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Narrative description

:

The concept is considered to be ambiguous when there is the potential for a user to interpret the meaning in more than one way. This may arise due to inherent conflict between or within the descriptions, where the modelling of the concept does not reflect the meaning of the FSN or where the subtypes or supertypes imply that the concept has been misplaced.

Details

(Provide specifics about the scenario to support comparison to other scenarios)

:

Ambiguity may be apparent for a number of reasons:

• The FSN is ambiguous
• Modeling is more specific than the FSN meaning
• The FSN meaning is more specific than the modeling; inactivation is determined case-by-case as this could simply be a primitive concept which cannot be defined
• Moving to a different top-level hierarchy
• Changing the common name to the scientific name
• Ancestors and descendants (if any) of the concept are inconsistent with what is implied by the FSN - inactivate concepts

POSSIBLY_EQUIVALENT_TO association reference set (foundation metadata concept)

Known issues

(Describe any issues that may occur for this scenario and which may complicate interpretation of the inactivation)

:

1. The presence of ambiguity implies that the concept could have more than one meaning, however, there may not be available concepts within SNOMED CT which match exactly all of the possible meanings. If this is the case new concepts should be created to provide the full set of appropriate associations.
2. While a concept may have more than one meaning it is possible that one or more of the meanings is considered not to be clinically useful and therefore only one target concept is considered to be appropriate.
3. Where there is ambiguity between the FSN and attached synonyms a judgement needs to be made as to whether it is better to inactivate the concept and create new concept(s) or inactivate the non-synonymous synonyms and link them to concepts which are semantically equivalent

Examples

Simple Example

269388002 Burn of eye (& [cornea]) (disorder)
MAY BE 282752000 Injury of eye region (disorder)
MAY BE 284542003 Burn of eye structure (disorder)
MAY BE 274204004 Corneal burn (disorder)

112524000 Northern barred owl (organism)
MAY BE 396690003 Strix varia (organism)
MAY BE 423927009 Strix varia varia (organism)

16704000 Repair AND revision of stoma of esophagus (procedure)
MAY BE 386697002 Repair AND revision of stoma of esophagus (procedure)
MAY BE 386695005 Repair of stoma of esophagus (procedure)
MAY BE 386698007 Revision of esophagostomy (procedure)

267940001 Joint effusion of the forearm (disorder)
MAY BE 202373004 Elbow joint effusion (disorder)
MAY BE 202375006 Wrist joint effusion (disorder)

239801005 Juvenile rheumatoid arthritis (disorder)
MAY BE 410795001 Juvenile rheumatoid arthritis (disorder)
MAY BE 410796000 Juvenile seropositive polyarthritis (disorder)

236568008 Renal transplant disorder (disorder)
MAY BE 58797008 Complication of transplanted kidney (disorder)
MAY BE 429451003 Disorder related to renal transplantation (disorder)

85062008 Isopropyl alcohol (substance)
MAY BE 259268001 Isopropyl alcohol (substance)

228318004 Regular drinker (finding)
MAY BE 365968000 Finding of drinking habits (finding)
MAY BE 228320001 Habitual drinker (finding)

78765007 Intrauterine device (physical object)
MAY BE 268460000 Intrauterine contraceptive device (physical object)
MAY BE ???

195746005 Recurrent chest infection (disorder)
MAY BE 448739000 Recurrent lower respiratory tract infection (disorder)
MAY BE ???

28746002 Recurrent apnea (finding)
MAY BE 1023001 Apnea (finding)
MAY BE 416945002 Recurrent apnea (finding)

Impact

(Describe how specific stakeholders are affected by the inactivation)

:

•  Authors

•  Release Management Team

•  Developers

1. Review and update refsets
2. Provide an appropriate user interface to enable the user to choose the appropriate replacement concept from the options provided

•  End Users

1. If the end user agrees the component is ambiguous then management ia decision needs to be made as to which option to choose on a case by case basis

2. If the end user disagrees that the component is erroneousambiguous, then a suitable replacement SNOMED component is will be needed. This can pose a problem.

3. Including the exact reason the component is determined to be erroneous would help the end user reconcile the inactivation.

Proposed improvement:

1. Resolve non-synonymous synonyms by inactivation of the descriptions and re-assign to either existing concepts which are semantically equivalent or by creating new concepts
2. Establish that the ambiguous FSN requires 2 or more clinically useful concepts are required to maintain semantic equivalence
3. If after due diligence only one target is considered to be clinically useful then the association type should be 'REPLACED_BY'
4. Update the tooling to support the allocation of a "REPLACED_BY" association with a text field to explain the reason(s)

Supporting resources:

Potential improvement

(Provide an indication of whether the current inactivation mechanism for this scenario is sufficient, or provide your ideas or thoughts on potential improvements)

Supporting resources