Clinical Core_CMAG input on content for inclusion

I was sure I'd posted comments about this somewhere before, but apparently not. So I agree with the focus on a core set. But it's going to be really hard to tie that down.

• I'd start with only content that has an associated Concept model, or is accessible by such (Ranges of concept model).
• This still includes most of the hierarchies but excludes a few. The "range" limit, excludes a lot of the qualifiers.
• For some of the other primitive hierarchies, focus on the clinically relevant.
  • Substances - drugs and biological materials. Maybe general chemicals. Probably exclude "prepared foods" like "Baked beans canned in tomato sauce with pork sausages (substance)"
  • Organisms - microbes..
  • etc.
• A lot of the suggestions above, I don't think are going to provide much gain by not maintaining.
  • e.g. laterality. I don't see left/right variants adding much in the way of maintenance.
  • Similarly for some of the compound concepts. If A is correct. And B is correct. Keeping A+B should come at no cost?
  • If users demand such concepts, each extension will end up creating them anyway.
• Severity - I'd agree in that it's a subjective adjective. But there are some concepts where some level of universal agreement/application might exist. e.g. depression.
• Groupers - again, these are low value but would seem to be no cost to keep. They also help reduce "wide expansions" on the taxonomy, maybe more an aesthetic thing.

I don't think the intention was such content would "go", rather just not be actively maintained. But once a concept was been QA'd - there shouldn't be any further maintenance required. At least until concept models or terming conventions change.

In the Canadian NRC, we have discussed this topic and we feel that before diving in the "weeds", basic questions should be answered and main principles established and agreed upon. We think that more joint discussions should be held and concerns and convergent agreements documented in a centralised area on Confluence. We need reassurance that the impacts (both negative and positive) on the NRCs, vendors, clinicians, researchers, patients, consumers, have been evaluated and are understood by all interested parties. 

We agree with Matt that maintenance should be maintain to a high quality level for all Editions content, understanding that after the current QI, less will need to be done, and so we don't compromise the future terminology quality. We need to assure it does not go against tenants of good terminology.

We have asked Alastair, that this topic be brought again to the MF for further discussion. We are looking forward to Rory's meeting to provide some answers to our questions as well.

Comments on the Clinical Core that were provided by Olivier Bodenreider can be located as a comment on: 2019-05-14 - CMAG Meeting.

The spreadsheet provided to the group has not been used been used by group members to make comments. 

In addition to the comments from group members above, the following has been drawn from the CMAG calls in May and June to draw all responses onto one page. Where points raised on the calls are already represented above they have not been repeated here. 

• The need for use cases to help develop the scope of the clinical core, international edition and community edition
  • Examples: International patient summary, collaborations between countries
• Inclusion of content that is required in subsets e.g. Core Problem List
• Communication on this topic is key- clear, positive messages explaining what is happening and why
• The need for sharing of information between groups discussing this.
  
  

Dear All,

this is a difficult question indeed, and since this is summer, I have not had the possibility of discussing this with my NRC colleagues.

I agree with Olivier Bodenreider that content which can be maintained with little effort can be included in the core, and I agree with Matt Cordell and Olivier Bodenreider that "atomic", "primitive" content important for use in definitions of other concepts needs to be of high quality and is thus also a priority. I also agree with the need for content to support the Core problem list, any WHO-FIC classification mappings, International patient summary etc.

The rest, e.g. which findings or procedures go in the core and which are out, seems almost impossible to determine, for the detailed content needed in real-world implementations, it's often the case that concepts need to be added anyhow, so perhaps SNOMED International should focus not on the content per se but developing templates, rules, guidelines, expanding the concept model, all to allow others (NRCs, working groups) to contribute in a more consistent manner.

/Daniel

I escalated this proposal to the UK Edition Committee for their input.  The feedback I received was that, before the Committee could contribute to an NHS Digital response on what content should be considered for 'active maintenance', they required more information relating to the Clinical Core, i.e. why this is being done / what is the motivation, how will such work be prioritised, and how this will be presented as a product.  The suggestion was made that it would be helpful to have someone from SI dialling in to the next Edition Committee meeting in September.