I wanted to discuss the changes to the Laparoscopic content that were published November 2023 (and continue to trickle through since). Since I suspect EAG members not maintaining an extension may not have noticed.
While I appreciate some change may have been required my concerns fall into two parts:
- The actual “implemented solution”
- The execution of the change
The actual “implemented solution”.
For context Endoscopy and endoscopic procedures - SNOMED CT Editorial Guide - SNOMED Confluence (ihtsdotools.org)
- The addition of an “incision” role group seems unnecessary? I agree that an incision is made to insert a laparoscope, but an incision is also made as part of EVERY surgical procedure. And it’s never been a part of SNOMED to model all the sundry actions (incisions, post-op closure, etc.). Should all “Procedures on abdominal structures” get an abdominal incision?
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I’m struggling to find any laparoscopic procedures that don’t already include a surgical action. A simple Laparoscopic exploration/examination with no intervention maybe.
- The inspection role group seem odd. The first line of the editorial guide has been updated “There is no need to distinguish between endoscopy and endoscopic procedure, as the procedure always includes inspection” (original guidance here). This misses that “scopy” is a (action) noun and “scopic” is an adjective.
- “-scopy” is the inspection.
- “-scopic” is doing some intervention with the assistance of a scope.
The change to merge these seems to be pre-empting how they are used – and that they might “convert” ? (Particularly for endoscopic procedures (natural orifice)). A referral for an endoscopy is just that. The performing clinician may do other things (as necessary). And may record more specific things. Different levels of detail are recorded throughout the process. And it’s OK for SNOMED CT to support different levels of precision.
- There’s there’s the GCIs used for SNOMED CT - Endoscopic operation (procedure) (snomedtools.org)
And Endoscopic operation is not subsumed by Endoscopic procedure
The execution of the change
- Community consultation and analysis may have helped work out a better solution. It’s not clear what the problem was, analysis performed etc. I did find this JIRA (that I unfortunately missed getting tagged in) it reported 1AU and 18NL concepts being affected. Rather than the actual 144AU and 251NL concepts (which was eventually identified in this JIRA)
- Lack of publicity around the change – Aside from the Jira above, I can’t find much publicly about this change. And only discovered it through an international update. Editorial rules weren’t updated until March 24 (at least 4 months after the change started to be published).
- Inconsistency of the solution. “partially fixed” can often be worse than “consistently broken”.
Monthly releases do allow work to trickle out, but this does have consequences to downstream users.