Use to provide a single place within the health record to document a range of clinical statements about adverse reactions, including:
- record a clinical assessment of the individual’s propensity for a potential future reaction upon re-exposure; and
- record cumulative information about the reaction to each exposure.
Use to record information about the positive presence of the risk of an adverse reaction:
- to support direct clinical care of an individual;
- as part of a managed adverse reaction or allergy/intolerance list;
- to support exchange of information about the propensity and events related to adverse reactions;
- to inform adverse reaction reporting; and
- to assist computerised knowledge-based activities such as clinical decision support and alerts.
Use to record information about the risk of adverse reactions to a broad range of substances, including: incipients and excipients in medicinal preparations; biological products; metal salts; and organic chemical compounds.
Adverse reaction may be:
- an immune mediated reaction - Types I-IV (including allergic reactions and hypersensitivities); or
- a non-immune mediated reaction - including pseudo-allergic reactions, side effects, intolerances, drug toxicities (eg to Gentamicin).
In clinical practice distinguishing between immune-mediated and non-immune mediated reactions is difficult and often not practical. Identification of the type of reaction is not a proxy for seriousness or risk of harm to the patient, which is better expressed by the manifestation in clinical practice.
The risk of an adverse reaction event or manifestation should not be recorded without identifying a proposed causative substance or class of substance. If there is uncertainty that a specific substance is the cause, this uncertainty can be recorded using the ‘Status’ data element. If there are multiple possible substances that may have caused a reaction/manifestation, each substance should be recorded using a separate instance of this adverse reaction archetype with the ‘Status’ set to an initial state of ‘Suspected’ so that adverse reaction checking can be activated in clinical systems. Once the substance, agent or class is later proven not to be the cause for a given reaction then the ‘Status’ can be modified to ‘Refuted’.
This archetype has been designed to allow recording of information about a specific substance (amoxycillin, oysters, or bee sting venom) or, alternatively, a class of substance (eg Penicillins). If a class of substance is recorded then identification of the exact substance can be recorded on a per exposure basis.
The scope of this archetype has deliberately focused on identifying a pragmatic data set that are used in most clinical systems or will be suitable for most common clinical scenarios, however it permits extension of the model when additional detail is required, for example 'Reaction details', 'Exposure details', and 'Reporting details' slots. Examples of clinical situations where the extension may be required include: a detailed allergist/immunologist assessment, for reporting to regulatory bodies or use in a clinical trial.
The act of recording any adverse reaction risk in a health record involves the clinical assessment that a potential hazard exists for an individual if they are exposed to the same substance/agent/class in the future – that is, a relative contraindication - and the default ‘Criticality’ value should be set to ‘Low risk’. If a clinician considers that it is not safe for the individual to be deliberately re-exposed to the substance/agent again, for example, following a manifestation of a life-threatening anaphylaxis, then the 'Criticality' data element should be amended to ‘High’.
A formal Adverse Event Report to regulatory bodies is a document that will contain a broad range of information in addition to the specific details about the adverse reaction. The report could utilise parts of this Risk of adverse reaction archetype plus include additional data as required per jurisdiction.
An adverse reaction or allergy/intolerance list is a record of all identified propensities for an adverse reaction for the individual upon future exposure to the substance or class, plus provides potential access to the evidence provided by details about each reaction event, such as manifestation.
Valuable first-level information that could be presented to the clinician when they need to assess propensity for future reactions are:
- statements about previous clinical manifestations following exposure;
- source of the information/reporter; and
- the ‘Criticality’ flag.
Second-level information can be drawn from each exposure event and links to additional detailed information such as history, examination and diagnoses stored elsewhere in the record, if it is available.
This archetype is designed as one component of the therapeutic precautions family of archetypes that need to be considered when a clinician is about to commence a new treatment, test or procedure for an individual.
Links to other parts of the health record where further details may be located, such as consultation notes, is allowed by the openEHR reference model, but not modelled explicitly in this archetype.
The content of this archetype is a result of a collaboration between the openEHR and HL7 FHIR communities. FHIR specific content that was included as part of the peer review process has been removed from this openEHR archetype.
Allergy and Intolerance Domain Analysis Model, Release 1, HL7 [Internet]. Publication pending, expected August 2014; Available at http://wiki.hl7.org/images/1/1b/Allergy_and_Intolerance_INFORM_2013_MAY.pdf (accessed 06 July 2014).
Allergy, clinical element model, GE/Intermountain Healthcare. Clinical Element Model Search. Available at: http://intermountainhealthcare.org/cem/Pages/Detail.aspx?NCID=520861661&k=allergy (accessed Jan 16, 2012).
Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000 Oct 7;356(9237):1255-9. PubMed PMID: 11072960.
HL7 FHIR Resource - AllergyIntolerance R1.2.0 STU3 draft [Internet]. Health Level Seven International; [accessed 2020 Jan 17]. Available from: http://hl7.org/fhir/2016Jan/allergyintolerance.html.
Horsfield P, Sibeko S. Representation in Electronic Patient Records of Allergic Reactions, Adverse Reactions, and Intolerance of Pharmaceutical Products [Internet]. London, UK: National Health Service; 2006 Sep 07 [cited 2011 Jun 21]; Available at https://svn.connectingforhealth.nhs.uk/svn/public/nhscontentmodels/TRUNK/ref/NPfIT/Allergy_ADR_Intolerance%20v%201.2Final.doc.
Long R, Bentley S. SCG Guidance on the Representation of Allergies and Adverse Reaction Information Using NHS Message Templates [Internet]. London, UK: National Health Service; 2008 Apr 30 [cited 2011 Jun 21]; Available at http://www.connectingforhealth.nhs.uk/systemsandservices/data/scg/scg0001.pdf.
Microsoft. Design Guidance: Displaying Adverse Drug Reaction Risks [Internet]. 2009 January 28 [cited 2011 Jun 21]; Available at www.mscui.net/DesignGuide/DisplayingAllergies.aspx.
Microsoft. Design Guidance: Recording Adverse Drug Reaction Risks [Internet]. 2009 March 27 [cited 2011 Jun 21]; Available at www.mscui.net/DesignGuide/RecordingAllergies.aspx.
Mosby. Mosby's Pocket Dictionary of Medicine, Nursing and Health Professions. 6th Edition. USA: Mosby Elsevier; 2010
National E-Health Transition Authority. Adverse Reactions (Data Specifications) Version 1.1 [Internet]. Sydney, Australia: NEHTA; 2008 Feb 29 [cited 2011 Jun 21]; Available at http://www.nehta.gov.au/component/docman/doc_download/453-adverse-reaction-data-specification-v11.
Riedl MA, Casillas AM. Adverse drug reactions: types and treatment options. Am Fam Physician. 2003 Nov 1;68(9):1781-90. Review. PubMed PMID: 14620598.
Royal Australian College of General Practitioners. Fact Sheet: Allergies & Adverse Reactions (Draft). 2010.
Thien FC. Drug hypersensitivity. Med J Aust. 2006 Sep 18;185(6):333-8. Review. PubMed PMID: 16999678.
- Uppsala Monitoring Centre (WHO): http://www.who-umc.org/
- European Medicines Agency: http://www.ema.europa.eu/ema/
- DIRECTIVE 2010/84/EU OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL, of 15 December 2010, amending, as regards pharmacovigilance, Directive 2001/83/EC on the Community code relating to medicinal products for human use: http://ec.europa.eu/health/files/eudralex/vol-1/dir_2010_84/dir_2010_84_en.pdf
Organisation: Ocean Informatics
Email: heather.leslie@oceaninformatics.com
Date originally authored: 2010-11-08
Organisation: Ocean Informatics
Email: heather.leslie@oceaninformatics.com
Date originally authored: 2010-11-08
- Licence: This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/.
- Custodian Organisation: openEHR Foundation
- References: Adverse Reaction, draft archetype, National eHealth Transition Authority [Internet]. NEHTA Clinical Knowledge Manager. Authored: 08 Nov 2010. Available at: http://dcm.nehta.org.au/ckm/OKM.html#showarchetype_1013.1.868_7 (accessed Jan 16, 2012). Allergy and Intolerance Domain Analysis Model, Release 1, HL7 [Internet]. Publication pending, expected August 2014; Available at http://wiki.hl7.org/images/1/1b/Allergy_and_Intolerance_INFORM_2013_MAY.pdf (accessed 06 July 2014). Allergy, clinical element model, GE/Intermountain Healthcare. Clinical Element Model Search. Available at: http://intermountainhealthcare.org/cem/Pages/Detail.aspx?NCID=520861661&k=allergy (accessed Jan 16, 2012). Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000 Oct 7;356(9237):1255-9. PubMed PMID: 11072960. HL7 FHIR Resource - AllergyIntolerance R1.2.0 STU3 draft [Internet]. Health Level Seven International; [accessed 2020 Jan 17]. Available from: http://hl7.org/fhir/2016Jan/allergyintolerance.html. Horsfield P, Sibeko S. Representation in Electronic Patient Records of Allergic Reactions, Adverse Reactions, and Intolerance of Pharmaceutical Products [Internet]. London, UK: National Health Service; 2006 Sep 07 [cited 2011 Jun 21]; Available at https://svn.connectingforhealth.nhs.uk/svn/public/nhscontentmodels/TRUNK/ref/NPfIT/Allergy_ADR_Intolerance%20v%201.2Final.doc. Long R, Bentley S. SCG Guidance on the Representation of Allergies and Adverse Reaction Information Using NHS Message Templates [Internet]. London, UK: National Health Service; 2008 Apr 30 [cited 2011 Jun 21]; Available at http://www.connectingforhealth.nhs.uk/systemsandservices/data/scg/scg0001.pdf. Microsoft. Design Guidance: Displaying Adverse Drug Reaction Risks [Internet]. 2009 January 28 [cited 2011 Jun 21]; Available at www.mscui.net/DesignGuide/DisplayingAllergies.aspx. Microsoft. Design Guidance: Recording Adverse Drug Reaction Risks [Internet]. 2009 March 27 [cited 2011 Jun 21]; Available at www.mscui.net/DesignGuide/RecordingAllergies.aspx. Mosby. Mosby's Pocket Dictionary of Medicine, Nursing and Health Professions. 6th Edition. USA: Mosby Elsevier; 2010 National E-Health Transition Authority. Adverse Reactions (Data Specifications) Version 1.1 [Internet]. Sydney, Australia: NEHTA; 2008 Feb 29 [cited 2011 Jun 21]; Available at http://www.nehta.gov.au/component/docman/doc_download/453-adverse-reaction-data-specification-v11. Riedl MA, Casillas AM. Adverse drug reactions: types and treatment options. Am Fam Physician. 2003 Nov 1;68(9):1781-90. Review. PubMed PMID: 14620598. Royal Australian College of General Practitioners. Fact Sheet: Allergies & Adverse Reactions (Draft). 2010. Thien FC. Drug hypersensitivity. Med J Aust. 2006 Sep 18;185(6):333-8. Review. PubMed PMID: 16999678. - Uppsala Monitoring Centre (WHO): http://www.who-umc.org/ - European Medicines Agency: http://www.ema.europa.eu/ema/ - DIRECTIVE 2010/84/EU OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL, of 15 December 2010, amending, as regards pharmacovigilance, Directive 2001/83/EC on the Community code relating to medicinal products for human use: http://ec.europa.eu/health/files/eudralex/vol-1/dir_2010_84/dir_2010_84_en.pdf
- Current Contact: Heather Leslie, Atomica Informatics, Australia
- Original Namespace: org.openehr
- Original Publisher: openEHR Foundation
- Custodian Namespace: org.openehr
- MD5-CAM-1.0.1: 220DC2F5751B64BCD8473FD53080C94F
- Build Uid: 68e26431-f282-43a9-9993-3ccc1fe20492
- Revision: 1.2.3
Both an individual substance and a substance class are valid entries in 'Substance'. A substance may be a compound of simpler substances, for example a medicinal product. If the value in 'Substance' is an individual substance, it may be duplicated in 'Specific substance'. It is strongly recommended that both 'Substance' and 'Specific substance' be coded with a terminology capable of triggering decision support, where possible. For example: Snomed CT, DM+D, RxNorm, NDFRT, ATC, New Zealand Universal List of Medicines and Australian Medicines Terminology. Free text entry should only be used if there is no appropriate terminology available.
Optional[{source=openEHR,FHIR,DAM}]
Decision support would typically raise alerts for 'Suspected', 'Likely', 'Confirmed', and ignore a 'Refuted' reaction. Clinical systems may choose not to display Adverse reaction entries with a 'Refuted' status in the Adverse Reaction List. However, 'Refuted' may be useful for reconciliation of the adverse reaction list or when communicating between systems . Some implementations may choose to make this field mandatory. 'Resolved' may be used variably across systems, depending on clinical use and context - there appears to be differing opinion whether this should still be used to raise potential alerts or to display in an Adverse Reaction List. The free text data type will allow for local variation by enabling other value sets to be applied to this data element in a template - in this situation it is recommended that values should be coded using a terminology.
Optional[{source=FHIR, DAM}]
Choice of:
Coded Text- Suspected [A low level of clinical certainty about the propensity of a reaction to the identified 'Substance'.]
- Likely [A reasonable level of certainty about the propensity for a reaction to the identified 'Substance'.]
- Confirmed [A high level of certainty about the propensity for a reaction to the identified 'Substance', which may include clinical evidence by testing or re-challenge.]
- Resolved [The previously known reaction to the identified 'Substance' has been clinically reassessed and considered no longer to be an active risk.]
- Refuted [The propensity for a reaction to the identified 'Substance' has been clinically reassessed or has been disproved with a high level of clinical certainty by re-exposure or deliberate challenge.]
Text
This can be regarded as a predictive judgement of a 'worst case scenario'. In most contexts 'Low' would be regarded as the default value.
Optional[{source=DAM, openEHR}]
- Low [Exposure to substance unlikely to result in critical system organ damage or life threatening consequence. Future exposure to the identified 'Substance' should be considered a relative contra-indication in normal clinical circumstances.]
- High [Exposure to substance may result in critical organ system damage or life threatening consequence. Future exposure to the identified 'Substance' should be considered an absolute contra-indication in normal clinical circumstances.]
- Indeterminate [Unable to assess with information available.]
This data element has been included because it is currently being captured in some clinical systems. This data can be derived from the Substance where coding systems are used, and is effectively redundant in that situation.
Choice of:
- Coded Text
- Food [Any substance consumed to provide nutritional support for the body, such as peanut or egg.]
- Medication [Any substance administered to achieve a physiological effect.]
- Other [Any other substance encountered including venom, latex and other environmental substances.]
- Text
This date may be be a duplicate of the most recent 'Onset of reaction' date. Where a textual representation of the date of last occurrence is required e.g 'In Childhood, '10 years ago' the Comment element should be used.
Optional[{source=IMH}]
Immune-mediated responses have been traditionally regarded as an indicator for escalation of significant future risk. Contemporary knowledge suggests that some reactions previously thought to be immune are actually non-immune and still carry life threatening risk. Immunological testing may provide supporting evidence for the mechanism and causative substance , but no tests are 100% sensitive or specific for a sensitivity. It is acknowledged that most clinicians will NOT be able to distinguish the mechanism of any specific reaction. However this data element is included because many legacy systems have captured this attribute.
Optional[{source=FHIR, DAM}]
Choice of:
- Coded Text
- Immune mediated [Immune mediated reaction, including allergic reactions and hypersensitivities.]
- Non-immune mediated [A non-immune mediated reaction, which can include pseudo-allergic reactions, side effects, intolerances, drug toxicities (for example, to Gentamicin).]
- Indeterminate [The physiological mechanism could not be determined.]
- Text
For example: including reason for flagging a 'Criticality' of 'High risk'; and instructions related to future exposure or administration of the Substance, such as administration within an Intensive Care Unit or under corticosteroid cover.
Optional[{source=openEHR}]
Optional[{source=openEHR,FHIR,DAM}]
For example: 'Amoxycillin'. Only an individual substance is a valid entry in 'Specific substance'. A substance may be a compound of simpler substances, for example a medicinal product. If the value in 'Substance' is an individual substance and not a substance class, then it may be duplicated in this data element. It is strongly recommended that 'Specific substance' be coded with a terminology capable of triggering decision support, where possible. For example: RxNorm, Snomed CT, DM+D, NDFRT, ICD-9, ICD-10, UNI, ATC and CPT. Free text entry should only be used if there is no appropriate terminology available.
Optional[{source=FHIR, openEHR,DAM}]
Optional[{source=FHIR}]
- Suspected [A low level of clinical certainty that the reaction was caused by the identified 'Specific substance'.]
- Likely [A reasonable level of clinical certainty that the reaction was caused by the identified 'Specific substance'.]
- Confirmed [A high level of clinical certainty that the reaction was due to the identified 'Substance', which may include clinical evidence by testing or re-challenge.]
Manifestation can be expressed as a single word, phrase or brief description. For example: nausea, rash. 'No reaction'may be appropriate where a previous reaction has been noted but the reaction did not re-occur after further exposure. It is preferable that 'Manifestation' should be coded with a terminology, where possible. The values entered here may be used to display on an application screen as part of a list of adverse reactions, as recommended in the UK NHS CUI guidelines. Terminologies commonly used include, but are not limited to, SNOMED-CT or ICD10.
Optional[{source=FHIR, openEHR,DAM}]
Optional[{source=FHIR, openEHR}]
Optional[{source=openEHR, FHIR, DAM}]
Optional[{source=openEHR}]
It is acknowledged that this assessment is very subjective. There may be some some specific practice domains where objective scales have been applied. Objective scales can be included in this model using the 'Reaction details' Cluster.
Optional[{source=DAM}]
Choice of:
- Coded Text
- Mild [Causes mild physiological effects.]
- Moderate [Causes moderate physiological effects.]
- Severe [Causes severe physiological effects.]
- Text
May include structured detail about symptoms; the anatomical location of the manifestation; grading, classification or formal severity assessments such as Common Terminology Criteria for Adverse Events; or the Multimedia CLUSTER archetype. [Note: FHIR - These would be extensions as specified in a profile.]
Optional[{source=FHIR, openEHR}]
Include:
openEHR-EHR-CLUSTER.anatomical_
openEHR-EHR-CLUSTER.media_
openEHR-EHR-CLUSTER.anatomical_
openEHR-EHR-CLUSTER.symptom_
Exposure can be more complicated by more than one exposure events leading to a reaction. Further details about the nature of the exposure can be provided by use of additional archetypes in the 'Exposure details' SLOT or as text in the 'Exposure description'.
Optional[{source=FHIR, openEHR,DAM}]
Optional[{source=openEHR}]
Coding of the Route of Exposure with a terminology should be used wherever possible.
Optional[{source=FHIR, DAM}]
Optional[{source=openEHR}]
Include:
openEHR-EHR-CLUSTER.citation.v1 and specialisations or
openEHR-EHR-CLUSTER.citation.v0 and specialisations
Optional[{source=openEHR}]
Include:
All not explicitly excluded archetypes
Optional[{source=FHIR, openEHR}]
Include:
All not explicitly excluded archetypes
This SLOT is intended to provide details about the source of information for this particular 'Reaction event'. Details about the source of information for the entire 'Adverse reaction risk' should be recorded using the 'Information Provider' reference model attribute.
Include:
All not explicitly excluded archetypes
Optional[{source=openEHR}]
Note: maps to recordedDate in FHIR.
Optional[{source=openEHR, FHIR, DAM}]
For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents.
Include:
All not explicitly excluded archetypes
For example, presenting symptoms, examination findings, diagnosis etc. [Note: FHIR,DAM: Maps to Sensitivity Test.]
Optional[{source=FHIR, openEHR, DAM}]
Optional[{source=openEHR}]
For example, the reason for non-reporting.
Optional[{source=openEHR}]
Optional[{source=openEHR}]
Grethe Almenning, Bergen kommune, Norway
Magnus Alsaker, Helsedirektoratet, Norway
Torunn Apelseth, Helse Bergen, Norway
Vebjørn Arntzen, Oslo University Hospital, Norway
Bent Asgeir Larsen, Helsedirektoratet, Norway
Koray Atalag, University of Auckland, New Zealand
Elaine Ayres, US National Institutes of Health, United States
Russell B Leftwich MD, United States (openEHR Editor)
Silje Ljosland Bakke, Helse Vest IKT AS, Norway (openEHR Editor)
John Bennett, NEHTA, Australia
Steve Bentley, Allscripts, United Kingdom
Sharmila Biswas, Dr Sharmila Biswas GP, Australia
Lars Bitsch-Larsen, Haukeland University hospital, Norway
Terje Bless, Helse Nord FIKS, Norway
Laila Bruun, Oslo universitetssykehus HF, Norway
Claire Chalopin, ICCAS, University of Leipzig, Germany
Rong Chen, Cambio Healthcare Systems, Sweden
Stephen Chu, Queensland Health, Australia
Matthew Cordell, NEHTA, Australia
Howard Edidin, Edidin Group, Inc, United States
Brett Esler, Oridashi, Australia
David Evans, Queensland Health, Australia
Jerry Fahrni, Kaweah Delta Health Care District, United States
Shahla Foozonkhah, Iran ministry of health and education, Iran
Einar Fosse, National Centre for Integrated Care and Telemedicine, Norway
Joanne Foster, School of Nursing & Midwifery, QLD University of Technology & Nursing Informatics Australia, Australia
Sebastian Garde, Ocean Informatics, Germany
Jacquie Garton-Smith, Royal Perth Hospital and DoHWA, Australia
Sarah Gaunt, NEHTA, Australia
Andrew Goodchild, NEHTA, Australia
Heather Grain, Llewelyn Grain Informatics, Australia
Trina Gregory, cpc, Australia
Grahame Grieve, Health Intersections, Australia (Editor)
Robert Hausam, Hausam Consulting LLC, United States
Sam Heard, Ocean Informatics, Australia
Kristian Heldal, Telemark Hospital Trust, Norway
Anca Heyd, DIPS ASA, Norway
Hilde Hollås, Norway
Roar Holm, Helse Vest IKT A/S, Norway
Andrew James, University of Toronto, Canada
Julie James, Blue Wave Informatics LLP, United Kingdom
Tom Jarl Jakobsen, Helse Bergen, Norway
Ivor Jones, Queensalnd Helath, Australia
Lars Jostein Silihagen, Sopra Steria / Sykehuspartner / Sykehuset Innlandet, Norway
Silje Kaada, Helse-Bergen, Avdeling for immunologi og transfusjonsmedisin, Norway
Konstantinos Kalliamvakos, Cambio Healthcare Systems, Sweden
Lars Karlsen, DIPS ASA, Norway
Lars Morgan Karlsen, DIPS ASA, Norway
Goran Karlstrom, County Of Värmland, Sweden
Mary Kelaher, NEHTA, Australia
Diane Kirkham, NEHTA, Australia
Shinji Kobayashi, Kyoto University, Japan
Robert L'egan, NEHTA, Australia
Jobst Landgrebe, ii4sm, Switzerland
Russell Leftwich, Russell B Leftwich MD, United States
Fest Legemiddelverket, Statens Legemiddelverk, Norway
Heather Leslie, Atomica Informatics, Australia (openEHR Editor)
Hugh Leslie, Ocean Informatics, Australia
Rikard Lovstrom, Swedish Medical Association, Sweden
Hallvard Lærum, Oslo Universitetssykehus HF, Norway
Arne Løberg Sæter, DIPS ASA, Norway
Sarah Mahoney, Australia
Luis Marco Ruiz, Norwegian Center for Integrated Care and Telemedicine, Norway
Siv Marie Lien, DIPS ASA, Norway
Mike Martyn, The Hobart Anaesthetic Group, Australia
Lloyd McKenzie, Gordon Point Informatics, Canada
David McKillop, NEHTA, Australia
Ian McNicoll, freshEHR Clinical Informatics, United Kingdom (openEHR Editor)
Chris Mitchell, RACGP, Australia
Stewart Morrison, NEHTA, Australia
Jörg Niggemann, Compugroup, Germany
Bjørn Næss, DIPS ASA, Norway
Tom Oniki, Intermountain Healthcare, United States
Chris Pearce, Melbourne East GP Network, Australia
Rune Pedersen, Universitetssykehuset i Nord Norge, Norway
General Practice Computing Group, Australia
Camilla Preeston, Royal Australian College of General Practitioners, Australia
Margaret Prichard, NEHTA, Australia
Jodie Pycroft, Adelaide Northern Division of General Practice Ltd, Australia
Cathy Richardson, NEHTA, Australia
Robyn Richards, NEHTA - Clinical Terminology, Australia
Tanja Riise, Nasjonal IKT HF, Norway
Jussara Rotzsch, Hospital Alemão Oswaldo Cruz, Brazil
Stefan Sauermann, University of Applied Sciences Technikum Wien, Austria
Thomas Schopf, University Hospital of North-Norway, Norway
Thilo Schuler, Australia
Jason Scott, Plymouth Hospitals NHS Trust, United Kingdom
Peter Scott, Medical Objects, Australia
Elena Shabanova, UMMSSOft, Russian Federation
Anoop Shah, University College London, United Kingdom
Elizabeth Stanick, Hobart Anaesthetic Group, Australia
Laila Storesund, Haraldsplass diakonale sykehus, Norway
Norwegian Review Summary, Nasjonal IKT HF, Norway
Line Sæle, Nasjonal IKT HF, Norway
Hwei-Yee Tai, Tan Tock Seng Hospital, Singapore
John Taylor, NEHTA, Australia
Micaela Thierley, Helse Bergen, Norway
Gordon Tomes, Australian Institute of Health and Welfare, Australia
John Tore Valand, Haukeland Universitetssjukehus, Norway (Nasjonal IKT redaktør)
Richard Townley-O'Neill, Australian Digital Health Agency, Australia
Ines Vaz, UFN, Portugal
Nils Widnes, Helse-Bergen, Norway
Andrew Yap, Australia
Kylie Young, The Royal Australian College of General Practitioners, Australia
Lin Zhang, Taikang Insurance Group, China
- German: Natalia Strauch, Medizinische Hochschule Hannover, Strauch.Natalia@mh-hannover.de
- Swedish: Emma Malm, Karolinska Universitetssjukhuset, emma.malm@cambio.se
- Norwegian Bokmål: Lars Bitsch-Larsen, Haukeland University Hospital, Bergen Norway, MD DEAA MBA spec in anesthesia and intensive care, spec in tropical med., Lbla@Helse-Bergen.No: lbla@helse-bergen.no
- Portuguese (Brazil): Osmeire Chamelette Sanzovo, Hospital Sírio Libanês, osmeire.acsanzovo@hsl.org.br