2019-03-25 - OBSERVABLE Meeting

• None stated

Draft editorial guidelines: Editorial Guidelines for Diagnostic Products Used for Susceptibility Testing

It was decided to recommend representation the physical form of the susceptibility test product, and also to use the | has presentation strenght... | attributes (as opposed to other strength attributes).

Two issues were discovered while re-reading the Inception/Elaboration document for susceptibility testing: 1. "oral form antibiotic susceptibility" exists as components in LOINC tests. 2. when other methods than culture are used, e.g. PCR or sequencing, to determine susceptibility, we might need to use another way of modeling, e.g. beta-lactamase producing ~ resistance towards beta-lactam antibiotics.

While the Susceptibility test products are needed for the mycobacteria tests (with strength-specified antibiotics), we might reconsider the approach for other cases, and use substances where products are not needed, together with a role chain | towards | o | ingredient | → | towards |.

Rob: Aren't all susceptibility tests strength-specified, even though the strength is not part of the definition?

Xavier: EUCAST breakpoint for diffusion disks : http://www.eucast.org/clinical_breakpoints/ the xls is at http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/Preliminary_v_9.0_Breakpoint_Tables_for_consultation.xlsx breakpoint requires a definite antibio amount in the disk.

Most tests (mycobacteria tests being an exception) are based on there being a concentration gradient (e.g. disk diffusion, etest, MIC procedures) and thus not a single concentration.

Modeling of 703745000 | Sulfamethoxazole and trimethoprim (substance) | seems odd, particularly the | Is modification of | attribute.

2019-02-11:

An OWL ontology with Diagnostic test products and susceptibility observables is attached.

The combination substances are to be inactivated, so modeling cannot rely on use of such concepts.

2019-03-25:

An alternative version not using combination substances was presented and discussed.

See 2018-10-16 - OBSERVABLE Face-to-face Meeting, Item 6.

• Update of | technique | to include | Assessment scale | in range.
• Allow use of | direct substance | to model observables.

What are the requirements for testing MRCM change proposals?

Examples of modeling of Observables with | technique | = | Assessment scale | was presented.

Technique

Editorial Panel: “As discussed at the Editorial Panel meeting, assessment scales are normally used as a device or tool that is different to techniques. Can we have additional information about requirements and benefits? Should a different attribute be considered?”

Response: "an assessment scale is a combination of the actual scale (e.g. 1-5, yes/no, +, ++, ...) and the technique (or tool!) used to make the observation and to go from the observation to the scale value. Thus, alternatively, one could create new technique concepts for each assessment scale, BV e.g. EQ-5D technique, Apgar appearance technique. That would generate several new concepts with limited benefit over using assessment scale concepts directly."

SH: agrees with response, if necessary there are examples from the UK.

The changes are presented on the Early Visibility page here.

2019-03-25: extension of the range of | technique | to include << | assessment scale | was approved. The | direct substance | proposal missed the deadline for July 2019.

See comments on this page.

The FSNs are generally under-specified compared to how concepts have been used. We need to decide whether to retire, rename, remodel, add or leave as is.

E.g. the blood pressure observables FSNs do not specify time aspect. Can we assume that they are single point in time or not?

The guidance given by the EAG was that we should allow more consideration of reasonable clinical interpretation and also to allow updating and clarification of FSNs if deemed necessary. Data concerning clinical use of the concepts should be used to inform decisions. Ambiguous concepts which are not in significant use may be retired.

As this might disrupt implementations the updated guidance should be discussed with the MF and CMAG. A briefing note has been sent out. Comments from MF and CMAG should be provided by 2019-01-31.

Two comments had been added 2019-01-21. Input from UK is to be expected.

Comments available here:

CMAG: Modelling of existing content in the Observable Entity hierarchy

MF: Modeling of existing content in the Observable entity hierarchy

Examples of changes which might happen include move of "target" and "aggregate" (e.g. 24 H) observables. Issues exist with concepts which might likely be confused, e.g. 271649006 | Systolic blood pressure (observable entity) | and 72313002 | Systolic arterial pressure (observable entity) |.

SH: Those changes are likely to be acceptable. This precision is however not needed for vital signs, but rather for laboratory medicine observables.

Copied from the Vital signs incept./elaborat. document:

Target observables

Among the 46680005 | Vital sign (observable entity) | observables, there are a few "target" observables: 428420003 | Target heart rate (observable entity) |, 315612005 | Target systolic blood pressure (observable entity) |, and 315613000 | Target diastolic blood pressure (observable entity) |. These concepts would not be considered vital signs according to the definition used in this document. While the representation of such targets have not yet been elaborated on, it is clear that a target observable is distinct from a "ordinary" observable, particularly true for e.g. 390734006 | Target weight (observable entity) | and 27113001 | Body weight (observable entity) |. There are related JIRA tickets: IHTSDO-457, PCP-5, IHTSDO-39 and also some potentially related tickets: IHTSDO-356, IHTSDO-308.

Here is a presentation from a previous Observables meeting.

Here is an updated presentation. This was presented and discussed.

Likely, Observables and Settables should be disjoint.

Quick comments during the meeting supported the separation of "observation observables" from "observation targets".

• A meeting has been requested and a half-day slot has been granted
  • Cognitive function observables, etc. Invite MH CRG
  • Existing modeled Observables
  • Susceptibility

• Next meeting will be 2019-04-08 13.30 (London time)