Dear members of CMAG,
In Sweden stakeholders have called for a general quality improvement of the hierarchy <<274035004 |Removal of urinary calculus (procedure)| Urologists points out that they find the hierarchy to be unstructured, with some concepts detailed and some are not. There is a lack of intermediate concepts. Many concepts are primitive.
The suggestion is to better/more clearly divide children concepts after method (open/endoscopic). The endoscopic ones should be modelled
I support this. (The modelling issues/inconsistency are not exclusive to this subhierarchy).
A review/revision of the existing content would be a great start. Determining what precoordinated content is missing generally requires some reference implementation/engagement, so as not to avoid generating unnecessary combinations.
I also agree with not using anything more specific than "Urinary endoscope" unless the FSN specifically refers to a specific scope. There may be procedures that could be refering to a site OR specific scope (maybe this is a english thing?) And if there are procedures (accurately) modelled with specific scopes, it's probably useful to (always?) have a more general "Urinary endoscope" supertype also.
A request has been received regarding the terming of the concept 169826009 |Single live birth (finding)| as it could be interpreted to mean a single live birth from a singleton pregnancy or alternatively a single live birth from a multiple pregnancy. The requester suggested it be re-termed to make it clear it was from a singleton pregnancy.
This concept has high usage when looking at UK usage data.
The concept looks to be derived from ICD 10. In ICD Z37 Outcome of delivery has the exact wor
Hi all,
Please be advised the following changes have been made for the December 2024 release.
169826009|Single live birth (finding)| has been updated to 169826009 |Single live birth from singleton pregnancy (finding)|. A synonym Singleton live birth has been retained.
A new concept 1351929005 |Single live birth from multiple pregnancy (finding)| has been added.
Kind regards,
Cathy Richardson
10756101000119107 |Group B streptococcus infection in mother complicating childbirth (disorder)| is stated as a child of 32801000119106 |Infectious disease in mother complicating childbirth (disorder)|, which makes it a descendant of 40733004 |Infectious disease (disorder)|. However, it has an acceptable synonym of "Group B streptococcus carrier in childbirth". So, carrier of B streptococcus in childbirth = to infection of streptococcus B in childbirth. Normally a carrier of a germ isn't
Currently the subtypes of 66598005|Infectious disease carrier (finding)| are modelled the same an "infection", with the addition of "interprets=General clinical state" (which doesn't really say anything, and inherited form much further up the hierarchy).
I feel like we need a "pathologic process" less specific than infection to represent this... something like "colonised".
Because arguably these concepts ARE infections. They're asymptomatic (as opposed to symptomatic) infections. (Which is probably a better FSN for these)
See: 699433000|HIV carrier| - does this person have an "HIV infection"?
Symptomatic infections are also "carriers" too...
There was a discussion years somewhere about commensal organisms and pathogenic organisms, and parasitism.
I wonder if this was perhaps the orginal intention of the "pathologic process heirarchy"? With "parasitic process" being a subtype of "infections process".
"Infection"==colonised. "parasitism" == harm to the host.
The current use of a different process (parasitic) for subset of organisms (parasites) - has always seemed like a tautology.
Hi,
I'm struggling with the clinical differences and the differences in modeling between injury, wound and lesions. For example 'injury of breast' vs 'wound of breast' vs 'breast lesion'.
Thank you for pointing this out.
Kind regards, Katrien
Hi kscheerlinck , This is a complex area. We do have an open tracker on the topic: Please add yourself as a watcher. I'll follow up further internally. Cathy
Wherever a clinical drug concept in the International edition of SNOMED CT uses the term 'international unit' this will be replaced with the internationally recognized abbreviation IU without expansion of this abbreviation. The planned change will be made to 20 clinical drug concepts and the abbreviation IU will be noted as an exception in the Editorial Guide.
Please add any comments or feedback to this page by no later than 30th June.
Thank you
Hi Cathy,
Thanks - This update is acceptable to drug content in Ireland. The Irish drug extension prefers the use of the full term 'international unit' across concepts where possible - but 'IU' is an acceptable abbreviation where needed, given;
- its widespread use in trade/brand descriptions of marketed products that will relate to the clinical drug ('real clinical drug' and 'real packaged clinical drug' concepts)
- the recognition of this specific abbreviation by our National Competent Authority (NCA) - Health Products Regulatory Authority
- the recognition of this specific abbreviation across multiple countries by the relevant NCAs (https://www.ema.europa.eu/en/documents/other/acceptability-iu-abbreviation-international-units-strength-human-medicinal-products_en.pdf https://www.ema.europa.eu/en/documents/other/acceptability-iu-abbreviation-international-units-strength-human-medicinal-products_en.pdf)
If a national need arises (e.g. patient safety issue) that the 'IU' abbreviation is not to be used in a specific clinical drug concept we have the option of creating a national level preferred term with the fully expanded term. With 20 clinical drug concepts affected (and even assuming expansion over time) this is manageable through national policies/guidance.
cc: tbarry
Regards,
Shane
TNM content of the AJCC has been added to SNOMED in one of the last releases. In the Netherlands we miss some categories that are not used in the USA. If more countries needs this part as well we can ask them to add them to the international release. Else we are in contact with AJCC to be able to add them to our extension.
It concerns codes for all possible ycT, ycN, rT, rN and rM categories
Are there more countries that also use this part of the TNM categories and needs them in SNOMED?
M
New subtypes added to 1222584008 |American Joint Committee on Cancer allowable value (qualifier value)|
Based on requests from several member countries through the Content Managers Advisory Group (CMAG), AJCC approved the addition to SNOMED CT of new cancer staging content as part of a joint collaborative process agreed between both organizations.
Following an AJCC review of the requested new content 248 new concepts were added to SNOMED CT for publication in June 2023.
Some finding-concept got inactivated with only a replacement by a disorder-concept. For example '16386004 Dry skin (findig)' got replaced by 52475004 |Xeroderma (disorder)| ; The observation and identification of having a dry skin, doesn't always go together with a pathological condition (disorder). My question, is this inactivation temporary and will there be a replacement by a finding concept in the future?
Hi Katrien
yes to terminology deferring to the data model. So let the data model have elements called 'Complaint', and 'Diagnosis' and lightly constrain the value domain; as happy clinicians are (in general) the source of the universe of discourse of the data model.[But don't forget contingent truths such as those in clinical inferencing systems which can help us decide on grey areas such as Family history of..; laterality and Situations. ]
I think we may be in agreement about not splitting too finely between findings and disorders. It's a clinician's prerogative to use both, or neither; eg GPs will use procedure terms in problem lists , past history lists and in reason for encounter. GPs will prob want their ICPC2Plus-like interface for some time as clinical users just see the preferred terms in front of them. There is a balance between over-constrainting within ISO:11179-like value domains and losing the hearts and minds of your clinical user base. I like your term frequency bottom-up approach thus far. I hope your terminologists and data modellers communicate well and also that the GPs can see some clinical benefits for their terming efforts.
From the secondary data use view, poor quality clinical terming data entry remains a prominent and ongoing concern for health information managers. There is a need to provide some context-aware guidance such as perhaps prompting for "acute" or "chronic" if the term is to be "bronchitis (disorder)" as these are different disorders not simply qualifiers on a bronchitis concept; but some data element refset scaffolding is required at the very least.
Metrics around what is a good level of data cleaning necessary for an appropriately constrained value domain; may exist to put some numbers on this balance. I'm thinking of precision and recall which are data science metrics in this regard.
In Australia there are multiple terming systems in GP software due to historical reasons whereby the GPs computerised first which is why I was wondering about UK experience. Sounds like Belgium has implemented SNOMED interfaces at the community level - congrats!
On meaning, data models have a kind of meaning-in-use, but it's implicit and we are ever-beguiled by names. (?data dictionary anyone..)
The "reference" in a reference terminology/mathematical ontology such as SNOMED comes from reference theories of meaning. According to adherents such as Bertrand Russell, names are simply abbreviated descriptions and meaning comes from multiple true statements about unique existent objects. This is formal and fundamental and its why description logics work.
But why bother? Before we had computers we went from commonly used free text terms and phrases and a full free text clinical narrative to classifications. If robust communications evolved amongst subcultural parts of the health system, implicit meanings were mostly shared.
Now we might start with an assumption that computers are both everywhere and remain dumb, and while syntactical algorithms such as NLP gets us some of the way, that words possess meaning which is "URU" (Understandable, Reproducible and Useful) becomes formalised so that the maths works when computers use SNOMED. (That SNOMED is a UMLS-like hub on a wheel that other systems can map to is to demote SNOMED to just another hub candidate.)
Semantic messaging, terminology binding to detailed clinical models such as with FHIR or ISO:13606 or openEHR archetypes and clinical decision support need computers and their algorithms to be able to "look up" meaning.
cheers
Peter
The concept 704497002 |Uses British sign language interpreter (finding)| has been raised for inactivation at the international level. Prior to proceeding with this we are looking for the need for this concept outside of the UK. Would you please advise if British sign language is used in your country.
I'm wondering if other countries have guidelines for brand names in FSN?
We more and more can't avoid the use of brand names in FSN, especially in lab domain. For example a KC type analyzer can give slightly different results depending on the brand used.
Our guidelines state not to use brand names in FSN, but I think we will come to exceptions on that guideline. I also read that Snomed Int will add vaccination brands to SNOMED (janssen&janssen, pfizer, astrazenica etc).
How do other co
In UK, we are sometimes asked to author for example procedures that include a brand name of a device used. However we follow editorial policy on this and do not add concepts with brand names - we try to work with requestor to reword the description so that the brand name is not included and if it is not possible, we would not author it.
Thanks, Cathy,
I also asked the same question to Don Sweete on Tuesday’s MF meeting because he talked about a renewing of the agreement with Regenstrief. He hoped for a more open approach to this issue. /Camilla
Matt Cordell