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Coding COVID-19 Related Data

The collection of coded COVID-19 related data can be critical for frontline service delivery, pandemic surveillance, and retrospective data analysis.

The following table lists a collection of data elements for which SNOMED CT can be used to capture COVID-19 related data.

|--- Provider and facility details([section 2.1](https://confluence.ihtsdotools.org/display/WIPCV19/2.1+Provider+and+Facility+Details?src=sidebar))|

Healthcare profession
Site of care
Health management finding
Personal protective equipment

Patient demographics

Biological sex
Gender identity
Marital or partnership status
Nationality

Clinical assessment

Symptoms
Severity
Clinical measurements
Clinical examination findings

Tests and Investigations

Specimen
Laboratory tests
Radiology procedures
Substances and virus

Prevention, treatment and education

Prevention
Prevention findings
Education
Medication

Note

The SNOMED CT subsets are provided as a guide only, and may need to be constrained or extended to meet local requirements.

Provider and Facility Details

Information about the healthcare providers and facilities involved with the investigation, treatment, and care of patients with suspected or confirmed COVID-19 are usually recorded in electronic health records. The monitoring of medical equipment availability at healthcare facilities, such as Personal Protective Equipment (PPE) and respiratory devices, is also of utmost importance during the COVID-19 pandemic. Relevant details, which can be recorded using SNOMED CT include:

Healthcare profession
Site of care
Health management finding
Personal protective equipment

These data elements are described below, with example SNOMED CT subsets for each.

The healthcare profession is the occupation or qualification of the healthcare provider who is involved in the investigation, treatment, care or education of the patient - for example or .

CV19-PFD-HealthcareProfession Intensional Definition : <

The site of care refers to the location of the specific investigation, treatment or care setting - for example , , or .

CV19-PFD- SiteOfCare Intensional Definition : < OR << OR << OR << OR << OR <<

2.1.3 Health Management Finding

Health management finding includes concepts that describe the circumstances which affect whether the planned patient outcomes are attained, that different areas within a health organization are running appropriately, that tasks are correctly defined and assessed and that resources are used efficiently. -for example , or .

CV19-PFD- HealthManagementFinding Intensional Definition : <

Personal protective equipment is protective clothing, or other garments or equipment designed to protect the wearer's body from injury or infection - for example and

CV19-PFD- PersonalProtectiveEquipment Intensional Definition : << OR << OR << OR << OR << OR << OR << OR <<

Patient Demographics

General demographic characteristics are important to record for each patient being investigated or treated for COVID-19. Relevant patient demographics, which can be recorded using SNOMED CT includes:

Biological sex
Gender identity
Marital or partnership status
Nationality
Ethnic group
Racial group
Occupation
Travel history
Residential location type
Next of kin relationship
Living arrangements
Care and support circumstances

These data elements are described below, with example SNOMED CT subsets for each.

Multiple types of sex and/or gender are recorded in clinical practice, including biological sex and gender identity. 1

SNOMED CT supports the distinction between biological sex (e.g. ) and gender identity (e.g. ), as shown in the two subset definitions below.

CV19-PAT- BiologicalSex Intensional Definition : < MINUS <<

CV19-PAT- GenderIdentity Intensional Definition : <

The marital or partnership status of a patient describes their legal, civil or personal relationship with their significant other, for example .

CV19-PAT- MaritalOrPartnershipStatus Intensional Definition : <

Nationality refers to a particular legal relationship between an individual person and a sovereign state. The nationality of a patient may refer to the nation in which they were born, have citizenship, or have other legal ties - for example or .

CV19-PAT- Nationality Intensional Definition : <

The ethnic group (or ethnicity) of a patient is the social or cultural group with whom they identify - for example, or .

CV19-PAT- EthnicGroup Intensional Definition : <

The racial group (or race) of a patient is the group (or groups) with whom they share inherited physical characteristics - for example, or .

CV19-PAT- RacialGroup Intensional Definition : <

Occupation is the patient's job or profession - for example, or .

CV19-PAT- Occupation Intensional Definition : <

The travel history of a patient is a record of their past visits to locations both inside and outside their country of residence. This may include a list of the specific countries and/or regions that they have travelled to (e.g. or ), or a descriptive travel history finding (e.g. ).

CV19-PAT-TravelHistory Intensional Definition : < OR < OR <

The residential location type is the type of place in which the patient is currently living, or was living prior to admission to hospital - for example, or .

CV19-PAT- ResidentialLocationType Intensional Definition : <

The next of kin relationship is the relationship that the patient has with their closest living relative (as chosen by the patient) - for example or .

CV19-PAT- NextOfKinRelationship Intensional Definition : <

The living arrangements of the patient describes the familial and non-familial relationships of a person to all the other people with whom they usually reside - for example or .

CV19-PAT- LivingArrangements Intensional Definition : <

The care and support circumstances of the patient describe how and by whom they are looked after when living at their usual place of residence - for example or .

CV19-PAT- CareAndSupportCircumstances Intensional Definition : <

Footnotes

Tests and Investigations

Laboratory testing for COVID-19 and the associated SARS-CoV-2 virus includes methods that detect the presence of the virus and antibodies produced in response to infection, in specimen samples taken from potentially infected individuals. Test and investigation data which can be recorded using SNOMED CT includes:

Specimen
Laboratory Tests
Radiology Procedures
Substances and Virus
Laboratory Test Results
Other Investigations

These data elements are described below, with example SNOMED CT subsets for each.

Specimens are samples of substances taken from an individual for testing - for example or . The following specimens may be relevant to COVID-19 testing in one or more countries affected by the virus.

CV19-INV-Specimen

The specimens prefixed with a star '*' are a subtype of another member of this subset.

Laboratory tests can be performed to detect the presence of the COVID-19 virus and antibodies produced in response to this virus. The following SNOMED CT concepts can be used to record laboratory tests that may be performed during the investigation process.

CV19-INV-LaboratoryTests

Radiology procedures are procedures that obtain images of the inside of the body. The following SNOMED CT concepts may be used to record radiology procedures that may be performed during the investigation and treatment of suspected or confirmed Covid-19 patients.

CV19-INV-RadiologyProcedures

An antibody is a protective protein produced by the immune system in response to the presence of a foreign substance, called an antigen. The following antibody/antigen and virus organism concepts can be used to record the focus of a COVID-19 investigation.

CV19-INV-SubstancesAndVirus

Laboratory test results are used to specify whether the Laboratory test focus was detected or not detected following the conducted laboratory test. The following qualifier values may be used for this purpose.

CV19-INV-LabTestResults

Other investigative procedures - e.g. and and and - may be performed to assess a COVID-19 patient. The following subset represents procedures that can be performed during the clinical assessment process.

The following subset represents a collection of findings with context that may be related to these investigations and captured using SNOMED CT - for example or .

Footnotes

1 , Division of Laboratory Systems, CDC, US

2 , The Native Antigen Company, UK

Patient Demographics

General demographic characteristics are important to record for each patient being investigated or treated for COVID-19. Relevant patient demographics, which can be recorded using SNOMED CT includes:

Biological sex
Gender identity
Marital or partnership status
Nationality
Ethnic group
Racial group
Occupation
Travel history
Residential location type
Next of kin relationship
Living arrangements
Care and support circumstances