Allergy recording in clinical systems: comparing general practice and hospital records
Authors: Soteriou O , Bastian L , Wilcock M 
Published: November 2023

Abstract

Introduction
Healthcare organisations may have different clinical and administrative electronic systems, meaning there may be gaps in how important information about a patient’s care is communicated effectively between organisations.1 Our current hospital discharge summary does not include a record of patients’ allergies and sensitivities despite this being one of the national standards.2 Furthermore, the electronic transfer of allergy/intolerance data must be classed as machine-readable through coded entries using SNOMED CT or dm+d terminology.3 We wanted to determine whether allergy/sensitivity records in primary and secondary care are transferred accurately and if our hospital discharge summaries should be amended to include allergy information for improved flow of data.

Aim
To record and compare the number of allergies/sensitivities matched on both the hospital electronic prescribing system (EPS, CareFlow Medicines Management) and a GP practice system (SystmOne), and to determine whether inconsistencies within allergy recording between primary and secondary care are significant, and if there is scope to add allergy recording to eDischarges.

Methods
A random sample of 150 patients registered with a GP practice who had been admitted to hospital and had undergone recent medicines reconciliations (during 2022/23) and had at least one allergy recorded on the hospital EPS was analysed. Allergy entries (medication or class of medication or other) were collated and analysed using Microsoft Excel. As this project falls under the definition of a service evaluation, according to UK NHS Research Ethics Committees, formal ethical approval was not required. This project was registered on the hospital’s clinical audit database.

Results
The 150 patients (61% female, mean age 63 years, range 1-97) recorded a total of 350 allergy entries in the hospital EPS system and 294 entries in primary care SystmOne. Only 71 (47%) patients had matching records across both systems. Fifty-two (35%) patients had one or more allergies not recorded on SystmOne compared to EPS, whereas only 16 (11%) patients had one or more allergies not recorded on EPS compared to SystmOne. A total of 11 (7%) patients had one or more inconsistencies across both systems. There were significant issues with how medication names were recorded e.g. generic/brand name for the same medicine. The majority of inconsistencies in records were related to penicillin allergies.

Discussion/Conclusion
Whilst a small-scale study only, we observed that allergy data is often not transferred accurately between primary and secondary care, resulting in unmatched records and discrepancies, particularly in transfer from secondary to primary care. This limits the potential of computerised decision support systems to help alert clinicians to the risk of further reactions. This problem may be due to a lack of allergy information on the current hospital eDischarge summaries; hence any new allergies identified through medicines reconciliation completed during the admission, or reactions to newly prescribed drugs in hospital, are not transferred. One patient safety improvement would be improved interoperability such that allergies on EPS are included on hospital eDischarge summaries in accordance with PRSB Standards.2 Ideally, this information should be coded in a suitable format to ensure effective transfer onto SystmOne.

References
1. Bennett J, Salter M. The documentation of allergy across electronic systems for patients presenting to emergency departments in Leeds. BMJ Health Care Inform 2022;29:doi: 10.1136/bmjhci-2022-FCIASC.3
2. Professional Records Standards Body (2019) eDischarge Summary Standard v2.1 https://theprsb.org/standards/edischargesummary/ (accessed 1 March 2023)
3. Data Alliance Partnership Board (2022) Medicine and Allergy/Intolerance Data Transfer Requirements Specification Version 1.2. https://digital.nhs.uk/data-and-information/information-standards/information-standards-and-data-collections-including-extractions/publications-and-notifications/standards-and-collections/dapb4013-medicine-and-allergy-intolerance-data-transfer (accessed 1 March 2023)