Nonconformance to Editorial Policy Component

Narrative description:

From time to time editorial policy may change, either to support changes in modelling practice, to update our approach to what is considered to be within scope for the international edition of SNOMED CT or bring consistency to existing content. Sometimes when this is done the meaning of an FSN or the implied meaning of a logical definition may change the meaning of an existing SNOMED CT concept.

When a change of meaning occurs the legacy concept should be inactivated and where appropriate a replacement concept be created if an equivalent concept does not already exist.

Details:

Known issues:

1. It is currently unclear which elements of a "change" to editorial policy might result in the need to inactivate a concept
2. There is currently no facility to record which editorial policy resulted in a requirement to inactivate the concept
3. It is not possible to allocate an historical association and so management of the inactivation at a local level is at best difficult
4. It is currently not clear whether non-conformance to editorial policy applies to the FSN alone or might include the logical definition

Examples:

Simple Example

185950005 Conf data - other Dr not see (finding)
WAS A (implicit)
270456003 Confidential patient data held (finding)

374547004 Dexamethasone sodium phospha 4mg/mL (product)
WAS A (implicit)
766346003 Dexamethasone sodium phosphate 0.1% conventional release eye drops (product)

331681007 Hydrocortisone ointments (product)
WAS A (implicit)
769209000 Product containing hydrocortisone in cutaneous dosage form (medicinal product form)

226807000 Elmlea cream (substance)
WAS_A (implicit)
226805008 Imitation cream (substance)

376026008 Testosterone 15mg (product) (Duplicate 20040731 → non-conformant 20180731)
SAME AS
404741007 Testosterone 15mg transdermal patch (product) (non-conformant 20180731)
WAS_A (implicit) 350366007 Testosterone patch (product) (also non-conformant 20180731)
WAS_A (implicit) 425047001 Topical form testosterone (product) (ambiguous 20180731)
MAYBE_A (explicit) 768999006 Product containing testosterone in cutaneous dosage form (medicinal product form)

312979000 Acquired blindness, one eye (disorder) (non-conformant 20180731)
WAS A (implicit; no explicit historical associations)
232149003 Acquired blindness (now itself ambiguous)
MAYBE 105597003 Blindness AND/OR vision impairment level (disorder)

NB contrast with earlier:

193743000 Acquired blindness, one eye (disorder) (ambiguous 20020131)
MAYBE_A (explicit)
105597003 Blindness AND/OR vision impairment level (disorder)

...noting that neither 312979000 nor 193743000 have any association with 22950006 Blindness of one eye (disorder)

Impact:

• Authors

1. Need to be clear about the distinction between editorial policy regarding ambiguous concepts e.g. AND/OR and those that relate to other aspects of non-conformance to editorial policy.
2. In cases where a replacement term that does conform to ed. policy  is available/created, need to have an historical relationship available.

• Release Management Team

• Developers

• End Users

Impact depends upon:

1. If the inactivated component replacement is straightforwardly synonymous then there is a minimal effect (in which case there is a designated replacement). This accounts for vast majority of cases.
2. If the inactivation results in a new component which the end user considers does not have the same meaning, then the end user must determine a replacement.

Potential improvement:

1. Support a drop down list of potential non-conformance to editorial policy reasons for inactivation:
   1. Change in editorial policy for drugs/substances- add text string to state Ed Guide section or General Content (GC) or EDITPANEL Ticket
   2. Change in editorial policy for clinical findings - add text string to state Ed Guide section or General Content (GC) or EDITPANEL Ticket
   3. Non-conformance to current editorial guide - add text string to state Ed Guide section
2. Support "REPLACED_BY" and "POSSIBLY_EQUIVALENT_TO" associations (NB: JTC - Not sure that POSSIBLY_EQUIVALENT_TO is an appropriate association.  We are not determining the semantics per se, but simply replacing a "bad" concept")
3. Explicitly include changes in editorial policy that affect the logical definition of a concept

Supporting resources: