Technical issues prevented sound from being added to the Go To Meeting recording

Actual and planned changes for the July 2017 International release

Planned changes for the Jan 2018 release

Discussion topics:

• Potential approaches for resolving “roles”.  It impacts what extensions will be allowed to do.
• Necessary but not sufficient sets
  • Technical approach needs to be discussed with the editorial group
• Dose forms and concept model for dose forms – needed for the January release
• Routes of administration – how it is used in the International release and how it might be expected to be used in extensions

Update on ongoing issues with ECE:

• Complications and sequela including new/approved temporal relationships

• Revised model for hypersensitivity/allergy/pseudoallergy
• Intolerance model proposal
• Complication of pregnancy, childbirth and/or the puerperium (disorder)

Discussion

The primary question on the hypersensitivity model was the benefit of adding a number of primitive concepts to accomplish the organizational structure. It was stated that while suboptimal, it was the "best" solution to accomplish the remodeling with a single model pattern rather than having to have multiple patterns for dispositions and diseases.

The EAG recognized that while this was a substantial improvement in the content representation in spite of the need to add intermediate primitives. Clear guidance on the use of the HAS REALIZATION attribute would be needed to avoid it inconsistent or improper use.

It was suggested that the group may want to investigate the use of multiple sufficient sets to define these top-level concepts that are disjunctive (i.e. allergic condition). This will be discussed at the MAG in more detail.

Clear editorial guidance is needed for the use of disposition-related concepts so HAS DISPOSITION is not used inappropriately

Intolerance

Discussed in detail at the ECE meeting. Proposal to add a new PATHOLOGICAL PROCESS = Intolerance was not agreed to, requiring Intolerance to substance to remain primitive. Consideration of the severity of the intolerance was brought up but not resolved. Referred back to the ECE for final proposed resolution.

Complications and Sequella

• The EAG agreed on keeping the current primitive concepts "Complication" and "Sequella" due to their widespread common clinical use. It was asked that future attempts to fully define these concepts be considered.
• Implication is that nearly all combined disorders would be a child of Complication or Sequella or both.
• Suggested that the FSN for 26634005 - During AND/OR after (attribute) be changed to "During OR after (attribute) - generally approved.

•  Approve final design of hypersensitivity predisposition model
• Jim Case Request addition of HAS REALIZATION attribute to MRCM for clinical findings hierarchy

Plans for working group meeting. Goals and objectives.

Discussion

• In general the EAG is happy that this area is being developed. While the focus was on clinical genomics, PAM asked why the scoep of SNOMED CT was not all of genomics, i.e. provide the genomics community with an environment to develop a comprehensive genomics model in the context of SNOMED CT.
• What are the use cases being addressed so we know what is needed to be supported? Adding concepts for everything creates a maintenance burden and may not meet the needs.
• Are there IP issues? Will be addressed by the genomics group as they recognize that IP and licensing are a remaining obstacle to open access to the needed data.

There have been multiple requests from members to consider the addition of "Patient-friendly vocabulary". A draft position document discussing the pros and cons and a proposed policy for inclusion of such terms in the International release is provided for discussion and input.

SNOMED International Position on the addition of “Patient-friendly terms” (PFT) to the International release of SNOMED CT

• There are a number of private companies that have made a business of mapping or creating these types of descriptions.
• A number of specific examples were given as to the difficulty of adding these in a way that is universally understood. The number of of localized terms is too large to be managed in the international release.
• The notion of "degree of synonymy" did not make it into the RF2 specification and it was proposed that this be revisited.
• Universal agreement that PFTs do not belong in the international release
• If people ask about this, will be referred to the Education and Product support team
• The position statement was simplified and revised and sent to the CEO for approval

• Jim Case Develop a clear statement of interpretation of the license and what an extension is allowed to do. Revise existing document to reflect discussion at the EAG meeting.

Relationship group zero proposal (DKA, YGA)

Normative relationship grouping editorial guidance

Initial proposed grouping guidance has been added to the SNOMED International Editorial Guide for four hierarchies: Clinical findings (disease only), Procedures, Situation with explicit context, and Observable entity. As we begin developing concept models for additional top level hierarchies, there is a need for additional guidance on how to create relationship groups with approved attributes.

Discussion on this topic was not covered as it was in a timing conflict with the MAG.

• Jim Case Develop additional policy proposal to refer to additional notion of substantive change.

TBA