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 Date: 2021-10-19

1. Time:

1600- 1930 UTC

0900 -1230 PDT


1.1. Zoom Meeting Details

Topic: SNOMED Editorial Advisory Group

Time: Oct 19, 2021 09:00 AM Pacific Time (US and Canada)

Join from PC, Mac, Linux, iOS or Android:
https://snomed.zoom.us/j/97847937047?pwd=eTNldGFrRy96K0FFZTg1Y0E1a3p3Zz09
Password: 974545

Meeting ID: 978 4793 7047

Password: 974545
International numbers available: https://snomed.zoom.us/u/acGP5dm1KP

Or Skype for Business (Lync):
https://snomed.zoom.us/skype/97847937047



5. Meeting Files:

6. Meeting minutes:

The call recording is located here.


6.1. Objectives

  • Obtain consensus on agenda items

6.2. Discussion items

Item Description Owner Notes Action
1 Call to order and role call

This meeting is being recorded to ensure that important discussion points are not missed in the minutes.  The recording will be available to the SNOMED International community.  

If a majority of participants object to recording, only written minutes will be available, otherwise, anyone objecting to recording is requested to exit the meeting.


  • Recording of meeting approved by participants.
2

Conflicts of interest and agenda review

None stated.


3 Accomplishments of EAG Jim Case

The following is a list of recommendations from the EAG that have been implemented in SNOMED CT since October 2020:

  • Spinal cord injuries and spinal cord syndromes have been remodeled to reflect the distinction between the structural damage and the clinical manifestation. - completed
  • The concept inactivation workgroup has finalized recommendations for revised and additional inactivation reasons and clarification on the use of historical relationships - in progress
  • Pathologic fractures have been remodeled so that they no longer classify as traumatic injuries - completed
    • Renaming Pathologic fracture due to neoplastic disease concepts - completed
  • The primitive "Sequela" concept has been inactivated and content using Sequela as a stated parent have been remodeled with "Disease" - completed
  • Approved new definitions for Poisoning, Overdose and Intoxication.  Content is being remodeled to adhere to these definitions - in progress
  • Approved modeling proposal for combined disorders - in progress
  • Approved new model pattern for "Aplasia", Congenital absence and "Agenesis" - completed
  • Provided guidance on the potential inactivation  of duplicate Computed Tomography combine procedures - completed
  • Provided guidance on remodeling/inactivation of "Positive/Negative" findings - in progress
  • Provided guidance on the use of "unambiguous" acronyms (i.e. do not require expansion in a non-FSN description) - in progress
  • Provided guidance on the use of HAS_CHARACTERISTIC generic attributes for use by extensions in their drug models - in progress
  • Provided guidance on consistent naming of Specimen vs. Sample in the Specimen hierarchy - in progress
  • Approved an ECE proposal for a new model for "Pressure ulcers"; renamed to "Pressure injuries" - in progress
  • Approved proposed editorial guidance for naming of lateralized procedures - in progress
  • Provided guidance and approved renaming of "Angiography" procedures for consistency - in progress



5 ECE Topics Bruce Goldberg

Osteoarthritis: A majority of descendants of Osteoarthritis (disorder) are not kinds of osteoarthritis. Model needs to be revised.

Discussion:

2021-09-22

Bruce Goldbergpresented a discussion related to deposition and degeneration.  Recommended moving Deposition out from under Degeneration.

Osteoarthritis has multiple child concepts that are not considered to be osteoarthritis.  This is due to the current definition of Osteoarthritis.  Current thought is that osteoarthritis is more than just degeneration of the joint.  It is a complex disorder.  Because of the complexity is it not possible to SD Osteoarthritis. Proposed remodeling will move hundreds of inappropriate concepts out from under Osteoarthritis.

Suggest creating new morphology = Inflammatory degeneration. The inflammatory aspect of this disorder is variable, but it is considered an arthritis, which requires an inflammatory morphology.  Some comment that common use of arthritis (inflammatory) and osteoarthritis do not consider them related.

Need a common parent for osteoarthritis and rheumatoid arthritis?  

As this is a high use area of content, we must carefully consider the impact on users.   Suggested that there be a site where the impact of the proposed changes can be viewed.  Will bring this up to the technical team to determine options for interim viewing.

Discussion: 

Should spondylosis be a subtype of Osteoarthritis?  Literature uses spondylosis synonymously with osteoarthritis of spine.  Ankylosing spondylitis is a subtype of arthritis, but osteoarthritis is not modeled as an arthritis.  What is the result of moving spondylosis out from under osteoarthritis?  The literature is mixed as to whether it is an arthritis or osteoarthritis.  It is often described as a disorder of spine (bony structure).  Can be viewed as an end stage of chronic arthritis with no remaining inflammatory component?  Do we agree that spondylosis is a degenerative disorder.  

Decision:

Will be modeled as a degenerative disorder out from under osteoarthritis using a morphology of "degeneration".  Will create a combined morphology of "inflammatory degeneration" to support the remodeling of osteoarthritis.  Results of remodeling will be made available to the EAG members.  Potential to make this available via the TS browser. 

Deposition_degeration_osteoarthritis.pptx

  • Jim Caseto discuss with tech team how to make proposed changes viewable to EAG.
  • Bruce Goldbergto make proposed changes for evaluation of impact.
6 Complication remodeling Jim Case

Issues have arisen with the remodeling of subtypes of 116223007 |Complication (disorder)|, based on earlier agreed decisions from EAG.

Proposal for revision of the “Complication” hierarchy

Based on agreed proposals, editorial guide will need to be updated.

Discussion:


Decision:

Consensus is to proceed with the modeling recommendations as described in the accompanying document.

  • Jim Caseto implement changes and make available for review in the TS browser.
7 Maternal vs. fetal periods of life

See attached document for review:

Modeling issues related to maternal periods

Complications related to pregnancy

Discussion:


Decision:


8 Review of requirement for external editors Jim Case

A draft document for review that outlines the requirements for external editors (non-SNOMED staff) to work within the International release is available for review.  This document will also be provided to the Member Forum and the CMAG.

2021-10-18: Comments received from four member countries of the CMAG, all positive. Request for more detail in some areas of the document.

Requirements for external editors of SNOMED CT International Release

Discussion:


Decision:


9 X (person) vs. X of subject (person) Jim Case

A question from a member country on when to use "X (person)" vs. "X of subject (person)" has exposed issues with determination of equivalence in information models that either split the relationship from the condition vs. using a precoordinated Situation concept to represent the SUBJECT RELATIONSHIP CONTEXT.

Discussion:

"X of person" was introduced to support the SUBJECT_RELATIONSHIP_CONTEXT of Situations.  Monique van Berkumwill look for some history on why they were added. Suggested that the ECE might have some history on these.  Question is whether we need to separate out the relationship values from "persons" as a class?

Background - https://confluence.ihtsdotools.org/download/attachments/17039782/Subject%20relationship%20context%20values_EDC_20060127.doc?api=v2

Decision:

Background will be investigated.  The person hierarchy needs some review and rationalization.

Background document posted above.  Will review for next meeting. Make sure page is open for viewing by the EAG.  



10 Late addition: Induced termination of pregnancy (disorder) Jim Case

Freshdesk ticket from member country:

"Our expert group have questioned the concepts 57797005 |Induced termination of pregnancy (disorder)| and all the child concepts as to why these are in the ‘disorder’ hierarchy as they are actually procedures? I actually agree, it seems a bit strange? There are synonyms as ‘termination of pregnancy’ which insinuates a procedure and that are the same as 386639001 |Termination of pregnancy (procedure)| which sits in the procedure hierarchy."

This hierarchy includes 196 concepts, which fall into the following categories

  • Induced termination of pregnancy during a particular gestation period (e.g. 6251000119101 |Induced termination of pregnancy in first trimester (disorder)|
  • Induced termination of pregnancy with a "complication" that occurs DURING or AFTER the procedure.  (e.g.  609514009 |Induced termination of pregnancy complicated by vaginal damage (disorder)|)
  • Induced termination of pregnancy performed "legally" or "illegally" (e.g. 49632008 |Illegally induced abortion (disorder)|)

Most of these have been in SNOMED since the 20020231 release. 

Questions:

  • Should some of these concepts that refer solely to the procedure be moved to the procedure hierarchy?
  • Should history concepts be created for each procedure (many already exist; e.g. 713649008 |History of induced termination of pregnancy (situation)|)?
  • Should the complication related concepts be retermed with a focus on the resulting disorder DUE TO the procedure (e.g. Vaginal damage due to induced termination of pregnancy))?

Discussion:

These have been of long-standing concern about the proper location.  Most look like they should be procedures.  

The notion of legal and illegal abortion is still something that is of concern, but should it be as part of the international terminology as this is a jurisdictional issue. Some expressed that this determination does not belong in the International release.  There are many aspects of induced termination that affect the risk of the procedure.  This cannot be captured within a single procedure.  The issue is the risk associated with the procedure that affects the outcome.  The method used, etc. is all of importance.  Best represented by a clinical statement model.  

Many of these originated with ICD-9 and have been carried through to ICD-10 including legal or illegal. 

The distinction of medical vs. surgical needs to be made where needed. Would this require the use of GCIs to represent the distinction?

The notion of legality should be represented with an alternative representation. It is important that we represent the environment in which the procedure is performed as well as the skill of the provider and the devices/medications used. Look at existing content for concepts related to the state of the patient as well as the procedures.

Need to look at the hierarchy above Induced termination of pregnancy as well for potential procedures. <<363681007 |Pregnancy with abortive outcome (disorder)|

Decision:

Will ask Jeremy Rogersfor frequency of use to determine value.  Will check on the impact of reterming on the complication concepts?

Most agree that these look like procedures then we will do an evaluation of what needs to be moved.  

The notion of "legal" or "illegal" is important for medical care, but not pre-coordinated with the procedure. Extensions may add this notion back if they find it necessary.

Need terming guidance to make the naming of these concepts consistent (continued use of "abortion"?)  

11 AOB EAG

12 Next meeting EAG

Next call tentatively on Nov 24.  Time to be determined
















2 Comments

  1. Osteoarthritis remodeled as per decision above. Now visible in TS browser at https://authoring.ihtsdotools.org/browser/?perspective=full&conceptId1=138875005&edition=MAIN/AUTHORTEST&release=AUTHORTEST-303&languages=en

    Project: AUTHORTEST

    Task: AUTHORTEST-303

  2. FYI, I remodeled many but not all OA concepts.