FHIR and SWEC Comparison

In the context of this SNOMED implementation guide, we have chosen to use the FHIR context model as an example of an information model for several reasons. FHIR is a widely adopted standard in the healthcare industry for exchanging electronic health records and related data. Its modular and extensible design makes it an ideal candidate to demonstrate how context information can be represented outside terminologies like SNOMED CT.

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Clinical Findings with Context vs. FHIR Resources

The following table maps SNOMED CT “Situations with Explicit Context” subhierarchies to relevant FHIR resources, showing how clinical context is represented across terminology and information models.

SNOMED CT Situation (Subhierarchy)	FHIR Resource	Domain	Context	Subject	Temporal Context
417662000 |History of clinical finding in subject (situation)|	Condition	Clinical finding	Known present	Subject of record	In the past
416471007 |Family history of clinical finding (situation)|	FamilyMemberHistory	Clinical finding	Known present	Person in the family	Current or past
160266009 |No family history of clinical finding (situation)|	(None / N/A)	Clinical finding	Known absent	Person in the family	All times of past
1260502004 |History of event in life of subject (situation)|	Condition	Event	Known present	Subject of record	In the past
373572006 |Clinical finding absent (situation)|	Observation	Clinical finding	Known absent	Subject of record	Current or specified time
History Events with finding context	Observation	Event	Known absent	Subject of record	Current or specified time
373573001 |Clinical finding present (situation)|	Condition	Clinical finding	Known present	Subject of record	Current
443859009 |Possible clinical finding (situation)|	Condition	Clinical finding	Known possible	Subject of record	Current or specified time
443938003 |Procedure carried out on subject (situation)|	Procedure	Procedure	Done	Subject of record	Current or specified time
416237000 |Procedure not done (situation)|	Procedure	Procedure	Not done	Subject of record	Current or specified time
439763000 |Procedure on family member (situation)|	Procedure	Procedure	—	Person in the family	Current or specified time

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Notes

• Where FHIR Resource is listed as N/A, there may be no direct mapping in the base FHIR specification.

• Context properties such as subject and temporal frame help clarify how the SNOMED concept aligns with FHIR resource attributes like subject, status, or effective[x].

Clinical Findings with Context vs. FHIR Resources

The table below maps specific types of Situations with Explicit contexts to specific FHIR resources and states the associated context properties

Attributes vs. FHIR Resource Elements

As seen in the previous table, depending on the type of context represented in the SWEC concept, it can be transformed into a Condition or Observation resource. Here, we provide some examples of values for different key elements.

Condition Resource vs. |History of clinical finding in subject|

FHIR Element Name	FHIR Element Value	SNOMED Attribute	SNOMED Value
Condition.clinicalStatus	inactive	Temporal context	In the past
Condition.code	Clinical finding	Associated finding	<< Clinical finding

Condition Resource vs. |Clinical finding present|

FHIR Element Name	FHIR Element Value	SNOMED Attribute	SNOMED Value
Condition.clinicalStatus	active	Temporal context	Current
Condition.code	Clinical finding	Associated finding	<< Clinical finding

Observation Resource vs. |Clinical finding absent|

FHIR Element Name	FHIR Element Value	SNOMED Attribute	SNOMED Value
Observation.code	Clinical finding	Associated finding	<< Clinical finding
Observation.value	Known absent	Finding context	Known absent

Procedure Resource vs |Procedure Done|

FHIR Element Name	FHIR Element Value	SNOMED Attribute	SNOMED Value
Procedure.code	Procedure	Associated procedure	<< Procedure
Procedure.status	Completed	Procedure context	Done
Procedure.category	Surgical	(Ancestor)	Surgical procedure
Procedure.reasonCode	Disease	Has focus	<< Clinical finding
Procedure.bodySite	Body site	Procedure site - direct	<< Anatomical structure