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  • Contextual information that is not represented by
    Gloss
    tSNOMED CT
  • Structures that may be labeled using
    Gloss
    tSNOMED CT
  • Status terms
    Specref
    RefTypefield
    tterm
    that have a profound effect on
    Gloss
    tSNOMED CT
    encoded statements;
  • Context that can safely be represented using
    Gloss
    tqualifiers

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Context and Axis Modifiers

ModifierExamplesIssue

Subject of information

Stating that a relative of the patient has a particular disease. This may be recorded to state either "family history" or a 

Concept
t48176007|social context|
.

If the family history condition is represented using a 

Gloss
tSNOMED CT Concept
representing the a disease then it must be distinguishable from a statement that patient has that disease.

Planning stages

Stating that a patient should have, has been referred for, or has declined to undergo a particular procedure.

Ensuring these are distinguishable from statements that a patient has had the stated procedure.

Negation and uncertainty

Stating that a diagnosis has been excluded or is unlikely.

Stating a possible diagnosis or a differential diagnosis list.

Ensuring these are distinguishable from statements that a patient has been diagnosed as having that condition.

Contraindications

For example, using a 

Gloss
tSNOMED CT Concept
 to refer to a condition that contraindicates as particular treatment.

Ensuring these are distinguishable from statements that a patient has been diagnosed as having that condition.

There is a temptation to treat modifications such as those shown in  as though they were

Gloss
tqualifiers
. This is not a safe practice because the assumption is that a
Gloss
tqualifier
refines the meaning of the qualified
Gloss
tConcept
. A refined
Gloss
tConcept
should always be a
Gloss
tsubtype
of the original
Gloss
tconcept
. This is not the case for these major modifications as illustrated by the following:

  • Records of a
    Concept
    t57177007|family history of|
    +
    Concept
    t73211009|Diabetes mellitus|
    would not be expected in a response to a
    Specref
    RefTypefield
    tquery
    for patients with a record of diabetes mellitus (and its
    Gloss
    tsubtypes
    );
  • Records of "planned" + "hip replacement" should not be counted when analyzing the records of patients who have had any type of "joint replacement.";
  • Records that state "meningitis" + "excluded" should not be counted as cases of meningitis;
  • Records that state the patient is
    Concept
    t|allergic to|
    + "penicillin" are not records of treatment with an antibiotic.

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