Prioritisation of Content Tracker Components

General comments:

Taking into account the Member response and prioritisation criteria the group have suggested the following priorities for these components. It needs to be noted that the priority for an individual tracker issue may well be different from the component level priority. Components that were either not identified by members as a priority and/or are not blocking CRS requests have been given a priority of 4 for now and will require further analysis prior to determining next steps. Some of these individual trackers may require a higher level of priority.

In addition to the work done by the group, tracker issues which are blocking CRS requests more than XX (TBA) should be given a priority of 1.

Identification of issues that should be in a component were identified via individual review and where time permitted word searches. Further word searches would assist in determining of there are missing tracker items.

Group analysis:

Focus Area Trackers: XXX some may be more than one component (total excludes last row)	Scope of Content	Member Priority Summary	Member Comments	Daniel	Linda	John	Cathy	Elaine	Group member comments	Final rating
Concept Modelling, Attributes and Values Trackers: 47 Modelling Review	This area focuses on the review (or addition) of attributes and the values that can be applied to them. While not a clinical area per se, work in this area supports the defining and quality of content which in turn supports implementations and secondary use.	3 countries high, 1 country medium. Have added AU input here.	AU: We'd rather see effort directed at the foundational quality ie. the first two items in the above list "Concept Modelling, Attributes and Values" and "qualifier values". This covers a lot of stuff, but if this isn't solid, the quality of the rest of the terminology suffers. Examples of things like the the organisation of 129264002\|Action (qualifier value)\| (the range of Method) affects the modelling of all procedure concepts.	(2+3+3)/3=2.67	(2+3+3)/3=2.67 I think this component and the Qualifier Value are quite linked	(2+3+3)/3=2.67	(2+3+3)/3=2.67 Overall rating using tracker priorities - recommend high.	(2+3+3)/3=2.67	Group: This component has a mix of issues and while overall priority for the component is high, the priority of the issues at an individual level needs to be considered. CRI: Clinical impact difficult to determine so went for average as I would expect there to be some. DKA: Agree that clinical impact is difficult. A wide clinical range of issues in this box. User and terminology impact can be assumed to be high. However, given the diversity the component level might not be the right level of prioritization for this one. EWO: I'm not sure many clinicians are focused on the complexities of SCT yet. Clinicians may do subsumption based queries but are more concerned that content looks correct in the patient record - no errors, odd abbreviations etc But any work to correct/assign parents would be seen as very useful indeed so some tracker items more clinically high priority than others.	Priority 1 for the component though noting this component contains a variety of issues and the actual priority of an individual issue would vary. Ave group rating: 2.67
Qualifier Value Trackers: 18 Pattern Review Hierarchy Cleaning Modeling Review	Remodeling related to new attributes and new content. Clarification of meaning of existing content.	2 countries high, 2 countries medium Have added AU input here.	Singapore: Better clarification of qualifier values would be beneficial as we use this hierarchy in our drug product concepts rather extensively. Comments: It would be good for us to be updated of the changes made as it might have impact to our Singapore Drug Dictionary. AU: We'd rather see effort directed at the foundational quality ie. the first two items in the above list "Concept Modelling, Attributes and Values" and "qualifier values". This covers a lot of stuff, but if this isn't solid, the quality of the rest of the terminology suffers. Examples of things like the the organisation of 129264002\|Action (qualifier value)\| (the range of Method) affects the modelling of all procedure concepts.	(2+3+2)=2.33 At least 85 requests → high user impact. Hard to determine terminology impact as most of Qualifier value hierarchy is not used in definitions. Qualifier values are tightly coupled to the domains in which they are used.	Here is my raking if the drug concepts are dealt rather in the Drug Project.(2+3+3)/3=2.67 Here is my rating if this work is not part of the Drug Projec(3+3+3)/3=3 I think this component and the previous one are quite linked	(2+3+3)=2.67	(2+3+3)/3=2.67 Overall rating using tracker priorities - recommend high.	(2+3+3)/3=2.67	CRI: Clinical impact difficult to determine so went for average as I would expect there to be some. DKA: Yes, clinical and terminology impact hard. Also, component level prioritization might not be helpful here. EWO:agree it would be useful to look at in more detail though there is increasing interest in post-coordinated expression from clinicians.	Priority 1 for the component. Ave group rating: 2.67
Clinical Finding: Neoplasm Trackers: 21 Pattern Review Hierarchy Cleaning Modeling Review	Naming conventions reviews and improvement of modeling of malignant disorders.	2 countries high	UK: As well as a general clean-up, we could suggest the creation of precoordinated cancer >disorders< which are currently expressible only as morphology concepts. (we could provide input in making suggestions on identifying these).	(3+3+3)=3 User impact: cannot see how many CRS tickets are related to this. Terminology impact: 3644 matches "neoplasm" (disorder, group by concept). 55342001 \| Neoplastic disease (disorder) \| has 7515 descendants (~ 10 % of all disorders), used to define 485 other concepts. Are not used to define other concepts.	(2+2+2)/3=2 Should that work be part of the collaborative work with WHO?	(2+3+3)/3=2.67	(3+2+2)/3=2.33 Overall rating using tracker priorities - recommend high.	(3+3+2)/3=2.67	CRI: Neoplasm work here basically outside of the WHO collaborative work. EWO: on searching CRS for Neoplasm in inception/elaboration there are 96 requests.	Priority 1 for the component. Ave group rating: 2.53
Clinical Finding: Obstetrics Trackers: 18 Pattern Review Hierarchy Cleaning Modeling Review	Revision work on abortion concepts and the modeling of antenatal and postnatal content.	2 countries high	UK: Disambiguation of therapeutic/iatrogenic abortion versus spontaneous abortion ('miscarriage') would be especially welcome albeit no small task. Many classifications type concepts that would not sensibly be applied within a real time individual patient could be deprecated. Also issues with “subjects of record” e.g. - Foo disorder complicating pregnancy, childbirth AND/OR puerperium - Foo disorder in pregnancy - [not yet] delivered - Foo disorder >in mother< etc. - Foo disorder >affecting management of mother<	(2+2+2)=2 Terminology impact: 198609003 \| Complication of pregnancy, childbirth and/or the puerperium (disorder) \| has 1315 descendants, 248982007 \| Pregnancy, childbirth and puerperium finding (finding) \| has 1979 descendants (489 in common w Complication...) + some other ones spread out. Are not used to define many other concepts (62 and 188 respectively).	(1+2+2)=1.67 I saw in other component tickets obstetrics, perhaps all ticket on that topic should be grouped together	(2+2+2)/3=2	(2+3+1)/3=2 Overall rating using tracker priorities - recommend - medium	(3+2+2)=2.33	CRI: did a search added Clinical Finding Obstetric issues. There is a small number of procedure ones as well which given interest should also be considered. EWO: Some highly emotive content so rated high clinically. Couldn't see how many requests were linked so rated 2 based on other explanations.	Priority 2 for the component. Ave group rating: 2
Procedures/Qualifier Value: Pathology Trackers: 27 Pattern Review Hierarchy Cleaning Modeling Review	Issues include cancer synoptic reporting, hierarchy reviews, specific issues e.g. measurement activity vs. quantity, units of measure, specimens	2 countries high		(2+2+3)=2.33 Terminology impact: high, as Observables is a new area, might require update of concept model guidance.	(2+2+2)=2 There seem to be duplicated ticket in the different component trackers. Linkage and dependencies should probably be determined before tackling this one.	(2+2+2)/3=2	(3+3+3)/3=3 Overall rating using tracker priorities - recommend high.	(3+3+3)/3	CRI: Units of measure in this group also covered under Qualifier Value and the Units of Measure tracker. EWO: There a lot of implementations in this area and high focus at present internationally for cancer and genomics	Priority 1 for the component. Average group rating: 2.47
Observable Entity Trackers: 21 Pattern Review Hierarchy Cleaning Modeling Review	Large review of observables and investigation procedures - including modeling but also specific areas such as functioning observation results	1 country high, 1 country medium		(2+3+3)=2.67 Clinical impact: hard to assess as it spans a wide range of clinical domains. User impact: 20 trackers, 28 CRS tickets (+ everything related to LOINC mapping) Terminology impact: high, as Observables is a new area, might require update of concept model guidance. Observables used to define 26721 other concepts (mostly findings).	Would the functioning observation results mean there would be a need to model more content in other hierarchies?	(3+2+2)/3=2.67	(3+3+3)/3=3 Overall rating using tracker priorities - recommend high.	(3+3+3)/3=3		Priority 1 for the component. Ave group rating: 2.83
Procedure: Diagnostic Imaging Trackers: 8 Pattern Review Hierarchy Cleaning Modeling Review	Remodeling and naming pattern review of imaging procedures and sub hierarchies such as gastrointestinal imaging, angiographies, Ultrasound scan - obstetric, Radiography vs. X-ray and others	1 country high, 1 country medium		(2+2+3)=2.33 Terminology impact: 5352 descendants of 363679005 \| Imaging (procedure) \| used to define 595 other concepts.	(1+2+2)=1.67	(2+2+2)/3=2	(2+2+2)/3=2 Overall rating using tracker priorities - recommend - medium	(3+3+2)/3=2.67	EWO: Heavily used content with large number of implementations and impacts high priority clinical areas.	Priority 2 for the component. Ave group rating: 2.13
Qualifier value: Units of Measure Trackers: 4 Pattern Review Hierarchy Cleaning Modeling Review	Reviewing of possible duplicated content and remodeling to align to agreed patterns.	1 country high, 1 country medium	Singapore: The usage of Qualifier Value: Units of measure is heavily used in our drug product concepts. Better refined UOM would be of good assistance. Comments: It would be good to share the remodelling agreement/document for Singapore Drug Dictionary to allows us to assess the impact to our use in the definition of strengths for our drug product concepts. Question: Any plans to map UOM to UCUM?	(1+1+1)=1 Clinical/user impact: there are other standards (UCUM) Terminology impact: 1177 descendants of used to define 0 (zero) concepts If used in national drug models, it could be higher.	Here is my raking if the drug concepts are dealt rather in the Drug Project.(2+3+3)/3=2.67 Here is my raking if this work is not part of the Drug Projec(3+3+3)/3=3	(3+2+3)=2.67	(3+3+2)/3=2.67 Overall rating using tracker priorities - recommend high.	Agree with Linda re relationship to drug work so either 2.67 or 3		Priority 1 for the component. Average group rating: 2.47
Situations/Context Trackers: 23 Pattern Review Hierarchy Cleaning Modeling Review	Reviewing patterns and concept modeling for content such as: No known allergies and other Non-x concepts, Resolved concepts, Seen in clinic, and others. Relocation of concepts from Findings and Procedures that have context.	1 country high, 1 country medium	UK: Reviewing patterns and concept modeling for content such as: ... Seen in clinic, and others. Relocation of concepts from Findings and Procedures that have context.	(2+3+3)=2.67 Terminology impact: 4430 concepts, impact on other hierarchies due to delimitation issues (wrt findings).	(2+2+2)=2 Not sure of the terminology content impacted	(2+2+2)/3=2	(2+3+3)/3=2.67 Overall rating using tracker priorities - recommend high.	(2+3+3)/3=2.67		Priority 1 for the component. Ave group rating: 2.40
Procedure: Interventions, Plans and Goals Trackers: 14 Pattern Review Hierarchy Cleaning Modeling Review	Remodeling of sub hierarchies as such as: Care plan, Types of encounter, Screening intent vs. Screening type, Prevention vs. Preventive regime, and others. Better define the meaning of Treatment vs. Therapy, Plans and Regimes and others, and adjust accordingly	2 countries medium	Singapore: As part of our Care Plan documentation, it is definitely beneficial if the contents are classified into sub hierarchies such as interventions / plans, etc.	(2+2+3)=2.33 (why goals? should be findings and/or observables) Terminology impact: Entire procedure hierarchy in scope!	(2+2+2)=2 Not sure of the terminology content impacted	(2+1+2)/3=1.67	(2+3+3)/3=2.67 Overall rating using tracker priorities - recommend high.	2+3+3)/3=2.67	EWO: Potentially high clinical impact as care planning the foundation of many clinicians practice - might be individual trackers that are more important.	Priority 1 for the component. Ave group rating: 2.27
Procedure: Surgical Procedure Trackers: 20 Pattern Review Hierarchy Cleaning Modeling Review	Remodeling of Intraoperative concepts, Surgical procedures not subsumed by Surgical procedure concept, Aspiration procedures, Needle biopsies & Fine needle aspiration biopsy procedures, Implantation (procedure) hierarchy . New patterns for Anastomosis from X to Y, Reamputation of <site> and others	2 countries medium	Singapore: We are planning to synchronise TOSP (Table of Surgical Procedures) codes with SNOMED. The remodelling of Surgical Procedures may help in our future exercise.	(2+3+3)=2.67 User impact: Several CRS tickets implies many users. Terminology impact: 20 000 concepts used to define 1742 other concepts.	(2+2+3)=2.33 Will this be part of the collaborative work for the CPT alignment?	(2+2+3)=2.33	(2+3+3)/3=2.67 Overall rating using tracker priorities - recommend high.	(2+3+3)/3=2.67		Priority 1 for the component. Ave group rating: 2.53
Clinical Finding: Congenital, Hereditary, Genetic and Familial Trackers: 9 Pattern Review Hierarchy Cleaning Modeling Review	Remodeling, hierarchy and naming pattern review - mainly congenital disorder modeling and definition and clarification of descriptions relating to familial, genetic and inherited.	2 countries medium	UK- Genetics please	(3+2+3)=2.67 Terminology impact: large number of concepts, e.g. 66091009 \| Congenital disease (disorder) \| subsumes 6870 used to define 379 other concepts.	Should that work be part of the collaborative work with that Genomic group?	(2+2+2)/3=2		Agree with comments re being part of genomics strategy. With only 9 trackers that group could be involved in prioritisation.	CRI: SNOMED International is working collaboratively to develop a Genomics strategy.	Given a priority 2, though these should be considered in relation to Genomics.
Clinical finding: Diabetes Mellitus Trackers: 5 Hierarchy Cleaning Modeling Review	Improvement in Diabetes Mellitus content.	1 country high		(3+1+1)=1.67 Terminology impact: 120 concepts subsumed by 73211009 \| Diabetes mellitus (disorder) \| used to define 353 other concepts.	(3+1+2)=2	(3+2+2)/3=2.33	(3+2+1)/3 = 2 Overall rating using tracker priorities - recommend medium.	(3+2+1)/3 = 2	CRI: 3 out of 4 of these trackers have had some work done on them. EWO: user impact could have been 1 but think a lot of implementations keen on this.	Priority 2 for the component. Ave group rating: 2
Clinical Finding/Event: Mental Health Trackers: 13 Pattern Review Hierarchy Cleaning Modeling Review	Overall review/update of psychiatry and mental health terminology. Also specific areas of concern such as substance abuse/misuse, neurosis descriptions and modeling,	1 country high	UK: Any improvement of subsumption, naming and rationalisation of content would be welcome.	(2+2+2)=2 Terminology impact: 74732009 \| Mental disorder (disorder) \| has 1499 descendants used to define 97 other concepts	(1+1+2)=1.33	(3+1+2)/3=2	(2+1+1)/3=1.33 Overall rating using tracker priorities - recommend medium.	(3+2+2)/3=2.33	EWO: 48 CMT mental health submissions but may be related to other trackers. This is a top health priority in UK and think it is elsewhere US probably? Linked to ICD-11 update and DSM-V - some contensious content e.g 91138005 \| Mental retardation (disorder)	Priority 2 for the component. Ave group rating: 1.80
Clinical Finding/Observables: Presence and Absence Trackers: 8 Pattern Review Hierarchy Cleaning Modeling Review	Issues relating to the presence or absence of a disorder. Links to observables redesign work also.	1 country medium	Singapore: We noted the lack of clarity over certain diagnosis (i.e.) ConceptID: 106074003 \| Electrocardiogram finding in hypertrophy, infarction AND/OR ischemia (finding) - so is that "And" or "Or"? It would be better if concepts like these are better defined.	(1+2+1)=1.33 Terminology impact: “presence” occurs for 83 concepts, modeling issues are present though...	(2+1+2)=1.67 I think this component and the Situation/context are quite linked	(2+1+2)/3=1.67	2+1+2)=1.67 Overall rating using tracker priorities - recommend medium.	(2+2+1)/3=1.67		Priority 2 for the component. Ave group rating: 1.87
Environment Trackers: 2 Hierarchy Cleaning	Review of entire hierarchy - content examples include inpatient, outpatient settings.	1 country medium		(1+1+1)=1 Terminology impact: 308916002 \| Environment or geographical location (environment / location) \| subsumes 1820 used to define 2 other concepts.	(1+1+1)=1	(1+1+1)/3=1	(1+1+1)=1 Overall rating using tracker priorities - recommend Low.	(1+1+1)=1		Priority 3 for the component. Ave group rating: 1
Clinical finding vs. Procedure: Administrative Statuses Content Trackers: 3 Pattern Review Hierarchy Cleaning	Revision work on Administrative statuses content. Overlap of referral content between Clinical Findings and Procedures.	1 country medium		(1+1+1)=1 Clinical impact: there are other solutions (information models), international level concepts?	(1+1+1)=1	(1+1+1)/3=1	(1+1+1)=1 Overall rating using tracker priorities - recommend Low.	(1+1+1)=1	EWO: Sometimes difficult to deal with this in the information model. Have discussed a separate admin module but only hypothetically. England Care Planning model uses qualifiers for procedure statuses from 288532009 \| Context values for actions (qualifier value)	Priority 3 for the component. Ave group rating: 1
Clinical finding: Temporal contexts Trackers: 14 Pattern Review Modeling Review	Remodeling to align to patterns. Issues which have a temporal aspect e.g. period of life, during an event etc.	1 country medium		(2+2+2)=2 Terminology impact: hard to assess, many tough issues but might not impact content outside the area as they are typically not used to define other concepts.	(1+1+3)=1.67 This component seems to include complex issues. Perhaps some issues should be moved over to other components, like the Modelling Attributes & values?	(1+1+2)/3=1.33	(2+2+2)=2 Overall rating using tracker priorities - recommend medium.	2+2+2)/3=2 Some tough ones but I think important to clinicians.	CRI: Two of these are also from the Obstetrics component. The ECE project group has been doing work on combined disorders and temporal context. Machine Readable Concept Model changes are currently being made to the authoring tool for new subtypes of the Associated with attribute plus an extension of the range for the Due to attribute. See: 6.1.4 Disorder combinations 6.1.5 Complications and Sequelae The X with Y component had a number of trackers with temporal context but this hadn't been explicitly stated. This link has now been added.	Priority 2 for the component. Ave group rating: 1.80
Content Issues for Authoring Trackers: Up to 82	Content includes: issues identified as small or simple enough to be managed in the authoring tool and issues that have progressed through the content development process and are ready for the construction phase. Some may be in construction review.	Not on listing for members			This tracker seems to include tickets that should be part of other components. A review should be done to reallocate where possible to proper components, like attributes and qualifier values issues, neoplasms, Diagnostic Imaging issues.. Examples: artf222786-Concept model: Presence of X (situation) - presence of X (finding) artf6217-Allergies and adverse reactions					Not rated by group. Issues in the construction phase in this component have been noted as priority 1 as they are ready for construction work to commence.

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General comments:

Group analysis:

Focus Area

Scope of Content

Member Priority Summary

Member Comments

Daniel

Linda

John

Cathy

Elaine

Group member comments

Final rating

Concept Modelling, Attributes and Values

Qualifier Value

Clinical Finding: Neoplasm

Clinical Finding: Obstetrics

Procedures/Qualifier Value: Pathology

Observable Entity

Procedure: Diagnostic Imaging

Qualifier value: Units of Measure

Situations/Context

Procedure: Interventions, Plans and Goals

Procedure: Surgical Procedure

Clinical Finding: Congenital, Hereditary, Genetic and Familial

Clinical finding: Diabetes Mellitus

Clinical Finding/Event: Mental Health

Clinical Finding/Observables: Presence and Absence

Environment

Clinical finding vs. Procedure: Administrative Statuses Content

Clinical finding: Temporal contexts

Content Issues for Authoring

4 Comments

Daniel Karlsson

Cathy Richardson

Daniel Karlsson

Matt Cordell