Valueset Mappings
22 Jan 2019: DK If all we're doing is looking for a word, then rather than pulling anything together then would we not be better having HL7 create their own concept within one FHIR specific subhierarchy
DetectedIssue.Severity - 3 concepts, mapped 2 Oct 2018, DONE
Possible home in << 272141005 |Severities (qualifier value)|
Discussion 22 Jan 2019: Mapping to qualifier values means that there is little context being supplied from SNOMED CT. That context would need to be supplied through the binding before meaningful reasoning could be performed.
HL7 Value | Suggested SNOMED Term | Discussion |
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High | 24484000 |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? All these values are children of 272141005 |Severities (qualifier value)| Conclusion: Mapping suggested here is sufficient (sufficient for what - use case required). 20 Nov |
Moderate | 6736007 |Moderate (severity modifier) (qualifier value)| |
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Low | 255604002 |Mild (qualifier value)| |
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AllergyIntolerance.ClinicalStatus - 3 values (superficially similar to Condition.ClinicalStatus but without relapse and recurrent)
Conclusion: 22 Jan 2019 Use << 394731006 |Problem statuses and add new concept for Resolved Problem is our preference.
HL7 Value | Suggested SNOMED Term | Discussion |
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Active | 394774009 |Active problem (qualifier value)| | 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. JC suggested that we accept lack of context and allow use of << 106234000 |General adjectival modifier (qualifier value)| eg 55561003 |Active (qualifier value)| |
Inactive | 394775005 |Inactive problem (qualifier value)| |
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Resolved | -- Would need to be created – | If we wanted the context supplied by << 394731006 |Problem statuses (qualifier value)| , then we'd need to add "Resolved problem" here. |
AllergyIntolerance.VerificationStatus
<< 106230009 |Qualifier for certainty of diagnosis (qualifier value)| doesn't have refuted
Better << 410514004 |Finding context value (qualifier value)|
HL7 Value | Suggested SNOMED Term | Discussion |
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Unconfirmed | 410590009 |Known possible (qualifier value)| | These 3 are children of 410514004 |Finding context value (qualifier value)| |
Confirmed | 410605003 |Confirmed present (qualifier value)| |
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Refuted | Move 723511001 | Refuted (qualifier value) | to a subtype of 410594000 |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. "Definitely not present" doesn't capture the implied history of "we used to think this was the case". New concept required?
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Entered in Error | 723510000 |Entered in error (qualifier value)|
| Child of 106232001 |Adjectival modifier (qualifier value)| |
AllergyIntolerance.Type DONE
Conclusion: Mapping suggested here is sufficient. 20 Nov
HL7 Value | Suggested SNOMED Term | Discussion |
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Allergy | 609328004 |Allergic disposition (finding)| | Descendant of 420134006 |Propensity to adverse reaction (finding)| via 609433001 |Hypersensitivity disposition (finding)| Allergic reaction is covered elsewhere in FHIR. Consider: 781474001 |Allergic disorder (disorder)| ? |
Intolerance | 782197009 |Intolerance to substance (finding)|
| Child of 420134006 |Propensity to adverse reaction (finding)| and it subsumes intolerance to both foods and drugs separately. |
22 January 2019: We're going too far with 420134006 |Propensity to adverse reaction (finding)| really for a category we're just looking for a textual label
Conclusion: It would be better for HL7 to create their own concepts here. The ones we found have little value being little more than word matches.
Note this group would recommend not using this field in any event since greater specificity is possible by using Code.
HL7 Value | Suggested SNOMED Term | Discussion |
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food | 255620007 Foods ( <! 762766007 |Edible substance (substance)| ) | Child of 418038007 |Propensity to adverse reactions to substance (finding)| 22 Jan 2019 Less favourable: 762766007 |Edible substance (substance)| even less so 373783004 |Dietary product (product)| Removed 418471000|Propensity to adverse reactions to food (disorder)| |
medication | 763158003 Medicinal product (<! 373873005 |Pharmaceutical / biologic product (product)|) | Removed 419511003|Propensity to adverse reactions to drug (disorder)| |
environment | 276339004 Environment ( <! 308916002 |Environment or geographical location (environment / location)| )
| If this is a NEC (Not elsewhere classified) sort of value, then would we use the more general 420134006 |Propensity to adverse reaction (finding)| here? PWI: This is actually the super parent of the previous two, so logical reasoning would be problematic. DK: ECL Expression helpful ie parent minus already used children?
FHIR says: "Any substances that are encountered in the environment, including any substance not already classified as food, medication, or biologic." Removed 420134006 |Propensity to adverse reaction (finding)| With moving to 276339004 Environment we note that the child indicate this concept was originally intended to be used for something completely different. |
| | Asked Bruce Goldberg if he thinks additional concepts in SNOMED are warranted here. His response: A similar question arose yesterday in the allergy project group call. Toni mentioned that 762766007 |Edible substance (substance)| might be going away in the future and this would therefore impact the modeling of food allergy and whether it would be useful to maintain this concept. I think that the concepts of food and drug allergy are so ingrained in the minds of clinicians and patients that they remain useful not only as groupers but may be documented when a patient has had an immediate reaction within minutes of ingesting multiple foods or medications and it is not clear prior to testing which specific food or drug is the cause. Groupings pertaining to food and drug allergy are also present in the substance, product and procedure hierarchies where they are useful as organizing nodes. - 387847008 |Food specific immunoglobulin E (substance)|
- 411536006 |Food specific diagnostic allergen extract (product)|
- 387851005 |Drug specific immunoglobulin E (substance)|
- 388450003 |Drug specific immunoglobulin E antibody measurement (procedure)|
- 388455008 |Food specific immunoglobulin E antibody measurement (procedure)|
I am less certain about the requirement for an environmental allergy grouper. Environmental allergy is somewhat vague as to what should be included under this term although it is often used interchangeably with inhalant allergy which usually refers to pollens, dust mites, mold and animal dander. Biologics could be included under drug allergy imo.
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AllergyIntolerance.Criticality 2 concepts, mapped 18 Oct 2018
Discussion 5 Feb 2019: Happy with the words here, but SNOMED is not providing any context. The context from FHIR is "How serious is the reaction, rather than how likely is the reaction" . Possible values in << 272141005 |Severities (qualifier value)|
HL7 Value | Suggested SNOMED Term | Discussion |
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low Display Term "Low risk" |
62482003 Low (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. YG: If the qualifier values are used in a concept model rule, we need to be careful. JC: All qualifier values need to be interpreted in the context provided by the information model OR the context provided by the concept model. JR: Could potentially add concepts to SNOMED here. |
high Display Term "High risk" | 75540009 High (qualifier value) or 723509005|High risk (qualifier value)| | "Assessed to the life threatening". Note that a wider range of values are available as children of 272141005 |Severities (qualifier value)|. In this case, going from SNOMED to FHIR would require a mapping from 7 categories down to 2. |
unable-to-assess |
| 162650008 |Patient not examined (situation)| 1631000175102 |Patient not asked (contextual qualifier) (qualifier value)| ? "Not a V3 null flavor" |
AdverseEvent.Severity - 3 concepts, mapped 2 Oct 2018
AllergyIntolerance.Reaction.Severity - 3 concepts, mapped 2 Oct 2018
HL7 Value | Suggested SNOMED Term | Discussion |
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Severe | 24484000 |Severe (severity modifier) (qualifier value)| | 5 Feb 2019: Good word match but again a lack of context from the SNOMED side. Context would be taken from the position in the record ie the field itself gives the context. |
Moderate | 6736007 |Moderate (severity modifier) (qualifier value)| |
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Mild | 255604002 |Mild (qualifier value)| |
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AdverseEvent.Outcome
JR 5 Feb 2019 - Could ECE group help out here to suggest how status of patient can be best described? Note that relapse is not covered here. Note the potential for overlap with ConditionClinicalStatusCodes - would it not be better to seek a generic solution across both?
HL7 Value | Suggested SNOMED Term | Discussion |
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resolved | 413322009|Problem resolved (finding)| |
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recovering | Not Found |
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ongoing | Not Found | 303350001|Ongoing episode (qualifier value)| exists, but to be consistent with semantic category of maps proposed for other valueset members, need a finding. |
resolvedWithSequelae | Not Found | 413322009|Problem resolved (finding)| is only part of the way there. Also 370996005|Patient condition resolved (finding)| |
fatal | 419099009|Dead (finding)| (preferred due to also being a finding ie describes the current state of the patient) | 399166001|Fatal (qualifier value)| is a severity.. 419620001 |Death (event)|
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unknown | Not Found | 261665006 |Unknown (qualifier value)| - has some context as is a child of 410514004 |Finding context value (qualifier value)| |
Condition.VerificationStatus
See http://build.fhir.org/valueset-condition-ver-status.html
Values taken from << 36692007 |Known (qualifier value)|
HL7 Value | Suggested SNOMED Term | Discussion |
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Unconfirmed | 410590009 |Known possible (qualifier value)| | 415684004 |Suspected (qualifier value)| |
Provisional | 410592001|Probably present (qualifier value)| |
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Differential | 410590009|Known possible (qualifier value)| OR 415684004|Suspected (qualifier value)| | 'known possible' is not quite the same as differential... HL7: "One of a set of potential and usually mutually exclusive diagnoses" |
Confirmed | 410605003 |Confirmed present (qualifier value)| |
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Refuted | 410594000 |Definitely NOT present (qualifier value)| |
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Entered In Error | 723510000 |Entered in error (qualifier value)| |
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Condition.ClinicalStatus
Discussion 13 Nov 18- consider enhancing << 394731006 |Problem statuses (qualifier value)| currently containing active & inactive. This valueset does seem like its use would go beyond just that of FHIR and may have broader usage.
Condition.ClinicalStatus relates to the SNOMED CT Clinical findings model in a non-trivial way, hence the red color coding. E.g. parts of the value set is related to the clinical course SNOMED CT relationship type.
5 Feb 2019 - Agreement to raise with Jim for possible inclusion in SNOMED CT to discuss perhaps with Clinical Groups (eg Nursing).
HL7 Value | Suggested SNOMED Term | Discussion |
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Active | Not Found | 55561003|Active (qualifier value)| would be undesirable to use. Its just a code for the word as an adjective : having a SNOMED code would add zero value over the original string, and only marginally more than the more obviously ludicrous but entirely possible SNOMED CT encoding as the expression: 422097006|Upper case Roman letter A (qualifier value)| + 257984003|Lower case Roman letter c (qualifier value)| + 257998006|Lower case Roman letter t (qualifier value)| + 257989008|Lower case Roman letter i (qualifier value)| + 258000009|Lower case Roman letter v (qualifier value)| + 257985002|Lower case Roman letter e (qualifier value)| PWI 6 Nov: I think it's worth doing two things routinely here, firstly including what the parent is (in this case 106234000 |General adjectival modifier (qualifier value)|) and secondly seeing where that concept is aleady used in SNOMED. In this case, no International concept uses this qualifier value. |
..Recurrence | Not Found | 263853000|Recurrent episode (qualifier value)| is in right neck of woods, as a member of SNOMED's Episodicities valueset, but other members of the HL7 valueset cross over into other aspects of disease phase rather than episodicity, so if a guiding map design principle were to be that all members of the valueset should at least be from the same SCT semantic category, then we'd need Findings for all of the values. Also 255227004|Recurrent (qualifier value)| as a member of SNOMED's Courses valueset. |
..Relapse | Not Found | 303359000|Relapse episode (qualifier value)| or 263855007|Relapse phase (qualifier value)| or 255318003|Relapsing course (qualifier value)| as a member of SNOMED's Courses valueset |
Inactive | Not Found | 73425007|Inactive (qualifier value)| would be undesirable to use as its just a code for the word and so having a SNOMED code adds zero value over the original string. Parent here is, again, 106234000 |General adjectival modifier (qualifier value)| |
..Remission | Not Found | 277022003|Remission phase (qualifier value)| 18 Dec Discussion that the "remission" aspect has often been represented in SNOMED through hierarchical association to 765205004 |Disorder in remission (disorder)| rather than modeling using a qualifier value. Perhaps we should note this sort of thing as moving towards an attribute modeled approach would allow for reasoning against information model combined values at some point in the future. |
..Resolved | Not Found | 723506003|Resolved (qualifier value)| would be undesirable to use as its just a code for the word : having a SNOMED code adds zero value over the original string |
Request.priority
2019-04-16: Found matching concepts in this subhierarchy: <<272125009|Priorities|
The specimen collection priority value set is partly overlapping http://build.fhir.org/valueset-specimen-collection-priority.html
Other priority value sets are: http://build.fhir.org/valueset-flag-priority.html http://build.fhir.org/valueset-goal-priority.html http://build.fhir.org/valueset-process-priority.html
HL7 Value | Suggested SNOMED Term | Discussion |
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routine | 50811001|Routine| |
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urgent | 103391001|Urgent| |
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asap | 709122007|As soon as possible| |
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stat | 49499008|Stat| |
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Care planning
2019-04-16: The value sets listed under Care planning all seem to be out of scope of SNOMED CT.
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.
Discussed Potential Additional ValueSets
https://www.hl7.org/fhir/observation-definitions.html#Observation.interpretation (39 Values) Possible home to be found in << 260245000 |Findings values (qualifier value)|
RH Suggested that this value set has already been harmonised between existing standards and that SNOMED CT was not used in general.
HL7 Value | Suggested SNOMED Term | Discussion |
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