SI – Inactivation of <<443938003 |Procedure carried out on subject (situation)|

Thank you Jon for this additional information which could indeed be very useful to take into consideration during future development/implementations.

Elena, as you already mentioned, the concept 435941000124100 |Patient given medical advice (situation)| is not affected and considering that it is only one concept that would be impacted by these changes, we suggest you submit a request for new concept via InfoRMS for us to fully assess how we can support your requirements, taking into account your particular use case.

Thank you,

Yes, I can how those constraints would be challenging.

However, I would add that by taking the contextual representation (and assoicated language) out of the terminology and into the information model, you would not be constrained by SI's naming conventions. You could use your IM to indicate "history / done / performed" using the words and terms that work for you.

Hi Jon,

Unfortunately, we are significantly behind in the modernization of our information systems, and we are often constrained by what the vendor is willing to implement and the costs involved. In short, we're doing our best to juggle all these factors in order to meet the client's needs even though some solutions would be much simpler under different circumstances.

We could also mention that we are concerned about the translation, which tends to lose some of it's original meaning in French.

Regards,

Hi Elena,

I wanted to share some additional considerations here which you may find helpful going forward.

In using concepts from the |Situation with explicit context| hierarchy, we are relying on the terminology to indicate contextual information. (For example, procedure DONE, advice GIVEN, HISTORY of condition, etc.) One of the main challenges with this approach is that when it comes to representing context, states, etc. - there are just too many combinations so it's not feasible for SI to include them all in the situation hierarchy as precoordinated concepts.

The good news is that your partners and clients do not require an application that supports postcoordination to record and represent contextual information. Another option is to use the information model if possible. This aligns with modern implementation advice from SI - "We encourage users to rely on the information model or use post-coordination to specify the state of a procedure in their environment."

So using your example of 165007007 |Allergy testing done (situation)|, which by definition has an associated procedure of 252512005 |In vivo test of hypersensitivity (procedure)|. Instead, you could have a section in your EHR defined as follows:

PROCEDURES:
252512005 |In vivo test of hypersensitivity (procedure)| Date performed: 2024-06-03

or

PROCEDURES PLANNED:
252512005 |In vivo test of hypersensitivity (procedure)|

In either case, there is a mechanism outside of the terminology to represent the contextual info surrounding the procedure. You could have other similar contextually relevant sections for family history, personal history, etc.

Furthermore you could argue that this approach gives you a lot more flexibility. SNOMED has about 60,00 procedures available for use but only about 2,500 are referenced under the |Procedure with explicit context| subhierarchy. Similarly, SNOMED has ~125,000 findings/diseases but only ~2500 are referenced under 413350009 |Finding with explicit context (situation)| and less than 700 under |Family history with explicit context|.

Regards,

Jon Zammit

Hi Julie,

Here are 2 concepts :
- 165007007 |Allergy testing done (situation)| (test d'allergie effectué)
- 435941000124100 |Patient given medical advice (situation)| (avis médical donné au patient) exempt from inactivation

Regards,

Hi Julie,

Here are 2 concepts :
- 165007007 |Allergy testing done (situation)| (test d'allergie effectué)
- 435941000124100 |Patient given medical advice (situation)| (avis médical donné au patient) exempt from inactivation

Regards,