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Relevant Valuesets

Required value sets that are possibly in scope:

http://build.fhir.org/valueset-detectedissue-severity.html

http://build.fhir.org/valueset-allergy-clinical-status.html

http://build.fhir.org/valueset-allergy-verification-status.html

http://build.fhir.org/valueset-allergy-intolerance-type.html

http://build.fhir.org/valueset-allergy-intolerance-category.html

http://build.fhir.org/valueset-allergy-intolerance-criticality.html

http://build.fhir.org/valueset-reaction-event-severity.html

http://build.fhir.org/valueset-adverse-event-severity.html

http://build.fhir.org/valueset-adverse-event-outcome.html

http://build.fhir.org/valueset-condition-ver-status.html

http://build.fhir.org/valueset-condition-clinical.html

Update 28 September 2018 from Grahame Grieve

Additional candidates as discussed from the patient care space:

+ http://build.fhir.org/valueset-detectedissue-severity.html

+ http://build.fhir.org/valueset-request-priority.html

possible candidates out of other spaces:

genomics

http://build.fhir.org/valueset-sequence-type.html

http://build.fhir.org/valueset-orientation-type.html

 http://build.fhir.org/valueset-strand-type.html

http://build.fhir.org/valueset-quality-type.html

 http://build.fhir.org/valueset-repository-type.html

care planning

http://build.fhir.org/valueset-action-cardinality-behavior.html

http://build.fhir.org/valueset-action-precheck-behavior.html

http://build.fhir.org/valueset-action-required-behavior.html

http://build.fhir.org/valueset-action-selection-behavior.html

http://build.fhir.org/valueset-action-grouping-behavior.html

http://build.fhir.org/valueset-action-relationship-type.html

http://build.fhir.org/valueset-action-condition-kind.html



Detected Issue Severity - 3 concepts, mapped 2 Oct 2018

HL7 ValueSuggested SNOMED TermDiscussion
High24484000 |Severe (severity modifier) (qualifier value)|

These values are inherited from V3. "High" does exist but in a different hierarchy - 75540009 |High (qualifier value)|

Severe does have a synonym of "High Grade"

Should we flag up this apparent inconsistency?

Moderate6736007 |Moderate (severity modifier) (qualifier value)|
Low255604002 |Mild (qualifier value)|

Allergy Clinical Status - 3 values

HL7 ValueSuggested SNOMED TermDiscussion
Active

JR suggests new sub-hierarchy for SCT containing disease activity to align with 370996005 |Patient condition resolved (finding)|

LB suggested use of << 394731006 |Problem statuses (qualifier value)| would need to add "Resolved". YG Notes that these are not in use and their use is not dictated by the MRCM.

DK suggested use of << 36692007 |Known (qualifier value)| again "Resolved" would be required.

Inactive

Resolved

Allergy Verification Status

<< 106230009 |Qualifier for certainty of diagnosis (qualifier value)| doesn't have refuted

Better << 410514004 |Finding context value (qualifier value)|

HL7 ValueSuggested SNOMED TermDiscussion
Unconfirmed410590009 |Known possible (qualifier value)|
Confirmed410605003 |Confirmed present (qualifier value)|
Refuted410594000 |Definitely NOT present (qualifier value)|Also considered 2667000 |Absent (qualifier value)| ? Doesn't really put over that a test was done and the absence of the allergy was proven.
Entered in ErrorNot Found723510000 |Entered in error (qualifier value)| is a 106232001 |Adjectival modifier (qualifier value)| ?

Allergy Intolerance Type

HL7 ValueSuggested SNOMED TermDiscussion
Allergy609328004 |Allergic disposition (finding)|
IntoleranceNot Found - expected for 20190131420134006 |Propensity to adverse reaction (finding)| ?

Allergy Intolerance Category

HL7 ValueSuggested SNOMED TermDiscussion
food

418471000|Propensity to adverse reactions to food (disorder)|

or 414285001|Food allergy (disorder)|


medication

419511003|Propensity to adverse reactions to drug (disorder)|

or 416098002|Drug allergy (disorder)|


environmentNot Found
biologicNot Found

Allergy Intolerance Criticality  2 concepts, mapped tentatively 18 Oct 2018

HL7 ValueSuggested SNOMED TermDiscussion
low risk723505004|Low risk (qualifier value)|

But very questionable whether (a) passing either of this pair 'adjectival modifier' codes is any more useful than passing the words 'low' and 'high;

and (b) the wisdom and clinical safety of passing a coded clinical statement stating 'high risk' that does not also explicitly include 'of what?'.

Would it be better/safer to pass as new clinical finding codes along the lines of 'high risk of adverse reaction' ?

Actually, the exact meaning of the original valueset is in fact not to grade the likelihood of an adverse event but rather of whether, should an adverse event occur,it is likely to be clinically significant one. A high probability of only trivial reactions would be graded 'low risk'. So passing only 'low risk' may be especially clinically rather ambiguous.

high risk723509005|High risk (qualifier value)|

Adverse Event Severity - 3 concepts, mapped 2 Oct 2018

Reaction Event Severity - 3 concepts, mapped 2 Oct 2018

HL7 ValueSuggested SNOMED TermDiscussion
Severe24484000 |Severe (severity modifier) (qualifier value)|
Moderate6736007 |Moderate (severity modifier) (qualifier value)|
Mild255604002 |Mild (qualifier value)|

Adverse Event Outcome

HL7 ValueSuggested SNOMED TermDiscussion
resolved

recovering

ongoing

resolvedWithSequelae

fatal

unknown

Condition Ver Status

HL7 ValueSuggested SNOMED TermDiscussion
Unconfirmed410590009 |Known possible (qualifier value)|
Provisional410592001|Probably present (qualifier value)|
Differential

410590009|Known possible (qualifier value)|

OR 415684004|Suspected (qualifier value)|


Confirmed410605003 |Confirmed present (qualifier value)|
Refuted410594000 |Definitely NOT present (qualifier value)|
Entered In ErrorNot Found

Condition Clinical

HL7 ValueSuggested SNOMED TermDiscussion
Active

Recurrence

Relapse

Inactive

Remission

Resolved


Outstanding questions

Which descriptions will the free set include - None, FSN, PT (in what languages?)

What if SNOMED Concepts split into more expressive versions ie HL7 code would then map to multiple SNOMED CT codes.

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