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Valueset-consistency-type.json

4.2 Terminology Binding Examples

Vocabulary icon Work Group Maturity Level : N/A 0 Standards Status : Informative Trial Use
Raw JSON ( canonical form + also see JSON Format Specification

4.2.1 Extensible binding examples )

4.2.1.1 Condition.code with Extensible binding

For example, we have a Condition.code and the applicable profile binds the code to the value set http://hl7.org/fhir/ValueSet/condition-code icon with an Extensible binding: 

{
  "path": "Condition.code",
  "definition" : "Identification of the condition, problem or diagnosis."
  "binding": {
    "strength": "extensible",
    "valueSetCanonical": "http://hl7.org/fhir/ValueSet/condition-code"
  }
}

Definition for Value SetFluid Consistency Type Codes This value set includes all SNOMED CT concepts that are clinical findings.

{ "resourceType" : "ValueSet", "id" : "consistency-type", "meta" : { "lastUpdated" : "2019-11-01T09:29:23.356+11:00", "profile" : ["http://hl7.org/fhir/StructureDefinition/shareablevalueset"] }, "text" : { "status" : "generated", "div" : "<div>!-- Snipped for Brevity --></div>" }, "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode" : "oo"

4.2.2 Condition instance #1 

{

  "resourceType": "Condition",
  "code": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "39065001",
        "display": "Burn of ear"
      }
    ],
    "text": "Burnt Ear"

  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "draft"

  "subject": {
    "reference": "Patient/example"
  }
}

This concept (code = 39065001) is included in the value set so the instance is valid.

4.2.2.1 Condition instance #2 

{

  "resourceType": "Condition",
  "code": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "312824007",
        "display": "Family history of cancer of colon"
      }
    ]

  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 1
  }],
  "url" : "http://hl7.org/fhir/ValueSet/consistency-type",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.3.389"
  }],
  "version" : "4.0.1",
  "name" : "FluidConsistencyTypeCodes",
  "title" : "Fluid Consistency Type Codes",
  "status" : "draft",
  "experimental" : false,
  "date" : "2019-11-01T09:29:23+11:00",
  "publisher" : "FHIR NutritionOrder team",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "http://hl7.org/fhir"
    }]
  }],
  "description" : "FluidConsistencyType :  Codes used to represent the consistency of fluids and liquids provided to the patient. This value set includes concepts from [SNOMED CT](http://snomed.info/sct)(US Extension) where concept is a 435681000124103  (Dietary liquid consistency diet (regime/therapy)). It is provided as a suggestive example.",
  "copyright" : "This resource includes content from SNOMED Clinical Terms® (SNOMED CT®) which is copyright of the International Health Terminology Standards Development Organisation (IHTSDO). Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org",
  "compose" : {
    "include" : [{
      "system" : "http://snomed.info/sct",
      "version" : "http://snomed.info/sct/731000124108",
      "concept" : [{
        "code" : "439031000124108",
        "display" : "honey thick liquid"
      },

  "subject": {
    "reference": "Patient/example"
  }
}

This SNOMED CT concept is not a clinical finding. So is it valid? With the extensible binding 2 questions must be answered:

  • Is there an applicable code in the bound value set (condition-code) for ‘family history of cancer of colon’? That doesn’t appear to be the case, so the instance is valid in that respect.
  • Does this code fit into the definition of the element in the profile: “Identification of the condition, problem or diagnosis.”? That also appears likely to be the case. But that isn’t entirely clear, which is the challenge of extensible bindings.

So this example is most likely valid (based on human review).

4.2.2.2 Condition instance #3 

{

  "resourceType": "Condition",
  "code": {
    "coding": [

      {
        "code" : "439021000124105",
        "display" : "nectar thick liquid"
      },

        "system": "http://my-local-organization.com",
        "code": "XYZ123",
        "display": "Severe pneumococcal pneumonia"
      }
    ]
  },
  "subject": {
    "reference": "Patient/example"
  }
}

This Condition instance contains a local code. Is it a valid instance? With the extensible binding, the same questions as before have to be answered:

  • Is there an applicable code in the bound value set (condition-code) for ‘Severe pneumococcal pneumonia’? In this case SNOMED CT does have the code 233607000 for ‘Pneumococcal pneumonia’. Since ‘Pneumococcal pneumonia’ is a more general meaning which "covers" (i.e. includes or subsumes) ‘Severe pneumococcal pneumonia’, this Condition instance is not valid and the SNOMED CT code 233607000 for ‘Pneumococcal pneumonia’ SHALL be used instead.
  • Does this code fit into the definition of the element in the profile: “Identification of the condition, problem or diagnosis.”? Yes, it does. But since it was already determined that there is an applicable code in the bound value set that should be used instead, this instance is not valid.

4.2.2.3 Condition instance #4

What if we would like to send our local code for ‘Severe pneumococcal pneumonia’ in the instance along with the SNOMED CT code 233607000 for ‘Pneumococcal pneumonia’? Because the datatype for Condition.code is CodeableConcept, we can do that using an additional Coding (as a translation): 

{

  "resourceType": "Condition",
  "code": {
    "coding": [

      {
        "code" : "439041000124103",
        "display" : "spoon thick liquid"

        "system": "http://snomed.info/sct",
        "code": "233607000",
        "display": "Pneumococcal pneumonia"

      },
      {
        "code" : "439081000124109",
        "display" : "thin liquid"
      }]
    }]

        "system": "http://my-local-organization.com",
        "code": "XYZ123",
        "display": "Severe pneumococcal pneumonia"
      }
    ]
  },
  "subject": {
    "reference": "Patient/example"

  }
}

Usage note: every effort has been made to ensure that So this is a valid Condition instance which contains both the applicable SNOMED CT code from the extensibly bound condition-code value set for ‘Pneumococcal pneumonia’ as well as my organization's local code for ‘Severe pneumococcal pneumonia’.

4.2.3 Preferred binding examples

The choice of code with a Preferred binding is considerably simpler than for an Extensional binding, because the Preferred binding is a suggestion from the developers of the resource or profile about which codes they believe would be best to use to represent this data. However, in a particular instance you are correct free to choose to follow that suggestion or not, depending on your particular desires and useful, but they needs, and there are not no specific conformance expectations regarding that choice.

So in this case we have a normative part Condition.code and the applicable profile binds the code to the value set http://hl7.org/fhir/ValueSet/condition-code icon with a Preferred binding:

4.2.3.1 Condition.code with Preferred binding 

{

  "path": "Condition.code",
  "definition" : "Identification of the condition, problem or diagnosis."
  "binding": {
    "strength": "preferred",
    "valueSetCanonical": "http://hl7.org/fhir/ValueSet/condition-code"
  }
}

With the Preferred binding all of the specification. following instances (and many other possibilities) are valid instances of the Condition resource:

4.2.3.2 Condition instance #5 

{

  "resourceType": "Condition",
  "code": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "39065001",
        "display": "Burn of ear"
      }
    ],
    "text": "Burnt Ear"
  },
  "subject": {
    "reference": "Patient/example"
  }
}

4.2.3.3 Condition instance #6 

{

  "resourceType": "Condition",
  "code": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "312824007",
        "display": "Family history of cancer of colon"
      }
    ]
  },
  "subject": {
    "reference": "Patient/example"
  }
}

4.2.3.4 Condition instance #7 

{

  "resourceType": "Condition",
  "code": {
    "coding": [
      {
        "system": "http://my-local-organization.com",
        "code": "XYZ123",
        "display": "Severe pneumococcal pneumonia"
      }
    ]
  },
  "subject": {
    "reference": "Patient/example"
  }
}

4.2.3.5 Condition instance #8 

{

  "resourceType": "Condition",
  "code": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "233607000",
        "display": "Pneumococcal pneumonia"
      },
      {
        "system": "http://my-local-organization.com",
        "code": "XYZ123",
        "display": "Severe pneumococcal pneumonia"
      }
    ]
  },
  "subject": {
    "reference": "Patient/example"
  }
}