This is an issue which has emerged in the COVID-19 work but is familiar to me from UK GP systems.
In theory the inferencing and relationships in SNOMED-CT should allow us to use any synonym in place of the defining concept.
e.g in the current COVID symptoms
‘Sore throat’ is actually a synonym
2164213014 for the fully-specified name
162397003 | Pain in throat (finding) | is the
as it should be possible for the underlying system to query for
162397003… and get any of the codes which are synonyms of …
However in practice, this has been difficult for systems to engineer for fast querying responses so that current practice in UK is to carry any synonym codes alongside the defining concept code (in out world as a mapping) with th
See the FHIR UK Condition Care-connect profile for an example.
Perhaps this is just a historical artefact that more modern systems can handle easily? Or is it just good practivce that we should follow - and if we do decide to carry both, how dod we organise the values, because actually
the value I would argue clinically should be what I want me, colleagues and patients to see - ‘difficulty breathing’
but arguably the definig_code/code_string should actually be the concept_code.
Either way open to interpretation and we need to agree an approach, as it will be critical in querying. Arguably the FHIR codeableConcept make this a little easier (if a little less precise) since the list of mappings is flatter.