D1.259 - Healthcare interoperability: the promises and pitfalls relating to penicillin allergy delabelling

Patient data are often located across heterogeneous, siloed health information systems. The interoperability of health IT systems can facilitate timely access to integrated patient information, ultimately improving both the quality of care and patient satisfaction.

The London Care Record (LCR) is an electronic health system (EHR) that delivers interoperability by providing a read-only summary view of patient Information collected from EHRs of most General Practices (GPs) and acute hospitals in London. Following delabelling, best practice includes updating hospital EHRs and requesting the removal of penicillin allergy labelling from community EHRs. There is little work exploring the role of EHR interoperability in facilitating penicillin re-use following delabelling. 

We retrospectively reviewed all patients seen in a weekly drug allergy clinic for suspected penicillin allergy between 2021 and 2022. Allergy status and prescription history from GP and acute hospital sources were examined on each patient’s LCR.

A total of 46 patients residing in London were included. All patients demonstrated negative penicillin skin prick and intradermal tests.  Thirty-eight patients tolerated penicillin drug provocation testing (DPT)  (n=20) or were advised to reintroduce penicillin in the community (n=18). Penicillin re-use was higher among patients delabelled compared to those whose penicillin allergy status remained on their GP or acute hospital EHRs. Delabelling in community EHR appears more influential in facilitating penicillin re-use than acute hospital delabelling (penicillin reintroduction in community EHR delabelled vs labelled: 37% vs 8%, penicillin reintroduction in acute hospital EHR delabelled vs labelled: 26% vs 18%).

Interoperable systems such as the LCR support more informed joined-up decision-making. However, given the importance of penicillin delabelling in EHRs, dynamic interoperability is required. LCRs read-only view risks sharing outdated inaccurate allergy information as allergy statuses can only be updated by other clinicians from the original EHR data source. Such reliance on other clinicians resulted in 50% and 30% of allergist delabelled patients continuing to have a penicillin allergy label on their community and acute hospital EHRs, respectively. To realise dynamic health record interoperability, barriers such as adopting standardised terminologies/ontologies, privacy and security concerns, and vendor-imposed proprietary restrictions must be overcome.