Electronic medical records (EMRs)

EMRs are not set up to include allergies to non-medicinal ingredients of medications

Currently, there are no Canada-wide — or even provincial — standards about keeping track of allergies to non-medicinal ingredients in medications in patient records. This means that there is no place in electronic medical records for recording allergies to the non-medicinal ingredients of medications, such as corn starch.

The electronic record formats used by most medical offices, clinics and hospitals have boxes where doctors can record allergies to foods and/or allergies to medications. The “foods” box is a blank space where doctors can write anything, but the “medications” list is almost always restricted to the types of drugs available in the jurisdiction where the facility is located — that is, a subset of the CPS (because drug availability varies by province). Usually it is in the form of a drop-down menu or a set of terms that the doctor clicks through so that the doctor can be precise about exactly which drug(s) the patient is allergic to. A predefined list of terms in the medications box also helps doctors avoid spelling errors. In other words, there is no way for a doctor to write comments like “allergic to corn” in it. So, even though corn derivatives are common as fillers, sweeteners or emulsifiers in many medications sold in Canada, there is no way to add “corn” to the “allergies to medications” list, because “corn,” is not listed as a medications in the CPS.

The exception here is dextrose solution, which is often used as a base to mix up medications to be delivered through IVs. Unfortunately, dextrose comes in many formats and concentrations, and doctors filling out the “allergies to medications” box are unlikely to check every one of the 20-or-so permutations of dextrose solution. Plus, the dextrose that shows up as a medication is only the IV bag type, not dextrose used as a filler in pills, so even if a doctor indicates in a patient’s records that he or she has an allergy to dextrose solution, other doctors looking at the records would still not be aware that dextrose in pills is equally bad.

This omission in the design of electronic medical records can have serious consequences: I had a severe reaction to a dextrose drip in the hospital. I was given dextrose in a magnesium drip that was prepared by a nurse who I had not spoken with personally but who had looked at my electronic medical record. If my medical record had a place to record my allergy to non-medicinal ingredients, the issue would have been flagged and she would have used saline solution instead of dextrose solution, saving everyone a load of stress.

  • I am currently in discussions with Anaphylaxis Canada to get a dedicated box for recording allergies to non-medicinal ingredients of medications added to the standards for EMRs in Canada. If you would like to help, contact me and/or your MPP!