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  2. CQM-927

Several SNOMED CT value sets in CQMs use SNOMED CT codes from the incorrect hierarchy

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      Thank you for the review and comments on the value sets. We agree that some of the concepts chosen for inclusion in value sets reflect a broad perspective on the kinds of concepts that might be found in a patient record, and that some of them seem to break proper code system usage rules. Your examples are good ones for this. At some point VSAC will provide some guidance on proper concept "type" selection, but in the mean time we thank you for your thorough review and will provide this feedback to the value set steward. Value set content is always under the control of the value set steward and they will make final decisions on any updates, during the annual update process.
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      Thank you for the review and comments on the value sets. We agree that some of the concepts chosen for inclusion in value sets reflect a broad perspective on the kinds of concepts that might be found in a patient record, and that some of them seem to break proper code system usage rules. Your examples are good ones for this. At some point VSAC will provide some guidance on proper concept "type" selection, but in the mean time we thank you for your thorough review and will provide this feedback to the value set steward. Value set content is always under the control of the value set steward and they will make final decisions on any updates, during the annual update process.
    • Improper SNOMED CT codes can lead to semantic drift

      There are several SNOMED CT value sets scattered throughout several CQMS using SNOMED CT codes that should not be used in that particular value set. Ie. a value set should not mix SNOMED CT disorder, procedure or finding codes with SNOMED CT attribute codes such as qualifiers or morphologic abnormalities.

      Here are two examples:
      Patient Reason 2.16.840.1.113883.3.117.1.7.1.474 is a list of findings and sitatuations, but has two SNOMED CT qualifer codes in it.

      443390004 Refused (qualifier value) and 385648002 Rejected by recipient (qualifier value)

      In SNOMED CT, Qualifiers are not allowed to stand on their own, they must be attached to a SNOMED CT code that can stand alone.

      Another example is:
      2.16.840.1.113883.3.666.5.1570 Congenital Anomalies Group has 18465005 Anomalous origin of vein (morphologic abnormality), but the other items in the value set are findings or disorders. Again, morphologic abnormality should not be used in a value set of disorders/findings. They could be use in a value set of other morphologic abnormalities, but should not mix with findings disorders.

      These two value sets are ok (2.16.840.1.113883.3.117.2.7.1.14 ( and 2.16.840.1.113883.3.67.1.101.11.724, principal) ) because they are used to qualify a diagnosis as the principal diagnoses.

      May I suggest that all SNOMED CT value sets be reviewed to make sure the values inside the value sets are used in the manner intended by SNOMED CT.

            rob.mcclure Rob McClure
            CTilley71 Cyndalynn Tilley (Inactive)
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