Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. 4.1. Model of Meaning (MoM) Tab -- Minimum Data Set 3.0/OASIS-C to SNOMED CT Mapping

12/01/2011

The MDS3.0 and OASIS-C consist of individual sections containing a series of questions and corresponding answers. Each of the MDS3.0 and OASIS-C data elements contains a coding schema that links a document section to the questions and answers for that section.

General principles guiding the mapping of MDS3.0 and OASIS-C data elements to SNOMED CT include:

  1. Data elements are mapped to active SNOMED CT concepts (SNOMED CT Concept Status code “0”).

  2. The MoM tab reflects the best SNOMED CT Fully Specified name (FSN) or its proximal parent code.

  3. The approach to mapping the OASIS and MDS content is at the level of the answered question, with a primary focus on showing how the completed form is to be represented.

  4. A one-to-one SNOMED CT mapping is selected whenever possible

    EXAMPLE:
    MDS3.0 Data Element: B0600-2 -- No speech -- absence of spoken words  
    SNOMED CT Concept ID: 286371003
    SNOMED CT FSN: Does not speak (finding)
    SNOMED CT Best Match on MoM tab:   286371003 -- Does not speak (finding)

     

  5. If a one-to-one mapping is not available, the data element is mapped to the SNOMED CT proximal parent that includes all of the possible descendent data elements necessary to represent the MDS/OASIS concept.

    Some MDS/OASIS data elements embody more than one concept (e.g. MDS item I4500 (CVA, TIA, or stroke)). When a one-to-one mapping to SNOMED CT is not available, the data element is mapped to the SNOMED CT code that best represents all concepts embodied in the MDS/OASIS data element.

     

    EXAMPLE:
    MDS3.0 Data Element: I4500 -- Cerebrovascular accident (CVA), TIA, or stroke)  
    SNOMED CT Concept ID #1 -- “CVA”: 230690007 Child concept to “cerebro-vascular disease (disorder)”
    SNOMED CT FSN #1: cerebrovascular accident (disorder)
    SNOMED CT Concept ID #2 -- “TIA”: 266257000 Child concept to “cerebro-vascular disease (disorder):
    SNOMED CT FSN #2: transient ischemic attack (disorder)
    SNOMED CT Concept ID #3 -- “‘stroke”: 230690007 Child concept to “cerebro-vascular disease (disorder):
    SNOMED CT FSN #3: cerebrovascular accident (disorder)
    SNOMED CT Best Match on MoM tab:   62914000 -- cerebrovascular disease (disorder)   “Cerebro-vascular disease (disorder)” -- parent concept for CVA and TIA

     

  6. If no comparable SNOMED CT concept is available for either 1:1 equivalent or most proximal parent mapping, the “Comment” column reflects the reason the data element could not be mapped.

    MDS and OASIS items that are not mapped to SNOMED CT would be represented by LOINC codes found in the MoU tab.

     

  7. Unique SNOMED CT codes SHALL be used for the question and associated answer(s).

    Representing the structure/content of an assessment item in SNOMED CT will require the use of one of the following coding techniques:

    1. Use of a single SNOMED CT code that fully represents the patient’s status in terms of the question/answer pair (see example in Section 4.1.1 “Rules for SNOMED CT Mapping Using an Assertion Pattern”), or
    2. Use of two SNOMED CT codes: a SNOMED CT code to represent the question and a SNOMED CT code to represent the patient’s performance as measured by the answer (see example below).

     

    EXAMPLE:
    MDS3.0 Data Element: Question: J0400 (Res pain interview: frequency)  
    SNOMED CT Concept ID:   364631005
    SNOMED CT FSN: pattern of pain (observable entity)
    MDS3.0 Data Element: Response: J0400-1 (Almost constantly)
    SNOMED CT Concept ID: 255238004
    SNOMED CT FSN: continuous (qualifier value)
    MDS3.0 Data Element: Response: J0400-2 (Frequently)
    SNOMED CT Concept ID: 70232002
    SNOMED CT FSN: frequent (qualifier value)
    MDS3.0 Data Element: Response: J0400-3 (Occasionally)
    SNOMED CT Concept ID: 84638005
    SNOMED CT FSN: occasional (qualifier value)
    MDS3.0 Data Element: Response: J0400-4 (Rarely)
    SNOMED CT Concept ID: 89292003
    SNOMED CT FSN: rare (qualifier value)

     

  8. The same SNOMED CT code MAY be used for more than one response to a question.

    EXAMPLE:
    MDS3.0 Data Element: Question: B0700 (Makes self understood)
    SNOMED CT Concept ID:   288743004
    SNOMED CT FSN: ability to make self understood (observable entity)
    MDS3.0 Data Element: Response: B0700-0 (Understood)
    SNOMED CT Concept ID: 288746007
    SNOMED CT FSN: does make self understood (finding)
    MDS3.0 Data Element: Response: B0700-1 (Usually understood -- difficulty communicating some words or finishing thoughts but is able if prompted or given time)  
    SNOMED CT Concept ID: 288748008
    SNOMED CT FSN: difficulty making self understood (finding)
    MDS3.0 Data Element: Response: B0700-2 (Sometimes understood -- ability is limited to making concrete requests)
    SNOMED CT Concept ID: 288748008
    SNOMED CT FSN: difficulty making self understood (finding)
    MDS3.0 Data Element: Response: B0700-3 (Rarely/never understood)
    SNOMED CT Concept ID: 288747003
    SNOMED CT FSN: does not make self understood (finding)

     

  9. SNOMED CT grouper concepts SHALL NOT be used to represent the answer to a question if possible

    EXAMPLE:
    OASIS-C Data Element: Question: M1100_PTNT_LVG_STUTN (Patient Living Situation)  
    SNOMED CT Concept ID:   224209007  
    SNOMED CT FSN: residence and accommodation circumstances (observable entity)  
    OASIS-C Data Element: Response: 1 (Patient Lives Alone -- Around the clock) DO NOT code to SNOMED CT parent concept: 365508006 -- finding of residence and accommodation circumstances (finding).

    This is a grouper concept.

    SNOMED CT Concept ID: 105529008
    SNOMED CT FSN: lives alone (finding)
    OASIS-C Data Element: Response: 6 (Patient Lives with Other Person -- Around the clock)
    SNOMED CT Concept ID: 160724009
    SNOMED CT FSN: independent housing, not alone (finding)
    OASIS-C Data Element: Response: 11 (Patient Lives in Congregate Situation -- Around the clock)  
    SNOMED CT Concept ID: 105530003
    SNOMED CT FSN: living in residential institution (finding)

     

  10. MDS3.0 or OASIS-C demographic data elements:

    • SHALL NOT be mapped to a SNOMED CT concept if they are mapped to a CDA Header element. For example:

      • MDS3.0 Data Elements: A0600A (Social Security Number)
             A0900 (Birthdate)

       

    • SHALL NOT be mapped to a SNOMED CT concept if the MDS CDA IG instructs that the data element be coded to another code sets. For example:

      • The MDS CDA IG recommends the use of HITSP-recognized HL7 administrative gender codes
      • The MDS CDA IG maps the MDS marital status responses to the HITSP-recognized HL7 marital status codes
      • The MDS CDA IG uses the Ethnicity pattern, modeled per HITSP recommendations, where observation/value is drawn from CDC Race and Ethnicity Code Set

       

    • SHALL NOT be mapped to SNOMED CT concept if there is no clear relevance/usefulness to other care providers/clinicians. For example:

      • MDS3.0 Data Element: A0310A (Type of assessment: OBRA)

Summary: SNOMED Representations in the Model of Meaning Tab

Available SNOMED representations for the MDS and OASIS are found column G (SNOMED CT code) and column H (SNOMED CT Fully Specified Name) of the Model of Meaning tab in the respective Rosetta Stones. These Rosetta Stones also identify the primary reason that an assessment item is not mapped to a SNOMED concept (see column G in the respective MoM tab). The following statements are used to indicate the reason a concept is not mapped to SNOMED CT.

  • Concept Not Mapped --

    • This demographic/administrative data element is mapped to the CDA Header or is not relevant/useful to other providers/clinicians
    • No comparable SNOMED CT concept is available for either 1:1 equivalent or most proximal parent mapping
    • Data element is a complex expression that is not mappable to a single SNOMED CT concept and requires post coordination*
    • Negated/frequency/qualifier data elements is addressed through the vendor information model or in the CCD
    • Ambiguous concepts such as "none", "other", "unknown", etc., cannot be mapped to SNOMED CT
    • Question responses are free text format and do not provide a fixed concept for SNOMED CT mapping

*NOTE: This study did not undertake activities to post-coordinate complex, compound MDS data elements.

See Section 6 below for examples of MDS and OASIS data elements relevant to each of the “Concept Not Mapped” statements below.

4.1.1. MoM Tab -- Rules for SNOMED-CT Mapping of MDS3.0/OASIS-C Data Elements

A variety of question/answer formats are found in the MDS3.0 and OASIS-C assessment instruments. Two techniques were used in mapping SNOMED CT concepts for these various question/answer formats:

  • Assertion Pattern
  • Question/Answer Pattern

Assertion Pattern

  1. Typically, MDS and OASIS questions that are in a “yes/no” or “check all that apply format” are represented using an “assertion pattern”.
  2. In an assertion pattern, the question itself is not mapped to SNOMED CT, only the response is represented (e.g. “the resident is comatose”, “the resident does not use hearing aid”).
  3. The SNOMED CT hierarchies used for mapping “assertion patterns” differ slightly from the hierarchies used to map data elements in a “question/answer pattern”.

Rules for SNOMED CT Mapping Using an Assertion Pattern

For items with a CDA MoM representation of “assertion pattern” (typically questions in a “yes/no” or “check all that apply” format):

  1. The question SHALL NOT be mapped to SNOMED-CT

  2. The answers SHALL be mapped to the following SNOMED CT hierarchies:

    • Clinical Findings
    • Situation with Specific Context
    • Procedure
EXAMPLE #1 -- Assertion Pattern (yes/no question format):
1. MDS 3.0 Question B0100 "Comatose"
  • Answer = "No" (B0100-0) -- 271591004 -- Fully conscious (finding)
  • Answer = "Yes" (B0100-1) -- 371632003 -- Coma (disorder)

 

EXAMPLE #2 -- Assertion Pattern (check all that apply format):
  • MDS 3.0 Item B0900A (Staff asmt mental status: recall current season) -- 225033002 -- Memory recall finding (finding)
  • MDS 3.0 Item B0900B (Staff asmt mental status: recall location of room) -- 165287001 -- Memory: present place known (finding)
  • MDS 3.0 Item B0900C (Staff asmt mental status: recall staff names/faces) -- 285227006 -- Able to remember faces (finding)
  • MDS 3.0 Item B0900D (Staff asmt mental status: recall in nursing home) -- 165287001 -- Memory: present place known (finding)

 

Question/Answer Pattern

  1. Typically, MDS and OASIS questions that are answered by means of a scale (e.g., 1=adequate, 2=slightly impaired) are represented using a “question/answer pattern”.
  2. Both the question and answer(s) are mapped to SNOMED CT.
  3. The SNOMED CT hierarchies that can be used for mapping questions in a “question/answer” pattern differ slightly from the hierarchies used to map answers in a “question/ answer” pattern.

Rules for SNOMED CT mapping using a Question/Answer Pattern

For items with a CDA MoM representation of “question/answer pattern” (typically questions that have some type of ‘scale’ for the response (i.e., 1=x, 2=y, etc.):

  1. The question SHALL be mapped to the following SNOMED-CT hierarchies:

    • Observable Entity
    • Procedure

     

  2. The answers MAY be mapped to the following SNOMED CT hierarchies:

    • Clinical Findings
    • Qualifier
    • Procedure
    • Situation with Specific Context
EXAMPLE:
1. MDS 3.0 Question B0200 "Hearing" -- 364019009 -- Ability to hear (observable entity)
  • Answer = "Adequate" (B0200-0) -- 16233902 -- Hearing Normal (finding)
  • Answer = "Minimal Difficulty" (B0200-1) -- 162340000 -- Hearing difficulty (finding)
  • Answer = "Moderate Difficulty" (B0200-2) -- 425091001 -- Difficulty hearing normal speech tones (finding)
  • Answer = "Highly Impaired" (B0200-3) -- 306972000 -- Unable to hear loud voice (finding)

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