Stream: implementers
Topic: SNOMED Value Sets
Jon Behr (Sep 11 2018 at 13:53):
Hi, total noob to FHIR (clinician) but have done lots of reading and video viewing but can't find anything that answers this (probably straightforward and basic) question: The Condition resource (for example) has a value set attached to the code element. This is currently taken from "Include codes from http://snomed.info/sct where concept is-a 404684003 (Clinical finding) and is generated 19 Apr 2017. " If I was to make this value set binding = "required" does this mean that only codes contained within the value set would be included in a message? If I didn't make this value set binding "required" does that mean the message could still be sent even in the absence of any (SNOMED CT) codes? Can I change the contents of the value set and control them myself? I'm concerned at how quickly out of date value sets such as these might become as SNOMED CT updates (e.g. inactive codes no longer in the active hierarchy). Thanks in advance for any guidance.
Lloyd McKenzie (Sep 11 2018 at 14:50):
If the binding strength is "required", then the Condition could only include the 'code' element if a SNOMED code from that value set was included. (You'd be free to include ICD9, ICD10 and other codes as translations too if you wanted.) The allowed set of codes would evolve as SNOMED CT evolved. Validation of legacy data would need to take into account codes that were once valid but had since been retired.
If the binding strength was "extensible", then you'd be expected to use a SNOMED code from the value set if one applied. However, you'd be free to send just text or some other code if none of the SNOMED codes could cover the concept.
If the binding strength was "preferred" or "example", you could send whatever you liked.
Jon Behr (Sep 11 2018 at 14:58):
Thanks @Lloyd McKenzie . In that case, how does one create a new value set in Forge? (That I could then maintain - not asking for entire method, just pointing in right direction). It's more obvious in ClinFHIR.
Lloyd McKenzie (Sep 11 2018 at 15:11):
Forge doesn't support value-set authoring. You'll need to create them by hand or use a different tool.
Elliot Silver (Sep 11 2018 at 16:42):
@Lloyd McKenzie, I feel I should know this, but how does binding work with multiple codings in a CodeableConcept? In particular, for a required binding, do alternative codes also have to come from the same valueset, or is the requirement that there be at least one from the required value set?
Lloyd McKenzie (Sep 11 2018 at 16:45):
At least one of the codings must comply with the binding. The others can be whatever you like. A profile can slice the codings to impose additional bindings (e.g. if you wanted to require both SNOMED and ICD10 codes).
Elliot Silver (Sep 11 2018 at 16:49):
OK, that's what I was hoping. And I just found the text to support that: http://build.fhir.org/terminologies.html#strength. (Hmm, link to "Required" section is bad; it takes you to "coding".)
Grahame Grieve (Sep 11 2018 at 21:16):
the FHIR Toolkit (http://www.healthintersections.com.au/FhirServer) can edit value sets
Last updated: Apr 12 2022 at 19:14 UTC
