2016-09-28 Editorial Advisory Group Conference Call

• Request AG to address critical reporting agenda items in advance of other items.

• Approve minutes from 06/27/2016
  
  

Decision from Copenhagen 2015, that the prescribing use case is not going to be supported. Thus the need for universal restrictions in the DL is not needed at this time.

KCA - Not sure that everyone understands the implication of the universal restriction.

Questions regarding the names of drug products that contain SOME substances if we disallow the use of universal restrictions:

-          Which concepts have this potential problem?

-          How to construct the FSN to make it unambiguous? KCA - How do we determine the semantics of (product). It may be an issue with the use of the semantic tag. Once something is a product, should it actually have subtypes? If these represent abstract classes of ingredient containing compounds, should we have another semantic tag.

GRE stated that the product tag is different than the substance tag so we don't want to duplicate the meaning. The product class allows the creation of forms and always has an explicit dose and unit. Perhaps another tag could be created to be more specific, but the current meaning is "product containing X". Thus anything that contains "X" will be a subclass of this concept. We have been discussing this for many years and this is why most of the products were made primitive, but now they are being made fully defined, so maybe the name should be clarified to "X-containing product" to remove the ambiguity. Not sure the universal restriction will help as still both universal and existential will need to be created. Agrees that universal restrictions can be out of scope at this time.

KCA - Agrees. Propose that we address this at the FSN naming level to distinguish between an abstract product and a dispensible product. All of the current FSNs are abstract until we get down to a certain level where it becomes a dispensible. Keith offered to have John Kilbourne take a look at this and using other data sources to align the different products wth the correct semantic tag.

GRE - Everything in the core right now is probably abstract. The core is a foundation layer for creating the dispensible products.

Discussion about what is the difference between a prescribable and dispensible product entails. To what level should the core go? To the level of a generic product, all the way down to strength. Can rely on external sources for details and for maintenance. Should review the proposed drug model that is beign considered and whether the creation of new semantic tags that differentiate between abstract, generic and trade products. The exact names could be discussed. KCA states we should be building on the AMD and DM+D models rather than building our own that may not align. Previous efforts to do this got stuck on the issues around ONLY and SOME semantics. If we agree on supporting only SOME in the core, and clarify the FSNs, we may be able to address the primary use cases,with the rest being addressed by extensions. EME states that the UK can deal with whatever structure SNOMED comes up with as long as it is consistent.

Actions resulting from this discussion will be developed:

Motion: To accept the proposed actions developed by GRE with suggested modifications (KCA/GRE). BGO had some questions about the impact of this discussion on the reactions to combined products. Currently this proposal does not address the issue that BGO needs to resolve. But this was not direclty in scope for this discussion. Approved uninimously.

• Need to combine the discussions on the drug model to a single site
• Develop actions from the combined discussion (actions proposed by GRE)
• If we change the FSN, is it a technical correction or retire and replace? 

Policy on addition of assessment tool responses to the International edition.

IHTSDO currently accepts "names" of assessment instruments and staging scales; however, there is nothing in the editorial guide that specifically addresses the responses to assessment instrument questions. As many of these are extremely context dependent, being tied specifically to the particular instrument, what should be the policy of IHTSDO to requests to add assessment instrument responses to the International release.

Example: Requests to add responses to Tinetti balance assessment tool.

KCA: In general we need to be able to represent the components of instruments. The issue revolves around the IP issues for these instruments. Does IHTSDO need to get approval for all of the instruments? Suggested that for areas where there is no IP restriction, we should be adding these. IHTSDO needs to develop a generic policy for what to do with copyrighted material. and meets editorial priciples

PAM agrees with most of the discussion. It would be nice to be able to use these ONLY in the context of the specific instrument. However, many of the responses on these are often not URU conformant, so we should devleop a guide on how to create such responses.

GRE the restriction of these "statements" to a specific use might be addressed using groupers that qualifies them to a specific instrument.

The EAG has been asked to do a self evaluation after the first two years of operation. We need to answer the following questions given that the role of the EAG is advisory.

Advisory group self-evaluation

1. Are the responsibilities of EAG members clear? Group agrees that the responsibilities are clear.
   
   
2. Are the topics that have been discussed relevant to the expectations of the members? Yes
3. Is the operation of the committee satisfactory? Satisfactory, but would like to meet more frequently. Recognize the challenge of getting the group together. The main issue is with the availability of the chair. Can the members be more flexible in scheduling meetings? Will address specifically in Wellington. Group feels there are many more issues that they could help to address. GRE stated the calls are only one form of interaction. May require more face-to-face meetings that are 2 days to address a larger number of issues. The visibility of editorial changes that are being made without input from the EAG needs to be addressed; especially when it involves large scale changes. A process to make this happen needs to be developed.
4. Does the group feel that it has made substantial progress over the first two years? We have made progress and would like to be able to make more int he future with more frequent meetings/calls/discussions.
5. Should the EAG be continued for the next year? Definite yes from the AG members.

Develop a set of 1-2 primary goals for the EAG for next quarter (specifically Wellington meeting) and the next year. What are the most important topics the group should attempt to address in the coming year?

Suggestions: Development of clear editorial approach and guidance around disorders, findings, observations and situations. When to use which? The current situation makes it difficult to determine which concept to use in different circumstances. How do we align the current SNOMED structure with the other initiatives that want to use SNOMED such as CIMI, FHIR? Begin discussion on approach (revitalize Condition hierarchy discussion).

How SNOMED CT can support the recording of clinical genomics data? Scope? Consistent with the approach used for other conditions. Recognize the need for use cases to support this effort.

How can SNOMED be structured to meet the different high level use cases that differ substantially in their approaches to using structured terminology? Single-code use vs. structured data (e.g. CIMI). This ties into the initial discussion of modularization of SNOMED CT.

•  Q4 2016 goals
• 2017 high level goals

A final proposal to resolve issues around the requirement for matching descriptions for FSN:

•  Gain consensus on final proposal

Disjunctive components

Final agreement

Review of disjunctive representations:

1. Use of "+": Combined components, being added as primitive combined concepts as a short term resolution.
2. Use of "&": Usually used as part of a panel, out of scope for the RII/IHTSDO agreement
3. Use of "&/or": Under review by RII as potentially erroneous. Out of scope for addition to SNOMED CT.

Impact of this is that a number of LOINC terms become ineligible for addition to SNOMED CT.

Postponed until next meeting - ran out of time

•  Gain consensus on final proposal

The IHTSDO Editorial Panel would like guidance on the creation of a policy regarding the addition of fully defined "grouper" concepts that are not clinically useful, but are used primarily for navigation of the hierarchy. For example "Procedure on vena cava" without any specifics as to the nature of the procedure.

Postponed until next meeting - ran out of time

Space Actions

Postponed until next meeting - ran out of time

We are meeting for a full day in New Zealand. Need substantive topics to move forward.

Will carry forward items from this call plus topics outlined in Item 6.