• Recording of meeting approved by participants.

Conflicts of interest and agenda review

Measurement Findings:

Proposed changes to FSNs

• Updated Briefing Note attached above
• This meeting will give a summary of the position to-date and address the following issues:
  • Concepts representing "borderline" levels
  • Concepts representing "therapeutic medication levels"
  • Concepts representing "Abnormal" or "outside reference range" levels

Decisions to date:

1. Following the discovery of a decision made in 2010 that within the context of measurement findings "increased" = "above reference range" and "decreased" = "below reference range" the EAG members agreed to support a change in FSN rather than inactivation.
2. In the rare event that a user has interpreted and used one of these concepts to represent a relative increase or decrease in measured value; advise use of 442387004 |Increased relative to previous (qualifier value)| and 442474009 |Decreased relative to previous (qualifier value)| with clear FSN e.g. Increased blood glucose level relative to previous level (finding) for implementation at the local level.
3. There was agreement that the notion of "normal" is context dependent and similarly "within reference range' should be interpreted within the context of the whole clinical record. Therefore, it was agreed that concepts representing "within reference range" will have their FSN/PT updated and a synonym description of "normal" should be retained or added as appropriate.

Additional Discussion:

Reviewed previous decisions:

1.  Will revise FSNs instead of inactivation and replacement of concepts

2.  If needed, will create terms related to "increased or decreased relative to previous measurement".

3.  The interpretation of "normal" is in relation to the clinical state of the patient as opposed to a standard reference range.  Reference ranges vary by organization and by clinical condition. 

To ensure that the meaning of reference range is interpreted correctly, a text definition will be added to the qualifier values stating that these are relative to the clinical state of the patient. "Normal" will not be used as a FSN or PT, but only as an alternative description.  Those that say "high" or "low" will be treated similarly. We will not add "normal" descriptions to those measurement findings that do not already have them as descriptions.

Abnormal measurement findings:

The discussion related to abnormal panel findings was determined to be out of scope. Because we now have the ability to sufficiently define "Abnormal" findings using "outside reference range" it was proposed to keep them, rename the FSN as for Normal (i.e. Outside the reference range). This is restricted to measurement findings. No opposition.

Borderline concepts - Borderline high and low are interpreted differently.  Suggestions made to how to name these concepts to avoid misinterpretation.  Suggested that these would be inactivated and replaced by the more clear terming. Another suggestion would be to inactivate as ambiguous as there are only 29 of them and there have been no requests for more.  

Medical level measurement findings were presented with the changes that had been made to address therapeutic levels. Is there a benefit to have the therapeutic reference ranges as subtypes of the general reference ranges. Suggest creating a template to ensure the appropriate use of these qualifiers.  Need to determine the need for "toxic level" qualifier. 

Decision:

Inactivate the borderline concepts as ambiguous. 

Remodel FSNs as previously approved. 

In the course of reterming FSNs as part of the Quality Improvement project, there are occurrences where the change in the FSN to conform to editorial policy results in a validation error identifying an inactive concept with the same FSN.  The error is:

An FSN must be unique within all active FSNs across all concepts. This term already exists against inactive concept <SCTID>.

There had been general guidance provided for this that the inactivated concept with the proper FSN would be reactivated and replace the concept with the improper FSN; however, in many cases this would result in frustration for users, as it would result in the inactivation and replacement of a concept with the concept that it replaced in the first place. 

Recognizing the need to minimize the impact on users, it is important to take into account the fact that time plays an important role in which concept to inactivate and which one to retain. One consideration is which term has had the "greater opportunity" to be used in health records.  This includes when a concept was introduced into the terminology, how long it was active and when it was inactivated.

Guidance is needed for instances where duplicate FSNs are created as part of the reterming of active concepts to align with the quality improvement project.

Options include:

1. Reactivate the original concept with the proper FSN regardless of when and how long it has been inactive.
2. Only reactivate the original concept if it has been inactive for less than a specified period of time (e.g. 5 years)
3. Never reactivate the original concept, whilelist the validation error.
4. Retain or reactivate the concept that had the longest period of active status.
5. Others? 

Discussion:

Is it possible to remove the validation constraint? Is that a reasonable approach?  If the historical relationship is SAME AS then the validation rule should not apply.  Should the validation rule only apply to active concepts? This would not work when creating new concepts. Another approach is to modify the inactive FSN so that it does not appear as a duplicate.  Consensus that the active concept with the FSN change should be retained.  The historical relationships should be SAME AS and changed if necessary. 

Decision:

Discuss with the technical team about the feasibility to change the validation rule to account for SAME AS relationships.  The most recent active concept should be retained and renamed.

A query has arisen internally regarding the definition and modeling of 784289008 |Nerve palsy (disorder)|.

The attached Briefing Note details the issues and asks the question; Does "Nerve palsy" have the same meaning as "Mononeuropathy"?  Proposals for an updated definition and modification to the modeling, depending on the answer to the above question, have been presented. Please review the briefing note and contribute your thoughts and comments at the meeting.

Discussion:

Revised definition of palsy proposed and discussed.  Equivalence between palsy and paralysis exists in non-English languages, but is distinguished in the English literature.  Not enough time to fully discuss, will be revisited in Lisbon.

Decision:

None.