactions, and medication reconciliation

Three tightly-coupled safety surfaces.

Allergies (FHIR AllergyIntolerance)

Patient’s recorded allergens with reaction severity. Captured at registration and updated at every encounter. Every prescribing event checks the allergen class against the proposed drug.

Severity vocabulary: low | moderate | severe | life-threatening. Severe + life-threatening allergens trigger a hard block at e-prescribe unless overridden with a rationale.

Drug-drug interaction (DDI) checking

Every new prescription runs a DDI check against the patient’s active medication list. The DDI database ships with the standard interaction classes (warfarin × NSAID, SSRI × MAOI, etc.) and tenant admins can extend with their own rules.

Severity buckets:

• contraindicated — hard block, rationale required to proceed.
• serious — warn at prescribe, prescriber acknowledges + signs.
• moderate — surface as a note on the script; no block.
• minor — informational only.

The check is provider-side at prescribe-time AND pharmacist-side at dispense — same call, two surfaces.

Medication reconciliation

Continuous, not point-in-time. The scribe pushes proposed med deltas (add / discontinue / change_dose) as the visit progresses; provider reviews + accepts before sign-off.

The reconciled list flows back to:

• Surescripts NewRx send.
• Care-plan Goal activities.
• Future allergy + DDI checks.

Audit trail

Every allergy add / remove / sev-change writes an audit row. Reconciliation runs persist as MedicationReconciliation resources with the before/after snapshot.