3.3: Modify Antigen Recommendations Based on Allergy History


The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s active allergies.


The system notifies the provider that Marcel Manuel Gonzales, age 2 (birth date 12/24/2012) is allergic to diphtheria CRM 197 protein, although the forecast included DTaP in the recommended vaccines. The provider, therefore, can select alternate vaccines.


All systems reviewed allow entry of allergy and adverse reactions in the allergy list and/or on the patient’s problem list. Less clear is the ability to ensure a provider is aware of an allergy or potential adverse reaction to the recommended vaccine product. Feedback to users about potential patient risks can be provided specific to the level of risk. Types of feedback defined in the context of software usability include:[i]

  1. Notification: A notification is a visual clue or displayed message that informs a user but does not require any action (examples include visual clues such as a persistent banner, color change, bolding, etc. (E.g., “This patient is allergic to ___”).
  2. Alert: An alert or warning is displayed when user action may result in unintended consequences, for example loss of data, etc.  These types of messages shall require the user to acknowledge the message before they can move on (e.g., click ok)
  3. Errors: Error message should be displayed in plain language describing specific error condition and instructions what steps a user need to take. This condition requires the user to fix something before they can move on (e.g., fix this date, it is invalid)

Notification in this context indicates that the system provides indication so the user is aware of a potential problem including the severity of previous reactions. Notification should include information, if available, about prior decisions, e.g. if a provider documented a reason to override notification about allergy or diagnosis in the past. The method for fulfilling the requirement is not prescriptive. Examples of notification include visual clues.

  • Vendor Perspective. Vendors should consider usability evaluation such as User Centered Design (UCD) to evaluate how the system handles notifications and alerts.
  • Provider and Implementer Perspective. Notifications and alerts can be a significant usability issue in EHRs. Providers should consider participating in vendor activities to address timely and appropriate notification.



Click here for a test script scenario that includes the capability, Modify Antigen Recommendations Based on Allergy History. The script also indicates successful performance for each of the test sections. The notification must be visible directly on the ordering and the documentation screens specific to the vaccine ordered or documented.

Data Elements

The data elements include the allergy and the reaction specific to the clinical scenario in the test script.


[i] Lowry JC, Fingerman PW. ECS User Interface Style Guide. January 1996. Available at: http://www.deepsloweasy.com/HFE%20resources/Hughes%20EOS%20CHI%20Guidebook.pdf. Accessed 22 September 2015.