SNOMED CT Editorial Advisory Group

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Date

02/17/2017

 1900-2100 UTC 

GoToMeeting Details

SNOMED Int'l Editorial Advisory group  

Fri, Feb 17, 2017 11:00 AM - 1:00 PM PST

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Attendees

Chair:

AG Members

 

 

 

 

Observers:

Sarah Harry

Yongsheng Gao

Toni Morrison

Mary Gerard

Penni Hernandez

Apologies

Paul Amos

Meeting Files

 

EAG meeting Feb_17_2017.pptx

Meeting minutes

EAG Minutes Jan 20, 2017

Objectives

  • Obtain consensus on agenda items

Discussion items

ItemDescriptionOwnerNotesAction
1Call to order and role callJCA

Paul Amos communicated that he would not be able to make the call.

 

2Conflicts of interestJCANone. 
3Approval of minutes from 01/20/2017JCAAs of the start of the meeting quorum did not exist. Could not approve.

 

4Drug Model deliverable reviewTMO

Drug Model Editorial Guide

Received 51 comments from six countries on the initial draft of the editorial guidelines for modeling and terming drugs. All issues identified were resolved or deferred.

Second iteration of guidelines released in early March.

 

5Substance redesign document reviewJCA/TMO

Substance hierarchy redesign

Substance disposition proposal (see attached document)

Comments from EAG regarding the proposal were sought.

BGO had a question about the use of the HAS DISPOSITION relationship; where would it be used? JCA stated it would be solely used for substances. WRT to substances associated with allergens, how would these be used when the substance had a disposition other than allergen. A substance has a disposition, whether it is being used in another context or not. Disposition is a defining attribute for substances.

  • Jim Case will prepare a briefing note for the MF to inform them of the proposed changes
6Guidance for creation of new anatomy conceptsJCA

Issue: In some cases, the representation of FINDING SITE at the proper level of granularity requires multiple body structures. E.g.:

The proposal under consideration is:

"If two body structures are needed to fully define the finding site for a condition, then a combined anatomic structure shall be created to represent that body structure."

For example: A new body structure "Bone structure of distal phalanx of great toe (body structure)" would be created to support the modeling of the concept above.

Discussion: PAM supported this approach by email. BGO supports this change as well. YGA was asked about his support and he also supported the new guidance.

  • Jim Case will send a edit to the Editorial guide editor to get this guidance implemented.
  • Monica Harry to work with technical writer to add this proposed (and accepted) wording to the guide where appropriate.
7Editorial guidance on role groupingJCA

Create a table of mandatory grouping of relationships.  Rationale – needed for template based authoring, provides internal consistency of model patterns, allows for batch editing due to consistency.

See initial review from Daniel Karlsson and Yongshen Gao

The grouping patterns are currently being defined in the groups of templates, but there has been no general guidance for how relationships should/must be grouped. This would define mandatory grouping as well as addressing exceptions to grouping in particular subhierarchies. These would provide guidance for the templates being created.

This is project that is currently not resourced, but will be put on the list of needed edits for the revision of the editorial guide.

  • Jim Case will address this when the technical writer comes on board to begin the comprehensive editorial guide review.
8"X in remission"JCA

Existing tracker: "In remission" disorders

Hold over item from initial meeting in Uruguay. Has been brought up again with a large number of requests for addition of "X in remission" concepts.

Existing Inception document: Modeling "disease in remission"

Document definition: "The period in the course of a disease/condition during which there is temporary lessening or abatement of signs and/or symptoms of the disease."

Based on historical view of "Disease in remission" there are some assumptions:

  1. The disease condition is still present.
  2. The disease is chronic and/or progressive

Prior proposals:

  • Model as situations with the reactivation of 278174000 | Disease phase (attribute) | with allowed values >303105007 | Disease phases (qualifier value) | with necessary changes to this set to align with standard representation of disease phases
  • Leave the concepts in the disorder hierarchy and create a new attribute such as disease activity and include as its range, qualifier values that specifically represent disease activities such as remission, recurrent, relapsing, active, relapsing/remitting, etc.
  • Model disorder X in remission as a child of disorder X and a child of disorder in remission (the latter as a replacement for patient in remission).
  • Extend the set of values under "Courses" to include disease phases and model "Disease in remission" as a subtype of "Disease"

One related issue is the current overlap of concepts under "Courses" and "Disease phases".

Challenge is that disease phases differ with the "type" of disease.

  • Infectious disease
  • Malignant disease
  • Mental and behavioral disorders

Question: Pros and cons of creating type specific phases?

The result of this discussion should be extensible to other patterns of "Disease in X" (e.g. latent disease, relapse, etc.) for which there are several CRS requests outstanding.

Related issue: IHTSDO-407 Frequencies and Courses

Discussion:

BGO reviewed the document and asked about the relationship of remission to "disposition". He sees overlap between those notions. Favors making disease in remission as a subtype of the disease. Also favored a separate "disease in remission" hierarchy (primitive parent). Needs additional discussion in London.

  • Jim Case A summary of the options for "Disease in remission" from the Inception document and the pros and cons for each including modeling examples will be developed for additional review.
9Extension of range of SPECIMEN SUBSTANCE to physical objectJCA

Initially discussed in Uruguay, postponed to future meeting

Existing tracker item: IHTSDO-604 Extend the range of "Specimen substance"

Use cases:

  • Physical object as a specimen for environmental and epidemiological testing
  • Pharmaceutical/biological products as specimens for sterility and quality assurance

Earlier discussion points:

  • "Device specimen" already allowed and fully defined but uses SPECIMEN SOURCE IDENTITY as the defining relationship. This scenario may work if the range for SPECIMEN SOURCE IDENTITY is extended to Physical object (<)

Discussion:


Given that "devices" submitted as specimens are sufficiently defined by using the relationship SPECIMEN SOURCE IDENTITY = <<Device, extending the range of SPECIMEN SOURCE IDENTITY to include <Physical object would allow for new specimen concepts that were not devices to be modeled.

  • JCA to test the use of subtypes of Physical object as values for SPECIMEN SOURCE IDENTITY.
10ECE UpdateBGO

Update on ongoing issues with ECE

Discussion:

Complications and Sequellae

Proposal made by BGO to model both "Complications" and "Sequellae" using the combined disorder patterns and following the FSN naming conventions for those concepts. Add descriptions that include the terms "Complication" or "Sequellae" as synonyms (or preferred terms where required) and retire the top level concepts of "Complication" and "Sequellae". This is still being discussed within the ECE. JCA leaned towards eliminating the primitive concept "Complication" due to its inconsistent use and to also look at the relationship of these to "Secondary disorders". Whether this fits with Sequellae needs more discussion. Bruce will update after the next ECE call.

Allergy model:

A revision to the proposed allergy model using the application of the HAS REALIZATION attribute to model "Allergy to X". A quesion about how the current concept model for Substances might impact this proposed model. BGO said he did not think it would have a deleterious effect. There would be some value is using the HAS DISPOSiTION attribute in substances to limit which substances might be used as values for "Allergy to X"; however, this might be an unnecessary complication.

Awaiting additional input from Stefan Shultz on the representation of the top level concepts of hypersensitivity condition, allergic condition and pseudoallergic condition.

 

 

11Aligning SNOMED CT with clinical use casesKCA/JCACarried over from past meetings: High level discussion on whether SNOMED CT is appropriately organized to support the highly variable granularity of content the are influenced by current EHR applications (i.e. single code recording of pre-coordinated content) and newer initiatives that are focused on capturing more structured data (e.g. CIMI, FHIR) 
12Next meetingEAG  

 

 

 

 

1 Comment

  1. Paul Amos

    Comments from Paul:

     

    Item 5: Substance disposition proposal

    I am content to support the proposal in full. My only query relates to the impact on systems that use the current structure for the purposes of decision support. Given the potential patient safety implications should we consider giving notice of the changes so that decision support systems can modify/update their systems in line with the change to modelling.

    Item 6: I support the proposal

    Item 8: Really interesting & really difficult. In the UK we have had a number of discourses with the psychiatrists over the meaning of the concept 'remission' and whether it is applicable to psychiatric disorders. Some argue that a patient with a psychiatric disorder can ever be 'cured' as they always have a propensity to show the signs of the disorder if subject to sufficient 'stress'.

    Is a patient who has documented hypertension but is normotensive on treatment in remission? - we would all probably say no.

    Therefore I think we need to have a clear understanding and definition of the phases/course of disease processes and an understanding as to whether they apply equally to each disorder domain.

    We have a current problem within the UK of how we represent the status of a diagnosis which has similar issues as the status of a disorder. Great care needs to be taken to ensure that there is a consistent approach with clear definitions and consistent modelling.

    Should be an interesting discussion.

    I will review the Drug Model Editorial Guide and submit comments next week.

     

    Regards and apologies for not being present.

    Kind regards

    Paul