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- SOMETHING ABOUT R4 because of our delivery timelines-
Use Case
- An orthopaedic clinician wants to record the procedure "Closed reduction of fracture of left radius"
- We assume the EHR system supports searching precoordinated codes and, if necessary, creating postcoordinated codes
- However, this EHR can only store codes up to 18 digits in length
- The clinician selects the 87971000 |Closed reduction of fracture of radius (procedure)| with 272741003 |Laterality (attribute)| = 7771000 |Left (qualifier value)|
- Then the orthopaedic department wants to report on the number of closed reduction vs. open reduction procedures.
Solution Overview
- A CodeSystem supplement will be used to act as an expression library
- A ConceptMap will be used to translate expressions to (and from) shorter codes for systems with restricted code lengths
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Create Expression Repository
- Create the CodeSystem supplement. This supplements a specific module and version of SNOMED CT
1234007is the identifier of the module that contains the postcoordination content
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- ML
- I would generate UUIDs for expressions rather than using SCTIDs
- Type 5? UUID could take expression as the seed to create deterministic ids
- KK - Maybe expression id generation should be implementation specific
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Add Expressions to Repository
The EHR system attempts to update the CodeSystem supplement with the expression, using either classifiable-form or close-to-user form depending on what is supported by the terminology server.
Example expression in close-to-user form: 87971000 |Closed reduction of fracture of radius (procedure)| : 272741003 |Laterality (attribute)| = 7771000 |Left (qualifier value)|
Add CTU form Expression to CodeSystem Supplement
PATCH /CodeSystem/snomed-exp
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The terminology server must perform MRCM domain-attribute and attribute-range validation. If close-to-user form is supported, then the expression should be transformed to classifiable form before MRCM validation. The terminology server may also classify the expression at this point to reduce the processing required during subsequent operations that use the hierarchy.
Generate the Expression Identifier
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GET /ConceptMap/$translate?url=http://snomed.info/xsct/101101234112/pce-id-gen/1101234
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The generated identifier, from CodeSystem "http://snomed.info/xsct/101101234112/pce-id-gen/1101234", can be stored in the EHR record. The code system is derivable from the code, within the bounds of SNOMED CT codes, because of the 16 partition identifier and the fact that the code contains the namespace.
Use Expression Repository
Lookup Expression Identifier from Expression
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Lookup Expression from Expression Identifier
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Query Expression
The department would like to report on the number of closed reduction procedures performed. All codes representing this type of procedure must be fetched so that they can be matched against the EHR records.
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