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Concept
The decision to initiate or terminate surveillance for a substance or group of substances that may cause an adverse reaction in the patient.
Purpose
Specifying a surveillance decision with an effective date makes it clear on which substance or group of substances surveillance has started or stopped. An overview of surveillance decisions provides insight into which substances are subject to surveillance and options for managing surveillance decisions.
Evidence Base
Note on zib SurveillanceDecision
The zib SurveillanceDecision represents the health professional’s decision to start or end surveillance of a substance or group of substances. Initiating surveillance means that the health professional wants to receive a warning if an unsafe substance is prescribed. The DecisionEffectiveDateTime represents the moment at which surveillance should start or end, depending on the DecisionType (started or discontinued).
The user can indicate the reason for starting a surveillance decision with one of the three following options:
- A hypersensitivity or intolerance: to be indicated via a reference to HypersensitivityIntolerance
- A reaction: to be indicated via a reference to Reaction
- Specify a decision reason via a selection from the StartReasonCodelist
The user can specify the reason for stopping a surveillance decision by selecting from the StopReasonCodelist.
The SafeWithinUnsafeGroup element makes it possible to make exceptions within a (large) group of unsafe substances. Suppose that 78 of a group of substances are unsafe and 2 are safe, then one does not need to record a surveillance decision for each of the 78 unsafe substances. Instead, it will suffice to record one surveillance decision in which the entire group of 80 substances is declared as unsafe and 2 substances that are safe within that group.
Where a reaction is related to a (component of) a substance actually administered, the health professional may decide to start surveillance for a broader collection of substances. The substance(s) indicated in a surveillance decision may therefore differ from the substance to which the patient has actually developed a reaction.
A hypersensitivity or intolerance involves a diagnosis in which it has been demonstrated or assumed that the patient has a tendency to develop an adverse reaction when exposed to a certain substance or group of substances. In most cases, a surveillance decision related to this hypersensitivity or intolerance will concern the same substances, but not necessarily. Additional diagnostiscs may reveal an allergy based on a limited number of actually tested substances, and it may then be decided to start surveillance for the entire group to which those substances belong.
Even if no additional diagnostics are possible, but an intolerance is suspected due to side effects based on a pharmacological property of a medicine, the specification of the substance(s) for which the health professional decides to start surveillance may deviate from the substance(s) that are recorded for the hypersensitivity or intolerance.
Functionality (informative)
It is desirable that an EHR supports the specification of a surveillance decision as efficiently as possible. If the health professional specifies a reaction or hypersensitivity or intolerance as the reason for a surveillance decision, the EHR can first propose the substance(s) to which that reaction or hypersensitivity or intolerance is related. The user then only needs to change the proposed substance(s) if he wishes.
The EHR must be able to show the user an overview of surveillance decisions that are active and offer the option to select a surveillance decision from this overview and then change or terminate it.
In general, a user will modify a surveillance decision if the reason for the surveillance decision remains the same, but he/she wants to adjust the specification of the substance(s) and/or the comment. The EHR then presents the selected surveillance decision with the data in the fields that the user can subsequently adjust. Changing a surveillance decision essentially means that the selected surveillance decision is terminated and replaced by the surveillance decision with the modified field values.
It is important that the EHR keeps track of the history of each surveillance decision, so that it is clear how the decisions follow each other.
Information Model
Type
Id
Concept
Card.
Definition
DefinitionCode
Reference
NL-CM:8.5.1
SurveillanceDecision
This is a reference to the root concept of information model SurveillanceDecision.
Technical specifications in HL7v3 CDA and HL7 FHIR
To exchange information based on health and care information models, additional, more technical specifications are required.<BR>
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:
HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment
HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR
SurveillanceDecision
DecisionType
or as spreadsheet 