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4 Comments
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Question from Kerry Goetz from NEI, who has been doing quite a bit of work in data standards, that I wanted to pose here in case we could get some information from SNOMED staff.
Kerry's question: "How are values represented in snomed? For example, if someone is capturing the measure of IOP how does snomed specify that value?"
I (Sally) did a brief search and found this on an online NHS forum (https://www.networks.nhs.uk/nhs-networks/snomed-ct/messageboard/snomed-ct-technical-discussions/210671047)
"Hi Chris
Currently, the international concept model does not include any attributes whose range is a numeric value.
Therefore to create a postcoordinated expression as you described, you would need to extend the concept model with new clearly-defined attributes to support the result value. - e.g. xxxx |Has result value| (Domain: 404684003 |Clinical finding|; Range: DECIMAL)
The following references may be useful:
- SNOMED CT Compositional Grammar - http://snomed.org/scg
- SNOMED CT Editorial Guide - http://snomed.org/eg
- SNOMED CT Machine Readable Concept Model - http://snomed.org/mrcm
Kind Regards
Denise"
Is this still the case? This post was from 2019 so I just wanted to check if there were potentially any updates more recent than that. Maybe Elaine Wooler or Ian Green would be aware and could share with us? Thanks!
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This is a good question. Do we, as part of a SNOMED term definition, define the type of data - e.g. integer, float, string etc.... Thanks for your advice Elaine Wooler Jane Millar
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HI, things have changed since 2019 with the implementation of concrete domains. Concrete domains are a means for SNOMED CT description logic to express concrete objects such as numbers when defining concepts that supports classification and inferred relationships. However this has only be implemented for the attributes of medicinal products as shown in this example https://dailybuild.ihtsdotools.org/?perspective=full&conceptId1=348315009&edition=MAIN&release=&languages=en
However I don't think this is what you are referring to. If someone is capturing IOP the usual way to do this is to use a concept from the Observable entity hierarchy which represent the question and can then take a numeric value in the information model rather than in SNOMED. e.g. 41633001 |Intraocular pressure (observable entity)| + value (greater than 21 mm Hg), which could then be interpreted as a clinical finding - 112222000 |Raised intraocular pressure (finding)|. I'm not an implementation expert but we do have implementation support within the SNOMED team if you have specific questions and the following confluence page is for that service and includes a helpdesk for queries - Implementation Support Services
Charles Gutteridge may also be able to comment based on his use of clinical systems in practice.
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I am not aware of any EHR systems where the information model is developed in the way Elaine Wooler describes. I believe in most systems a data field may have a SNOMED encoded heading which then supports entry of values. The EHR provider will then return the data in the from of relational tables that link a column to an ID, a subject heading and a value. I would be interested to hear if implementers have developed the use of concrete values in the way described.
Elaine Wooler