Conflicts of interest and agenda review

Distilled background from below:

Per Ed:  I see a lot of ‘mRNA’ [in new COVID-related codes].  Outside the realm of clinical imaging and organisms, does SI publish a list of acronyms and abbreviations that do not need to be accompanied by expansions in synonyms?  If not, what is your process for approving internationally distributed exceptions to the published editorial rules?

Per Jim:  We currently only have exceptions for the addition of acronyms for a few items and do not have a comprehensive list.  For descriptions, in this case we are following the guidance related to the use of acronyms in FSNs, which is "An acronym is allowed in a [description] when it has become a word in its own right, i.e., included in dictionaries; understood without expansion to its original full form." A search on Google as well as searches in various dictionaries does not provide an alternative meaning for mRNA other than "messenger ribonucleic acid". It would be useful for us to create a section where approved abbreviations and acronyms are listed.  

Per Ed:  My query relates to the presence of mRNA (without accompanying expansion) in the synonyms listed in the briefing note. It’s confusing if the approach taken is justified by reference to the FSN guidance. Substituting ‘…a [description]…’ in place of ‘…an FSN…’ (in the current editorial guide) is unhelpful. Is the member community free (or indeed expected) to make this substitution anywhere in SNOMED CT’s documentation? 

The Acronyms subsection ‘Preferred terms and synonyms’ guidance begins “…Acronyms are allowed in a Preferred Term or Synonym when followed by the expanded term’ which seems pretty clear to me (and our authoring team, who have spent hundreds of person hours defending this approach to customers). __ However, the international content added here (and plenty elsewhere – both old and new) is in conflict with this clause. Hence my question.

 Deep down I share the view that ‘mRNA’ is only likely have one interpretation in a health record setting (and I’m comfortable, for example, that the SARS-CoV-2 /COVID-19 train left a long time ago), but that is not the point.

A stated editorial stance creates expectations, and exceptions need to be explicit, justified and risk-managed. The current international documentation only gives us imaging modalities (acronyms) and organism names (abbreviations) as exceptions, but the data is full of them. Bafflingly, the second ‘organism abbreviation’ example is illustrated by an unexpanded acronym (‘CRM’) that is used in SNOMED CT to mean both ‘circumferential resection margin’ and ‘cross-reacting material’ and I would wager is NOT ‘understood without expansion to its original full form’ by the majority of readers.

Both these quotes are served by the spirit of the international editorial rules, but sadly not by the data.

From the current Editorial guide:

"Acronyms

Acronyms are easily misinterpreted. For this reason, all acronyms are unacceptable in FSNs.

For example, the FSN should be the expanded form, Computed tomography of chest (procedure), however as a preferred term, CT of chest (procedure) is acceptable.

If there is an acronym in an existing FSN, the FSN DescriptionId is inactivated and a new FSN is created (regardless of whether or not the acronym was in parentheses with the expanded form). The replacement FSN concept has the expanded description with the acronym entirely removed. Inactivating the ConceptId is not necessarily required, unless the FSN had significant ambiguity before changing it to its expanded form."

Discussion:

Briefing note regarding acronyms in SNOMED CT

Does the current editorial guidance need to be updated/expanded to represent exceptions in synonyms?

What should be the rules for exceptions?

Decision:

Background:

Discussed at the 2020-09-09 EAG:

For the vaccine model we used a HAS PRODUCT CHARACTERISTIC to cover about 5 attributes.  In the MRCM, the range is bound to the attribute and so the ranges for these general attributes are difficult to manage and use.  Many of these characteristics are required by extensions and not the core.  The question is whether these should instantiated within the International release or allow extension more freedom to create new attributes.  

The group recommended that we create specific attributes rather than use the generic attribute relationships. Modeling within the international release would not use the generic attributes.  It is important to align new attributes to a specific subdomain so that the use of the attribute is clearer.  

The group did not make a recommendation on the retention of inactivation of the generic "characteristic" attributes; however,it was decided that these generic attributes would not be used to model content  in the International release. SNOMED International had originally detemrined that we would move towards creating ONLY specific attributes and eventually inactivate the generic attributes after giving extensions that may have used them in their local models to either adopt the more specific international attributes or create their own specific attributes. 

We have received concerns from a number of NRCs that have adopted the use of the generic attributes that inactivation would result in substantial problems. 

Usage:

Feedback from Canada: In Canada, we have a vaccine extension and we are happy to see that new attributes like “Has target population (attribute)” and the “Has ingredient qualitative strength (attribute)”, will be created to better support the vaccine (extensions) model. Where I am not in agreement, is for the “Has product characteristic (attribute)”. That is an Attribute we use to define different things like unadjuvanted vaccine product, adjuvanted vaccine product, the thimerosal free products and we were thinking to use it for seasonal information. I think that it will be very important to consult with member countries that maintain extensions before removing key concepts we use frequently. (n≈100 concepts affected)

Also used for modeling in Argentina's and Uruguay's national extension (n≈30 concepts affected)

Discussion:

Decision: 

Inactivation of Ambiguous Concepts - examples and updated proposal

Document attached to the agenda Meeting Files above.

Inquiries from Germany outlined inconsistencies in terming in the Specimen hierarchy.  A background document with proposed changes is available for review and comment by the EAG prior to broader circulation: 

Specimen term change proposal

Discussion:

Decision: