HealthcareTechnology

PENallergy✔ – The SMART on FHIR App That De-Labels Penicillin Allergies at the Point of Care

ClientJames Allen, MD, PhD, FIDSA

ProductSMART on FHIR application for Epic and Cerner EHR systems

Itirra's roleEvery layer of the integration

Now listed in the Epic Showroom

Penicillin allergy de-labeling, inside the clinical workflow

A SMART on FHIR clinical decision support tool

Adults and childrenInpatient and outpatientBilingual questionnairesBy history alone

PENallergy SMART on FHIR app open as a tab inside the EHR patient chart, showing step 1 of the allergy evaluation

95%+

of patients labeled penicillin-allergic are not actually allergic

80%

lose their allergy within 10 years

Up to 20%

of U.S. patients carry a penicillin allergy label

Introduction

A problem hiding in plain sight

James Allen, MD, PhD, FIDSA, saw a problem hiding in plain sight inside every hospital chart.

Over 95% of patients labeled penicillin-allergic are not actually allergic. Eighty percent lose their allergy within 10 years. Nobody was fixing this — because no tool existed to do it at the point of care.

He decided to challenge the status quo. Dr. Allen took it upon himself to build the solution — and reached out to Itirra to develop PENallergy✔ as a SMART on FHIR application for Epic and Cerner EHR systems.

Challenges

The data behind that label tells a different story

Up to 20% of U.S. patients carry a penicillin allergy label. The gap between the label and true allergy costs the healthcare system $7.2 billion a year.

Patients flagged as penicillin-allergic face a 30% higher risk of VRE, 23% higher risk of C. difficile, and 14% higher risk of MRSA — all from receiving the wrong antibiotics.

The AAAAI published guidance for standardizing allergy de-labeling in EHR systems. The clinical case was made. But no app in Epic or Cerner made it actionable at the point of care. That was the gap.

Solution

The app lives where clinicians already work

Itirra built PENallergy✔ as a SMART on FHIR app embedded inside Epic Hyperspace. No extra login. No screen switching. The app lives where clinicians already work.

The app reads the patient chart and guides the clinician through a bilingual risk stratification questionnaire — adult, pediatric, or pre-operative — classifying risk by history alone. No skin testing required.

When de-labeling is appropriate, the allergy record updates via the FHIR R4 API through Epic's native physician reconciliation workflow. The entire process stays inside Epic.

From clinical concept to the Epic Showroom — Itirra handled every layer of the integration, so James Allen, MD, could focus on the medicine.

Integration	SMART on FHIR, Epic Hyperspace (SSO, embedded interface)
API	FHIR R4 — `GET /AllergyIntolerance`, `POST /AllergyIntolerance`
Compliance	HIPAA-compliant cloud infrastructure
Languages	English / Spanish (bilingual questionnaires)
Patients	Adult, pediatric, pre-operative
Distribution	Epic Showroom

Results

What systematic de-labeling delivers

The research on systematic de-labeling is consistent. PENallergy✔ is built to deliver exactly these outcomes — at the point of care, without adding workflow overhead.

~28% ↓in antibiotic costs per labeled patient, driven by reduced use of broad-spectrum alternatives

5.5% ↓shorter average hospital length of stay compared to patients with an unresolved penicillin allergy label

$1,444estimated savings per inpatient in the U.S. when de-labeling is performed proactively

$2,000in annual savings per de-labeled patient across inpatient and outpatient settings

Sources: Powell et al., Journal of Hospital Infection, 2020 (antibiotic cost and LOS data, 750-bed UK hospital); Sousa-Pinto et al., Annals of Allergy, Asthma & Immunology, 2018 (102,872 hospitalizations, Portugal); economic model from PMC / J Allergy Clin Immunol Pract, 2021 (U.S. inpatient savings estimate); Blumenthal et al., Military Medicine, 2018.

Testimonials

“The Itirra team has greatly exceeded my expectations for embedding my clinical decision support tool, PENallergy✔, into Epic and Cerner/Oracle. Itirra added great value to PENallergy✔ and was very easy to work with and accessible. PENallergy✔ would not be in the current market position had they not been extremely professional and proactive — easily meeting the established timelines. Great team!”James Allen, MD, PhD, FIDSA, Developer of PENallergy✔

Let's talk about your project.

Schedule a meeting with Michael →