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 delabeling, 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. 80% 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 fight this 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. That gap costs the healthcare system $7.2 billion a year.

Patients flagged as penicillin-allergic face 30% higher risk of VRE, 23% higher C. difficile risk, and 14% higher MRSA risk — 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 FHIR R4 API through Epic's native physician reconciliation workflow. The entire process stays inside Epic.

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

IntegrationSMART on FHIR, Epic Hyperspace (SSO, embedded interface)
APIFHIR R4 — GET /AllergyIntolerance, POST /AllergyIntolerance
ComplianceHIPAA-compliant cloud infrastructure
LanguagesEnglish / Spanish (bilingual questionnaires)
PatientsAdult, pediatric, pre-operative
DistributionEpic App Orchard
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% ↓reduction 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 Cerna/Oracle. Itirra added great value to PENallergy✔, were very easy to work with and accessible. PENallergy✔ would not be in the current marketing position had they not been extremely professional and proactive - easily meeting the established timelines. Great team!”James Allen, MD, PhD, FIDSA, Developer of PENallergy✔

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