Jim Case

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Jim Case

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Paul Amos

Jeremy Rogers

James R. Campbell

Inactivation of Ambiguous Concepts - examples and updated proposal

Document attached to the agenda Meeting Files above.

Requirement to ensure adequate advice and guidance to vendors and users - JRC 

Discussion:

No further feedback received from the group.  Assume then that the proposed mechanism for AMBIGUOUS concepts (creating "invalid" concepts where needed to allow for two POSSIBLY RELATED TO relationships and then immediately inactivating it).

Draft editorial guidance of inactivation reasons have been developed at: 

Impact of inactivations on end users:James R. Campbell

See attached presentation.

Suggested that SNOMED needs to provide guidelines on how to create queries to track historical relationships and include content that was assigned to records prior to changes in the hierarchies.  These are implementation issues and may need to be referred to the Implementation group as the original design was to assist internal editors in creating valid historical relationships.

This topic is still under discussion at the Modelling AG. More information can be found at Historical Analytics.  This page should be open to members of the EAG to review.

Additional documentation: 3.2.6.3. Managing Component Inactivation

Decision:

• EAG members to review document related to AMBIGUOUS issues 
• Paul Amosto present summary document at the EAG meeting 20210630
• EAG members asked to review ed guidance draft and provide comments by July 30

Inquiries from Germany outlined inconsistencies in terming in the Specimen hierarchy.  A background document with proposed changes is available for review and comment by the EAG prior to broader circulation: 

Specimen term change proposal

Discussion:

Group generally felt that historically and clinically, specimen and sample were used interchangeably.  There was unanimous agreement on the changing of FSNs and PTs to use the term "specimen". James R. Campbellobjected to the universal addition of "sample" descriptions to terms that already had "Specimen" in their FSNs

Update 6/14/2021:

From UNMC via Jim Campbell: "I asked Scott to poll our anatomic pathologists (and also lab pathologists) whether Specimen and Sample can be considered synonyms. The answer was clearly NO. Anatomic pathology is arguably the clearest example where the surgical Tissue Specimen is examined visually by the pathologist who then dissects the tissue into component Samples representing important aspects of the case Specimen. The samples are processed in Blocks for histologic examination and results are reported with reference to the Sample Block. In this way examination of Margins, lymphatic invasion, regional invasion and spread of the malignancy can be assessed and reported. "

Note: Additional clarification on the James R. Campbell proposed solution was sought. 

From the LIVD Community via John Snyder: "I brought this up to the LIVD team for discussion as it includes members from LOINC, APHL, Abbott laboratories, and FDA. In general, everyone agreed that the two terms are used synonymously across the implementation level and are in favor of the work listed under Next Steps section being completed. While they did recognize that there were some edge cases where differentiation between the two may be useful, at this time the group did not think the edge cases were significant enough to out-weigh the general benefit."

Comments from James R. Campbell 6/22/2021

"In response to your previous message, we are attempting to affirm that “sample” and “specimen” are NOT always equivalent. A “Sample” is “a small part or quantity intended to show what the whole is like”. A “Specimen” is “an entity or independent continuant obtained by some procedure for scientific study”. As we have agreed, the procedure is an important feature defining the Specimen concept and it SOMETIMES includes sampling in accruing the specimen, but that is not always true as Scott and I have attempted to demonstrate with our anatomic pathology exemplars.

The oncologic surgeon may remove an entire breast mass, being careful to preserve good tissue margins, and provides the excisional breast mass specimen to pathology specimen receiving for examination, preparation and sampling into tissue blocks. The blocks are further sampled and prepared as slides which are examined microscopically in order to make a useful set of observations about the excisional specimen, even though examining the individual samples prepared for study are steps in that process. These actions are to organized and executed to answer basic questions such as “Was the mass excised completely and cleanly?”

When asked the question: “What would you call this mass the surgeon excised?” The pathologists responded as Specimen and rejected Sample which they thought did not apply.

We suggest that “Sample” synonyms should only be considered for addition in specimen concepts where “sampling” is a required part of the specimen accrual process. "

6/30/2021

Questions remain as to the resolution of the existing content.  

• Do we need to have a separate "sample" hierarchy to meet the needs of the pathology community? A: No, that would be more confusing.
• What are the criteria for when specimen and sample are synonymous? when they are not?
• Should existing concepts where both specimen and sample are used be reviewed?

There are over 400 concepts that have "sample" in the FSN in the Specimen hierarchy.  The proposal to make the FSN changes but not add "sample" descriptions where they do not exist does not solve the problem where the distinction needs to be made.  An additional proposal would be to remove all mentions of "sample" from the concepts. The issue may lie in the use of language, i.e. sample is just used to represent a part of a specimen.   There are also issues between "specimen of" vs. "specimen from".  This needs to be considered in any review of the specimen hierarchy.  

Decision: 

EAG consensus was that changes to FSNs may be made without inactivation and replacement of concepts.  The other issues still need resolution.  Jim Case will document the remaining issues for external consultation. 

• Jim Case to revise proposal as needed.

Based on international consensus pressure ulcer stages are now referred to as pressure injuries. A new model and terming is required and was presented.  Pressure injuries are currently defined as traumatic injuries.  The modeling proposal is to remove the DUE TO event and creating new morphologic abnormalities. 

Discussion:

Need to evaluate whether "suspected" and "deep tissue injury" are equivalent.

Do we need a CAUSATIVE AGENT relationship? The reason is to get these terms to classify under a grouper term that was derived from ICD.  If/when the grouper term is inactivated, the CAUSATIVE AGENT relationship could be removed.  

Decision: 

Add Erythema as a parent to Stage 1 pressure injury.

Remove the CAUSATIVE AGENT relationships.

• Pressure injuries.pptx
• Bruce Goldbergto implement changes as discussed for pressurre injuries