Draft ANF Work

Questionaire	Topic	Result	Type
Does have a comorbidity of alcohol use	[Observation procedure] (has focus) [Finding of alcohol drinking behavior]	(0,INF) countable quantity	performance
Does not have a comorbidity of alcohol use	[Observation procedure] (has focus) [Finding of alcohol drinking behavior]	[0,0] countable quantity	performance
Does have a comorbidity of diabetes	[Observation procedure] (has focus) [Diabetes mellitus]	(0,INF) countable quantity	performance
Does not have a comorbidity of diabetes	[Observation procedure] (has focus) [Diabetes mellitus]	[0,0] countable quantity	performance
Does have a comorbidity of cancer	[Observation procedure] (has focus) [Malignant neoplastic disease]	(0,INF) countable quantity	performance
Does not have a comorbidity of cancer	[Observation procedure] (has focus) [Malignant neoplastic disease]	[0,0] countable quantity	performance
Does have a comorbidity of taking a statin medication	[Observation procedure] (has focus) [Product containing 3-methylglutaryl-coenzyme A reductase inhibitor]	(0,INF) countable quantity	performance
Does not have a comorbidity of taking a statin medication	[Observation procedure] (has focus) [Product containing 3-methylglutaryl-coenzyme A reductase inhibitor]	[0,0] countable quantity	performance
COVID-19 Test ordered	[Laboratory procedure] (component) [Severe acute respiratory syndrome coronavirus 2]	[1,1] countable quantity	request
COVID-19 test result positive	SARS-CoV+SARS-CoV-2 (COVID-19) Ag [Presence] in Respiratory specimen by Rapid immunoassay	(0,INF) countable quantity	performance

No adjustment is necessary. There is an existing exact match for the variable

Acute respiratory infection	Acute respiratory infection (disorder)
Acute respiratory distress	Acute respiratory distress (finding)
Respiratory failure	Respiratory failure (disorder)

Optional adjustment. If it is felt that the existing concept is logically the correct one but the terming is suboptimal the fix could be to add a synonym to the existing concept for VA use.

Acute respiratory arrest

Respiratory arrest (disorder)

In-depth adjustment or an identified gap.

Chronic lung condition	Chronic lung disease (disorder)	The existing SNOMED concept is not correctly modeled and it is not subsuming correctly. E.g. it does not subsume Chronic obstructive lung disease (disorder). The screenshot is shown below this table.
	Chronic obstructive lung disease (disorder)	Is a sibling to Chronic lung disease (disorder) when it should subsume.
	Asthma (disorder)	Is not currently defined as "chronic" in SNOMED International July 2020 Release
	Chronic asthmatic bronchitis (disorder)	Not sure this is a match for the requested variable, this is under: Chronic bronchitis (disorder)
	Chronic bronchitis (disorder)	Exact match for the requested variable.

The optimal process to fix this error would be to fix it locally for the immediate benefit of the VA. Then there would need to be a submission of the change request to the US National Release Center (NRC). The US NRC would evaluate the request as to whether it is applicable to only the US or if it is an issue for the International core of SNOMED. If the US NRC determined that this was an issue for the International core they would then forward the request to the International staff for consideration. Acknowledging that there is limited bandwidth at both the US and International level for authoring, the request may not make the next 6-month Release cycle. This request has been submitted to the US Content Request Service for evaluation (Request ID: 349742, Jira Ticket ID: USCRS-31022).

As an example, if the request submitted to fix the error was picked up and forwarded immediately to SNOMED International, the earliest it would be available in the US Release for the VA to use would be March 2021.

	Editorial Cut Off Date	Product Release Date

	Editorial Cut Off Date	Product Release Date
SNOMED International July 2020 Release	April 30th, 2020	July 31th, 2020
US SNOMED Release 2020	~July 2020	September 2020
SNOMED International January 2021	~Oct 31st, 2019	January 31, 2021
US SNOMED Release 2021	~January 2021	March 2021

To speed up the process to meet the VA Use Cases the error could be fixed directly in both the VA extension and the US National Release. The corrected content would be immediately available to the VA and also available in the September 2020 US Release.

The process would be the same for a noted gap in variables, it would be authored locally for the VA and US National Release and forwarded to SNOMED International for consideration.

Chronic asthma

Asthma (disorder)

In SNOMED “asthma” is not defined as "chronic". A new concept would need to be added to represent this condition.

Literature exists to support the addition of a new concept of “Chronic asthma (disorder)” and the existing concept model could be used to define the meaning.