This implementation guidance provides guidance to support the implementation of the PRSB Diabetes Record Information Standard.\u00a0General guidance is provided here. Data item specific implementation guidance can be found under the 'context' field.\u00a0PRSB\n has carried out a clinical safety review in accordance with DCB0129, which is detailed in the clinical safety case and accompanying Diabetes Information Standards hazard log.\u00a0\n This guidance should be used in conjunction with the Risk Mitigation section.\u00a0This guidance should be used in conjunction with the final report for the Diabetes Information Standards.
\n\n 1.2 Audience
\n \n
\n This guidance is intended for anyone implementing and using the PRSB Diabetes Record Information Standard. This will include health and social care professionals, IT system suppliers, developers, and implementers.\u00a0
\n 1.3 Definition and scope of the Diabetes Record Information Standard
\n
\n \n 1.3.1 What the diabetes record information standard\u00a0is:
\n \n
\u00a0
\nThe set of rules and instructions governing the type of information expected within a section, cluster, record entry and element and how it is communicated is defined in the information model under the titles of Description, Cardinality, Conformance and Valuesets.\u00a0
The Diabetes Record Information Standard contains the following\n information components as outlined below:What is defined is a set of information which should be common to most systems recording information to support a person's direct diabetes care. Information recorded may be drawn from different settings.\u00a0How information from a person's diabetes apps and devices is transferred to (e.g. via the cloud) and stored in a person's\n electronic health record for diabetes is out of scope. It is recognised that different local implementations across settings may differ in their level of digital maturity. For example some systems may not be capable, at least at first, of storing/ processing raw a data from diabetes devices or platforms (and using this to calculate and\n display derived summary statistics). It may be that in such cases initial 'simpler' implementations may preferentially send and receive pre-calculated metrics and preformed graphical representations of the data for display to the end-user (e.g. Ambulatory Glucose Profiles (AGPs) shared as PDFs) with a view to progressing to more complex/\n sophisticated implementations later. Further work may need to define different \u2018views\u2019 in a diabetes care record of the information for different professionals (and other users, including people with diabetes who use services and those with permissioned proxy access) and local use cases based on the information governance framework which has been published by NHS England. These views should define what information is needed by a professional (or person) in particular circumstances. How the information is\n presented to professionals and citizens in a shared care record will be dependent on the local systems in place but it should be presented in such a way as to provide maximum benefit for different users (in different roles) in each given use case.\u00a0
\n
There is a complex environment of systems and technology to support diabetes that need to share information and will need to conform with the information and technical standards to do so.\u00a0There are four broad groups of systems and technology increasing from the micro to macro level for example an app, a device, a local management\n system at ICS level though to a regional or national system:
a.\u00a0\u00a0\u00a0\u00a0 lifestyle apps for supported self-management.
\nb.\u00a0\u00a0\u00a0\u00a0 medical devices (including self-monitoring and insulin delivery devices, Point of Care systems in hospitals and systems integrating\n data from devices e.g. Glooko)
\nc.\u00a0\u00a0\u00a0\u00a0 specialist diabetes management systems (e.g. My Way Diabetes Health, Hicom\u2019s Diamond and Twinkle).
\nd.\u00a0\u00a0\u00a0\u00a0 non-diabetes specific health and care record and electronic prescribing and medications administration systems (e.g. Cerner\n Millenium, Epic, EMIS, TPP SystmOne, Graphnet, Orion, Patient Centred Software, Nourish).
\nIn order for information to be shared between these systems they may need to be adapted to ensure that the information is structured and coded in alignment with the standards.\u00a0
\n2.3 Dependencies
\n \n2.4 Risk mitigation
\n \n
We recommend system suppliers and local implementers apply further risk mitigations when implementing the PRSB Diabetes Record Information Standard by addressing the risks that have been flagged in the clinical safety case report and hazard log for the standard.\u00a0\u00a0Suppliers and implementers should aim to reduce the risk scores to 2,\n or better, when carrying out clinical risk assessments and developing safety cases for their implementations with respect to DCB0129 and DCB0160.
\n
\n 2.5 Information governance
\n
\n Sound principles of information governance and respecting the privacy of people and their information is paramount. NHS England has published a national\u00a0Information\n Governance Framework\u00a0\u00a0that needs to be considered when planning implementation. Local agreements should be drawn up between organisations to define information requirements for communication.
2.6 Data quality
\n
\n Data quality and accuracy of coded data entry should be managed in local \u2018source\u2019 systems to ensure that information shared with people and professionals through other systems is dependent on the source data quality.\u00a0 \u00a0
2.7 Context of the information (see also Provenance Data Standard)
\n
\n It is vital for use of the data that all contextual information is maintained and should not be lost on exchange or import of information. For example, a person with diabetes self-managing their condition at home may record their own blood pressure or conduct self-monitoring of blood glucose (SMBG). They may also be using diabetes devices\n including CGM, connected insulin pens or ambulatory insulin pumps. In all cases\u00a0it is important that the full context of the information is known (where and when the measurement was done and by whom or what device). The principle, for PRSB standards, is that for clinical safety and efficacy of communications, the key contextual data described within\n the PRSB Provenance Data Standard should be easily accessible to the end-user of any implementation of the Diabetes Record Information Standard. The principle applied in the information model is that where it is important (from a professional perspective) to know who or what device undertook the activity and who or what device recorded the that this\n is made available to the end-user accessing the record. For every item of information shared it is important that an audit trail is recorded (even if not explicitly stated in the information model). This is set out below (see time stamp and audit trail).\u00a0
\n
\n 2.8 Provenance Data Standard
\n \n
Implementation of the Diabetes Record Information Standard requires use of the PRSB Provenance Data Standard. See Provenance data \u2013 PRSB (theprsb.org)
2.9 Time stamp and audit trail
\n
\n It is important that an audit trail is recorded for every item of information recorded or shared (even if not explicitly stated in the information model). Each record entry will need to be time stamped from the source system with date and time recorded and the identity of the person making the record. This needs to be viewable in the records\n themselves where appropriate and via a full audit trail which may be viewable by the end user to enhance transparency.
2.10 Links to other systems and records
\n
\n Effective use of the Diabetes Record Information Standard will require the ability to safely link and share the information recorded by the person or their devices (initially onto proprietary apps, applications or other systems and shared in compliance with the Diabetes Self-Management Information Standard) with the person's electronic health\n record. How this is done is yet to be determined/ clarified with suppliers but may require integration with the person demographics service API where there is a legal basis to do so (see https://digital.nhs.uk/services/demographics) or other secure methods.
2.11 Coding
\n \n \n
The\u00a0 Personalised Health and Care 2020 framework for action\u00a0(\u00a0 \n https://www.gov.uk/government/publications/personalised\n \n \u00a0\n \n -\n \n \u00a0\n \n health\n \n \u00a0\n \n -\n \n \u00a0\n \n and\n \n \u00a0\n \n -\n \n \u00a0\n \n care\n \n \u00a0\n \n -\n \n \u00a0\n \n 2020\n \n \u00a0\n \n )\n \n \u00a0\n \u00a0\n recommends the use of SNOMED CT and the dictionary of medicines and devices (dm+d). Local decisions need to be\n made about when these codes are to be used, depending on local system functionality and plans. The current ambition is for SNOMED CT and dm+d to be the primary clinical coding schemes in use in the NHS.\n \n \u00a0\n \n
2.13 PRSB Support\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0
\nThe PRSB support service is available for any help, enquiries or issues with the using or implementing the standards. Any feedback on the standard (including proposed changes) resulting from putting the standard into practice would also be welcome. Contact is via support@theprsb.org or Tel: 02045515225.
\nHow content is displayed in systems is outside of the scope of the diabetes record information standard. However, during the PRSB consultation health and care professionals expressed a desire for the age of the person (subject of record) to be displayed in systems alongside date of birth. Where this is done this could be displayed in parenthesis, e.g.\n 1986-01-07 (36y). An example age display scale can be found in the (now deprecated) NHS CUI (Common User Interface) standard (ISB 1500 \u2013 1508). *
\n* (see https://digital.nhs.uk/data-and-information/information-standards/information-standards-and-data-collections-including-extractions/publications-and-notifications/standards-and-collections/isb-1500-1508-common-user-interface ; https://webarchive.nationalarchives.gov.uk/ukgwa/20160921150545/http://systems.digital.nhs.uk/data/cui/uig)
\nDetails of the person's GP practice.
\n ", "concept": [{"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "*", "mro": "R", "name": "GP practice record entry", "description": "This is an GP practice record entry. There may be 0 to many record entries under a section. Each record entry is made up of a number of elements or data items", "informationType": "Record", "concept": [{"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "GP name", "description": "The name of the person's GP. If the person is registered with a GP practice, their usual GP name will be something volunteered by the person or their representative.", "valueSets": "Free text", "valueDomain": [{"type": "text", "property": [{"maxLength": "70"}]}]}, {"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "GP practice details", "description": "Name and address of the person's registered GP Practice. Registered GP practice details are available from the Person Dempographics Service (PDS), or volunteered from the person or their representative. Include details of the practice name and address.", "valueSets": "Free text", "valueDomain": [{"type": "text", "property": [{"maxLength": "150"}]}]}, {"type": "item", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "GP practice identifier", "description": "The identifier of the registered GP practice.", "valueSets": "\nA description of how you communicate normally including any communication aids you use, for example a hearing aid.
\nDescribe how you would like others to engage and communicate with you, including how you would like to be addressed.
\n ", "valueSets": "Free text", "valueDomain": [{"type": "text"}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "My wellness", "implamentationGuidance": "Prompt questions: \n| \n \n \n \n \n A description covering what you are able to do, how you engage with others and how you feel on a typical day through to on a day when you are unwell or really unwell \n | \n
| \n \n \n \n \n \n
\n | \n
A description of how and when you want someone caring for you to support you.
\n\n
A description of what is also worth knowing about you for people caring or supporting you.
\n\n
Under the Equality Act 2010, organisations have a legal duty to make changes in their approach or provision to ensure that services are as\n accessible to people with disabilities as they are for everybody else. These changes are called reasonable adjustments.
\nReasonable adjustments can mean alterations to buildings by providing lifts, wide doors, ramps and tactile signage, but may also mean changes to policies, procedures and staff training to ensure that services work equally well for people with physical or sensory disabilities, learning disabilities or long-term conditions such as dementia.
\nOther adjustments include longer appointments, providing easy read materials or communications via a carer. This legal duty is anticipatory which means a service should know about a person\u2019s need for adjustments when they are referred or present for care. For this to happen, and for optimum care to be delivered, adjustments need to be recorded and shared across\n the NHS.
\n ", "valueSets": "The coded value field for reasonable adjustment must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference sets.
\nThe coded value field for mobility needs must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\nDiabetic eye screening information sharing consent status should be coded using only one SNOMED CT concept that is a subtype of the following concept:\u00a0
\n\n SNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance\n
\n305401000000104 \u2502 Information sharing consent status for national screening programme for diabetic retinopathy (finding) \u2502 Descendant of concept.
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\n ", "description": "\nThe coded value field for safeguarding concerns must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\nThe relationship the personal contact has to the person, e.g. father, grandmother, family friend etc. Includes additional roles the person performs on behalf of the other (e.g. carer, next of kin, emergency contact, dependent, etc.).
\n ", "concept": [{"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Coded value", "implamentationGuidance": "The coded value for relationship.
\n ", "valueSets": "\nNationally or internationally maintained code system(s) (see implementation guidance).
\n "}, {"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Free text", "description": "\nFree text field to be used if no code is available.
\n ", "valueSets": "\nReferral status should be coded using only one SNOMED CT concept that is a subtype of the following concepts:
SNOMED CT ID\u00a0\u00a0\u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
309012006 \u2502 Referral statuses (finding) \u2502 Descendant of concept.
768251000000109 \u2502\u00a0Referral offered (finding) \u2502 Descendant or self of concept.
353811000000108 \u2502 Referral declined (situation) \u2502 Descendant or self of concept.
3457005 \u2502 Patient referral (procedure) \u2502 Descendant of concept. Where no relevant finding concept is available, procedure concepts can be used to indicate that a particular type of referral was made.\u00a0
\u00a0
For example:
025301000000100 \u2502\u00a0Referral to National Health Service Diabetes Prevention Programme declined (situation) \u2502\u00a0 Equal of concept. \u00a0
871641000000105 \u2502\u00a0Referral to smoking cessation service declined (situation) \u2502\u00a0 Equal of concept.\u00a0
838731000000104 \u2502\u00a0Referral to community diabetes specialist nurse declined (situation) \u2502\u00a0 Equal of concept.
\u00a0
The following concepts apply to structured education referrals:
1103691000000102 \u2502\u00a0Diabetes structured education programme offered (situation) \u2502 Equal of concept.
415270003 \u2502 Referral to diabetes structured education program (procedure) \u2502 Descendant or self of concept.
781161000000107 \u2502\u00a0Referral to diabetes education and self management for ongoing and newly diagnosed structured programme declined (situation) \u2502 Equal of concept. \u00a0
860981000000106 \u2502\u00a0Referral to dose adjustment for normal eating diabetes structured education programme declined (situation) \u2502 Equal of concept.\u00a0
\u00a0
The following concepts apply to continuous glucose monitoring referrals:
1464581000000103 \u2502 Referral for real-time continuous glucose monitoring (procedure) \u2502 Equal of concept.
1464571000000100 \u2502 Referral for intermittently scanned continuous glucose monitoring (procedure) \u2502 Equal of concept.
\u00a0
The following concept applies to diabetic eye screening service referrals:
248161000000101 \u2502 Referral for diabetic retinopathy screening (procedure) \u2502 Equal of concept.
\u00a0
Where required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
", "description": "The coded value for referral status.", "valueSets": "The coded value field for attendance source must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\nThe coded value field for presenting complaint or issue must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\nThe coded value field for discharge destination must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\nThe coded value field for discharge status must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\nThe coded value field for service must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\n\n
This is the vaccinations record entry.
\n\n
There may be 0 to many record entries under a section.
\n\n
Each record entry is made up of a number of elements or data items.
\n ", "informationType": "Event.Record", "concept": [{"type": "group", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Vaccine product", "description": "The vaccine product administered.", "concept": [{"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Coded value", "description": "The coded value for vaccine product.", "valueSets": "dm+d (SNOMED) Concept ID AMP (preferred) or VMP term for the vaccine productThe coded value field for vaccination procedure must contain only one SNOMED CT concept that is either a descendant (the set of all subtypes) of the given concept (where expression constraint language (ECL) operator symbol is \u2018<\u2019) or descendant (the set of all subtypes) or self (the concept itself) of the given concept (where ECL operator symbol is\n \u2018<<\u2019).
\nThe coded value field for body site must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\nThe coded value field for route must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\nThe coded value field for indication must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\nThe coded value field for indication must contain only one SNOMED CT concept from the following valueset:
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n201741000000102 \u2502 Did not attend child immunisation (finding) \u2502 Equal of concept.
\n281399006 \u2502 Did not attend (finding) \u2502 Equal of concept.
\n213257006 \u2502 Generally unwell (finding) \u2502 Equal of concept.
\n266758009 \u2502 Immunization contraindicated (situation) \u2502 Descendent or self of concept.
\n310376006 \u2502 Immunization consent not given (finding) \u2502 Descendent or self of concept.
\n591000119102 \u2502 Vaccine declined by patient (situation) \u2502 Descendent or self of concept.
\nWhere required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nThe laterality of the problem should be coded using only one SNOMED CT concept that is a descendant of the following concept:
\nSNOMED CT ID \u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n182353008 \u2502Side (qualifier value) \u2502 Descendant of concept.
Additional coding of the laterality of a problem is not required where already specified elsewhere, for example:
PRSB data item\u00a0\u2502\u00a0\u00a0SNOMED CT ID\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
Problem \u2502 15630811000119104 \u2502 Uveitis of left eye (disorder) \u2502 Laterality code not required.
Body site \u2502 8966001 \u2502 Left eye structure (body structure) \u2502 Laterality code not required.
Where required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
Further guidance on the use of problem lists in systems can be found in PRSB's diagnosis recording guidance\u00a0(see\u00a0https://theprsb.org/standards/diagnosesrecording/).
The coded value field for procedure must contain only one SNOMED CT concept that is a descendant (the set of all subtypes) of the given concepts (where expression constraint language (ECL) operator symbol is \u2018<\u2019).
The following concepts apply to continuous glucose monitoring:
SNOMED CT ID\u00a0\u00a0\u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
1464651000000108 \u2502\u00a0Discussion about intermittently scanned continuous glucose monitoring (procedure)\u00a0\u2502 Equal of concept.\u00a0
1464661000000106 \u2502\u00a0Discussion about real-time continuous glucose monitoring (procedure)\u00a0\u2502 Equal of concept.\u00a0
1464621000000103\u00a0\u2502 Intermittently scanned continuous glucose monitoring stopped (situation)\u00a0\u2502\u00a0Equal of concept.\u00a0
1464641000000105 \u2502\u00a0Real-time continuous glucose monitoring stopped (situation)\u00a0\u2502 Equal of concept.\u00a0
1464551000000109 \u2502\u00a0Provision of intermittently scanned minimally-invasive interstitial fluid continuous glucose monitoring system (procedure)\u00a0\u2502 Equal of concept.\u00a0
1464561000000107 \u2502\u00a0Provision of real-time minimally-invasive interstitial fluid glucose monitoring system (procedure)\u00a0\u2502 Equal of concept.
1464531000000102 \u2502\u00a0Intermittently scanned continuous glucose monitoring declined (situation)\u00a0\u2502 Equal of concept.
1464541000000106 \u2502\u00a0Real-time continuous glucose monitoring declined (situation)\u00a0\u2502 Equal of concept.
Where required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
", "description": "The procedure code.", "valueSets": "The coded value field for anatomical site must contain only one SNOMED CT concept that is a descendant (the set of all subtypes) of the given concept (where expression constraint language (ECL) operator symbol is \u2018<\u2019).
\n ", "description": "The coded value of the anatomical site.", "valueSets": "The coded value field for laterality must contain only one SNOMED CT concept that is a descendant (the set of all subtypes) of the given concept (where expression constraint language (ECL) operator symbol is \u2018<\u2019).
\n ", "description": "The coded value for laterality.", "valueSets": "The coded value field for complications related to procedure must contain only one SNOMED CT concept that is a descendant (the set of all subtypes) of the given concept (where expression constraint language (ECL) operator symbol is \u2018<\u2019).
\n ", "description": "The coded value for complications relating to procedure.", "valueSets": "\u00a0
"}, {"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Free text", "description": "Free text field to be used if no code is available", "valueSets": "Free text", "valueDomain": [{"type": "text", "property": [{"maxLength": "150"}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Specific anesthesia issues", "description": "Details of any adverse reaction to any anesthetic agents including local anesthesia. Problematic intubation, transfusion reaction, etc.", "valueSets": "\n| \n \n \n \n \n Household composition should be coded using only one SNOMED CT concept from the following refset: \n \n \n \n \n SNOMED CT ID\u00a0\u00a0\u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance\n \n \n \n \n \n 1027891000000106 \u2502 Household composition findings simple reference set (foundation metadata concept)\u00a0\u2502 No specific guidance. \n \n \n \n Where required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0 \n | \n
| \n \n \n \n \n Occupation should be coded using only one SNOMED CT concept from the following refset: \n \n \n \n \n SNOMED CT ID\u00a0\u00a0\u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance\n \n \n \n \n \n 999001571000000109 \u2502\u00a0Occupation simple reference set (foundation metadata concept) \u2502 No specific guidance. \n \n \n \n Where required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0 \n | \n
Where a person with diabetes has been advised by the professional to monitor\n blood glucose before driving, use the information and advice given section and the following concept:
\n\u00a0
\nNew code request | Patient advised to monitor blood glucose level before driving (situation)\n | Record under information and advice given.
\n\u00a0
\nA new code request for the above item has been submitted to NHS Digital. The FSN of the final approved code\n may differ.
\n
Where required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\n
Healthcare professionals including dieticians may need to record the meal patterns of people with diabetes to establish whether they have a regular meal pattern and for which meals carbohydrates are included.\u00a0
\nMeal patterns should be coded using only one SNOMED CT concept that is a subtype of the following parent codes:
\nThe coded value field must contain only one SNOMED CT that is a subtype of the following concepts:
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n1003631002 \u2502 Estimated quantity of carbohydrate intake in one meal (observable entity) \u2502 Descendant of concept. Use if intake quantity is being recorded.
\n42239005 \u2502 Carbohydrate diet (finding) \u2502 Descendant of concept. Use if intake quantity is not being recorded.
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\n\u00a0
\u00a0\u00a0
\nThis field is mandatory if the coded value (observable entity) is shared.
The table below details examples UCUM codes for this element:
UCUM code \u00a0* \u2502\u00a0Description of the unit\u00a0** \u2502\u00a0Parent PRSB Element\u00a0\u2502 Implementation guidance
g \u2502 gram \u2502 Carbohydrate intake. \u2502 No specific guidance.\u00a0
* UCUM codes are mixed case American Standard Code for Information Interchange (ASCII) text.
** Exact UCUM description.
Further information including a full specification on the Unified Code for Units of Measure (UCUM) is available (see unitsofmeasure.org).
", "description": "\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Smoking status", "description": "Details of the person's smoking status.", "informationType": "Event.Record", "concept": [{"type": "group", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Smoking status", "description": "\n
Alcohol intake should be coded using only one SNOMED CT concept from the following value set:
SNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
219006 \u2502 Current drinker of alcohol (finding) \u2502 Descendant or self of concept.\u00a0
\n105542008 \u2502 Current non-drinker of alcohol (finding) \u2502\u00a0Descendant or self of concept.
\n783261004 \u2502 Lifetime non-drinker of alcohol (finding) \u2502\u00a0 Equal of concept.
\n371434005 \u2502 History of alcohol abuse (situation) \u2502 Equal of concept.
\n1104551000000109 \u2502\u00a0Declined to provide information about alcohol use (situation) \u2502 Equal of concept.\u00a0
\nThe following SNOMED CT concept is inactive and should not be used.\u00a0
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n228274009 \u2502 Lifetime non-drinker (finding) \u2502 Inactive concept.\u00a0Use 783261004 instead.\u00a0
\nDrug/substance use should be coded using only one SNOMED CT concept from the following value set:
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN) \u2502 Implementation guidance
\n361055000 \u2502\u00a0Misuses drugs (finding) \u2502 Descendant or self of concept.
371422002 \u2502 History of substance abuse (situation) \u2502 Descendant or self of concept.
228368007 \u2502 Has never misused drugs (situation)\u2502 Descendant or self of concept.
783241000000102 \u2502 Declined to give substance misuse history (finding) \u2502 Equal of concept.
Where required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nThe coded value field for relationship to person must contain only one SNOMED CT concept that is a descendant (the set of all subtypes) of the given concept (where expression constraint language (ECL) operator symbol is \u2018<\u2019).
\nThe coded value field for family history must contain only one SNOMED CT concept that is a descendant (the set of all subtypes) of the given concepts (where expression constraint language (ECL) operator symbol is \u2018<\u2019).
\nThe coded value field must contain only one SNOMED CT code that is a subtype of the following concept:\u00a0
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n371525003 \u2502 Clinical procedure report (record artifact) \u2502 Descendant of concept.
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.
\nInvestigations that are laboratory tests should be recorded in alignment with NHS Digital's DAPB4017: Pathology tests and results standard where possible and appropriate (see https://digital.nhs.uk/data-and-information/information-standards/information-standards-and-data-collections-including-extractions/publications-and-notifications/standards-and-collections/dapb4017-pathology-test-and-results-standard). This means that where possible the SNOMED CT Unified test list (UTL) results codes should be used. For example, the following UTL investigation result codes (non exhaustive) may be relevant for the nine care processes of diabetes care *:
\nCare Process \u00a0\u2502\u00a0SNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\nHbA1c \u2502 1107481000000106 \u2502 Substance concentration of haemoglobin A1c in blood (observable entity) \u2502 UTL code. This is the concept aligned to the pathology bounded code list and should be used for IFCC (see https://www.ifcc.org/) standardised results reporting substance concentration ratio of haemoglobin A1c to haemoglobin A1 in blood.
\n
Kidney function (eGFR) \u2502 1011481000000105 \u2502 Estimated glomerular filtration rate using creatinine Chronic Kidney Disease Epidemiology Collaboration equation per 1.73 square metres (observable entity) \u2502 UTL code. Nice recommended equation (see\u00a0https://www.nice.org.uk/guidance/ng203).
Kidney function (urinary albumin) \u2502\u00a01023491000000104\u00a0\u2502 Urine albumin:creatinine ratio (observable entity) \u2502 UTL code.
Kidney function (serum creatinine) \u2502 1107001000000108 \u2502 Substance concentration of creatinine in serum (observable entity) \u2502 UTL code.
Lipids (cholesterol) \u2502\u00a0multiple \u2502 Code dependent on panel reported \u2502 See UTL report codes for lipids.
* For further information on the NICE nice care processes (see https://www.bjpcn.com/browse/editorial/item/1361-nine-processes-of-care-for-diabetes.html).
Where required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nThis element has a FHIR value set of observation interpretation codes (see http://hl7.org/fhir/stu3/valueset-observation-interpretation.html) that includes codes of\u00a0 \u2018<\u2019 for \u2018Off scale low\u2019 and \u2018>\u2019 for \u2018Off scale high\u2019\u00a0 for use where the true physiological value falls outside\n the analytical range of the device providing the reading.
\nSome devices can only report results accurately within a limited range. For example, the Abbott Freestyle Precision Pro Blood Glucose and Blood \u03b2-Ketone meter* is a networked device used by some NHS Trusts for point-of-care testing (POCT) that has a lower analytical range of 1.1 mmol/L (results less than this will be displayed on the device as < 1.1 mmol/L)\n and an upper analytical range of 27.8 mmol/L (displaying results more than this on the device as > 27.8 mmol/L). If the true result for a patient was outside of this range (e.g. 46.1 mmol/L would be reported by the device as > 27.8 mmol/L) there is a potential risk that this would be misinterpreted by end users as being exactly 27.8 mmol/L if the \u2018greater\n than\u2019 sign was not shared with the person\u2019s record. \u00a0
\n* Referenced without preference.
\n ", "description": "\nThe coded value field for indication must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\nThe coded value field for indication must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\nThe type of examination during which the examination finding was identified should be coded using only one subtype of the following SNOMED CT concept:
\nSNOMED CT ID\u00a0\u00a0\u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
\n315306007 \u2502Examination by method (procedure) \u2502 Descendants of concept. \u00a0
The following concept should be used where recording examination findings elicited as part of a diabetic foot check:
SNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
401191002\u00a0\u2502 Diabetic foot examination (regime/therapy) \u2502 Equal of concept.\u00a0
Where required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
Examination findings should be coded using only one SNOMED CT concept from the following refset:
SNOMED CT ID\u00a0\u00a0\u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
1127601000000107 \u2502 Healthcare matters simple reference set (foundation metadata concept) \u2502 Members of this refset (including child concepts) are sufficient to support National Diabetes Audit (NDA) requirements.\u00a0
Relevant examination finding codes will generally be subtypes of the following concepts:
SNOMED CT ID\u00a0\u00a0\u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
404684003 \u2502 Clinical finding (finding) \u2502 Top-level concept.
64572001 \u2502 Disease (disorder) \u2502 Subtype of 404684003.
Examination findings that are subtypes of the following top-level concept should be considered observations and therefore should be entered as a coded value under 'Observations record entry'.
SNOMED CT ID\u00a0\u00a0\u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
363787002 \u2502Observable entity (observable entity) \u2502 Top-level concept.
Where necessary additional supplementary information is permissible to\u00a0be entered as free text in the free text field to provide additional meaning to the code used. For example:
SNOMED CT ID\u00a0\u00a0\u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
827160004 \u2502 Erythematous rash (finding) \u2502 Relevant supplementary free text information to provide additional meaning to this concept might include e.g. colour, tenderness, temperature etc.
If a precoordinated concept for an examination finding is available that incorporates body site or laterality these codes may not be required, for example:
SNOMED CT ID\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
394674001 \u2502 On examination - Left diabetic foot - ulcerated (finding) \u2502 Body site and laterality codes not required.
See the following link for details of the examination findings codes accepted by the National Diabetes Audit (NDA) (see https://nhs-prod.global.ssl.fastly.net/binaries/content/assets/website-assets/data-and-information/clinical-audits-and-registries/national-diabetes-audit/nda-2019-20-snomed-code-set.xlsx). Codes supporting examination findings can be found under the following 'Cluster Descriptions':
Cluster Description\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
Foot checks for people with diabetes
The variable way that certain footcare assessments have been authored in SNOMED CT means that these would variously be recorded under the assessments, examination findings or observations sections of the standard depending on the hierarchy of the concept. These should be visible to the end user together and in the user-interface. For example, the PRSB consultation identified the Ipswich Touch Test * as an assessment that is being increasingly used by professionals and people with diabetes as part of their routine foot examination (see assessments). However, other clinically similar rapid footcare assessments, such as the 10g monofilament test would be recorded under the examination findings section of the standard as these are coded as clinical finding concepts in SNOMED CT. Ankle brachial pressure index (ABPI) and Toe brachial pressure index are observable entity concepts in SNOMED and would be recorded under observations.
SNOMED CT ID\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
299910003 \u2502 Finding of light touch (finding) \u2502 Descendants of concept for 10g monofilament outcome recorded in Examination findings
252059006 \u2502 Vascular measure (observable entity) \u2502 Descendants of concept for e.g., toe brachial index, ankle brachial pressure index and lower limb doppler pressures recorded in Observations.
1443851000000100 \u2502 Ipswich Touch Test score (observable entity) \u2502\u00a0Equal of concept recorded in Assessments or Observations.
763258007\u00a0\u2502\u00a0Site, Ischemia, Neuropathy, Bacterial Infection and Depth classification total score (observable entity)\u00a0\u2502\u00a0Equal of concept recorded in Assessments or Observations.
763004009\u00a0\u2502\u00a0University of Texas Wound Classification System grade (observable entity)\u00a0\u2502\u00a0Equal of concept recorded in Assessments or Observations.
763005005\u00a0\u2502\u00a0University of Texas Wound Classification System stage (observable entity)\u00a0\u2502\u00a0Equal of concept recorded in Assessments or Observations.
1099121000000104\u00a0\u2502\u00a0Young Townson FootSkin Hydration Scale for Diabetic Neuropathy level (observable entity)\u00a0\u2502\u00a0Equal of concept recorded in Assessments or Observations.
* [See\u00a0https://doi.org/10.1111/dme.12450 ;\u00a0https://dx.doi.org/10.1016%2Fj.jcte.2021.100252]
Where required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
Where necessary additional supplementary information is permissible to\u00a0be entered as free text in the free text field to provide additional meaning to the code used. For example:
SNOMED CT ID\u00a0\u00a0\u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
827160004 \u2502 Erythematous rash (finding) \u2502 Relevant supplementary free text information to provide additional meaning to this concept might include e.g. colour, tenderness, temperature etc.
390931008 \u2502 10g monofilament sensation present (finding) \u2502 Relevant supplementary free text information to provide additional meaning to this concept might include \u201cscore = 10/10\u201d [NB: there is currently no observable entity concept for 10g monofilament test in SNOMED CT].
390932001 \u2502 10g monofilament sensation absent (finding) \u2502 Relevant supplementary free text information to provide additional meaning to this concept might include \u201cscore = 6/10\u201d indicating neuropathy. [NB: there is currently no observable entity concept for 10g monofilament test in SNOMED CT].
", "description": "Free text field to be used if no coded text available", "valueDomain": [{"type": "text", "property": [{"maxLength": "150"}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Body site", "implamentationGuidance": "Body site is not required where already implied by the examination finding.This element is for recording a clinician\u2019s assessment of the person\u2019s diabetic foot risk (low, moderate, high risk or active diabetic foot problem) in line with the NICE criteria. *
\n* https://www.nice.org.uk/guidance/ng19 (see also https://www.bmj.com/content/bmj/suppl/2017/11/16/bmj.j5064.DC1/chas041916.ww1.pdf).
\nThe coded value field should contain only one SNOMED CT concept from the following value set:
\nSNOMED CT ID\u00a0\u2502 Fully specified name (FSN) \u2502\u00a0\u00a0Implementation guidance
\n~394671009 |On examination - Right diabetic foot at low risk (finding) | For use where there are \u2018no risk factors present except callus alone\u2019, see NICE guideline (ng19). *
\n~394675000 |On examination - Left diabetic foot at low risk (finding) | For use where there are \u2018no risk factors present except callus alone\u2019, see NICE guideline (ng19). *
\n~394682001 |On examination - Right diabetic foot at moderate risk (finding) | For use where there is \u2018deformity or neuropathy or non-critical limb ischaemia\u2019, see NICE guideline (ng19). *
\n~394681008 |On examination - Left diabetic foot at moderate risk (finding) | For use where there is \u2018deformity or neuropathy or non-critical limb ischaemia\u2019, see NICE guideline (ng19). *
\n~394672002 |On examination - Right diabetic foot at high risk (finding) | For use where there is \u2018previous ulceration or previous amputation or renal replacement therapy or neuropathy and non-critical limb ischaemia together or neuropathy in combination with callus and/ or deformity or non-critical limb ischaemia in combination with callus and/ or deformity.\u2019 See NICE guideline (ng19). *
\n~394676004 |On examination - Left diabetic foot at high risk (finding) | For use where there is \u2018previous ulceration or previous amputation or renal replacement therapy or neuropathy and non-critical limb ischaemia together or neuropathy in combination with callus and/ or deformity or non-critical limb ischaemia in combination with callus and/ or deformity.\u2019 See NICE guideline (ng19). *
\n~183924009 |Referral needed (finding) | For use where \u2018a person has a limb-threatening or life-threatening diabetic foot problem\u2026or other active diabetic foot problems\u2019, see NICE guideline (ng19). * Active diabetic foot problems require an urgent referral (depending on severity either immediately to acute services or within one working day to the multidisciplinary foot care or foot protection service), Details of the referral made should be recorded under the \u2018Referral details\u2019 section of the standard.
\nClinical details indicating the use of the above concepts should be available in the record under the appropriate section(s) of the standard. For example, a clinician\u2019s assessment that a person has a high-risk foot may have been informed by the person\u2019s renal dialysis therapy (265764009 |Renal dialysis (procedure) recorded under a \u2018Procedures and therapies\u2019) and/ or their previous amputation for which there may be a coded procedure record (e.g. 88312006 |Amputation of leg through tibia and fibula (procedure)) or an examination finding (e.g. 771367001 |Amputation stump of left lower limb (body structure)|).
\nWhere required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\n* https://www.nice.org.uk/guidance/ng19 (see also https://www.bmj.com/content/bmj/suppl/2017/11/16/bmj.j5064.DC1/chas041916.ww1.pdf).
\nWhere necessary additional supplementary information is permissible to\u00a0be entered as free text in the free text field to provide additional meaning to the code used. For example:
\nSNOMED CT ID\u00a0\u00a0\u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
\n394681008 |On examination - Left diabetic foot at moderate risk (finding) \u2502 Relevant supplementary free text information to provide additional meaning to this concept might include e.g. Additional information indicating that the person is unable to check their own feet. *
\n394672002 |On examination - Right diabetic foot at high risk (finding) \u2502 Relevant supplementary free text information to provide additional meaning to this concept might include e.g. Additional information indicating an immediate concern (for which NICE advises that the person should be assessed very frequently (i.e. every 1 \u2013 2 weeks). *
\n\nThis section is used to record individual observations.\u00a0
Observations are traditionally measured or 'observed' at the patient bedside as part of physical examination e.g. heart rate, blood pressure, etc. For the purposes of this standard the following are also considered to be observations (as opposed to investigation results):
~Self-monitoring of blood glucose (SMBG).
~Real-time or intermittently scanned/ 'flash' continuous glucose monitoring (CGM).\u00a0
~Monitoring of blood and urinary ketones at home.
~Other tests \u00a0which may be done by the person or the carer at home as part of their self-management. These tests provide data in real-time or near real-time and are conducted without the involvement of a laboratory.\u00a0
Results of point-of-care tests, defined by the Medicine and Healthcare products Regulatory Agency (MHRA) as \u2018any analytical test performed for a patient by a healthcare professional outside of the conventional laboratory setting\u2019 (e.g. readings from glucose or ketone metres performed by a healthcare professional) are not considered observations for the purposes of this standard and should be recorded under the investigation results section.
Whether and how observations or investigations measuring the same substance (e.g. blood glucose) should be displayed together in the user interface of the receiving system (e.g. electronic health record) is out of scope.\u00a0
Consideration needs to be given to how this section is used in particular for devices that produce many measurements in a 24 hour period. For example, CGM devices provide between 96 (e.g. most commonly every 15 minutes by Freestyle Libre), 288 readings (e.g. every five minutes by Dexcom G6 and Metronic devices) and 1040 readings (e.g. every minute by Menarini Glucoday) per day (see https://doi.org/10.1177/1932296818822539).
Individual data readings may be used in the receiving system to calculate summary metrics (e.g. 2019 international consensus group list of 10 core CGM metrics (see https://doi.org/10.2337/dci19-0028)) and/ or display the data graphically (e.g. glucose readings displayed as part of the Ambulatory Glucose Profile (AGP).
The system SHOULD be able to receive and display a person's blood glucose levels information from Blood Glucose Meters, Continuous Glucose Monitors, Point of Care glucose meters (recorded under investigation results section) and Closed loop systems.
It SHOULD be possible for a health and care professional to manually record information about blood glucose, blood pressure, ketones, insulin administration, height, weight, BMI, patient-reported outcomes, physical activity, dietary (including carbohydrate) intake and sleep.
The system MAY be able to receive and display information from other devices used by a person in the self-management of their diabetes such as personal blood pressure monitoring devices, fitbits where the sending systems are conformant with the standard
The system SHOULD be able to receive and display manually entered data by the person with diabetes about blood glucose levels, insulin administration, blood pressure, ketones, height, weight, BMI, patient-reported outcomes, physical activity, dietary (including carbohydrate) intake and sleep where the sending systems are conformant with the standard.
", "description": "The record of essential physiological measurements, e.g., heart rate, blood pressure, temperature, pulse, height, weight, respiratory rate, oxygen saturation.", "concept": [{"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "*", "mro": "R", "name": "Observations record entry", "implamentationGuidance": "Observations are traditionally measured or 'observed' at the patient bedside as part of physical examination. For the purposes of this standard the following are also considered to be observations (as opposed to investigation results):
\n
~Self-monitoring of blood glucose (SMBG).
~Real-time or intermittently scanned/ 'flash' continuous glucose monitoring (CGM).\u00a0
~Monitoring of blood and urinary ketones at home.
~Other tests, which may be done by the person or the carer at home as part of their self-management. These tests provide data in real-time or near real-time and are\n conducted without the involvement of a laboratory.\u00a0
Whether and how observations or investigations measuring the same substance (e.g. blood glucose) should be displayed together in the receiving system (e.g. electronic health record) is out of scope.\u00a0
\nResults of point-of-care tests, defined by the Medicine and Healthcare products Regulatory Agency (MHRA) as \u2018any analytical test performed for a patient by a healthcare professional outside of the conventional laboratory setting\u2019 (e.g. readings from glucose or ketone metres performed by a healthcare professional) are not considered observations for the purposes\n of this standard and should be recorded under the investigation results section.
\n ", "description": "This is an observations record entry. There may be 0 to many record entry/entries under a section. Each record entry is made up of a number of elements or data items.", "informationType": "Event.Record", "concept": [{"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Device type", "implamentationGuidance": "Recording of device type is needed only in circumstances where this is clinically relevant (e.g. to distinguish readings from self-monitoring of blood glucose versus continuous glucose monitoring) and therefore sharing this information is not necessary for most observations.\u00a0Recording of device type is needed only in circumstances where this is clinically relevant (e.g. to distinguish readings from self-monitoring of blood glucose versus continuous glucose monitoring) and therefore sharing this information is not necessary for most observations (e.g., blood pressure).
\n
The following concepts relate to blood glucose monitoring devices:\u00a0
\n
SNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n Self-monitoring of blood glucose (SMBG):\n
\n337414009\u2502 Blood glucose meter (physical object)\u2502 Equal of concept.
\n\n Continuous glucose monitoring (CGM):\n
\n34865511000001109\u2502 Glucose interstitial fluid detection sensor (physical object) \u2502 Equal of concept. This includes both intermittently scanned (isCGM) and real time (rtCGM) continuous glucose monitors.
\n463729000 \u2502 Point-of-care blood glucose continuous monitoring system (physical object) \u2502 Equal of concept. This applies to intravascular and interstitial fluid monitors used in a hospital setting only.
\nWhere required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\n ", "description": "The coded value for device type.", "valueSets": "SNOMED CT."}, {"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Free text", "implamentationGuidance": "Where a coded value is provided this field must not be used.\u00a0Observations are traditionally measured or 'observed' at the patient bedside as part of physical examination\u00a0e.g. heart rate, blood pressure, etc. For the purposes of this standard the following are also considered to be observations (as opposed to investigation results):
~Self-monitoring of blood glucose (SMBG) using whole blood or plasma calibrated blood glucose meters.
~Real-time or intermittently scanned/ 'flash' continuous glucose monitoring (CGM).
~Monitoring of blood and urinary ketones.
~Other tests, which may be done by the person or the carer at home as part of their self-management.
\u00a0
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n1110521000000108 \u2502 Substance concentration of glucose in plasma (observable entity) \u2502 UTL code. Applies to readings from devices reporting molar concentration of glucose in plasma including plasma calibrated glucose meters. *
\n56991000237104\u00a0\u2502 Substance concentration of glucose in blood (observable entity) \u2502 UTL code. Applies to readings from devices reporting molar concentration of glucose in blood including whole blood calibrated blood glucose meters. *\u00a0
\n341151000000104 \u2502 Interstitial fluid glucose level (observable entity) \u2502\u00a0Applies to devices reporting molar concentration of glucose in interstitial fluid including, which may include some continuous glucose monitor (CGM) readings. For the purposes of this standard this concept is preferred to 434910001 |Interstitial fluid glucose concentration (observable entity)| although both concepts are active and neither are currently conformant with SNOMED CT Encoded Unified Test List (UTL) Editorial Principles (see https://hscic.kahootz.com/gf2.ti/f/972002/57976005.9/PDF/-/UTL_SNOMED_Editorial_Principles_v1.6.pdf) and may be superseded in future releases.
\n* Medicines and Healthcare Products Regulatory Agency (MHRA) guidance on blood glucose meters states that \u201c[i]t is essential that accurate records are kept for all aspects of blood glucose testing. This could include\u2026calibration\u2026patient results [etc]\u2026Blood glucose meter test strips generally use capillary whole blood as a sample\u2026Some blood glucose meter test strips are calibrated to give results that are comparable with laboratory glucose results, and these are termed \u2018plasma calibrated\u2019. Plasma calibrated test strips give results that are approximately 12% higher than whole blood results [(see https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/403511/Point_of_care_testing_-_blood_glucose_meters.pdf)].\u201d SNOMED CT concepts used to record results from devices should unambiguously represent what was reported as measured by the device. \u00a0Therefore device reported glucose readings from interstitial fluid and blood/ plasma (including plasma calibrated) samples should not be coded interchangeably (see also\u00a0https://dx.doi.org/10.1177%2F1932296817699637). Where these results are used for calculation of summary glucose metrics reporting molar concentrations these are given as \u2018substance concentration in capillary blood\u2019 (see summary observations section).
\nThe following is a non-exhaustive list of other codes that may be relevant to a person's diabetes self-management and should be used when sharing/ recording the corresponding observations:
\nSNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
271649006\u00a0\u2502 Systolic blood pressure (observable entity) \u2502 Vital sign. NICE care process.
271650006\u00a0\u2502 Diastolic blood pressure (observable entity) \u2502 Vital sign. NICE care process.
\n27113001\u00a0\u2502 Body weight (observable entity) \u2502 NICE care process (required to calculate BMI).
\n50373000\u00a0\u2502 Body height measure (observable entity) \u2502 Use if person standing upright. NICE care process (required to calculate BMI).
\n248334005 \u2502 Length of body (observable entity) \u2502 Use if person lying supine. NICE care process (required to calculate BMI).
\n60621009 \u2502 Body mass index (observable entity) \u2502 NICE care process.
\n446974000 \u2502 Body mass index centile (observable entity) \u2502 NICE care process.
\n896691000000102 \u2502 Child body mass index centile (observable entity) \u2502 For use in children. NICE care process.
\n364075005\u00a0\u2502 Heart rate (observable entity) \u2502 Descendants and self of concept. Vital sign.
\n386725007\u00a0\u2502 Body temperature (observable entity) \u2502 Descendants and self of concept. Vital sign.
\n86290005\u00a0\u2502 Respiratory rate (observable entity) \u2502 e.g. measured by person's carer. Vital sign.
\n431314004\u00a0\u2502 Peripheral oxygen saturation (observable entity) \u2502 Descendants and self of concept. Vital sign.
\n364589006\u00a0\u2502 Birth weight (observable entity) \u2502 Applies to child with diabetes.\u00a0
\n363812007\u2502 Head circumference (observable entity) \u2502 Descendants and self of concept. Applies to child with diabetes.
\n707205007\u00a0\u2502 Toe brachial pressure index (observable entity) \u2502 Descendants and self of concept. Applicable to diabetic foot checks.
\n446841001 \u2502 Ankle brachial pressure index (observable entity) \u2502 Descendants and self of concept.\u00a0 Applicable to diabetic foot checks.
\nSee the following link for details of the observation codes accepted by the National Diabetes Audit (NDA) (see https://nhs-prod.global.ssl.fastly.net/binaries/content/assets/website-assets/data-and-information/clinical-audits-and-registries/national-diabetes-audit/nda-2019-20-snomed-code-set.xlsx). Codes supporting examination findings can be found under the following 'Cluster Descriptions':
\nCluster Description\u00a0\u00a0\u2502\u00a0Implementation guidance
\nWhere required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nWorked example for ketones observables
\nThe following UTL results codes may be relevant for a person self-managing their diabetes at home and testing their own ketones as part of 'sick day rules' (see https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/illness):
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n53221000237100 \u2502 Substance concentration of ketone in blood (observable entity) \u2502 Equal of concept.
\n58621000237108 \u2502 Ordinal value of ketones in urine (observable entity) \u2502 Equal of concept.\u00a0
\nThe reporting of urinary ketones by people with diabetes may depend on the product used or local practice. For example, two products available in the UK provide report ordinal ketone results in the following ways:
\nNegative \u2502 Trace \u2502 Small \u2502 Moderate \u2502 Large \u2502 Large\u00a0
\nNot applicable \u2502 0.5 mmol/L \u2502 1.5 mmol/L \u2502 4.0 mmol/L \u2502 8.0 mmol/L \u2502 16.0 mmol/L
\nNegative \u2502 Trace \u2502 + \u2502 ++ \u2502 +++ \u2502 ++++
\nNot applicable \u2502 0.5 mmol/L \u2502 1.5 mmol/L \u2502 4.0 mmol/L \u2502 8.0 mmol/L \u2502 16.0 mmol/L
\nNB: Observable entities are the only coded values permissible\u00a0in the observations section of the standard. For example, the following codes for urinary ketone results would need to be recorded under examination findings.\u00a0
SNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance\u00a0 \u00a0
167288007 \u2502 Urine ketone test = trace (finding) \u2502 Equal of concept.
\n167289004\u00a0\u2502\u00a0Urine ketone test = + (finding) \u2502 Equal of concept.
\n167290008\u00a0\u2502\u00a0Urine ketone test = ++ (finding) \u2502 Equal of concept.
\n167291007\u00a0\u2502\u00a0Urine ketone test = +++ (finding) \u2502 Equal of concept.
\n167292000\u00a0\u2502 Urine ketone test = ++++ (finding)\u2502 Equal of concept.
This does not preclude these terms being displayed to the end-user as observations as they are widely used in clinical practice. For example, ++++ ketones can be inferred from a combination of:
Observable entity\u00a0\u2502\u00a0Value\u00a0\u2502\u00a0UCUM\u00a0\u00a0code
\nOrdinal value of ketones in urine (observable entity) \u2502 16.0 \u2502 mmol/L\u00a0
\nPeople with diabetes may also use devices or products that report blood or urinary ketones in units of mg/dl. All results should be converted into values with units of mmol/L before sharing (see units of measure).\u00a0
\nWhether and how observations or investigations measuring the same substance (e.g. blood glucose) should be displayed together in the receiving system (e.g. electronic health record) is out of scope.\u00a0
\nThis element has a FHIR value set of observation interpretation codes (see http://hl7.org/fhir/stu3/valueset-observation-interpretation.html) that includes codes of \u2018<\u2019 for \u2018Off scale low\u2019 and \u2018>\u2019 for \u2018Off scale high\u2019 for use where the true physiological value falls outside\n the analytical range of the device providing the reading.
\nSome devices can only report results accurately within a limited range. For example, the Gluco Rx Q* Blood Glucose Monitoring System* a device used by some people with diabetes who perform their own self-monitoring of blood glucose (SMBG) that has a lower analytical range of 1.1 mmol/L (results less than this will be displayed on the device as Lo, coded in\n FHIR as \u2018<\u2019 not \u2018L\u2019 **) and an upper analytical range of 33.3 mmol/L (displaying results above this on the device as \u2018Hi\u2019, coded in FHIR as \u2018>\u2019 not \u2018H\u2019 ** ).
\n* Referenced without preference (see https://www.glucorx.co.uk/wp-content/uploads/2021/12/GlucoRX-Q-Strip-Manual.pdf).
\n** (See https://simplifier.net/packages/hl7.fhir.r4.core/4.0.1/files/78998)
\nThis record entry allows for sharing of a person's calculated glucose summary metrics calculated from \u00a0data sources including the following device types:
\n~Capillary blood glucose measured using a blood glucose meter and obtained using fingerstick testing.\u00a0
\n~Interstitial fluid glucose measured using either \"Flash\" intermittent scan (isCGM) or real-time (rtCGM) continuous glucose monitoring (CGM) devices.
\nThe elements in this section that align to the 2019 international consensus group list of 10 core CGM metrics (see https://doi.org/10.2337/dci19-0028) are listed below:
\n~Mean glucose.
\n~Glucose management indicator (GMI).
\n~Coefficient of variation (%CV).
\n~Time above range (TAR) level 2.
\n~Time above range (TAR) level 1.
\n~Time in range (TIR).
\n~Time below range (TBR) level 1.
\n~Time below range (TBR) level 2.
\nThis standard does not support sharing of the following 2019 core CGM metrics:
\n~Number of days CGM worn.
\n~Percentage of time CGM is active.
\nHowever, an approximation of the number of days the CGM device was worn and active during the reporting period could be inferred from the following elements:
\n~Reporting period (Start and end date).
\n~Percent sensor data available.
\nElements in this section that align to an earlier 2017 consensus (see https://doi.org/10.2337/dc17-1600) are listed below:
\n~Number of significant hypoglycaemic episodes.
\n~Standard deviation (of mean glucose).
\nHow blood glucose data is shown in systems to the end user as part of the graphical user interface (GUI) is an active area of development (see https://doi.org/10.1089/dia.2020.0524) and is out of scope of this standard but it is anticipated that these metrics could be included in a dashboard that displayed individual readings as part of the ambulatory glucose\n profile (AGP) (see http://www.agpreport.org/agp/agpreports) using UK units for plasma glucose of mmol/ L. The use of electronic clinical decision support (CDS) such as active pop up alerts are widely used in proprietary and third party apps and applications for reporting data from CGM devices. It is recognised that this may also be utilised during\n implementation but a definition of CDS requirements is out of scope of this standard.\u00a0
\nRecording of device type is needed only in circumstances where this is clinically relevant (e.g. to distinguish readings from self-monitoring of blood glucose versus continuous glucose monitoring) and therefore sharing this information is not necessary for most observations (e.g., blood pressure).
\n
The following concepts relate to blood glucose monitoring devices:\u00a0
\n
SNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n Self-monitoring of blood glucose (SMBG):\n
\n337414009\u2502 Blood glucose meter (physical object)\u2502 Equal of concept.
\n\n Continuous glucose monitoring (CGM):\n
\n34865511000001109\u2502 Glucose interstitial fluid detection sensor (physical object) \u2502 Equal of concept. This includes both intermittently scanned (isCGM) and real time (rtCGM) continuous glucose monitors.
\n463729000 \u2502 Point-of-care blood glucose continuous monitoring system (physical object) \u2502 Equal of concept. This applies to intravascular and interstitial fluid monitors used in a hospital setting only.
\nWhere required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\n\u00a0
\n~1464931000000109 | Mean number of self-monitored capillary blood glucose measurements per day (observable entity)|) \u2502 Calculated from any allowable data source where the data was collected as part of a person\u2019s self-monitoring of blood glucose (SMBG) including fingerstick tests or \u201cflash\u201d/ intermittently scanned continuous glucose monitors (isCGM).
\n~1465041000000100 | Mean number of point-of-care capillary blood glucose measurements per day (observable entity) | Calculated from any allowable data source (e.g. blood glucose meter) where the data was collected at point-of-care by a healthcare professional.
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.
\nThis element is mandatory for data derived from a continuous glucose monitoring (CGM) device.
\nThe coded value field must contain the following SNOMED CT concept:
\n\u00a0
\n~1464941000000100 | Percentage of successful data capture time to total expected continuous glucose monitoring sensor wear time using minimally-invasive continuous glucose monitoring device (observable entity) \u2502 Applies to CGM only.
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nThis metric refers to sensor failures detected by CGM devices themselves (e.g. Dexcom G6 \"Sensor failed\" screen). Currently, if a person with diabetes or their carer wishes to report CGM device sensor failures to a healthcare professional they would need to do this manually as this information is not shared from the devices themselves. This metric should be\n reported as the sum of continuous glucose monitoring sensor failures recorded/ reported by the person during the reporting period expressed as a percentage of sensors applied.
\nThe coded value field must contain only the following SNOMED CT concept:
SNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
~New code request \u2502 Number of continuous glucose monitoring device sensor failures reported by subject of record expressed as a percentage of sensors applied (observable entity) \u2502\u00a0Applies to CGM only.
A new code request for the above item has been submitted to NHS Digital. The FSN of the final approved code may differ. For updates or queries relating to newly submitted codes contact info@theprsb.org.
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.
", "description": "\nThis field is mandatory if the coded value (observable entity) is shared.
The table below details the required UCUM code for this element:
UCUM code\u00a0* \u2502\u00a0Description of the unit\u00a0\u2502\u00a0Parent PRSB Element\u00a0\u2502\u00a0Implementation guidance
% \u2502 percent ** \u2502 Percent number of sensor failures.\u2502 No specific guidance.\u00a0
* UCUM codes are mixed case American Standard Code for Information Interchange (ASCII) text.
** Exact UCUM description.
Further information including a full specification on the Unified Code for Units of Measure (UCUM) is available (see unitsofmeasure.org).
", "description": "\nThe coded value field must contain only one SNOMED CT concept from the following value set:\u00a0
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n~1464671000000104 | Mean substance concentration of glucose in capillary blood using minimally-invasive continuous glucose monitoring device (observable entity)) \u2502\u00a0Calculated from CGM device data.
\n~1464731000000106 | Mean substance concentration of glucose in capillary blood by self-monitoring of blood glucose using blood glucose meter (observable entity) \u2502\u00a0Calculated from any allowable data source where the data was collected as part of a person\u2019s self-monitoring of blood glucose (SMBG) using fingerstick testing.
\n~1464951000000102 | Mean substance concentration of glucose in capillary blood using point-of-care testing device (observable entity) \u2502 Calculated from any allowable data source (e.g. blood glucose meter) where the data was collected at point-of-care by a healthcare professional.
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nThe coded value field must contain only one SNOMED CT concept from the following value set:\u00a0
SNOMED CT ID \u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
~1464741000000102 | Standard deviation of mean substance concentration of glucose in capillary blood using minimally-invasive continuous glucose monitoring device (observable entity) \u2502\u00a0Calculated from CGM device data.
~1464751000000104 | Standard deviation of mean substance concentration of glucose in capillary blood by self-monitoring of blood glucose using blood glucose meter (observable entity) \u2502\u00a0Calculated from any allowable data source where the data was collected as part of a person\u2019s self-monitoring of blood glucose (SMBG) using fingerstick testing.
~1464961000000104 | Standard deviation of mean substance concentration of glucose in capillary blood using point-of-care testing device (observable entity) \u2502 Calculated from any allowable data source (e.g. blood glucose meter) where the data was collected at point-of-care by a healthcare professional.
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.
", "description": "The coded value for standard deviation.", "valueSets": "SNOMED CT."}, {"type": "item", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Value", "implamentationGuidance": "This field is mandatory if the coded value (observable entity) is shared.The coded value field must contain only one SNOMED CT concept from the following value set:\u00a0
SNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
~1464761000000101 | Coefficient of variation of mean substance concentration of glucose in capillary blood using minimally-invasive continuous glucose monitoring device (observable entity) \u2502\u00a0Calculated from CGM device data.
~1464771000000108 | Coefficient of variation of mean substance concentration of glucose in capillary blood by self-monitoring of blood glucose using blood glucose meter (observable entity) \u2502\u00a0Calculated from any allowable data source where the data was collected as part of a person\u2019s self-monitoring of blood glucose (SMBG) using fingerstick testing.
~1464971000000106 | Coefficient of variation of mean substance concentration of glucose in capillary blood using point-of-care testing device (observable entity) \u2502 Calculated from any allowable data source (e.g. blood glucose meter) where the data was collected at point-of-care by a healthcare professional.
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
", "description": "The coded value for coefficient of variation (%CV).\u00a0", "valueSets": "SNOMED CT."}, {"type": "item", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Value", "implamentationGuidance": "This field is mandatory if the coded value (observable entity) is shared.The coded value field must contain only one SNOMED CT concept from the following value set:\u00a0
SNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN) \u2502\u00a0Implementation guidance
~1464791000000107 | Percentage of time above level 2 hyperglycaemic threshold to total continuous glucose monitoring time using minimally-invasive continuous glucose monitoring device (observable entity) \u2502 Calculated from CGM device data.
~1464851000000107 | Percentage of readings above level 2 hyperglycaemic threshold to total self-monitored capillary blood glucose readings using blood glucose meter (observable entity)\u00a0\u2502 Calculated from any allowable data source where the data was collected as part of a person\u2019s self-monitoring of blood glucose (SMBG) using fingerstick testing.
~1464991000000105 | Percentage of readings above level 2 hyperglycaemic threshold to total point-of-care capillary blood glucose readings using blood glucose meter (observable entity) \u2502 Calculated from any allowable data source (e.g. blood glucose meter) where the data was collected at point-of-care by a healthcare professional.
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
", "description": "The coded value for T/VAR level 2.", "valueSets": "SNOMED CT."}, {"type": "item", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Value", "implamentationGuidance": "This field is mandatory if the coded value (observable entity) is shared.Elements under this group are used to define the reference ranges for both times and proportions in ranges.
\nThe 2019 international consensus on time in range (see https://doi.org/10.2337/dci19-0028) outlined the following basic guidance on target ranges for people with diabetes:
\nDiabetes group \u00a0\u2502\u00a0TAR (Level 2)\u00a0\u2502\u00a0TAR (Level 1)\u00a0\u2502\u00a0TIR\u00a0\u2502\u00a0TBR (Level 1)\u00a0\u2502\u00a0TBR (Level 2)
\nType 1 or 2 \u2502 > 13.9 mmol/ L \u2502 > 10.0 mmol/ L \u2502 3.9 - 10.0 mmol/ L \u2502< 3.9 mmol/ L \u2502 < 3.0 mmol/ L
\nOptimally greater than 70% of the time (or of recorded values) the glucose levels should sit within the optimal 3.9 - 10 mmol/L target range with under 4% of the time (or recorded values) being spent below 3.9 mmol/L.
\nThe standard supports personalised glucose targets that are based on a different percentage within each range (as opposed to changing the range). For further details and guidance target ranges for older/ high risk persons and pregnant people with type 1 or type 2 diabetes (see https://doi.org/10.2337/dci19-0028).
\n\u00a0
\nThe coded value field must contain only the following SNOMED CT concept:
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n~ 385524004 \u00a0\u2502 Lower limit of reference range (qualifier value) \u2502\u00a0 No specific guidance
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nThis field is mandatory if the coded value (observable entity) is shared.
\nThis field is mandatory if the coded value (observable entity) is shared.
The table below details the required UCUM code for this element:
UCUM code \u00a0* \u2502\u00a0Description of the unit\u00a0\u2502\u00a0Parent PRSB Element\u00a0\u2502\u00a0Implementation guidance
mmol/L \u2502 millimole per liter **\u2502 Reference range lower bound.\u2502 Molar concentration measured in mmol/L is the international standard way of measuring blood glucose used in the UK.
* UCUM codes are mixed case American Standard Code for Information Interchange (ASCII) text.
** Exact UCUM description (US spelling).
Further information including a full specification on the Unified Code for Units of Measure (UCUM) is available (see unitsofmeasure.org).
", "description": "\nThe coded value field must contain only one SNOMED CT concept from the following value set:\u00a0
SNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
~1464801000000106 | Percentage of time above level 1 hyperglycaemic threshold to total continuous glucose monitoring time using minimally-invasive continuous glucose monitoring device (observable entity) \u2502 Calculated from CGM device data.
~1464861000000105 |Percentage of readings above level 1 hyperglycaemic threshold to total self-monitored capillary blood glucose readings using blood glucose meter (observable entity) \u2502 Calculated from any allowable data source where the data was collected as part of a person\u2019s self-monitoring of blood glucose (SMBG) using fingerstick testing.
~1465001000000103 | Percentage of readings above level 1 hyperglycaemic threshold to total point-of-care capillary blood glucose readings using blood glucose meter (observable entity) \u2502 Calculated from any allowable data source (e.g. blood glucose meter) where the data was collected at point-of-care by a healthcare professional.
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
", "description": "The coded value for T/VAR level 1.", "valueSets": "SNOMED CT."}, {"type": "item", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Value", "implamentationGuidance": "This field is mandatory if the coded value (observable entity) is shared.Elements under this group are used to define the reference ranges for both times and proportions in ranges.
\nThe 2019 international consensus on time in range (see https://doi.org/10.2337/dci19-0028) outlined the following basic guidance on target ranges for people with diabetes:
\nDiabetes group \u00a0\u2502\u00a0TAR (Level 2)\u00a0\u2502\u00a0TAR (Level 1)\u00a0\u2502\u00a0TIR\u00a0\u2502\u00a0TBR (Level 1)\u00a0\u2502\u00a0TBR (Level 2)
\nType 1 or 2 \u2502 > 13.9 mmol/ L \u2502 > 10.0 mmol/ L \u2502 3.9 - 10.0 mmol/ L \u2502< 3.9 mmol/ L \u2502 < 3.0 mmol/ L
\nOptimally greater than 70% of the time (or of recorded values) the glucose levels should sit within the optimal 3.9 - 10 mmol/L target range with under 4% of the time (or recorded values) being spent below 3.9 mmol/L.
\nThe standard supports personalised glucose targets that are based on a different percentage within each range (as opposed to changing the range). For further details and guidance target ranges for older/ high risk persons and pregnant people with type 1 or type 2 diabetes (see https://doi.org/10.2337/dci19-0028).
\nThe coded value field must contain only the following SNOMED CT concept:
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n~ 385524004 \u00a0\u2502 Lower limit of reference range (qualifier value) \u2502\u00a0 No specific guidance
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nThis field is mandatory if the coded value (observable entity) is shared.
\nThis field is mandatory if the coded value (observable entity) is shared.
The table below details the required UCUM code for this element:
UCUM code \u00a0* \u2502\u00a0Description of the unit\u00a0\u2502\u00a0Parent PRSB Element\u00a0\u2502\u00a0Implementation guidance
mmol/L \u2502 millimole per liter **\u2502 Reference range lower bound.\u2502 Molar concentration measured in mmol/L is the international standard way of measuring blood glucose used in the UK.
* UCUM codes are mixed case American Standard Code for Information Interchange (ASCII) text.
** Exact UCUM description (US spelling).
Further information including a full specification on the Unified Code for Units of Measure (UCUM) is available (see unitsofmeasure.org).
", "description": "\nThe coded value field must contain only the following SNOMED CT concept:
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n~ 371933006 \u2502 Upper limit of reference range (qualifier value)\u2502\u00a0 No specific guidance
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nThis field is mandatory if the coded value (observable entity) is shared.
\nThis field is mandatory if the coded value (observable entity) is shared.
The table below details the required UCUM code for this element:
UCUM code \u00a0* \u2502\u00a0Description of the unit\u00a0\u2502\u00a0Parent PRSB Element\u00a0\u2502\u00a0Implementation guidance
mmol/L \u2502 millimole per liter **\u2502 Reference range upper bound.\u2502 Molar concentration measured in mmol/L is the international standard way of measuring blood glucose used in the UK.
* UCUM codes are mixed case American Standard Code for Information Interchange (ASCII) text.
** Exact UCUM description (US spelling).
Further information including a full specification on the Unified Code for Units of Measure (UCUM) is available (see unitsofmeasure.org).
", "description": "\nThe coded value field must contain only one SNOMED CT concept from the following value set:\u00a0
SNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
~1464781000000105 | Percentage of time in target glucose range to total glucose monitoring time using minimally-invasive continuous glucose monitoring device (observable entity) \u2502 Calculated from CGM device data.
~1464841000000109 | Percentage of readings in target range to total self-monitored capillary blood glucose readings using blood glucose meter (observable entity) \u2502 Calculated from any allowable data source where the data was collected as part of a person\u2019s self-monitoring of blood glucose (SMBG) using fingerstick testing.
~1464981000000108 | Percentage of readings in target range to total point-of-care capillary blood glucose readings using blood glucose meter (observable entity) \u2502 Calculated from any allowable data source (e.g. blood glucose meter) where the data was collected at point-of-care by a healthcare professional.
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
", "description": "The coded value for times or values in range (T/VIR).\u00a0", "valueSets": "SNOMED CT."}, {"type": "item", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Value", "implamentationGuidance": "This field is mandatory if the coded value (observable entity) is shared.The coded value field must contain only the following SNOMED CT concept:
SNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
~ 385524004 \u00a0\u2502 Lower limit of reference range (qualifier value) \u2502\u00a0 No specific guidance
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
", "description": "The coded value for reference range lower bound.\u00a0", "valueSets": "SNOMED CT.The coded value field must contain only the following SNOMED CT concept:
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n~ 371933006 \u2502 Upper limit of reference range (qualifier value)\u2502\u00a0 No specific guidance
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nThe coded value field must contain only one SNOMED CT concept from the following value set:\u00a0
SNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
~1464831000000100 | Percentage of time below level 1 hypoglycaemic threshold to total continuous glucose monitoring time using minimally-invasive continuous glucose monitoring device (observable entity) \u2502 Calculated from CGM device data.
~1464881000000101 | Percentage of readings below level 1 hypoglycaemic threshold to total self-monitored capillary blood glucose readings using blood glucose meter (observable entity) \u2502 Calculated from any allowable data source where the data was collected as part of a person\u2019s self-monitoring of blood glucose (SMBG) using fingerstick testing.
~1465021000000107 | Percentage of readings below level 1 hypoglycaemic threshold to total point-of-care capillary blood glucose readings using blood glucose meter (observable entity) \u2502 Calculated from any allowable data source (e.g. blood glucose meter) where the data was collected at point-of-care by a healthcare professional.
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
", "description": "The coded value for T/VBR level 1.", "valueSets": "SNOMED CT."}, {"type": "item", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Value", "implamentationGuidance": "This field is mandatory if the coded value (observable entity) is shared.Elements under this group are used to define the reference ranges for both times and proportions in ranges.
\nThe 2019 international consensus on time in range (see https://doi.org/10.2337/dci19-0028) outlined the following basic guidance on target ranges for people with diabetes:
\nDiabetes group \u00a0\u2502\u00a0TAR (Level 2)\u00a0\u2502\u00a0TAR (Level 1)\u00a0\u2502\u00a0TIR\u00a0\u2502\u00a0TBR (Level 1)\u00a0\u2502\u00a0TBR (Level 2)
\nType 1 or 2 \u2502 > 13.9 mmol/ L \u2502 > 10.0 mmol/ L \u2502 3.9 - 10.0 mmol/ L \u2502< 3.9 mmol/ L \u2502 < 3.0 mmol/ L
\nOptimally greater than 70% of the time (or of recorded values) the glucose levels should sit within the optimal 3.9 - 10 mmol/L target range with under 4% of the time (or recorded values) being spent below 3.9 mmol/L.
\nThe standard supports personalised glucose targets that are based on a different percentage within each range (as opposed to changing the range). For further details and guidance target ranges for older/ high risk persons and pregnant people with type 1 or type 2 diabetes (see https://doi.org/10.2337/dci19-0028).
\nThe coded value field must contain only the following SNOMED CT concept:
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n~ 385524004 \u00a0\u2502 Lower limit of reference range (qualifier value) \u2502\u00a0 No specific guidance
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nThis field is mandatory if the coded value (observable entity) is shared.
\nThis field is mandatory if the coded value (observable entity) is shared.
The table below details the required UCUM code for this element:
UCUM code \u00a0* \u2502\u00a0Description of the unit\u00a0\u2502\u00a0Parent PRSB Element\u00a0\u2502\u00a0Implementation guidance
mmol/L \u2502 millimole per liter **\u2502 Reference range lower bound.\u2502 Molar concentration measured in mmol/L is the international standard way of measuring blood glucose used in the UK.
* UCUM codes are mixed case American Standard Code for Information Interchange (ASCII) text.
** Exact UCUM description (US spelling).
Further information including a full specification on the Unified Code for Units of Measure (UCUM) is available (see unitsofmeasure.org).\u00a0
\u00a0
", "description": "\nThe coded value field must contain only the following SNOMED CT concept:
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n~ 371933006 \u2502 Upper limit of reference range (qualifier value)\u2502\u00a0 No specific guidance
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nThis field is mandatory if the coded value (observable entity) is shared.
\nThis field is mandatory if the coded value (observable entity) is shared.
The table below details the required UCUM code for this element:
UCUM code \u00a0* \u2502\u00a0Description of the unit\u00a0\u2502\u00a0Parent PRSB Element\u00a0\u2502\u00a0Implementation guidance
mmol/L \u2502 millimole per liter **\u2502 Reference range upper bound.\u2502 Molar concentration measured in mmol/L is the international standard way of measuring blood glucose used in the UK.
* UCUM codes are mixed case American Standard Code for Information Interchange (ASCII) text.
** Exact UCUM description (US spelling).
Further information including a full specification on the Unified Code for Units of Measure (UCUM) is available (see unitsofmeasure.org).
", "description": "\nThe coded value field must contain only one SNOMED CT concept from the following value set:\u00a0
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n~1464821000000102 | Percentage of time below level 2 hypoglycaemic threshold to total continuous glucose monitoring time using minimally-invasive continuous glucose monitoring device (observable entity) \u2502 Calculated from CGM device data.
\n~1464871000000103 | Percentage of readings below level 2 hypoglycaemic threshold to total self-monitored capillary blood glucose readings using blood glucose meter (observable entity) \u2502 Calculated from any allowable data source where the data was collected as part of a person\u2019s self-monitoring of blood glucose (SMBG) using fingerstick testing.
\n~1465011000000101 | Percentage of readings below level 2 hypoglycaemic threshold to total point-of-care capillary blood glucose readings using blood glucose meter (observable entity) \u2502 Calculated from any allowable data source (e.g. blood glucose meter) where the data was collected at point-of-care by a healthcare professional.
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nElements under this group are used to define the reference ranges for both times and proportions in ranges.
\nThe 2019 international consensus on time in range (see https://doi.org/10.2337/dci19-0028) outlined the following basic guidance on target ranges for people with diabetes:
\nDiabetes group \u00a0\u2502\u00a0TAR (Level 2)\u00a0\u2502\u00a0TAR (Level 1)\u00a0\u2502\u00a0TIR\u00a0\u2502\u00a0TBR (Level 1)\u00a0\u2502\u00a0TBR (Level 2)
\nType 1 or 2 \u2502 > 13.9 mmol/ L \u2502 > 10.0 mmol/ L \u2502 3.9 - 10.0 mmol/ L \u2502< 3.9 mmol/ L \u2502 < 3.0 mmol/ L
\nOptimally greater than 70% of the time (or of recorded values) the glucose levels should sit within the optimal 3.9 - 10 mmol/L target range with under 4% of the time (or recorded values) being spent below 3.9 mmol/L.
\nThe standard supports personalised glucose targets that are based on a different percentage within each range (as opposed to changing the range). For further details and guidance target ranges for older/ high risk persons and pregnant people with type 1 or type 2 diabetes (see https://doi.org/10.2337/dci19-0028).
\nThe coded value field must contain only the following SNOMED CT concept:
\nSNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n~ 371933006 \u2502 Upper limit of reference range (qualifier value)\u2502\u00a0 No specific guidance
\nWhere required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
\nThis field is mandatory if the coded value (observable entity) is shared.
\nThis field is mandatory if the coded value (observable entity) is shared.
The table below details the required UCUM code for this element:
UCUM code \u00a0* \u2502\u00a0Description of the unit\u00a0\u2502\u00a0Parent PRSB Element\u00a0\u2502\u00a0Implementation guidance
mmol/L \u2502 millimole per liter **\u2502 Reference range upper bound.\u2502 Molar concentration measured in mmol/L is the international standard way of measuring blood glucose used in the UK.
* UCUM codes are mixed case American Standard Code for Information Interchange (ASCII) text.
** Exact UCUM description (US spelling).
Further information including a full specification on the Unified Code for Units of Measure (UCUM) is available (see unitsofmeasure.org).
", "description": "\nGlucose management indicator (GMI) is supported by the 2019 consensus on CGM metrics (see https://doi.org/10.2337/dci19-0028) and a 2021 consensus report (see https://doi.org/10.1007/s00125-021-05568-3) and \"is calculated based on the average sensor glucose over the last 14 days and provides an approximation of laboratory based HbA1c, in some individuals, but it\n may be higher or lower than actual HbA1c in others.\" For further background on GMI including how to calculate it (see https://doi.org/10.2337/dc18-1581).
\nThis is calculated using either of the following equations:
\n\n OR\n
\nGMI is applicable to CGM data only.
\n ", "description": "Estimate of HbA1c using glucose management indicator (GMI), during the reporting period.The coded value field must contain the following SNOMED CT concept:
SNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
~1464891000000104 | Glucose Management Indicator expressed as substance concentration ratio (observable entity)) \u2502 Applies to CGM only.
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
", "description": "The coded value for glucose management indicator (GMI).", "valueSets": "SNOMED CT."}, {"type": "item", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Value", "implamentationGuidance": "This field is mandatory if the coded value (observable entity) is shared.The coded value field must contain only one SNOMED CT concept from the following value set:\u00a0
SNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
~1464911000000101 | Number of clinically significant hypoglycaemic episodes recorded by continuous glucose monitoring device (observable entity) \u2502\u00a0Calculated from CGM device data.
~1464901000000103 | Number of clinically significant hypoglycaemic episodes recorded by self-monitoring of capillary blood glucose (observable entity) \u2502\u00a0Calculated from any allowable data source where the data was collected as part of a person\u2019s self-monitoring of blood glucose (SMBG) using fingerstick testing.
~1465031000000109 | Number of clinically significant hypoglycaemic episodes recorded by point-of-care monitoring of capillary blood glucose (observable entity) \u2502Calculated from any allowable data source (e.g. blood glucose meter) where the data was collected at point-of-care by a healthcare professional.
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
", "description": "The coded value for number of significant hypoglycaemic episodes.", "valueSets": "SNOMED CT."}, {"type": "item", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Value", "implamentationGuidance": "This field is mandatory if the coded value (observable entity) is shared.The coded value field must contain the following SNOMED CT concept:
SNOMED CT ID \u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
~1464921000000107 | Mean duration of hypoglycaemic episodes in minutes (observable entity) \u2502 Applies to CGM only.\u00a0
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
", "description": "The coded value for mean duration of hypoglycaemic episodes.", "valueSets": "SNOMED CT."}, {"type": "item", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Value", "implamentationGuidance": "This field is mandatory if the coded value (observable entity) is shared.
Length of gestation should be coded using the below SNOMED CT concept:
SNOMED CT ID \u2502 Fully specified name (FSN) \u2502 Implementation guidance
412726003 \u2502 Length of gestation at birth (observable entity) \u2502 Equal of concept. \u00a0
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
", "description": "The coded value for length of gestation at birth.", "valueSets": "SNOMED CT.Structured assessment name should be coded using only one SNOMED CT concept that is a subtype of the following concept:
SNOMED CT ID\u00a0\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
273249006\u00a0\u2502\u00a0Assessment scales (assessment scale)\u00a0\u2502\u00a0No specific guidance.
The following list of assessment scale codes was identified during the PRSB consultation as relevant to diabetes care * and is non-exhaustive:
* Not all assessments identified will necessarily be appropriate for use by people with diabetes or their carers without the involvement of a healthcare professional. Included items generally had a minimum of 5% of respondents saying that they 'sometimes' or 'nearly always' used the assessment (see Diabetes Survey Report).
Assessment name\u00a0\u2502\u00a0SNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
Hypoglycaemia awareness or fear
Gold score\u00a0\u2502\u00a01104881000000101\u00a0\u2502\u00a0Gold Score for awareness of hypoglycaemia (assessment scale)\u00a0\u2502\u00a0No specific guidance.
Clarke score\u00a0\u2502\u00a0838301000000106\u00a0\u2502\u00a0Clarke hypoglycaemia awareness questionnaire (assessment scale)\u00a0\u2502\u00a0No specific guidance.
Hypoglycaemia fear survey **\u00a0\u2502\u00a0837671000000105\u00a0\u2502\u00a0Hypoglycaemia fear survey (assessment scale)\u00a0\u2502\u00a0Validated for use by people with type 1 diabetes (see https://doi.org/10.2337/dc10-1343).
Foot care assessments
SINBAD\u00a0\u2502\u00a0921741000000108\u00a0\u2502\u00a0Site, ischaemia, neuropathy, bacterial infection and depth wound classification (assessment scale)\u00a0\u2502\u00a0No specific guidance.
University of Texas Wound Classification System\u00a0\u2502\u00a0763003003\u00a0\u2502\u00a0University of Texas Wound Classification System (assessment scale)\u00a0\u2502\u00a0No specific guidance.
Young Townson FootSkin Scale\u2502\u00a0980351000000105\u00a0\u2502\u00a0Young Townson FootSkin Scale for Diabetic Neuropathy (assessment scale)\u00a0\u2502\u00a0No specific guidance.
Ipswich touch test \u2502\u00a01443841000000103\u00a0Ipswich Touch Test (assessment scale) \u2502\u00a0No specific guidance.
Diabetes distress
Diabetes Distress Scale (DDS) 2 item **\u00a0\u2502\u00a0909401000000106\u00a0\u2502\u00a0Diabetes Distress Scale 2 item (assessment scale)\u00a0\u2502\u00a0No specific guidance.
DDS 17 item **\u00a0\u2502\u00a0909441000000109\u00a0\u2502\u00a0Diabetes Distress Scale 17 item (assessment scale)\u00a0\u2502\u00a0Validated for use by people with type 2 diabetes (see https://diabetesdistress.org/dd-assess-score-3).
T1-DDS **\u00a0\u2502\u00a01373521000000101 \u00a0\u2502\u00a0Type 1 Diabetes Distress Scale (assessment scale)\u00a0\u2502\u00a0Validated for use by people with type 1 diabetes. For rationale (see https://dx.doi.org/10.1016%2Fj.jdiacomp.2015.01.012).
PAID-20 **\u00a0\u2502\u00a01363131000000101\u2502\u00a0Problem Areas in Diabetes (assessment scale)\u00a0\u2502\u00a0For rationale (see https://doi.org/10.2337/diacare.18.6.754).
PAID-11 **\u00a0\u2502\u00a01373391000000108\u2502\u00a0Problem Areas in Diabetes 11-item (assessment scale)\u00a0\u2502\u00a0For rationale (see https://doi.org/10.1016/j.diabres.2019.01.026).
PAID-5 **\u2502\u00a01373411000000108 \u2502\u00a0Problem Areas in Diabetes 5-item (assessment scale)\u00a0\u2502\u00a0For rationale (see https://doi.org/10.1007/s00125-009-1559-5).
PAID-1 **\u2502\u00a01373441000000109\u00a0\u2502\u00a0Problem Areas in Diabetes 1-item (assessment scale)\u00a0\u2502\u00a0For rationale (see https://doi.org/10.1007/s00125-009-1559-5).
General emotional health and wellbeing
WHO Well-being index \u2502 1144752009 \u2502 5-item World Health Organization Well-being Index questionnaire (assessment scale) \u2502 No specific guidance.
Patient Health Questionnaire (PHQ) 2 item **\u00a0\u2502\u00a0836521000000107\u00a0\u2502\u00a0Patient health questionnaire 2 (assessment scale)\u00a0\u2502\u00a0No specific guidance.
PHQ 4 item **\u00a0\u2502\u00a0865935003\u00a0\u2502\u00a0Patient Health Questionnaire-4 (assessment scale)\u00a0\u2502\u00a0No specific guidance.
PHQ 9 item **\u00a0\u2502\u00a0758711000000105\u00a0\u2502\u00a0Patient health questionnaire 9 (assessment scale)\u00a0\u2502\u00a0No specific guidance.
PHQ 15 item **\u00a0\u2502\u00a01065421000000105\u00a0\u2502\u00a0Patient Health Questionnaire 15 (assessment scale)\u00a0\u2502\u00a0No specific guidance.
Hospital anxiety and depression scale (HADS)\u00a0\u2502\u00a0273524006\u00a0\u2502\u00a0Hospital anxiety and depression scale (assessment scale)\u00a0\u2502\u00a0No specific guidance.
Generalised anxiety disorder (GAD) 2 item **\u00a0\u2502\u00a0836551000000102\u00a0\u2502\u00a0Generalised anxiety disorder 2 scale (assessment scale)\u00a0\u2502\u00a0No specific guidance.
Generalised anxiety disorder (GAD) 7 item **\u00a0\u2502\u00a0704501007\u00a0\u2502\u00a0Generalized anxiety disorder 7 item scale (assessment scale)\u00a0\u2502\u00a0No specific guidance.
Diet, nutrition and eating disorders
Malnutrition Universal Screening Tool (MUST)\u00a0\u2502\u00a0414648004\u00a0\u2502\u00a0Malnutrition universal screening tool (assessment scale)\u00a0\u2502\u00a0Validated for use in people with type 2 diabetes. For rationale (see https://www.bapen.org.uk/pdfs/must/must_explan.pdf).
mSCOFF\u00a0\u2502\u00a01362371000000109\u2502\u00a0Modified Sick, Control, One, Fat, Food questionnaire (assessment scale)\u00a0\u2502\u00a0Validated in female adolescents with type 1 diabetes. For rationale (see https://doi.org/10.2337/dc13-1637).
Diabetes Eating Problem Survey Revised (DEPS-R) 16 item\u00a0\u2502\u00a01362831000000102 \u00a0\u2502\u00a0Diabetes Eating Problem Survey - Revised (assessment scale) \u00a0\u2502\u00a0Validated for use in youth and adolescents (see https://dx.doi.org/10.2337%2Fdc09-1890) and adults (see https://doi.org/10.1186/s40337-018-0232-0) with type 1 diabetes.
Diabetes self-management and quality of life
Diabetes Quality of Life (DQOL) questionnaire\u00a0\u2502\u00a0838221000000109\u00a0\u2502\u00a0Diabetes quality of life questionnaire (assessment scale)\u00a0\u2502\u00a0No specific guidance.
Diabetes Self Management Questionnaire (DSMQ) 16 item\u00a0\u00a0\u2502\u00a0New code request\u00a0\u00a0\u2502\u00a0Diabetes Self Management Questionnaire (DSMQ) 16 item (assessment scale)\u00a0\u00a0\u2502\u00a0For rationale (see\u00a0https://doi.org/10.1186/1477-7525-11-138\u00a0).
Diabetes Self Management Questionnaire (DSMQ-R) 27 item \u2013 revised\u00a0\u00a0\u2502\u00a0New code request\u00a0\u00a0\u2502\u00a0Diabetes Self Management Questionnaire (DSMQ-R) 27 item - revised (assessment scale)\u00a0\u00a0\u2502\u00a0For rationale (see https://doi.org/10.3389/fcdhc.2021.823046).
Diabetes management self-efficacy scale (DMSES) UK\u00a0\u2502\u00a01373991000000107 \u2502\u00a0Diabetes management self-efficacy scale United Kingdom 15-item (assessment scale) \u00a0\u2502\u00a0Validated for people with type 2 diabetes. For rationale (see\u00a0https://psycnet.apa.org/doi/10.1017/S1463423610000101).
Insulin and medication questionnaires
Insulin Treatment Appraisal Scale (ITAS) **\u00a0\u2502\u00a01423591000000108 \u00a0\u2502\u00a0Insulin Treatment Appraisal Scale (assessment scale)\u00a0\u2502\u00a0Validated for use in people with type 2 diabetes. For rationale (see https://dx.doi.org/10.1186%2F1477-7525-5-69 AND https://doi.org/10.1186/1477-7525-12-87).
Medication Adherence Report Scale (MARS) 5 item\u00a0\u2502\u00a01363071000000103 \u00a0\u2502\u00a0Medication Adherence Report Scale 5-item (assessment scale) \u00a0\u2502\u00a0For rationale (see https://dx.doi.org/10.1111%2Fbcp.14193).
Risk assessment tools
QRISK2\u00a0\u2502\u00a0763245006\u00a0\u2502\u00a0QRISK2 cardiovascular disease 10 year risk calculator (assessment scale)\u00a0\u2502\u00a0NICE recommends QRISK2 for use in people with type 2 diabetes (https://www.nice.org.uk/guidance/ng28). Use in people with type 1 is not recommended as they are already considered at high risk (see https://www.nice.org.uk/guidance/cg181).
QRISK3 \u2502 1085771000000100 \u2502 QRISK3 cardiovascular disease 10 year risk calculator (assessment scale) \u2502 No specific guidance.
Patient activation, physical activity and sleep
Patient Activation Measure (PAM)\u00a0\u2502713863004\u2502\u00a0Patient Activation Measure (assessment scale) | No specific guidance.
GPPAQ\u00a0\u2502770231000000109\u2502\u00a0General practice physical activity questionnaire (assessment scale) | No specific guidance.
Pittsburgh sleep quality\u00a0index\u00a0\u2502 699200007\u00a0\u2502 Pittsburgh sleep quality index (assessment scale) \u2502 No specific guidance.
Diabetes treatment satisfaction
DTSQ status version\u00a0\u2502\u00a0739663003\u00a0\u2502\u00a0Diabetes Treatment Satisfaction Questionnaire status version (assessment scale) | No specific guidance.
DTSQ change version\u00a0\u2502739664009\u2502\u00a0Diabetes Treatment Satisfaction Questionnaire status version (assessment scale) | No specific guidance.
Frailty assessments
Electronic frailty index\u00a0\u25021084951000000107\u00a0\u2502\u00a0Electronic Frailty Index (assessment scale) \u2502 See\u00a0https://www.guidelines.co.uk/diabetes/type-2-diabetes-frailty-in-older-people/454600.article). Frailty is also relevant for care home residents with diabetes (see\u00a0https://www.diabetes.org.uk/resources-s3/2017-09/Care_homes_report2010_0.pdf).Electronic frailty index 2\u00a0\u2502 1423651000000101\u00a0\u2502\u00a0
Electronic Frailty Index 2 (assessment scale) \u2502 No specific guidance.
Rockwood clinical frailty scale \u2502 445414007 \u2502 Canadian Study of Health and Aging clinical frailty scale (assessment scale) \u2502 For rationale (see https://doi.org/10.1503%2Fcmaj.050051).
Cognition, mood and memory
Abbreviated mental test score (AMTS) \u2502 273255001 \u2502 Abbreviated Mental Test Score (assessment scale) \u2502 No specific guidance.
General practitioner assessment of cognition (GPCOG) \u2502 770753000 \u2502 General Practitioner Assessment of Cognition (assessment scale) \u2502 No specific guidance.
Mini-cog brief cognitive screening test \u2502 713262003 \u2502 Mini-Cog brief cognitive screening test (assessment scale) \u2502 No specific guidance.
Six item cognitive impairment test \u2502 1085141000000105 \u2502 Six Item Cognitive Impairment Test (assessment scale) \u2502 No specific guidance.
Mini mental state examination (MMSE) \u2502 273617000 \u2502 Mini-mental state examination (assessment scale) \u2502 No specific guidance.
Modified mini mental state examination (3MS) \u2502 273619002 \u2502 Modified mini-mental state examination (assessment scale) \u2502 No specific guidance. \u00a0
Montreal Cognitive Assessment (MoCA) \u2502 859351000000102 \u2502 Montreal cognitive assessment (assessment scale) \u2502 For further information (see https://www.mocatest.org/). ***
4AT rapid clinical test for delirium \u2502 1239191000000102 \u2502 4 A's Test for delirium and cognitive impairment (assessment scale) \u2502 No specific guidance. ***
Confusion assessment method (CAM) \u2502 824471000000102 \u2502 Confusion assessment method short version (assessment scale) \u2502 No specific guidance. ***
Geriatric depression scale (GDS) \u2502 273481004 \u2502 Geriatric depression scale (assessment scale) \u2502 Descendent or self of concept (including original long form, short form, and 4-item form scales). ***
Addenbrooke\u2019s cognitive examination revised (ACE-R) \u2502 445412006 \u2502 Addenbrooke's cognitive examination revised (assessment scale) \u2502 No specific guidance. ***
Skin integrity
Waterlow pressure sore risk score \u2502 278897004 \u2502 Waterlow pressure sore risk score (assessment scale) \u2502 No specific guidance.
Mobility and activities of daily living
Barthel ADL index \u2502 273302005 \u2502 Barthel index (assessment scale) \u2502 Descendent or self of concept (including original, UK or modified scales).
Instrumental activities of daily living (I-ADL) \u2502 273534002 \u2502 Instrumental activities of daily living (assessment scale) \u2502 No specific guidance.
Pain assessment
Abbey pain scale \u2502 763306003 \u2502 Abbey Pain Scale (assessment scale) \u2502 No specific guidance.
BPI \u2502 494711000000101 \u2502 Brief pain inventory (assessment scale) \u2502 No specific guidance.
BPCI \u2502 494721000000107 \u2502 Brief pain coping inventory (assessment scale) \u2502 No specific guidance.
PAINAD \u2502 7121000122100 \u2502 Pain Assessment in Advanced Dementia Scale (assessment scale) \u2502 No specific guidance.
S-LANSS \u2502 810601000000106 \u2502 Self-completed Leeds assessment of neuropathic symptoms and signs pain scale (assessment scale) \u2502 No specific guidance.
VAPS \u2502 273904000 \u2502 Visual analog pain scale (assessment scale) \u2502 No specific guidance.
** For key diabetes assessments identified by the American Diabetes Association (see https://professional.diabetes.org/sites/professional.diabetes.org/files/media/ada_mental_health_toolkit_questionnaires.pdf).
*** For further information on some key cognitive assessments recommended by NHS England in 2014 for use in primary care in England (see https://www.england.nhs.uk/wp-content/uploads/2014/09/dementia-revealed-toolkit.pdf).
", "description": "The coded value for structured assessment name.\u00a0", "valueSets": "Assessment score should be coded using only one SNOMED CT concept that is a subtype of the following concept:
SNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
363787002\u00a0\u2502\u00a0Observable entity (observable entity)\u00a0\u2502\u00a0No specific guidance.
The following list of assessment score codes was identified during the PRSB consultation as relevant to diabetes care * and is non-exhaustive:
* Not all assessments identified will necessarily be appropriate for use by people with diabetes or their carers without the involvement of a healthcare professional. Included items generally had a minimum of 5% of respondents saying that they 'sometimes' or 'nearly always' used the assessment (see Diabetes Survey Report).
Assessment name\u00a0\u2502\u00a0SNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
Hypoglycaemia awareness or fear
Gold score\u00a0\u2502\u00a01104871000000103\u00a0\u2502\u00a0Gold Score for awareness of hypoglycaemia (observable entity)\u00a0\u2502\u00a0No specific guidance.
Clarke score\u00a0\u2502\u00a0851981000000106\u00a0\u2502\u00a0Clarke hypoglycaemia awareness questionnaire score (observable entity)\u00a0\u2502\u00a0No specific guidance.
Hypoglycaemia fear survey
**\u00a0\u2502\u00a0851971000000109\u00a0\u2502\u00a0Hypoglycaemia fear survey score (observable entity)\u00a0\u2502\u00a0Validated for use by people with type 1 diabetes (see https://doi.org/10.2337/dc10-1343).
Foot care assessments
SINBAD\u00a0\u2502\u00a0763258007\u00a0\u2502\u00a0Site, Ischemia, Neuropathy, Bacterial Infection and Depth classification total score (observable entity)\u00a0\u2502\u00a0No specific guidance.
University of Texas Wound Classification System (grade)\u00a0\u2502\u00a0763004009\u00a0\u2502\u00a0University of Texas Wound Classification System grade (observable entity)\u00a0\u2502\u00a0No specific guidance.
University of Texas Wound Classification System (stage)\u00a0\u2502\u00a0763005005\u00a0\u2502\u00a0University of Texas Wound Classification System stage (observable entity)\u00a0\u2502No specific guidance.
Young Townson FootSkin Scale\u00a0\u2502\u00a01099121000000104\u00a0\u2502\u00a0Young Townson FootSkin Hydration Scale for Diabetic Neuropathy level (observable entity)\u00a0\u2502\u00a0No specific guidance.
Ipswich touch test \u2502\u00a01443851000000100 \u2502 Ipswich Touch Test score (observable entity)\u00a0\u2502\u00a0No specific guidance.
Diabetes distress
Diabetes Distress Scale (DDS) 2 item **\u00a0\u2502\u00a0909421000000102\u00a0\u2502\u00a0Diabetes Distress Scale 2 item score (observable entity)\u00a0\u2502\u00a0No specific guidance.
DDS 17 item **\u00a0\u2502\u00a0910931000000101\u00a0\u2502\u00a0Diabetes Distress Scale 17 item score (observable entity)\u00a0\u2502\u00a0Validated for use by people with type 2 diabetes (see https://diabetesdistress.org/dd-assess-score-3).
T1-DDS **\u00a0\u2502\u00a01373531000000104 \u00a0\u2502\u00a0Type 1 Diabetes Distress Scale total score (observable entity) \u00a0\u2502\u00a0Validated for use by people with type 1 diabetes. For rationale (see https://dx.doi.org/10.1016%2Fj.jdiacomp.2015.01.012).
PAID-20 **\u00a0\u2502\u00a01363101000000107 \u00a0\u2502\u00a0Problem Areas in Diabetes score (observable entity) \u00a0\u2502\u00a0For rationale (see https://doi.org/10.2337/diacare.18.6.754).
PAID-11 **\u00a0\u2502\u00a01368271000000101 \u00a0\u2502\u00a0Problem Areas in Diabetes 11-item score (observable entity)\u00a0\u2502\u00a0For rationale (see https://doi.org/10.1016/j.diabres.2019.01.026).
PAID-5 **\u2502\u00a01373421000000102 \u00a0\u2502\u00a0Problem Areas in Diabetes 5-item score (observable entity) \u00a0\u2502\u00a0For rationale (see https://doi.org/10.1007/s00125-009-1559-5).
PAID-1 **\u2502\u00a01373451000000107 \u00a0\u2502\u00a0 Problem Areas in Diabetes 1-item score (observable entity)\u00a0\u2502\u00a0For rationale (see https://doi.org/10.1007/s00125-009-1559-5).
General emotional health and wellbeing
WHO Well-being index \u2502 1144665009 \u2502 5-item World Health Organization Well-being Index value (observable entity) \u2502 No specific guidance. \u00a0
Patient Health Questionnaire (PHQ) 2 item **\u00a0\u2502\u00a0836541000000100\u00a0\u2502\u00a0Patient health questionnaire 2 score (observable entity)\u00a0\u2502\u00a0No specific guidance.
PHQ 4 item **\u00a0\u2502\u00a01104961000000104\u00a0\u2502\u00a0Patient Health Questionnaire-4 score (observable entity)\u00a0\u2502\u00a0No specific guidance.
PHQ 9 item **\u00a0\u2502\u00a0720433000\u2502\u00a0Patient Health Questionnaire Nine Item score (observable entity)\u00a0\u2502\u00a0No specific guidance.
PHQ 15 item **\u00a0\u2502\u00a01065441000000103\u00a0\u2502\u00a0Patient Health Questionnaire 15 score (observable entity)\u00a0\u2502\u00a0No specific guidance.
Hospital anxiety and depression scale (HADS)\u00a0\u2502\u00a0401319005\u00a0\u2502\u00a0Hospital Anxiety and Depression scale: anxiety score (observable entity)\u00a0\u2502\u00a0No specific guidance.
Generalised anxiety disorder (GAD) 2 item **\u00a0\u2502\u00a0836571000000106\u00a0\u2502\u00a0Generalised anxiety disorder 2 scale score (observable entity)\u00a0\u2502\u00a0No specific guidance.
Generalised anxiety disorder (GAD) 7 item **\u00a0\u2502\u00a0445455005\u00a0\u2502\u00a0Generalized anxiety disorder 7 item score (observable entity)\u00a0\u2502\u00a0No specific guidance.
Diet, nutrition and eating disorders
Malnutrition Universal Screening Tool (MUST)\u00a0\u2502\u00a0444297006\u00a0\u2502\u00a0Malnutrition universal screening tool score (observable entity)\u00a0\u2502\u00a0Validated for use in people with type 2 diabetes. For rationale (see https://www.bapen.org.uk/pdfs/must/must_explan.pdf).
mSCOFF\u00a0\u2502\u00a01362261000000106 \u00a0\u2502\u00a0Modified Sick, Control, One, Fat, Food questionnaire score (observable entity) \u00a0\u2502\u00a0Validated in female adolescents with type 1 diabetes. For rationale (see https://doi.org/10.2337/dc13-1637).
Diabetes Eating Problem Survey Revised (DEPS-R) 16 item\u00a0\u2502\u00a01362751000000101 \u00a0\u2502\u00a0Diabetes Eating Problem Survey - Revised score (observable entity) \u00a0\u2502\u00a0Validated for use in youth and adolescents (see https://dx.doi.org/10.2337%2Fdc09-1890) and adults (see https://doi.org/10.1186/s40337-018-0232-0) with type 1 diabetes.
Diabetes self-management and quality of life
Diabetes Quality of Life (DQOL) questionnaire\u00a0\u2502\u00a0851991000000108\u00a0\u2502\u00a0Diabetes quality of life questionnaire score (observable entity)\u00a0\u2502\u00a0No specific guidance.
Diabetes Self Management Questionnaire (DSMQ) 16 item\u00a0\u00a0\u2502\u00a0New code request\u00a0\u00a0\u2502\u00a0Diabetes Self Management Questionnaire (DSMQ) 16 item score (observable entity)\u00a0\u00a0\u2502\u00a0For rationale (see\u00a0https://doi.org/10.1186/1477-7525-11-138\u00a0).
Diabetes management self-efficacy scale (DMSES) UK\u00a0\u2502\u00a01374011000000100 \u00a0\u2502\u00a0Diabetes management self-efficacy scale United Kingdom 15-item score (observable entity) \u2502\u00a0Validated for people with type 2 diabetes. For rationale (see\u00a0https://psycnet.apa.org/doi/10.1017/S1463423610000101).
Insulin and medication questionnaires
Insulin Treatment Appraisal Scale (ITAS) **\u00a0\u2502\u00a01423611000000100 \u00a0\u2502\u00a0Insulin Treatment Appraisal Scale total score (observable entity) ) \u2502\u00a0Validated for use in people with type 2 diabetes. For rationale (see https://dx.doi.org/10.1186%2F1477-7525-5-69 AND https://doi.org/10.1186/1477-7525-12-87).
Medication Adherence Report Scale (MARS) 5 item\u00a0\u2502\u00a01362991000000107 \u00a0\u2502\u00a0Medication Adherence Report Scale 5-item score (observable entity) \u00a0\u2502\u00a0For rationale (see https://dx.doi.org/10.1111%2Fbcp.14193).
Risk assessment tools
QRISK2\u00a0\u2502\u00a0718087004\u00a0\u2502\u00a0QRISK2 cardiovascular disease 10 year risk score (observable entity)\u00a0\u2502\u00a0NICE recommends QRISK2 for use in people with type 2 diabetes (https://www.nice.org.uk/guidance/ng28). Use in people with type 1 is not recommended as they are already considered at high risk (see https://www.nice.org.uk/guidance/cg181).
QRISK3 \u2502 1085871000000105 \u2502 QRISK3 cardiovascular disease 10 year risk calculator score (observable entity) \u2502 No specific guidance.
Patient activation, physical activity and sleep
Patient Activation Measure (PAM)\u00a0\u2013 score \u2502713644003\u00a0\u2502\u00a0Patient Activation Measure score (observable entity) | No specific guidance.
Patient Activation Measure (PAM) - level\u00a0\u2502\u00a0962851000000103\u00a0\u00a0\u2502\u00a0Patient Activation Measure Level (observable entity)\u00a0\u00a0| No specific guidance.
GPPAQ\u00a0\u2502\u00a01086511000000107\u00a0\u00a0\u2502\u00a0General Practice Physical Activity Questionnaire Physical Activity Index (observable entity)\u00a0| No specific guidance.
Pittsburgh sleep quality index\u00a0\u2502\u00a0761879005\u00a0\u2502Pittsburgh Sleep Quality Index score (observable entity)\u00a0| No specific guidance.
Diabetes treatment satisfaction
DTSQ status version\u00a0\u2502\u00a0765147009\u00a0\u2502\u00a0Diabetes Treatment Satisfaction Questionnaire status version score (observable entity)\u00a0\u00a0| No specific guidance.
DTSQ change version\u00a0\u2502 1373471000000103 \u2502\u00a0Diabetes Treatment Satisfaction Questionnaire change version\u00a0score (observable entity)\u00a0| No specific guidance.
Frailty assessments
Electronic frailty index\u00a0\u25021084961000000105\u00a0\u2502\u00a0Electronic Frailty Index score (observable entity) | See\u00a0https://www.guidelines.co.uk/diabetes/type-2-diabetes-frailty-in-older-people/454600.article). Frailty is also relevant for care home residents with diabetes (see\u00a0https://www.diabetes.org.uk/resources-s3/2017-09/Care_homes_report2010_0.pdf).
Electronic frailty index 2\u00a0\u2502 1423641000000104 \u2502\u00a0Electronic Frailty Index 2 score (observable entity) \u2502 No specific guidance.
Rockwood clinical frailty scale \u2502 763264000 \u2502 Canadian Study of Health and Aging Clinical Frailty Scale score (observable entity) \u2502 For rationale (see https://doi.org/10.1503%2Fcmaj.050051).
Cognition, mood and memory
Abbreviated mental test score (AMTS) \u2502 446840000 \u2502 Abbreviated mental test score (observable entity) \u2502 No specific guidance.
General practitioner assessment of cognition (GPCOG) \u2502 756521000000105 \u2502 General practitioner assessment of cognition score (observable entity) \u2502 No specific guidance.
Mini-cog brief cognitive screening test \u2502 713408000 \u2502 Mini-Cog brief cognitive screening test score (observable entity) \u2502 No specific guidance.
Six item cognitive impairment test \u2502 1085151000000108 \u2502 Six Item Cognitive Impairment Test total score (observable entity) \u00a0\u2502 No specific guidance.
Mini mental state examination (MMSE) \u2502 447316007 \u2502 Mini-mental state examination score (observable entity) \u2502 No specific guidance.
Modified mini mental state examination (3MS) \u2502 720485003 \u2502 Modified Mini-Mental State Examination score (observable entity) \u2502 No specific guidance. \u00a0
Montreal Cognitive Assessment (MoCA) \u2502 859371000000106 \u2502 Montreal cognitive assessment score (observable entity) \u2502 For further information (see https://www.mocatest.org/). ***
4AT rapid clinical test for delirium \u2502 1239211000000103 \u2502 4 A's Test for delirium and cognitive impairment score (observable entity) \u2502 No specific guidance. ***
Confusion assessment method (CAM) \u2502 736537001 \u2502 Confusion Assessment Method short version score (observable entity) \u2502 No specific guidance. ***
Geriatric depression scale (GDS) \u2502 273481004 \u2502 Geriatric depression scale (assessment scale) \u2502 Descendent or self of concept (including original long form, short form, and 4-item form scales). ***
Addenbrooke\u2019s cognitive examination revised (ACE-R) \u2502 711061000000109 \u2502 Addenbrooke's cognitive examination revised - score (observable entity) \u2502 No specific guidance. ***
Skin integrity
Waterlow pressure sore risk score \u2502 201221000000101 \u2502 Observation of Waterlow pressure sore risk score (observable entity) \u00a0\u2502 No specific guidance.
Mobility and activities of daily living
Barthel ADL index (original)\u2502 493451000000105 \u2502 Barthel original index of activities of daily living score (observable entity) \u2502 No specific guidance.
Barthel ADL index (modified) \u2502 443653008 \u2502 Modified Barthel index of activities of daily living score (observable entity) \u2502 No specific guidance.
Barthel ADL index (UK) \u2502 493441000000107 \u2502 Barthel United Kingdom index of activities of daily living score (observable entity) \u2502 No specific guidance.
Instrumental activities of daily living (I-ADL) \u2502 404981008 \u2502 Ability to perform instrumental activities of daily living (observable entity) \u2502 No specific guidance.
Pain assessment
Abbey pain scale \u2502 770634001 \u2502 Abbey Pain Scale score (observable entity) \u2502 No specific guidance.
BPI \u2502 443223005 \u2502 Brief pain inventory score (observable entity) \u2502 No specific guidance.
BPCI \u2502 446038006 \u2502 Brief pain coping inventory score (observable entity) \u2502 No specific guidance.
PAINAD \u2502 1091141000000107 \u2502 Pain Assessment in Advanced Dementia Scale score (observable entity) \u2502 No specific guidance.
S-LANSS \u2502 810611000000108 \u2502 Self-completed Leeds assessment of neuropathic symptoms and signs pain score (observable entity) \u2502 No specific guidance.
VAPS \u2502 443394008 \u2502 Visual analog scale pain score (observable entity) \u2502 No specific guidance.
Where required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.
** For key diabetes assessments identified by the American Diabetes Association (see https://professional.diabetes.org/sites/professional.diabetes.org/files/media/ada_mental_health_toolkit_questionnaires.pdf).
*** For further information on some key cognitive assessments recommended by NHS England in 2014 for use in primary care in England (see https://www.england.nhs.uk/wp-content/uploads/2014/09/dementia-revealed-toolkit.pdf).
", "description": "The coded value for assessment score.\u00a0", "valueSets": "Subscale score should be coded using only one SNOMED CT concept that is a subtype of the following concept:
\nSNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n363787002 \u2502 Observable entity (observable entity) \u2502 No specific guidance.
\nExisting subscale concepts for the assessments identified as relevant to diabetes care are below:
\nSNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0
\nDiabetes distress score (17- item)
\n1374051000000101 | Diabetes Distress Scale 17 item Regimen Distress score (observable entity) |
\n1374031000000108 | Diabetes Distress Scale 17 item Emotional Burden score (observable entity) |
\n1374041000000104 | Diabetes Distress Scale 17 item Physician Distress score (observable entity) |
\n1374061000000103 | Diabetes Distress Scale 17 item Interpersonal Distress score (observable entity) |
\nType 1 diabetes distress score
\n1373551000000106 | Type 1 Diabetes Distress Scale Powerlessness score (observable entity) |
\n1373591000000103 | Type 1 Diabetes Distress Scale Eating Distress score (observable entity) |
\n1373601000000109 | Type 1 Diabetes Distress Scale Physician Distress score (observable entity) |
\n1373561000000109 | Type 1 Diabetes Distress Scale Management Distress score (observable entity) |
\n1373571000000102 | Type 1 Diabetes Distress Scale Hypoglycemia Distress score (observable entity) |
\n1373611000000106 | Type 1 Diabetes Distress Scale Friend/Family Distress score (observable entity) |
\n1373581000000100 | Type 1 Diabetes Distress Scale Negative Social Perceptions score (observable entity) |
\nDiabetes self management questionnaire (DSMQ)
\nNew code request | Diabetes Self Management Questionnaire (DSMQ) 16 item Eating behaviour score (Observable entity)
\nNew code request | Diabetes Self Management Questionnaire (DSMQ) 16 item Medication taking score (Observable entity)
\nNew code request | Diabetes Self Management Questionnaire (DSMQ) 16 item Glucose monitoring score (Observable entity)
\nNew code request | Diabetes Self Management Questionnaire (DSMQ) 16 item Physical activity score (Observable entity)
\nNew code request | Diabetes Self Management Questionnaire (DSMQ) 16 item Cooperation with diabetes team score (Observable entity)
\nDiabetes self management questionnaire \u2013 revised (DSMQ - R)
\nNew code request | Diabetes Self Management Questionnaire \u2013 Revised (DSMQ-R) 27 item Eating behaviour score (Observable entity)
\nNew code request | Diabetes Self Management Questionnaire \u2013 Revised (DSMQ-R) 27 item Medication taking score (Observable entity)
\nNew code request | Diabetes Self Management Questionnaire \u2013 Revised (DSMQ-R) 27 item Glucose monitoring score (Observable entity)
\nNew code request | Diabetes Self Management Questionnaire \u2013 Revised (DSMQ-R) 27 item Physical activity score (Observable entity)
\nNew code request | Diabetes Self Management Questionnaire \u2013 Revised (DSMQ-R) 27 item Cooperation with diabetes team score (Observable entity)
\nInsulin treatment appraisal scale (ITAS)
\n1423621000000106 | Insulin Treatment Appraisal Scale positive appraisal score (observable entity) |
\n1423631000000108 | Insulin Treatment Appraisal Scale negative appraisal score (observable entity) |
\nGeneral practitioner assessment of cognition (GPCOG)
\n756501000000101 | General practitioner assessment of cognition informant score (observable entity) |
\n756511000000104 | General practitioner assessment of cognition patient score (observable entity) |
\nAddenbrooke\u2019s cognitive examination revised (ACE-R)
\n711111000000108 | Addenbrooke's cognitive examination revised - attention and orientation subscore (observable entity) |
\n711101000000106 | Addenbrooke's cognitive examination revised - fluency subscore (observable entity) |
\n711081000000100 | Addenbrooke's cognitive examination revised - language subscore (observable entity) |
\n711091000000103 | Addenbrooke's cognitive examination revised - memory subscore (observable entity) |
\n711071000000102 | Addenbrooke's cognitive examination revised - visuospatial subscore (observable entity) |
\nSNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\nWaterlow pressure sore risk score
\n201221000000101 | Observation of Waterlow pressure sore risk score (observable entity) | Descendants of concept only (including subscales for Waterlow age, sex, appetite, mobility, continence, medication, tissue malnutrition, major surgery/ trauma, neurological deficit, skin type visual risk areas and build/ weight for height scores).
\nInstrumental activities of daily living
\nInstrumental activities of daily living (I-ADL) \u2502 404981008 \u2502 Ability to perform instrumental activities of daily living (observable entity) \u2502 Relevant descendants of concept.
\nWhere required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.
\n** For key diabetes assessments identified by the American Diabetes Association (see https://professional.diabetes.org/sites/professional.diabetes.org/files/media/ada_mental_health_toolkit_questionnaires.pdf).
\n*** For further information on some key cognitive assessments recommended by NHS England in 2014 for use in primary care in England (see https://www.england.nhs.uk/wp-content/uploads/2014/09/dementia-revealed-toolkit.pdf).
\nThe coded value field for risk must contain only one SNOMED CT concept that is a descendant (the set of all subtypes) of the given concept (where expression constraint language (ECL) operator symbol is \u2018<\u2019).
\nSNOMED CT: - <281694009 |Finding of at risk (finding)|
\u00a0
The coded value field for causative agent must contain either any dictionary of medicines and devices (dm+d) code from the given classes (may be represented in SNOMED CT) or one SNOMED CT concept that is either a descendant (the set of all subtypes) of the given concept (where expression constraint language (ECL) operator symbol is \u2018<\u2019), a descendant (the\n set of all subtypes) or self (the concept itself) of the given concept (where ECL operator symbol is \u2018<<\u2019) or equal to the given concept (no ECL operator symbol).
\n| \n \n \ndm+d:- any code from the VTM, VMP, AMP, VMPP, AMPP and ingredient concept classes \n |
The coded value field for substance must contain only one SNOMED CT concept that is a descendant (the set of all subtypes) of the given concepts (where expression constraint language (ECL) operator symbol is \u2018<\u2019).
\nThe coded value field for route of exposure must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\nThe medication change cluster and medications discontinued cluster both derive from discharge standards to ensure clarity of what medications had changed or been stopped in hospital. They are retained in the diabetes record information standard as they may still be useful to professionals in understanding\n previous medications.\u00a0\u00a0
\nThe Medical devices element is for medical devices that cannot (in general) be prescribed and do not have representation in the NHS dictionary of medicines and medical devices (dm+d). Whilst medical devices that can be prescribed in primary care are generally well represented in dm+d, there are other\n kinds of devices used in hospital care which may not be so this section provides for this.\u00a0\u00a0
\nThe following implementation guidance refers to insulin only. As a medicine insulin must be prescribed and dispensed (and therefore coded) as a brand name. For further information (see https://bnf.nice.org.uk/guidance/guidance-on-prescribing.html).
NHS dictionary of medicines and devices (dm+d) is the recognised NHS standard for recording and sharing of medicines information (see https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/dictionary-medicines-and-devices-dmd). Contact nhsbsa.dmdenquiries@nhs.net for further information. Dm+d concepts for recording insulin must be of the actual medicinal product (AMP) type. These contain brand/ trade family name (e.g., Humulin I KwikPen), concentration (e.g., U100 [100units/ml] suspension or solution for injection), presentation type and size (e.g., 3ml cartridge or 10ml vials) and supplier name (e.g., Eli Lilly & Co Ltd). If an appropriate dm+d concept is not available, the free text entry must contain these components. For example, the following terminology aligned to the AMP would be acceptable: \u2018Humulin I 100units/ml suspension for injection 10ml vials (Mawdsley-Brooks & Company Ltd); whereas the following wording representing the generic virtual medicinal product (VMP) would not be acceptable: \u2018Insulin isophane human 100units/ml suspension for injection 10ml vials\u2019.
Common examples of basal insulin types include:\u00a0
Trade family group\u00a0\u2502\u00a0Generic\u00a0\u2502\u00a0Concentration\u00a0\u2502Example dm+d mapped SNOMED Concept (FSN)
~Humulin I \u2502 Human isophane insulin/ NPH. \u2502 U100 \u2502 Humulin I 100units/ml suspension for injection 3ml cartridges (Sigma Pharmaceuticals Plc) (product)
~Insulatard \u2502 Human isophane insulin/ NPH. \u2502 U100 \u2502 Insulatard Penfill 100units/ml suspension for injection 3ml cartridges (Novo Nordisk Pharmaceuticals Ltd) (product)
~Lantus \u2502 Insulin glargine. \u2502 U100\u00a0\u2502 Lantus 100units/ml solution for injection 10ml vials (PI) (Waymade Ltd) (product)
~Toujeo \u2502 Insulin glargine. \u2502 U300 \u2502 Toujeo 300units/ml solution for injection 1.5ml pre-filled SoloStar pens (Sanofi) (product)
~Levemir \u2502 Insulin detemir. \u2502 U100\u00a0\u2502 Levemir FlexPen 100units/ml solution for injection 3ml pre-filled pens (Mawdsley-Brooks & Company Ltd) (product)
~Tresiba \u2502 Insulin degludec.\u2502 U100 & U200 \u2502 Tresiba FlexTouch 200units/ml solution for injection 3ml pre-filled pens (Pharmaram Ltd) (product)
Basal insulin preparations are also available as fixed-dose combinations with other (non-insulin) medications. e.g Xultophy (Insulin degludec and Liraglutide) and Suliqua (Insulin glargine and Lixisenatide)*
Common examples of bolus insulin types include:
Trade family group\u00a0\u2502\u00a0Generic\u00a0\u2502\u00a0Concentration\u00a0\u2502 Example dm+d mapped SNOMED Concept (FSN)
~Humulin S \u2502 Human soluble insulin. \u2502 U100 \u2502 Humulin S 100units/ml solution for injection 3ml cartridges (CST Pharma Ltd) (product)
~Novorapid \u2502 Insulin aspart. \u2502 U100\u00a0\u2502 NovoRapid FlexPen 100units/ml solution for injection 3ml pre-filled pens (Ethigen Ltd) (product)
~Humalog \u2502 Insulin lispro. \u2502 U100 & U200 \u2502 Humalog KwikPen 100units/ml solution for injection 3ml pre-filled pens (Ethigen Ltd) (product)
Premixed (biphasic) insulin injections include a combination of two insulins mixed together (rapid or medium acting insulin), given once, twice or three times a day e.g., Insuman Comb 25 (isophane insulin suspension of 25% dissolved insulin and 75% crystalline protamine insulin).**
For further examples (see https://www.gloshospitals.nhs.uk/media/documents/InsulinFormulary.pdf).
* An example of acceptable terminology aligned to the AMP for the fixed dose combination medication Suliqua would be: \u2018Suliqua 100units/ml / 33micrograms/ml solution for injection 3ml pre-filled SoloStar pens (Sanofi)\u2019; whereas the VMP \u2018Insulin glargine 100units/ml / Lixisenatide 33micrograms/ml solution for injection 3ml pre-filled disposable devices\u2019 would not be acceptable.
** An example of acceptable terminology aligned to the AMP for the premixed (biphasic) insulin Insuman Comb 25 would be: \u2018Insuman Comb 25 100units/ml suspension for injection 5ml vials (Aventis Pharma)\u2019; whereas the VMP \u2018Insulin isophane biphasic human 25/75 100units/ml suspension for injection 5ml vials\u2019 would not be acceptable.
", "description": "May be generic name or brand name.", "concept": [{"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Coded value", "implamentationGuidance": "When administering insulin people with diabetes rotate their injection sites (e.g. upper arms, thighs, buttocks, abdomen) to help prevent lipohypertrophy (see https://www.diabetes.co.uk/conditions/lipohypertrophy.html) and cutaneous amyloidosis (see\n https://cks.nice.org.uk/topics/insulin-therapy-in-type-1-diabetes/management/insulin-therapy-type-1-diabetes/). NICE recommends that the person alternates between the left and right side of the body on a weekly basis. CQC guidance for providers states: \u2018When nursing or care staff administer insulin, they should record where they injected the insulin each\n time. [(see https://www.cqc.org.uk/guidance-providers/adult-social-care/diabetes-insulin-use)].\u2019
\nWhen recording the dose context of an administration of insulin, the coded value field must contain only one SNOMED CT code from the following value set:\u00a0
\nSNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n789480007 | Insulin dose (observable entity) | Parent concept.
\n789497001 \u2502 Insulin dose calculated by insulin to carbohydrate ratio (observable entity) \u2502 This codes for a carbohydrate coverage bolus insulin dose.
\n789499003 \u2502 Insulin dose at breakfast calculated by insulin to carbohydrate ratio (observable entity) \u2502 This code applies for a a carbohydrate coverage bolus insulin dose at breakfast.
\n789498006 \u2502 Insulin dose at lunch calculated by insulin to carbohydrate ratio (observable entity) \u2502 This code applies for a carbohydrate coverage bolus insulin dose at lunch.
\n789500007 \u2502 Insulin dose at evening meal calculated by insulin to carbohydrate ratio (observable entity) \u2502 This code applies for a carbohydrate coverage bolus insulin dose at evening meal.
\nNew code request \u2502 Insulin dose at other calculated by insulin to carbohydrate ratio (observable entity) \u2502 This code applies for a carbohydrate coverage bolus insulin dose at other times.
\n789495009\u2502Insulin dose calculated by insulin sensitivity factor (observable entity) \u2502 This code applies for a high blood sugar correction bolus insulin dose.
\nNew code request \u2502Insulin dose at breakfast calculated by insulin sensitivity factor (observable entity) \u2502 This code applies for a high blood sugar correction bolus insulin dose at breakfast.
\n789484003\u2502Insulin dose at lunch calculated by insulin sensitivity factor (observable entity)\u2502 This code applies for a high blood sugar correction bolus insulin dose at lunch.
\n865982005\u2502Insulin dose at evening meal calculated by insulin sensitivity factor (observable entity)\u2502 This code applies for a high blood sugar correction bolus insulin dose at evening meal.
\nNew code request \u2502Insulin dose at snack time calculated by insulin sensitivity factor (observable entity)\u2502 This code applies for a high blood sugar correction bolus insulin dose at other (snack) times.
\n870499003 \u2502 Basal insulin infusion rate (observable entity) \u2502 Use if recording a basal insulin infusion dose.
\nThe fact an insulin dose was basal can be ascertained by medication name (brand name) if delivered by multiple daily injection (MDI). 'Basal' insulin delivered by pump (either continuous subcutaneous insulin infusion (CSII) or continuous intraperitoneal insulin infusion (CIPII)) uses an infusion of rapid acting insulin as a basal analogue and therefore to identify the dose as basal should be recorded using this concept (SCTID:870499003).
\nA new code request for the above items has been submitted to NHS Digital. The FSN of the final approved code may differ. For updates or queries relating to newly submitted codes contact info@theprsb.org.
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
The PRSB consultation defined a preliminary consensus around the following time blocks for recording data related to calculation and administration of insulin boluses:
\nTime block \u2502\u00a0Description\u00a0\u2502\u00a0Implementation guidance
\nBreakfast.\u2502 Any bolus administered between 05.30 and 10.29. \u2502 E.g., the bolus dose at breakfast.
\nLunch.\u2502 Any bolus administered between 10.30 and 15.29. \u2502 E.g., the bolus at lunch.
\nEvening meal.\u2502 Any bolus administered between 15.30 and 22.59. \u2502 E.g., the bolus dose at evening meal.
\nOther.\u2502 Any bolus administered between 23.00 and 05.29 \u2502 E.g., the bolus dose at other (snack) times. This includes overnight.
\nThis element supports the recording of the following types of administered insulin dose:
\n\n Basal insulin injections:\n
\nBasal insulin (delivered by multiple daily injection (MDI) as part of a basal, basal/ bolus or basal plus regimen). Basal insulin is usually administered as a reproducible dose (either as two injections of 12 hour insulin or one injection of a 24+ hour insulin). For an overview of basal insulin therapy (see https://doi.org/10.1111/dom.14552 AND see\n https://doi.org/10.1002/pdi.1846).
\n\n Bolus insulin injections:\n
\n~Bolus insulin delivered either by multiple daily injection (MDI) as part of a basal/ bolus or basal plus regimen.
\nBolus insulin is commonly administered along with a meal by people with diabetes in relation to carbohydrate content of a meal and ambient glucose level at the time of the meal and is therefore potentially very variable and is thus easiest recorded in relation to the variables which determine this (i.e., insulin to carbohydrate ratio and insulin sensitivity\n factor).
\n\n Premixed insulin injections: \n
\nA combination of two insulins mixed together (rapid or medium acting insulin), given once, twice or three times a day.
\n\n Basal insulin infusions:\n
\nBasal insulin when delivered by pump therapy is either a continuous subcutaneous infusion of rapid acting insulin (CSII) or continuous intraperitoneal infusion of rapid acting insulin (CIPII). The minimum required dosing elements to support the recording of basal insulin delivered by CSII / CIPII are Dose context (coded value) and Dose administered (start date/\n time, end date / time, value, units of measure).
\n\n Bolus insulin infusions:\n
\nModern insulin pumps have features that allow bolus insulin to be administered in up to four different ways (See https://doi.org/10.1177%2F193229680900300631), which are outlined in the table below (as applied in software-based recording). For manual bolus dose recording (where a person is not using a pump or connected insulin pens) summary data is expected to be\n recorded in the usual insulin dosing section.
\n\n Recording pump delivered bolus insulin:\n
\n\n Name \u2502 Synonym(s)\u00a0\u2502 Description \u2502 Implementation guidance \u2502 Minimum required dosing elements\n
\n~Single short bolus. \u2502 Standard bolus; quick/ fast/ easy bolus. \u2502 Bolus dose is infused/ injected all at once. \u2502 Applies to both injected and pump boluses. \u2502 One record entry of: Medication name (coded value), Dose context (coded value), Dose administered (value, units of measure, administration data and time).
\n~Two boluses. \u2502 Split bolus. \u2502 A percentage of the bolus dose (e.g. 50%) is given immediately and remainder is delivered all at once a period of time later (e.g. 30 minutes later). \u2502 Can apply to both injected and pump boluses. \u2502Two record entries of: Medication name (coded value), Dose context (coded value), Dose administered (value, units of measure,\n administration data and time).
\n~Extended bolus. \u2502 Bolus dose is delivered as an infusion over a period of time (e.g. 3 hours)\u2502 Applies to insulin pumps only. \u2502One record entry of: Medication name (coded value), Dose context (coded value), Dose administered (Start date/ time, end date / time, value, units of measure).
\n~Combination bolus \u2502 Multi-wave bolus; dual wave bolus. \u2502 A proportion of the bolus is delivered immediately (e.g 70%) and the rest is delivered as an extended bolus (e.g. 30%) over a period of time (e.g. infusion over 2 hours)\u2502 Applies to insulin pumps only.\u00a0 \u2502 Two record entries: one for a single short bolus and one for an extended bolus.
\nFurther information on CSII bolus types can be found in the following pump user guide (see https://www.accu-chek.com/download/file/fid/16301), which is referenced for illustrative purposes only without preference).
\n ", "description": "Details of dose administered.", "concept": [{"type": "item", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Value", "implamentationGuidance": "This field is mandatory if the coded value (observable entity) is shared.This field is mandatory if the coded value (observable entity) is shared.
\nThe table below details the required UCUM code for this element where the medication administered is an insulin (either as a single short bolus or infusion):
\nUCUM code \u00a0* \u2502\u00a0Description of the unit\u00a0\u2502\u00a0Parent PRSB Element\u00a0\u2502\u00a0Implementation guidance
\n[IU] \u2502 international unit **\u2502 Dose administered \u2502 Dose given as a single short bolus. Systems must display 'unit(s)' or 'international unit(s)' without abbreviation.***
\n[IU]/h \u2502 international unit per hour\u2502 Dose administered \u2502 Dose given as an infusion. Systems must display 'unit(s) per hour' or 'international unit(s) per hour' without abbreviation.***
\n* UCUM codes are mixed case American Standard Code for Information Interchange (ASCII) text.
\n** Exact UCUM description.
\n*** 'Overdose of insulin due to abbreviations or incorrect device' is on the NHS Never Events list (see https://www.england.nhs.uk/wp-content/uploads/2020/11/2018-Never-Events-List-updated-February-2021.pdf), which includes where 'overdose' refers to when:
\n~'a patient is given a 10-fold or greater overdose of insulin because the words 'unit' or 'international units' are abbreviated; such an overdose was given in a care setting with an electronic prescribing system.'
\nThe words 'unit(s)' [the norm] and 'international unit(s)' should not be abbreviated when displayed in systems implementing the standard.
\nFurther information including a full specification on the Unified Code for Units of Measure (UCUM) is available (see unitsofmeasure.org).\u00a0\u00a0
\nSNOMED CT.
\u00a0
\u00a0\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Insulin carbohydrate ratio", "implamentationGuidance": "
\u00a0
\u00a0\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Insulin sensitivity factor", "implamentationGuidance": "
\u00a0
\n\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Correction target", "implamentationGuidance": "
The person's correction target for the bolus dose administered. This includes entries for the correction target for breakfast, lunch, evening meal, or other times.
\n
\n
\n
\u00a0
\u00a0\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}]}]}, {"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "*", "mro": "R", "name": "Comment", "implamentationGuidance": "This free text comment applies to an individual dose of any medication.
As a medicine insulin must be prescribed and dispensed (and therefore coded) as a brand name. For further information (see https://bnf.nice.org.uk/guidance/guidance-on-prescribing.html).
NHS dictionary of medicines and devices (dm+d) is the recognised NHS standard for recording and sharing of medicines information (see https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/dictionary-medicines-and-devices-dmd). Contact nhsbsa.dmdenquiries@nhs.net for further information. Dm+d concepts for recording insulin must be of the actual medicinal product (AMP) type. These contain brand/ trade family name (e.g., Humulin I KwikPen), concentration (e.g., U100 [100units/ml] suspension or solution for injection), presentation type and size (e.g., 3ml cartridge or 10ml vials) and supplier name (e.g., Eli Lilly & Co Ltd). If an appropriate dm+d concept is not available, the free text entry must contain these components. For example, the following terminology aligned to the AMP would be acceptable: \u2018Humulin I 100units/ml suspension for injection 10ml vials (Mawdsley-Brooks & Company Ltd); whereas the following wording representing the generic virtual medicinal product (VMP) would not be acceptable: \u2018Insulin isophane human 100units/ml suspension for injection 10ml vials\u2019.
Common examples of basal insulin types include:\u00a0
Trade family group\u00a0\u2502\u00a0Generic\u00a0\u2502\u00a0Concentration\u00a0\u2502Example dm+d mapped SNOMED Concept (FSN)
~Humulin I \u2502 Human isophane insulin/ NPH. \u2502 U100 \u2502 Humulin I 100units/ml suspension for injection 3ml cartridges (Sigma Pharmaceuticals Plc) (product)
~Insulatard \u2502 Human isophane insulin/ NPH. \u2502 U100 \u2502 Insulatard Penfill 100units/ml suspension for injection 3ml cartridges (Novo Nordisk Pharmaceuticals Ltd) (product)
~Lantus \u2502 Insulin glargine. \u2502 U100\u00a0\u2502 Lantus 100units/ml solution for injection 10ml vials (PI) (Waymade Ltd) (product)
~Toujeo \u2502 Insulin glargine. \u2502 U300 \u2502 Toujeo 300units/ml solution for injection 1.5ml pre-filled SoloStar pens (Sanofi) (product)
~Levemir \u2502 Insulin detemir. \u2502 U100\u00a0\u2502 Levemir FlexPen 100units/ml solution for injection 3ml pre-filled pens (Mawdsley-Brooks & Company Ltd) (product)
~Tresiba \u2502 Insulin degludec.\u2502 U100 & U200 \u2502 Tresiba FlexTouch 200units/ml solution for injection 3ml pre-filled pens (Pharmaram Ltd) (product)
Basal insulin preparations are also available as fixed-dose combinations with other (non-insulin) medications. e.g Xultophy (Insulin degludec and Liraglutide) and Suliqua (Insulin glargine and Lixisenatide)*
Common examples of bolus insulin types include:
Trade family group\u00a0\u2502\u00a0Generic\u00a0\u2502\u00a0Concentration\u00a0\u2502 Example dm+d mapped SNOMED Concept (FSN)
~Humulin S \u2502 Human soluble insulin. \u2502 U100 \u2502 Humulin S 100units/ml solution for injection 3ml cartridges (CST Pharma Ltd) (product)
~Novorapid \u2502 Insulin aspart. \u2502 U100\u00a0\u2502 NovoRapid FlexPen 100units/ml solution for injection 3ml pre-filled pens (Ethigen Ltd) (product)
~Humalog \u2502 Insulin lispro. \u2502 U100 & U200 \u2502 Humalog KwikPen 100units/ml solution for injection 3ml pre-filled pens (Ethigen Ltd) (product)
Premixed (biphasic) insulin injections include a combination of two insulins mixed together (rapid or medium acting insulin), given once, twice or three times a day e.g., Insuman Comb 25 (isophane insulin suspension of 25% dissolved insulin and 75% crystalline protamine insulin).**
For further examples (see https://www.gloshospitals.nhs.uk/media/documents/InsulinFormulary.pdf).
* An example of acceptable terminology aligned to the AMP for the fixed dose combination medication Suliqua would be: \u2018Suliqua 100units/ml / 33micrograms/ml solution for injection 3ml pre-filled SoloStar pens (Sanofi)\u2019; whereas the VMP \u2018Insulin glargine 100units/ml / Lixisenatide 33micrograms/ml solution for injection 3ml pre-filled disposable devices\u2019 would not be acceptable.
** An example of acceptable terminology aligned to the AMP for the premixed (biphasic) insulin Insuman Comb 25 would be: \u2018Insuman Comb 25 100units/ml suspension for injection 5ml vials (Aventis Pharma)\u2019; whereas the VMP \u2018Insulin isophane biphasic human 25/75 100units/ml suspension for injection 5ml vials\u2019 would not be acceptable.
", "description": "The insulin name. May only be a brand name.", "concept": [{"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Coded value", "implamentationGuidance": "When recording the dose context of an administration of insulin, the coded value field must contain only one SNOMED CT code from the following value set:\u00a0
SNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
789480007 | Insulin dose (observable entity) | Parent concept.
789497001 \u2502 Insulin dose calculated by insulin to carbohydrate ratio (observable entity) \u2502 This codes for a carbohydrate coverage bolus insulin dose.
789499003 \u2502 Insulin dose at breakfast calculated by insulin to carbohydrate ratio (observable entity) \u2502 This code applies for a a carbohydrate coverage bolus insulin dose at breakfast.
789498006 \u2502 Insulin dose at lunch calculated by insulin to carbohydrate ratio (observable entity) \u2502 This code applies for a carbohydrate coverage bolus insulin dose at lunch.
789500007 \u2502 Insulin dose at evening meal calculated by insulin to carbohydrate ratio (observable entity) \u2502 This code applies for a carbohydrate coverage bolus insulin dose at evening meal.
New code request \u2502 Insulin dose at other calculated by insulin to carbohydrate ratio (observable entity) \u2502 This code applies for a carbohydrate coverage bolus insulin dose at other times.
789495009\u2502Insulin dose calculated by insulin sensitivity factor (observable entity) \u2502 This code applies for a high blood sugar correction bolus insulin dose.
New code request \u2502Insulin dose at breakfast calculated by insulin sensitivity factor (observable entity) \u2502 This code applies for a high blood sugar correction bolus insulin dose at breakfast.
789484003\u2502Insulin dose at lunch calculated by insulin sensitivity factor (observable entity)\u2502 This code applies for a high blood sugar correction bolus insulin dose at lunch.
865982005\u2502Insulin dose at evening meal calculated by insulin sensitivity factor (observable entity)\u2502 This code applies for a high blood sugar correction bolus insulin dose at evening meal.
New code request \u2502Insulin dose at snack time calculated by insulin sensitivity factor (observable entity)\u2502 This code applies for a high blood sugar correction bolus insulin dose at other (snack) times.
870499003 \u2502 Basal insulin infusion rate (observable entity) \u2502 Use if recording a basal insulin infusion dose.
The fact an insulin dose was basal can be ascertained by medication name (brand name) if delivered by multiple daily injection (MDI). 'Basal' insulin delivered by pump (either continuous subcutaneous insulin infusion (CSII) or continuous intraperitoneal insulin infusion (CIPII)) uses an infusion of rapid acting insulin as a basal analogue and therefore to identify the dose as basal should be recorded using this concept (SCTID:870499003).\u00a0
A new code request for the above items has been submitted to NHS Digital. The FSN of the final approved code may differ. For updates or queries relating to newly submitted codes contact info@theprsb.org.
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
The PRSB consultation defined a preliminary consensus around the following time blocks for recording data related to calculation and administration of insulin boluses:
Time block \u2502\u00a0Description\u00a0\u2502\u00a0Implementation guidance
Breakfast.\u2502 Any bolus administered between 05.30 and 10.29. \u2502 E.g., the bolus dose at breakfast.
Lunch.\u2502 Any bolus administered between 10.30 and 15.29. \u2502 E.g., the bolus at lunch.
Evening meal.\u2502 Any bolus administered between 15.30 and 22.59. \u2502 E.g., the bolus dose at evening meal.
Other.\u2502 Any bolus administered between 23.00 and 05.29 \u2502 E.g., the bolus dose at other (snack) times. This includes overnight.
", "description": "\n\n
\n
\u00a0
\u00a0\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Time of day", "implamentationGuidance": "
\u00a0
\u00a0\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Usual insulin carbohydrate ratio", "implamentationGuidance": "
\u00a0
\u00a0\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Usual insulin sensitivity factor", "implamentationGuidance": "
\n
\n
\u00a0
\u00a0\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Usual correction target", "implamentationGuidance": "
\n
\n
\u00a0
\u00a0\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}]}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Summary medication metrics", "implamentationGuidance": "Implementation guidance under this section refers to insulin summary metrics.
The coded value field must contain the following SNOMED CT code:
\n
\n
\n \n SNOMED CT ID\u00a0 \u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n
\n \n \n
261000004 \u2502 Closed loop (qualifier value) \u2502 No specific guidance.\u00a0
\n
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.
The coded value field must contain only one SNOMED CT concept from the following value set:\u00a0
\nSNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
\n859291000000102\u2502 Changing infusion set (procedure) \u2502 Equal of concept.
\nNew code request \u2502 Changing infusion patch pump (procedure)\u00a0\u2502 Equal of concept.
\n~New code request \u2502 Percentage of successful data capture time to total expected insulin pump wear time using insulin pump device (observable entity) \u2502 Equal of concept.
\n"}, {"type": "item", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Value", "implamentationGuidance": "This field is mandatory if the coded value (observable entity) is shared.
"}, {"type": "item", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Value", "implamentationGuidance": "This field is mandatory if the coded value (observable entity) is shared.
\n
\n
\u00a0
\u00a0\u00a0
\nAs a medicine insulin must be prescribed and dispensed (and therefore coded) as a brand name. For further information (see https://bnf.nice.org.uk/guidance/guidance-on-prescribing.html).
NHS dictionary of medicines and devices (dm+d) is the recognised NHS standard for recording and sharing of medicines information (see https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/dictionary-medicines-and-devices-dmd). Contact nhsbsa.dmdenquiries@nhs.net for further information. Dm+d concepts for recording insulin must be of the actual medicinal product (AMP) type. These contain brand/ trade family name (e.g., Humulin I KwikPen), concentration (e.g., U100 [100units/ml] suspension or solution for injection), presentation type and size (e.g., 3ml cartridge or 10ml vials) and supplier name (e.g., Eli Lilly & Co Ltd). If an appropriate dm+d concept is not available, the free text entry must contain these components. For example, the following terminology aligned to the AMP would be acceptable: \u2018Humulin I 100units/ml suspension for injection 10ml vials (Mawdsley-Brooks & Company Ltd); whereas the following wording representing the generic virtual medicinal product (VMP) would not be acceptable: \u2018Insulin isophane human 100units/ml suspension for injection 10ml vials\u2019.
Common examples of basal insulin types include:\u00a0
Trade family group\u00a0\u2502\u00a0Generic\u00a0\u2502\u00a0Concentration\u00a0\u2502Example dm+d mapped SNOMED Concept (FSN)
~Humulin I \u2502 Human isophane insulin/ NPH. \u2502 U100 \u2502 Humulin I 100units/ml suspension for injection 3ml cartridges (Sigma Pharmaceuticals Plc) (product)
~Insulatard \u2502 Human isophane insulin/ NPH. \u2502 U100 \u2502 Insulatard Penfill 100units/ml suspension for injection 3ml cartridges (Novo Nordisk Pharmaceuticals Ltd) (product)
~Lantus \u2502 Insulin glargine. \u2502 U100\u00a0\u2502 Lantus 100units/ml solution for injection 10ml vials (PI) (Waymade Ltd) (product)
~Toujeo \u2502 Insulin glargine. \u2502 U300 \u2502 Toujeo 300units/ml solution for injection 1.5ml pre-filled SoloStar pens (Sanofi) (product)
~Levemir \u2502 Insulin detemir. \u2502 U100\u00a0\u2502 Levemir FlexPen 100units/ml solution for injection 3ml pre-filled pens (Mawdsley-Brooks & Company Ltd) (product)
~Tresiba \u2502 Insulin degludec.\u2502 U100 & U200 \u2502 Tresiba FlexTouch 200units/ml solution for injection 3ml pre-filled pens (Pharmaram Ltd) (product)
Basal insulin preparations are also available as fixed-dose combinations with other (non-insulin) medications. e.g Xultophy (Insulin degludec and Liraglutide) and Suliqua (Insulin glargine and Lixisenatide)*
Common examples of bolus insulin types include:
Trade family group\u00a0\u2502\u00a0Generic\u00a0\u2502\u00a0Concentration\u00a0\u2502 Example dm+d mapped SNOMED Concept (FSN)
~Humulin S \u2502 Human soluble insulin. \u2502 U100 \u2502 Humulin S 100units/ml solution for injection 3ml cartridges (CST Pharma Ltd) (product)
~Novorapid \u2502 Insulin aspart. \u2502 U100\u00a0\u2502 NovoRapid FlexPen 100units/ml solution for injection 3ml pre-filled pens (Ethigen Ltd) (product)
~Humalog \u2502 Insulin lispro. \u2502 U100 & U200 \u2502 Humalog KwikPen 100units/ml solution for injection 3ml pre-filled pens (Ethigen Ltd) (product)
Premixed (biphasic) insulin injections include a combination of two insulins mixed together (rapid or medium acting insulin), given once, twice or three times a day e.g., Insuman Comb 25 (isophane insulin suspension of 25% dissolved insulin and 75% crystalline protamine insulin).**
For further examples (see https://www.gloshospitals.nhs.uk/media/documents/InsulinFormulary.pdf).
* An example of acceptable terminology aligned to the AMP for the fixed dose combination medication Suliqua would be: \u2018Suliqua 100units/ml / 33micrograms/ml solution for injection 3ml pre-filled SoloStar pens (Sanofi)\u2019; whereas the VMP \u2018Insulin glargine 100units/ml / Lixisenatide 33micrograms/ml solution for injection 3ml pre-filled disposable devices\u2019 would not be acceptable.
** An example of acceptable terminology aligned to the AMP for the premixed (biphasic) insulin Insuman Comb 25 would be: \u2018Insuman Comb 25 100units/ml suspension for injection 5ml vials (Aventis Pharma)\u2019; whereas the VMP \u2018Insulin isophane biphasic human 25/75 100units/ml suspension for injection 5ml vials\u2019 would not be acceptable.
", "description": "The insulin name. May only be a brand name.", "concept": [{"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Coded value", "implamentationGuidance": "When recording the dose context of an administration of insulin, the coded value field must contain only one SNOMED CT code from the following value set:\u00a0
SNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
789480007 | Insulin dose (observable entity) | Parent concept.
789497001 \u2502 Insulin dose calculated by insulin to carbohydrate ratio (observable entity) \u2502 This codes for a carbohydrate coverage bolus insulin dose.
789499003 \u2502 Insulin dose at breakfast calculated by insulin to carbohydrate ratio (observable entity) \u2502 This code applies for a a carbohydrate coverage bolus insulin dose at breakfast.
789498006 \u2502 Insulin dose at lunch calculated by insulin to carbohydrate ratio (observable entity) \u2502 This code applies for a carbohydrate coverage bolus insulin dose at lunch.
789500007 \u2502 Insulin dose at evening meal calculated by insulin to carbohydrate ratio (observable entity) \u2502 This code applies for a carbohydrate coverage bolus insulin dose at evening meal.
New code request \u2502 Insulin dose at other calculated by insulin to carbohydrate ratio (observable entity) \u2502 This code applies for a carbohydrate coverage bolus insulin dose at other times.
789495009\u2502Insulin dose calculated by insulin sensitivity factor (observable entity) \u2502 This code applies for a high blood sugar correction bolus insulin dose.
New code request \u2502Insulin dose at breakfast calculated by insulin sensitivity factor (observable entity) \u2502 This code applies for a high blood sugar correction bolus insulin dose at breakfast.
789484003\u2502Insulin dose at lunch calculated by insulin sensitivity factor (observable entity)\u2502 This code applies for a high blood sugar correction bolus insulin dose at lunch.
865982005\u2502Insulin dose at evening meal calculated by insulin sensitivity factor (observable entity)\u2502 This code applies for a high blood sugar correction bolus insulin dose at evening meal.
New code request \u2502Insulin dose at snack time calculated by insulin sensitivity factor (observable entity)\u2502 This code applies for a high blood sugar correction bolus insulin dose at other (snack) times.
870499003 \u2502 Basal insulin infusion rate (observable entity) \u2502 Use if recording a basal insulin infusion dose.
The fact an insulin dose was basal can be ascertained by medication name (brand name) if delivered by multiple daily injection (MDI). 'Basal' insulin delivered by pump (either continuous subcutaneous insulin infusion (CSII) or continuous intraperitoneal insulin infusion (CIPII)) uses an infusion of rapid acting insulin as a basal analogue and therefore to identify the dose as basal should be recorded using this concept (SCTID:870499003).\u00a0
A new code request for the above items has been submitted to NHS Digital. The FSN of the final approved code may differ. For updates or queries relating to newly submitted codes contact info@theprsb.org.
Where required codes are unavailable consideration should be given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
The PRSB consultation defined a preliminary consensus around the following time blocks for recording data related to calculation and administration of insulin boluses:
Time block \u2502\u00a0Description\u00a0\u2502\u00a0Implementation guidance
Breakfast.\u2502 Any bolus administered between 05.30 and 10.29. \u2502 E.g., the bolus dose at breakfast.
Lunch.\u2502 Any bolus administered between 10.30 and 15.29. \u2502 E.g., the bolus at lunch.
Evening meal.\u2502 Any bolus administered between 15.30 and 22.59. \u2502 E.g., the bolus dose at evening meal.
Other.\u2502 Any bolus administered between 23.00 and 05.29 \u2502 E.g., the bolus dose at other (snack) times. This includes overnight.
", "description": "\n\n
\n
\u00a0
\u00a0\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Time of day", "implamentationGuidance": "
\u00a0
\u00a0\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Modal insulin carbohydrate ratio", "implamentationGuidance": "
\u00a0
\u00a0\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Modal insulin sensitivity factor", "implamentationGuidance": "
\n
\n
\u00a0
\u00a0\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Modal correction target", "implamentationGuidance": "
\n
\n
\u00a0
\u00a0\u00a0
\n", "valueDomain": [{"type": "string", "property": [{"maxLength": "10"}]}]}]}]}]}]}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "*", "mro": "R", "name": "Medication item entry", "description": "All medications and devices that can be prescribed to be entered via this Medication item entry. Handles details of continuation / addition / amendment of admission medications.", "informationType": "Event.Record", "concept": [{"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Medication item cluster", "description": "Medication item cluster", "informationType": "Event.Record", "concept": [{"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Medication prescribed by", "description": "The type of organisation responsible for authorising and issuing the medication e.g. GP
The following implementation guidance refers to insulin only. As a medicine insulin must be prescribed and dispensed (and therefore coded) as a brand name. For further information (see https://bnf.nice.org.uk/guidance/guidance-on-prescribing.html).
\nNHS dictionary of medicines and devices (dm+d) is the recognised NHS standard for recording and sharing of medicines information (see https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/dictionary-medicines-and-devices-dmd). Contact nhsbsa.dmdenquiries@nhs.net for further information. Dm+d concepts for recording insulin must be of the actual medicinal product (AMP) type. These contain brand/ trade family name (e.g., Humulin I KwikPen), concentration (e.g., U100 [100units/ml] suspension or solution for injection), presentation type and size (e.g., 3ml cartridge or 10ml vials) and supplier name (e.g., Eli Lilly & Co Ltd). If an appropriate dm+d concept is not available, the free text entry must contain these components. For example, the following terminology aligned to the AMP would be acceptable: \u2018Humulin I 100units/ml suspension for injection 10ml vials (Mawdsley-Brooks & Company Ltd); whereas the following wording representing the generic virtual medicinal product (VMP) would not be acceptable: \u2018Insulin isophane human 100units/ml suspension for injection 10ml vials\u2019.
\nCommon examples of basal insulin types include:\u00a0
\nTrade family group\u00a0\u2502\u00a0Generic\u00a0\u2502\u00a0Concentration\u00a0\u2502Example dm+d mapped SNOMED Concept (FSN)
\n~Humulin I \u2502 Human isophane insulin/ NPH. \u2502 U100 \u2502 Humulin I 100units/ml suspension for injection 3ml cartridges (Sigma Pharmaceuticals Plc) (product)
\n~Insulatard \u2502 Human isophane insulin/ NPH. \u2502 U100 \u2502 Insulatard Penfill 100units/ml suspension for injection 3ml cartridges (Novo Nordisk Pharmaceuticals Ltd) (product)
\n~Lantus \u2502 Insulin glargine. \u2502 U100\u00a0\u2502 Lantus 100units/ml solution for injection 10ml vials (PI) (Waymade Ltd) (product)
\n~Toujeo \u2502 Insulin glargine. \u2502 U300 \u2502 Toujeo 300units/ml solution for injection 1.5ml pre-filled SoloStar pens (Sanofi) (product)
\n~Levemir \u2502 Insulin detemir. \u2502 U100\u00a0\u2502 Levemir FlexPen 100units/ml solution for injection 3ml pre-filled pens (Mawdsley-Brooks & Company Ltd) (product)
\n~Tresiba \u2502 Insulin degludec.\u2502 U100 & U200 \u2502 Tresiba FlexTouch 200units/ml solution for injection 3ml pre-filled pens (Pharmaram Ltd) (product)
\nBasal insulin preparations are also available as fixed-dose combinations with other (non-insulin) medications. e.g Xultophy (Insulin degludec and Liraglutide) and Suliqua (Insulin glargine and Lixisenatide)*
\nCommon examples of bolus insulin types include:
\nTrade family group\u00a0\u2502\u00a0Generic\u00a0\u2502\u00a0Concentration\u00a0\u2502 Example dm+d mapped SNOMED Concept (FSN)
\n~Humulin S \u2502 Human soluble insulin. \u2502 U100 \u2502 Humulin S 100units/ml solution for injection 3ml cartridges (CST Pharma Ltd) (product)
\n~Novorapid \u2502 Insulin aspart. \u2502 U100\u00a0\u2502 NovoRapid FlexPen 100units/ml solution for injection 3ml pre-filled pens (Ethigen Ltd) (product)
\n~Humalog \u2502 Insulin lispro. \u2502 U100 & U200 \u2502 Humalog KwikPen 100units/ml solution for injection 3ml pre-filled pens (Ethigen Ltd) (product)
\nPremixed (biphasic) insulin injections include a combination of two insulins mixed together (rapid or medium acting insulin), given once, twice or three times a day e.g., Insuman Comb 25 (isophane insulin suspension of 25% dissolved insulin and 75% crystalline protamine insulin).**
\nFor further examples (see https://www.gloshospitals.nhs.uk/media/documents/InsulinFormulary.pdf).
\n* An example of acceptable terminology aligned to the AMP for the fixed dose combination medication Suliqua would be: \u2018Suliqua 100units/ml / 33micrograms/ml solution for injection 3ml pre-filled SoloStar pens (Sanofi)\u2019; whereas the VMP \u2018Insulin glargine 100units/ml / Lixisenatide 33micrograms/ml solution for injection 3ml pre-filled disposable devices\u2019 would not be acceptable.
\n** An example of acceptable terminology aligned to the AMP for the premixed (biphasic) insulin Insuman Comb 25 would be: \u2018Insuman Comb 25 100units/ml suspension for injection 5ml vials (Aventis Pharma)\u2019; whereas the VMP \u2018Insulin isophane biphasic human 25/75 100units/ml suspension for injection 5ml vials\u2019 would not be acceptable.
\n337414009\u2502 Blood glucose meter (physical object)\u2502 Equal of concept.
\n\n Continuous glucose monitoring (CGM):\n
\n34865511000001109\u2502 Glucose interstitial fluid detection sensor (physical object) \u2502 Equal of concept. This includes both intermittently scanned (isCGM) and real time (rtCGM) continuous glucose monitors.
\n463729000 \u2502 Point-of-care blood glucose continuous monitoring system (physical object) \u2502 Equal of concept. This applies to intravascular and interstitial fluid monitors used in a hospital setting only.
\n| \n \n \n dm+d:- any code from the VTM, VMP, AMP, VMPP and AMPP concept classes \n | \n
SNOMED CT ID\u00a0\u00a0\u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
1055210001\u00a0\u2502\u00a0Target observable (observable entity)\u00a0\u2502\u00a0Descendant of concept.\u00a0
Where appropriate SNOMED CT codes other than the children of this concept may be selected as long as the context/ provenance that the code represents a target (for a goal or stage goal) is clear. This may require the authoring of new codes or the generation of post-coordinated expressions * in enabled systems including this concept (SCTID: 1055210001).
* For example (see\u00a0https://confluence.ihtsdotools.org/display/DOCGLOSS/postcoordinated+expression)
The following children of the above concept are a non-exhaustive list of example codes relevant to diabetes care and self-management:
SNOMED CT ID\u00a0\u2502\u00a0Fully specified name (FSN)\u00a0\u2502\u00a0Implementation guidance
446074002 \u2502\u00a0Hemoglobin A1c target value using International Federation of Clinical Chemistry and Laboratory Medicine standardized method (observable entity)\u00a0\u2502Equal of concept. NICE care process.
390896004 \u2502\u00a0Target cholesterol level (observable entity)\u00a0\u2502 Descendant or self of concept.\u00a0NICE care process.
315612005 \u2502\u00a0Target systolic blood pressure (observable entity)\u00a0\u2502 Equal of concept.\u00a0NICE care process.
315613000 \u2502\u00a0Target diastolic blood pressure (observable entity)\u00a0\u2502\u00a0Equal of concept. NICE care process.
1078215008 \u2502\u00a0Target body weight (observable entity)\u00a0\u2502 Descendant or self of concept.\u00a0NICE care process.
391105003 \u2502\u00a0Target physical activity (observable entity)\u00a0\u2502 Equal of concept.
Further work is required to identify if additional codes for diabetes related targets and goals are required.\u00a0
Where required codes are unavailable consideration should be given to the generation of appropriated post-coordinated expressions or the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.
", "description": "The coded value for the target.", "valueSets": "SNOMED CT.** NHS England and Improvement has developed a safe discharge plan for people using insulin available from (england.londoncagsupport@nhs.net).
\n ", "description": "Additional support plans", "informationType": "Event.Record", "concept": [{"type": "group", "minimumMultiplicity": "1", "maximumMultiplicity": "1", "mro": "M", "name": "Additional support plan name", "description": "The name of the particular additional supporting plan, e.g. dieticians plan, wound management plan, discharge management plan and behaviour support plan.", "concept": [{"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Coded value", "description": "The coded value for the type of care plan", "valueSets": "It SHOULD be possible in systems to view information related to a diabetic foot check together (for example assessments, examination findings, observations and images).
\nThe system SHOULD be able to receive and display eye screening images from the eye screening service using a standardised and clinically safe resolution without distortion or loss of clinically relevant detail where the eye screening system is conformant with the standard.
\nFHIR value set : - Confidentiality\n
\n "}, {"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Class", "description": "The document type e.g. report, summary, images, treatment plan, patient preferences, workflow", "valueSets": "Free text.", "valueDomain": [{"type": "text", "property": [{"maxLength": "150"}]}]}, {"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Document title", "description": "The title of the document.", "valueSets": "Free text", "valueDomain": [{"type": "text", "property": [{"maxLength": "150"}]}]}, {"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Document name", "description": "The name of the document. This should align to the PRSB document naming standard. Where the document is a KOS document this field (designated typeCode) is used to carry the DICOM Imaging procedure: This attribute shall be populated by the XDS-I Imaging Document Source from a code in the Procedure Code Sequence (0008,1032) of the performed procedure\n with which the document is associated. Values may be found in a suitable DICOM browser", "valueSets": "SNOMED CT: - As per the https://theprsb.org/wp-content/uploads/2018/11/Clinical-document-indexing-standards_NHS-Scotland.pdf \n "}, {"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Document MIME type", "description": "MIME type of the document e.g. application, pdf, audio, jpeg", "valueSets": "Free text", "valueDomain": [{"type": "text"}]}, {"type": "group", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Service", "description": "The high level imaging speciality code e.g. (R-3027B, SRT, \u201cRadiology\u201d)", "concept": [{"type": "item", "minimumMultiplicity": "0", "maximumMultiplicity": "1", "mro": "R", "name": "Coded value", "implamentationGuidance": "The coded value field for service must contain only one SNOMED CT concept that is a member of the set of referenced components in the given reference set.
\nIt SHOULD be possible in the system to view Information related to a diabetic eye screening test together (including images).
\nInformation about diabetic eye screening referrals to be recorded under the referral details section.
\nInformation about diabetic eye screening consent status to be recorded under the legal information section.
\n\u00a0
\n373031000000105 \u2502\u00a0Diabetic retinopathy screening administrative status (finding) \u2502 Descendant of concept.
\nSubtypes of this concept amongst others include:
\n374901000000103 \u2502 Excluded from diabetic retinopathy screening (finding) \u2502 Descendant or self of concept.
\n374871000000103 \u2502 Excluded from diabetic retinopathy screening as physical disorder (finding) \u2502 Equal of concept.
\n
The following codes may also apply:
\n
1103701000000102 \u2502\u00a0Diabetic retinopathy screening offered (situation) \u2502 Equal of concept.
413122001 \u2502 Diabetic retinopathy screening declined (situation) \u2502 Equal of concept.
\nThe implementation guidance in this section refers to diabetic eye screening. The screening process performed would normally be either retinal photography or ocular slit lamp procedure. As of January 2021, optical coherence tomography (OCT) has started to be delivered by diabetic eye screening (DES) services (see\n https://www.healthscotland.scot/health-topics/screening/diabetic-eye-screening/changes-to-diabetic-eye-screening). The use of OCT is not currently included in DES services (as of July 2020, see\n https://www.gov.uk/government/publications/diabetic-eye-screening-optical-coherence-tomography-in-surveillance/optical-coherence-tomography-oct-in-diabetic-dye-screening-des-surveillance-clinics). If a person with diabetes did not attend their screening appointment this should be recorded under 'screening result'.\u00a0
\n
For further information about the NHS Diabetic Eye Screening Programme (see\u00a0https://www.gov.uk/guidance/diabetic-eye-screening-programme-overview).\u00a0
282096008 \u2502 Retinal photography (procedure) \u2502 Descendant or self of concept.
\n55468007 \u2502 Ocular slit lamp examination (procedure) \u2502 Descendant or self of concept.
\n392010000 \u2502 Optical coherence tomography (procedure) \u2502 Descendant or self of concept.
\nThe following implementation guidance refers to diabetic eye screening only.
It is recommended that screening result should be coded using \u00a0SNOMED CT concepts from the following value sets although other concepts may apply.
Grade\u00a0\u00a0 \u2502\u00a0\u00a0SNOMED CT ID\u00a0\u00a0\u2502\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u2502\u00a0\u00a0Implementation guidance
Retinopathy grading
R0 - no retinopathy \u2502 201141000000103 \u2502No diabetic retinopathy (situation) \u2502 See grading guidance *.
R1 - background retinopathy \u2502 390834004 \u2502 Nonproliferative retinopathy due to diabetes mellitus (disorder) \u2502 Parent code - children that specify laterality are (SCTID: 816177009 OR 816178004). See grading guidance *
R2 - preproliferative retinopathy \u2502 193349004 \u2502 Preproliferative retinopathy due to diabetes mellitus (disorder) \u2502 Parent code - children that specify laterality are (SCTID:\u00a0769182000 OR\u00a0769181007) . See grading guidance *
R3a - active proliferative retinopathy \u2502 59276001 \u2502 Proliferative retinopathy due to diabetes mellitus (disorder) \u2502 Parent code - children that specify laterality are (SCTID:\u00a0770766000 OR 770765001). Codes should be interpreted to represent active proliferative disease unless specified as stable in the description. See grading guidance *
R3s - stable proliferative retinopathy (left eye) \u2502\u00a0816962002 \u2502\u00a0Stable treated proliferative retinopathy of left eye due to diabetes mellitus (disorder) \u2502 See grading guidance *
R3s - stable proliferative retinopathy (right eye) \u2502\u00a0816961009 \u2502\u00a0Stable treated proliferative retinopathy of right eye due to diabetes mellitus (disorder) \u2502 See grading guidance *
Additional codes that are subtypes of the following concept may be needed to support the reporting of a retinopathy result and should be used as appropriate:
SNOMED CT ID\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0Implementation guidance
4855003 \u2502 Retinopathy due to diabetes mellitus (disorder) \u2502 See grading guidance *.
Maculopathy grading
M0 - no maculopathy (left eye) \u2502\u00a0860709007 \u2502No disorder of macula of left eye due to diabetes mellitus (situation) \u2502 See grading guidance *.
M0 - no maculopathy (right eye) \u2502 860710002 \u2502 No disorder of macula of right eye due to diabetes mellitus (situation) \u2502 See grading guidance *.
M1 - maculopathy \u2502 232020009 \u2502Disorder of macula due to diabetes mellitus (disorder) \u2502 Parent code - children that specify laterality are (SCTID:\u00a0769245002 OR 769244003). See grading guidance *.
Additional codes that are subtypes of the following concept may be needed to support the reporting of a retinopathy or maculopathy result and should be used as appropriate:
SNOMED CT ID\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0Implementation guidance
232020009 \u2502 Disorder of macula due to diabetes mellitus (disorder) \u2502 Descendant of concept. See grading guidance *.
4855003 \u2502 Retinopathy due to diabetes mellitus (disorder)\u00a0 \u2502 Descendant of concept.
Photocoagulation grading
P0 -\u00a0 No photocoagulation scars \u2502\u00a0414902006 \u2502On examination - No retinal laser photocoagulation scars (situation) \u2502 Equal of concept.\u00a0
P1 -\u00a0 Photocoagulation scars \u2502\u00a0394718001 \u2502 On examination - Laser photocoagulation scars (finding)\u2502 Equal of concept.\u00a0
If a person did not attend their appointment the following concept should be used:
SNOMED CT ID\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0Implementation guidance
201751000000104 \u2502 Did not attend retinal screening (finding) \u2502 Equal of concept
If the image is ungradable only one SNOMED CT concept from the following value set should be used:
SNOMED CT ID\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0Fully specified name (FSN)\u00a0\u00a0\u00a0\u2502\u00a0\u00a0\u00a0Implementation guidance
New code request \u2502 Diabetic digital retinal screening image ungradable (finding) \u2502 Suggested parent.\u00a0
New code request \u2502 Diabetic digital retinal screening image of left eye ungradable (finding)\u00a0\u2502 No specific guidance.
New code request \u2502 Diabetic digital retinal screening image of right eye ungradable (finding)\u00a0\u2502 No specific guidance.
New code request \u2502 Diabetic digital retinal screening image of bilateral eyes ungradable (finding)\u00a0\u2502 No specific guidance.
A new code request for the above items has been submitted to NHS Digital. The FSN of the final approved code may differ. For updates or queries relating to newly submitted codes contact info@theprsb.org.
Where required codes are unavailable the free text field should be used and consideration given to the submission of a new code request to UK SNOMED CT request submission portal (see https://isd.digital.nhs.uk/rsp/user/guest/home.jsf). Contact info@thePRSB.org for further information.\u00a0
* For further information on grading definitions (see\u00a0https://www.gov.uk/government/publications/diabetic-eye-screening-retinal-image-grading-criteria/nhs-diabetic-eye-screening-programme-grading-definitions-for-referable-disease).\u00a0
The system SHOULD be able to receive and display information about a person's attendance at structured education courses where other systems are conformant with the standard.
\nDetails of attendance and outcome to be recorded in this section and details of referrals to structured education to be recorded under referral details.
\n