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

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)|

394775005 |Inactive problem (qualifier value)|

-- 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.

723506003 |Resolved (qualifier value)| exists, but without the context of the problem statuses.

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?

Dictionary defn of refuted is "to prove wrong" so possibly history is not implied, but convention is that there was some previous possible condition. But "Not Present" is clearer - is there scope for FHIR changing the value?

DM - could this be considered History of (contextual qualifier) (qualifier value) ?

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)| ?

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)|

763158003 Medicinal product (<! 373873005 |Pharmaceutical / biologic product (product)|)

low

Display Term "Low risk"

62482003 Low (qualifier value)

or

723505004|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.

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.

162650008 |Patient not examined (situation)|

1631000175102 |Patient not asked (contextual qualifier) (qualifier value)| ?

"Not a V3 null flavor"

413322009|Problem resolved (finding)| is only part of the way there.
Also 370996005|Patient condition resolved (finding)|

DM 65320000 | Residual (qualifier value) | added to sequela?

399166001|Fatal (qualifier value)| is a severity..

419620001 |Death (event)|

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"

DM - in clinical coding terms possible v's probable rule (UK) =

Possible is suspected and probable is highly likely (treat as condition exists for example)

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.

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.

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

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)|

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.

50811001|Routine|

103391001|Urgent|

709122007|As soon as possible|

49499008|Stat|