In the context of this SNOMED implementation guide, we have chosen to use the FHIR context model as an example of an information model for several reasons. FHIR is a widely adopted standard in the healthcare industry for exchanging electronic health records and related data. Its modular and extensible design makes it an ideal candidate to demonstrate how context information can be represented outside terminologies like SNOMED CT.
Clinical Findings with Context vs. FHIR Resources
The table below maps specific types of Situations with Explicit contexts to specific FHIR resources and states the associated context properties
| Situation with Explicit Context Subhierarchy | FHIR Resource | Context properties | |||
|---|---|---|---|---|---|
| Domain | Context | Subject | Temporal | ||
| 417662000 |History of clinical finding in subject (situation)| | Condition | Clinical finding | Known present | Subject of record | In the past |
| 416471007 |Family history of clinical finding (situation)| | FamilyMemberHistory | Clinical finding | Known present | Person in the family | Current or past |
| 160266009 |No family history of clinical finding (situation)| | N/A? | Clinical finding | Known absent | Person in the family | All times of past |
| 1260502004 |History of event in life of subject (situation)| | Condition | Event | Known present | Subject of record | In the past |
| 373572006 |Clinical finding absent (situation)| | Observation | Clinical finding | Known absent | Subject of record | Current or specified time |
| History Events with finding context | Observation | Event | Known absent | Subject of record | Current or specified time |
| 373573001 |Clinical finding present (situation)| | Condition | Clinical finding | Known present | Subject of record | Current |
| 443859009 |Possible clinical finding (situation)| | Condition | Clinical finding | Known possible | Subject of record | Current or specified time |
| 443938003 |Procedure carried out on subject (situation)| | Procedure | Procedure | Done | Subject of record | Current or specified time |
| 416237000 |Procedure not done (situation)| | Procedure | Procedure | Not done | Subject of record | Current or specified time |
| 439763000 |Procedure on family member (situation)| | Procedure | Procedure | - | Person in the family | Current or specified time |
Attributes vs. FHIR Resource Elements
As seen in the previous table, depending on the type of context represented in the SWEC concept, it can be transformed into a Condition or Observation resource. Here, we provide some examples of values for different key elements.
Condition Resource vs. |History of clinical finding in subject|
| FHIR Element Name | FHIR Element Value | SNOMED Attribute | SNOMED Value |
|---|---|---|---|
| Condition.clinicalStatus | inactive | Temporal context | In the past |
| Condition.code | Clinical finding | Associated finding | << Clinical finding |
Condition Resource vs. |Clinical finding present|
| FHIR Element Name | FHIR Element Value | SNOMED Attribute | SNOMED Value |
|---|---|---|---|
| Condition.clinicalStatus | active | Temporal context | Current |
| Condition.code | Clinical finding | Associated finding | << Clinical finding |
Observation Resource vs. |Clinical finding absent|
| FHIR Element Name | FHIR Element Value | SNOMED Attribute | SNOMED Value |
|---|---|---|---|
| Observation.code | Clinical finding | Associated finding | << Clinical finding |
| Observation.value | Known absent | Finding context | Known absent |
Procedure Resource vs |Procedure Done|
| FHIR Element Name | FHIR Element Value | SNOMED Attribute | SNOMED Value |
|---|---|---|---|
| Procedure.code | Procedure | Associated procedure | << Procedure |
| Procedure.status | Completed | Procedure context | Done |
| Procedure.category | Surgical | (Ancestor) | Surgical procedure |
| Procedure.reasonCode | Disease | Has focus | << Clinical finding |
| Procedure.bodySite | Body site | Procedure site - direct | << Anatomical structure |
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