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Request for input: Definitions and use cases in relation to Care plan documents. Please see the links section for further information.

Topic presenter: Monica Harry


DateRequested actionRequester(s)Response required by:Comments
 14 March 2017
 Upload of any additional documents or links by Monica Harry
  16 March 2017 

Document Link: SCTQA-92 Revise Care plan concepts

EAG discussion: 2017-01-20 Editorial Advisory Group Conference call

CMAG meeting: 2017-03-14 - CMAG Meeting

Relevant documents

  File Modified
Microsoft Powerpoint Presentation Care Plan Representation.pptx 2017-Mar-14 by Cathy Richardson
Microsoft Word Document CMAG Briefing note - Care plan document proposal.docx 2017-Mar-15 by Monica Harry
Microsoft Word Document CARE PLANS UK feedback.docx 2017-Apr-13 by Elaine Wooler


DateRequested actionRequester(s)Response required by:Comments
 14 March 2017

Review proposed plan for the management of Care plan concepts and provide your countries feedback.

Note: Monica to provide a briefing note.

  • Camilla Wiberg Danielsen Please provide feedback on the proposal for management of Care plan concepts  
  • Daniel Karlsson Please provide feedback on the proposal for management of Care plan concepts   
  • Elaine Wooler Please provide feedback on the proposal for management of Care plan concepts   
  • Elze de Groot  Please provide feedback on the proposal for management of Care plan concepts   
  • John Fountain  Please provide feedback on the proposal for management of Care plan concepts   
  • Linda Parisien Please provide feedback on the proposal for management of Care plan concepts    
  • Matt Cordell Please provide feedback on the proposal for management of Care plan concepts    
  • Olivier Bodenreider Please provide feedback on the proposal for management of Care plan concepts    
  • Jostein Ven Please provide feedback on the proposal for management of Care plan concepts    
Please post your final responses in the Country response table below. Discussion comments can be made as comments.

Country response 

US18MAR2017This proposal seems beneficial to SNOMED, because 1) it derives from another standard; 2) it provides strong editorial guidance for content that has been inconsistently modeled across extensions. Moreover, it squarely anchors care plans into information artifacts. No drawbacks come to mind.
 UK 27MAR2017 Although generally this is what the UK expected I will need to consult on the recommendations formally with the change in the description. If we could extend the deadline for feedback to the 14th April this should enable me to do this.
DK27MAR2017Danish nurses tell me care plans are very relevant for them too, but presently the nurses do not have any comments to this proposal.

I not aware of any immenent requirement for this work within Australia, so no obvious impact, but it seems reasonable. Tidying up the qualifiers is always good. I assume it's only a specific subset of "regime/therapies" that are to be deprecated (it doesn't look like these are in the international release anyway? As for the "concept model" for these - seems reasonable, though I'm not sure about the need for "Type of clinical document" attribute... would an |IS A| be sufficient?

One thing to note though, is that the FHIR seems to have defined a value set based on the qualifier values (see ) (It's only a "maturity level 1". But Record Artifact seems like a more accurate class. (I've made a note for FHIR to "watch this space").

NL29MAR2017We agree with deprecating the suggested qualifier values and regime/therapies, because we do believe a care plan is a document. I would like to discuss the suggested modelling changes (like care location) internally with my team. It would be a good thing to share the record artifacts with other countries before more countries will do the same. We are not yet working on care plans related with Snomed CT, but we do have some record artifacts in our extension, may be modelled in a different way (other parents, not EHR related). We made those for XDS metadata purposes (what document is exchanged). I checked, but that does not count for the care plans. Summary: Agree.
SE2017-03-30There is a current Swedish national project looking at representation of care plans. No decisions have been made regarding terminology so Sweden would not be affected. The suggested changes would improve consistency.
NZ3APR2017General comments summarised: A useful initiative and the link to ISO 139040:2015 is noted. It may be too narrow to consider a care plan as simply a record artifact (i.e. the documentation of a care plan). This seems a reasonable way forward.

Comment received from the UK are attached. Whilst the proposal seems reasonable for this smaller piece of work there are some bigger issues which need to be considered and it would be helpful if the questions raised in the attached document could be considered by SNOMED International and the Nursing SIG.


Member countries without a CMAG rep  


CMAG response

DateCMAG ResponseNext steps


Final outcome: 



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  1. Hi I get this message next to the JIRA Link above: SCTQA-92 - JIRA issue doesn't exist or you don't have permission to view it.


  2. Hi there,

    That issue is located on an internal tracker. All the information on that page is contained in the document.


  3. Hi there, 

    Just to respond to Elaine's request for an extension to April 14th; that is fine as long as it is understood that it is much less likely that these will be edited in time for July 2017 release. Does not seem that anyone has an imminent implementation. 

    Thank you for your attention to this matter. 

    Sincerely, Monica

  4. Thanks Monica. I may well get feedback by the 10th so that's only three days over the due date we were given.

  5. Having reviewed the comments on the fast track proposal and the acceptance of the meaning of care plans as aligning with ISO 13940 which includes many aspects of care plans other than just a document, I propose a slight modification to the fast track to eliminate the term "document" from the FSN and PT, but still consolidate the various care plan representations under "qualifier value" and 'regime/therapy" under record artifact.  

    As the UK already has a concept 325661000000106 |Care plan (record artifact)|, SI requests that that term be promoted to the International release as the parent concept for this new subhierarchy.  The same review and revision to the existing care plan concepts would be undertaken as proposed in the fast track document. 

  6. Hi Jim

    I can see that a concept has been added in the Daily Build - 734163000 Care plan (record artifact).  Our current RF1 authoring tool can't handle reconciliation with the international release if our concept ID's are retained so would be happy with the concept as authored in the daily build with the SI identifier as is.

    Many thanks


  7. Good to know, so we are copacetic

  8. Thank you, I will amend the fast track document accordingly and proceed with the work henceforth. Monica