| Context values for actions (qualifier value) |
Proposed allowed qualifier values within the International release
Background:
The table below provides the following information:
The number of times the concept has been used as a qualifier within the current International Release
The qualifier value
The proposed status of the qualifier value within the International Release
The proposed status indicates whether these qualifier values will be allowed as part of a pre-coordinated concept within the International Release and will therefore determine whether SNOMED International will accept requests for new content that use these qualifier values.
Local NRCs will be able to use those qualifier values which are deemed as not allowed within the International Release as part of either post-coordinated or pre-coordinated concepts within their National Extension.
Many of the disallowed qualifier values relate to content which may be used within scheduling systems and it was felt that such systems are likely to be organised in ways which are specific to individual realms and therefore not easily shared across national and international boundaries. These qualifier values may be used by local NRC's but will not be pre-coordinated within the International Core.
Action:
CMAG are asked to consider the statuses indicated below and provide feedback if they are likely to give rise to any specific issues within their realm.
| Context values for actions (qualifier value) |
Proposed allowed qualifier values in the International release
Context values for actions (qualifier value | Status in the International Release | |||
49 | Action status unknown (qualifier value) | Not allowed | ||
75 | Contraindicated (qualifier value) | Allowed | ||
19 | Indicated (qualifier value) | Allowed | ||
123 | Not done (qualifier value) | Allowed | ||
18 | Did not attend (qualifier value) | Allowed | ||
47 | Not indicated (qualifier value) | Allowed | ||
Post-starting action status (qualifier value) | ||||
1 | Ended (qualifier value) | May be used as a grouper concept | ||
34 | Discontinued (qualifier value) | Allowed | ||
1210 | Done (qualifier value) | Allowed | ||
0 | Attended (qualifier value) | Not allowed | ||
0 | Performed (qualifier value) | Not allowed - Where 'performed' forms part of the FSN use 'Done' as the qualifier value | ||
31 | Stopped before completion (qualifier value) | Allowed | ||
2 | Abandoned (qualifier value) | Not allowed - this is the same as stopped before completion | ||
2 | Suspended (qualifier value) | Allowed - moved up a level | ||
55 | In progress (qualifier value) | Allowed | ||
0 | Change made (qualifier value) | Allowed | ||
0 | Change recommended (qualifier value) | Allowed | ||
0 | Not to be stopped (qualifier value) | Allowed | ||
0 | To be stopped (qualifier value) | Allowed | ||
38 | Started (qualifier value) | Allowed | ||
3 | Pre-starting action status (qualifier value) | Many of these qualifier values relate to a scheduling system. These may be used by local NRC's for the purposes of scheduling but will not be pre-coordinated within the International Core. | ||
1 | Being organized (qualifier value) | Allowed for use in local realm | ||
0 | Accepted (qualifier value) | Not allowed | ||
39 | Planned (qualifier value) | Allowed | ||
61 | Requested (qualifier value) | Allowed | ||
8 | Requested by recipient (qualifier value) | Not allowed | ||
1 | Scheduled - procedure status (qualifier value) | Not allowed | ||
0 | Approved and scheduled (qualifier value) | Not allowed | ||
7 | Not to be done (qualifier value) | Many of these qualifier values relate to a scheduling system, are often realm specific and should not be used. | ||
0 | Canceled (qualifier value) | Not allowed - local scheduling | ||
0 | Denied (qualifier value) | Not allowed | ||
2 | Not needed (qualifier value) | Not allowed | ||
33 | Not offered (qualifier value) | Not allowed | ||
29 | Not wanted (qualifier value) | Not allowed | ||
186 | Refused (qualifier value) | Allowed | ||
4 | Refused by caregiver of subject (qualifier value) | Allowed | ||
2 | Refused by parents of subject (qualifier value) | Allowed | ||
1 | Rejected by performer (qualifier value) | Allowed | ||
3 | Organized (qualifier value) | Not allowed - part of scheduling system | ||
0 | Schedule rejected (qualifier value) | Not allowed - part of scheduling system | ||
28 | To be done (qualifier value) | Not allowed - use planned | ||
6 - Under consideration (qualifier value) | Not allowed - ambiguous | |||
2 | Consented (qualifier value) | Not allowed - Consent is realm specific | ||
0 | Legal agent consented (qualifier value) | Not allowed - Consent is realm specific | ||
0 | Recipient consented (qualifier value) | Not allowed - Consent is realm specific | ||
5 | Needed (qualifier value) | Not allowed | ||
16 | Offered (qualifier value) | Not allowed - ambiguous, could be offered and refused or offered and accepted | ||
0 | Under consideration, not wanted yet (qualifier value) | Not allowed | ||
0 | Under consideration, not yet offered (qualifier value) | Not allowed | ||
0 | Wanted (qualifier value) | Not allowed - ambiguous | ||
0 | Was not started (qualifier value) | Allowed | ||
0 | Canceled (qualifier value) | Not allowed - local scheduling | ||
0 | Considered and not done (qualifier value) | Not allowed | ||
10 Comments
Matt Cordell
This won't cause any problem for us (we could create locally if required). However, generally, we're steering users away from much of SWEC hierarchy and encouraging post-coordinating especially via the information model where possible.
All this content poses a combinatorial risk. if one context is provided there's almost an expectation/requirement all (alternative contexts) are provided too...
John Fountain
I can't see that this will be an issue in New Zealand for similar reasons as outlined by Matt.
Linda Parisien
Hi,
Can you clarify if the current core concepts that include «not allowed» terms will stay active?
Will the «not allowed» concepts flagged above remain in the international version?
Thank you!
Camilla Wiberg Danielsen
"Abandoned (qualifier value): Not allowed - this is the same as stopped before completion"
Could it not be "the same as Discontinued (qualifier value)" as well? Both Discontinued and Stopped before completion are 'Allowed', but are they unambiguous? /Camilla
Jostein Ven
According to the document linked to by Daniel, Abandoned and Discontinued are two subtypes of "Stopped before completion". It is difficult for me to see the difference between the two subtypes.
Paul Amos
Hi Linda,
The column which states, allowed or not allowed refers to use by SNOMED International for inclusion in pre-coordinated content in the international release.
The list of currently available attribute values will remain available for use by Individual realms/NRCs either as part of pre-coordinated content or as qualifier values for use in post coordination and can be made available in national extension releases.
Elaine Wooler
There are more general issues about these values which it would be worthwhile addressing as part of this work. It has been noted in the UK that regarding some values as "allowed" suggests that these are inter-operable between systems. If so it would be very useful if values could be accompanied by text definitions indicating their meaning as understood by SNOMED International so that they can be safely used to transfer data between systems. For example, what do SNOMED International understand by the ‘allowed’ term ‘not to be stopped’? – a sending system might intend ‘not to be stopped ever’ whilst a receiving system could interpret the same term as ‘not to be stopped before completion of current course’ – very different meanings. More dynamically, declaring the meaning of ‘allowed’ values will help them integrate across system-specific state models.
It has also been commented that it is unclear why there are the allowed values Refused by caregiver of subject, Refused by parents of subject and Rejected by performer - however Requested by recipient is not allowed. This appears to be overloading an action state value set with mention of a specific agent. A cleaner approach is suggested that would be based on a new axis of actors and could be introduced whilst other things are changing and preserving allowed action states as independent of actors/agents.
I attach a document written by Ed Cheetham which although dates back to 2009 we have found very useful in the UK in assisting specifications for post-coordination of procedure status. A lot has changed since this document was produced but it is useful in indicating the thinking that took place at the time and probably needs to take place again for us to fully understand this content's use and meaning.
Olivier Bodenreider
It is unclear to me why the issue of consent, realm specific, excludes presence in the international release. Seems that, even if consent may be obtained under different conditions, it still is consent. Moreover, if several member countries request consent-based Context values for actions, is it going to make those eligible in the international release?
Maybe the most important point is the absence of use for these concepts.
Theresa Barry
HI,
Can I check why some are "not allowed", does this mean de-activation ? If these have been specified in systems to date will they remain as part of analytics?
It would be great to have some metadata around qualifier values.
Thanks
Theresa
Cathy Richardson
Theresa Barry, we are moving this work to make it part of the CMAG 2019 work plan. Activity 4 on here: CMAG 2019 Work Plan There will be further discussion on this table as we work through definitions. You will be welcome to be involved in the work.
In regards to your other questions, where a concept is not permitted for use in the international edition that would not preclude use at a national level. In addition, any released components that are inactivated (concepts, descriptions and relationships) remain in the release files.
Kind regards,
Cathy