Description | Owner | Notes |
|---|
Welcome and agenda | All | - Next meeting - Thursday 16th June 2022
- Meeting room in Portugal has been booked (half day session)
| URIs for edition plus module composition | All | - - Sunday 25th September 5pm-6:30pm (followed by group dinner?)
| | ECL v2.1 | Linda Bird | Proposal - Add the ability to find concepts for a given description id, e.g. Please review the following pages: Homework from last week: Consider new URI formathttp://snomed.info/sct/900000000000207008;module/733983009;module/715152001 | | URIs for edition plus module composition | All | Homework from last week: - Consider new URI format
- http://snomed.info/sct/900000000000207008;module/733983009;module/715152001
- http://
Reminder of Problem We're Solving - SNOMED CT user, who needs to use an edition with one or more derivative packages that are not included in the MDRS for that edition
- For example, how do they specify a substrate for this ECL in a shareable way?
- Possible use case: Implicit value sets defined using ECL
- Constraint: Only concepts
- metadata (e.g. module concept with no defining attributes) in package - does not require classification
Solutions considered: Require everyone (e.g. every country) to create their own module and module dependencies to define which derivatives are to be used- Action: Make this process super easy (Q: is that possible? Everyone will need a namespace identifier)
International modules created for each (popular) derivative combinations with associated module dependenciesA 'flexible' derivative extension module created by SI, with locally defined module dependenciesURI format to include edition plus derivate composition, e.g.http://- snomed.info/sct/900000000000207008/version/20220228;module/733983009/time/20191031;module/715152001/time/20191031
Terminology services endpoints to check (a) what modules are required to execute a given ECL, and (b) what modules are currently loaded | | URIs for ECL | | Proposal - Publish format of URIs for language instances
- Implement resolution of URIs for ECL instances → SNOMED International browser
- Update ECL specification, to create clickable ECL execution
| Reminder of Problem We're Solving - SNOMED CT user, who needs to use an edition with one or more derivative packages that are not included in the MDRS for that edition
- For example, how do they specify a substrate for this ECL in a shareable way?
- Possible use case: Implicit value sets defined using ECL
- Constraint: Only concepts
- metadata (e.g. module concept with no defining attributes) in package - does not require classification
Solutions considered: - Require everyone (e.g. every country) to create their own module and module dependencies to define which derivatives are to be used
- Action: Make this process super easy (Q: is that possible? Everyone will need a namespace identifier)
- International modules created for each (popular) derivative combinations with associated module dependencies
- A 'flexible' derivative extension module created by SI, with locally defined module dependencies
- URI format to include edition plus derivate composition, e.g.
- http://snomed.info/sct/900000000000207008/version/20220228;module/733983009/time/20191031;module/715152001/time/20191031
- Terminology services endpoints to check (a) what modules are required to execute a given ECL, and (b) what modules are currently loaded
| | URIs for ECL | | Proposal - Publish format of URIs for language instances
- Implement resolution of URIs for ECL instances → SNOMED International browser
- Update ECL specification, to create clickable ECL execution
| ECL 2.1 | | Proposal - Add the ability to find concepts for a given description id, e.g. Please review the following pages: | | The items below are currently on hold | | ECL v2.1 - Requirement proposals | All | Potential requirements for ECL v2.1 - Discussion and brainstorming - Daniel's comments
- Context supplements - e.g.
- << 56265001 |Heart disease| {{ + CONTEXT }} – This syntax is too general, as there is a risk of including absent finding, not-done procedure and family history
- << 56265001 |Heart disease| {{ + CONTEXT-DEFAULT }} ? – What would this mean?
- Brief form:
- [[@ecl_query]] {{ + Context (Temporal = [[ @temporal_value]] }}
- Expanded form:
- [[ @ecl_query ]] OR (< 243796009 |Situation with explicit context|:
{ ( 246090004 |Associated finding| = ( [[ @ecl_query ]] )
OR |Associated procedure| = ( [[ @ecl_query ]] )
( |Procedure context| = |Done| OR |Finding context| = |Known present|),
|Subject relationship context| = |Subject of record|,
|Temporal context| = [[ @temporal_value ]] } )
- Example 1: << |Heart procedure| {{ + Context (Temporal = *) }}
- << |Heart procedure| OR (< 243796009 |Situation with explicit context|:
{ 246090004 |Associated finding| = << 56265001 |Heart disease|,
|Procedure context| = |Done|,
|Subject relationship context| = |Subject of record|,
|Temporal context| = * } ) - Example 2: (<< |Heart disease| OR << |Heart procedure| ) {{ + Context (Temporal = *) }}
- << |Heart procedure| OR (< 243796009 |Situation with explicit context|:
{ ( 246090004 |Associated finding| = (<< |Heart disease| OR << |Heart procedure| )
OR |Associated procedure| = ( << |Heart disease| OR << |Heart procedure| ) )
( |Procedure context| = |Done| OR |Finding context| = |Known present|),
|Subject relationship context| = |Subject of record|,
|Temporal context| = * } )
- << 56265001 |Heart disease| {{ + Context (Temporal = *, FindingContext=<<|Known present| }}
- Will return all types of heart disease, plus concepts like 394886001 |Suspected heart disease (situation)|, and 429007001 |History of cardiac arrest (situation)|
- Expands to:
- However, you may want to exclude (or include) specific contexts - for example:
- To ensure that the finding was about the subject of the record (and not a family history, e.g. to exclude 429959009 |Family history of heart failure (situation)|), you could say:
- << 56265001 |Heart disease| {{ + CONTEXT (relationship = 410604004 |Subject of record| }}
- To ensure that the finding was 'Known present' (e.g. to exclude 394926003 |Heart disease excluded (situation)|), you could say:
- << 56265001 |Heart disease| {{ + CONTEXT (finding_context = << 410515003 |Known present| }}
- To ensure that the finding was about the subject of the record AND known present, you could say:
- << 56265001 |Heart disease| {{ + CONTEXT (relationship = 410604004 |Subject of record|,
finding_context = << 410515003 |Known present| }}
- ?? Is there any use case for restricting adding temporal context? (e.g. temporal != << 410513005 |In the past|)
- Is any more syntactic sugar required? E.g.
- {{ + CONTEXT (relationship = self, finding context = present, temporal != past) }}
- {{ + CONTEXT (self, present, ! past) }}
- Other ideas? Common profiles?
- --------------------------
- Ability to return attribute types (see proposal below)
- [ attributes ] << 125605004 |Fracture of bone (disorder)|
- << 125605004 |Fracture of bone (disorder)| . Attributes
- << 125605004 |Fracture of bone (disorder)| . (<< 125605004 |Fracture of bone (disorder)| . Attributes )
- [ attribute, value] << 125605004 |Fracture of bone (disorder)|
- -------------------------
- Reverse membership (see below)
- Which reference sets "contain" the given concept(s) - e.g. 421235005 |Structure of femur|?
- 421235005 |Structure of femur| . Refsets
- 421235005 |Structure of femur|. Refsets [ referencedComponentId ]
- 421235005 |Structure of femur| . Refsets [ targetComponentId ]
- --------------------------
- Other?
| | Returning Attributes | Michael Lawley | - Currently ECL expressions can match (return) concepts that are either the source or the target of a relationship triple (target is accessed via the 'reverse' notation or 'dot notation', but not the relationship type (ie attribute name) itself.
For example, I can write: << 404684003|Clinical finding| : 363698007|Finding site| = <<66019005|Limb structure| << 404684003|Clinical finding| . 363698007|Finding site| But I can't get all the attribute names that are used by << 404684003|Clinical finding| - Perhaps something like:
- ? R.type ? (<< 404684003 |Clinical finding|)
- This could be extended to, for example, return different values - e.g.
- ? |Simple map refset|.|maptarget| ? (^|Simple map refset| AND < |Fracture|)
| | Reverse Member Of | Michael Lawley | What refsets is a given concept (e.g. 421235005 |Structure of femur|) a member of? - Possible new notation for this:
- ^ . 421235005 |Structure of femur|
- ? X ? 421235005 |Structure of femur| = ^ X
| | Postcoordination Topics |
| - Discuss feedback on transformation implementation
- Resources
- Recap of SNOMED on FHIR discussions
- What is the functionality scope of a terminology server that supports postcoordination? For example, does it include:
- Classifying multiple expressions in a single substrate? What are the use cases for this?
- Assigning (local) identifiers to expressions? What are the use cases for this?
- Autogenerating or assigning a term to an expression? What are the use cases for this?
- Does a terminology server that supports postcoordination, include all the functions of an expression repository?
- What is the relationship between a terminology server that supports postcoordination, and an expression repository?
- Outstanding questions
- What are the pros and cons of extending SCG to allow an expression as the focus of a postcoordinated expression?
- Note: This was raised in context of a NNF generated over a postcoordinated substrate, where the proximal parent is an expression
- Example of using expressions in focus concept
- ( 125605004 |Fracture of bone|:363698007 |finding site| = 84167007 |Foot bone| ) :
272741003 |Laterality| = 7771000 |Left| - 125605004 |Fracture of bone|:363698007 |finding site| = 84167007 |Foot bone| ,
272741003 |Laterality| = 7771000 |Left|
- What is the expected NNF when classifying an expression that is equivalent to a precoordinated concept? For example:
- Expression that is equivalent to 111273006 |Acute respiratory disease|
- 64572001 | Disease (disorder) | :
{263502005 |Clinical course (attribute)| = 424124008 |Sudden onset AND/OR short duration (qualifier value)|}
{363698007 |Finding site (attribute)| = 89187006 |Airway structure (body structure)|} - Options:
- 111273006 |Acute respiratory disease| :
{263502005 |Clinical course| = 424124008 |Sudden onset AND/OR short duration|}
{363698007 |Finding site| = 89187006 |Airway structure|} - 50043002 |Disorder of respiratory system (disorder)| +
2704003 |Acute disease (disorder)| :
{263502005 |Clinical course| = 424124008 |Sudden onset AND/OR short duration|}
{363698007 |Finding site| = 89187006 |Airway structure|} - Other?
- Recap of internal discussions with Content Team
- Inter-attribute dependencies
- Grouping rules
| | Dynamic Templates |
| - Continue discussion on dynamic templates
- Inter-attribute dependencies
- Acute/Chronic and Inflammation - Adding a clinical course requires specializing the inflammation morphology
 - E.g. |Pyelonephritis| : |Clinical course| = |Chronic|
should be
|Pyelonephritis| : |Clinical course| = |Chronic|, |Associated morphology| = |Chronic inflammation| - E.g. |Pyelonephritis| : |Clinical course| = |Sudden onset AND/OR short duration|
should be
|Pyelonephritis| : {|Clinical course| = |Sudden onset AND/OR short duration||, |Associated morphology| = |Acute inflammation|
- Infectious Causative Agents - Adding a |causative agent| = |Domain Bacteria| or |Virus| requires adding a |Pathological process| = |Infectious process|
- E.g. |Nephritis|: |Causative agent| = |Domain bacteria|
should be
|Nephritis|: |Causative agent| = |Domain bacteria|, |Pathological process| = |Infectious process|
- Congenital and Acquired - Adding an |Occurrence| of |Congenital| to a focus concept with an abnormal morphology, requires adding a |Pathological process| of |Pathological development process|
- E.g. |Koilonychia|: |Occurrence| = |Congenital|
should be
|Koilonychia|: |Occurrence| = |Congenital|, |Pathological process| = |Pathological developmental process|
- Situations with Explicit Context
- if the procedure context = |Planned|, then the temporal context should be << |Current of specified time|
- If the procedure context = |In progress|, then the temporal context should be << |Current|
- If the procedure context = |Performed| or |Done|, then the temporal context should be << |Current or past (actual)|
- Note: for this use case (of |Procedure with explicit context|) perhaps we just recommend (or require) that the full role group is spelled out.
- Next steps
- Representation of the content rules
- Who creates the complete list of rules and how?
- What formalism?
- Determine which are mandatory and which are optional
- Implementation of content rules - e.g.
- Guided data entry by pre-populating role groups in expression template based on definition of focus concepts (for design-time use, such as mapping)
- Mandatory content rules could be added to transform process
| | Postcoordination Use Case Examples | All | Example 1 - Dentistry / Odontogram - Requires an expression template to create expressions.
- Resulting expression still requires a transformation to make it classifiable
Example 2 - Terminology binding - Uses a fixed expression template to combine codes entered into separate fields
- The procedure+laterality example still requires a transformation to make it classifiable
Example 3 - Mapping - Design-time activity
- Map targets may not be able to be fully represented using concept model attributes
- In many cases, an extension (with primitive concepts) should be recommended where there are gaps in the mapping
- There may be some cases in which postcoordination is helpful (e.g. LOINC to SNOMED CT map)
Example 4 - Natural Language Processing - Usually run-time activity.
- May require manual confirmation of coding suggestions (unless low clinical risk, eg for suggesting relevant patient records for manual review)
| | Postcoordination Guidance | | Practical Guide to Postcoordination - Proposal - Use syntax (i.e. braces) to distinguish refinement vs new role group
- There should be a syntactic distinction between refinement and constructive addition (ie adding a new role group). That is:
- 83152002 |Oophorectomy| : 405815000 |Procedure device| = 122456005 |Laser device|
- is classified as (i.e. the refinement is added to the role groups in the definition of the focus concept(s)):
- 83152002 |Oophorectomy| : { 405815000 |Procedure device| = 122456005 |Laser device| }
- However, for attributes which are always self-grouped - i.e. Priority, Due to, After, Before, During, Clinical course, Temporally related to, and all Observable entity attributes (see Relationship Group), these must always be put into their own role group:
- 125605004 | Fracture of bone |: 42752001 | Due to (attribute) | = 1912002 | Fall |
- is classified as:
- 125605004 | Fracture of bone |: { 42752001 | Due to (attribute) | = 1912002 | Fall | }
- or
- 125605004 | Fracture of bone |:
{ 363698007 |Finding site|= 272673000 |Bone structure|,
116676008 |Associated morphology |= 72704001 |Fracture|}
{ 42752001 | Due to (attribute) | = 1912002 | Fall | }
- Proposal: Expression forms needed for this (see 3.4 Transforming Expressions)
- Close to user form - e.g. 83152002 |Oophorectomy| : 405815000 |Procedure device| = 122456005 |Laser device|
- Canonical close to user form - e.g. 83152002:405815000=122456005
- Classifiable form (SCG) - e.g. 83152002:{260686004=129304002,405813007=15497006,405815000=122456005}
- PLUS Classifiable form (OWL) - e.g.
- EquivalentClasses(:123063
ObjectIntersectionOf (:71388002
ObjectSomeValuesFrom(:609096000 ObjectIntersectionOf( ObjectSomeValuesFrom(:260686004 :129304002)
ObjectSomeValuesFrom(:405813007 :15497006))))
- Necessary normal form - e.g. 83152002+416376001:{260686004=129304002,405813007=15497006,405815000=122456005}
- PLUS Necessary normal form (tables)
- Relationships:
- (123063 116680003 83152002) - 0
- (123063 260686004 129304002) - 0
- (123063 405813007 15497006) - 1
- (123063 405815000 122456005) - 1
- Primitive expressions - "<<<" (only useful in a mapping context) → .... relies on the assigned identifier (which are necessarily semantically unique).
- Proposed Transformation Rules - Refinements (in valid domain of focus concepts)
Close-to-user-form - IF the grouping of the refinement is not concept model valid THEN
If there is a single (non-self-grouped) role group in the definition of the focus concept, then any ungrouped (but groupable) refinements are merged with this role group
If there is more than one (non-self-grouped) role group in the definition then flag as ambiguous and require refinement
NEED TO FIND a realistic clinical example where this may occur // Prevent failing cases from coming up // use template
ALTERNATIVE: Refinement is applied to all (non-self-grouped) role groups in the definition
Self-grouped attributes in the refinement are grouped on their own - i.e. Priority, Due to, After, Before, During, Clinical course, Temporally related to, and all Observable entity attributes (see Relationship Group)
Self-grouped attributes in the definition of the focus concept(s) are left unchanged - Single refinement
83152002 |Oophorectomy| : 405815000 |Procedure device| = 122456005 |Laser device| - Two groupable refinements
83152002 |Oophorectomy| : 405815000 |Procedure device| = 122456005 |Laser device|, 363700003 |Direct morphology| = 367643001 |Cyst | - One groupable refinement with one self-grouped refinement
83152002 |Oophorectomy| : 405815000 |Procedure device| = 122456005 |Laser device|, 260870009 |Priority| = 394849002 |High priority|
- Refinement attribute matches (or subsumed by) attribute in focus concept's definition
83152002 |Oophorectomy| : 260686004 |Method| = 277261002 |Excision biopsy (qualifier value)| - Refinement explicitly in role group
83152002 |Oophorectomy| : { 260686004 |Method| = 281615006 | Exploration - action | , 405813007 |Procedure site - direct| = 367643001 |Cyst | }
Proposed Transformation Rules - Refinements (NOT in valid domain of focus concepts)
Close-to-user-form - IF the refinement's attribute is not valid for the domain of the focus concept THEN
If there is a single role group in the definition of the focus concept, which has an attribute value in the domain of the refinement's attribute THEN nest the relevant attribute value with the refinement added to the attribute value
(Note: It doesn't matter if the role group is self-grouped or not (see example 1 below)
If there is more than one role group in the definition of the focus concept, which has an attribute value in the domain of the refinement's attribute THEN (non-self-grouped) role group in the definition then flag as ambiguous and require refinement - Left aural temperature
- 415974002 |Aural temperature|: 272741003 |Laterality| = 7771000 |Left|
- → 415974002 |Aural temperature|: {704327008 |Direct site| = (42859004 |Ear drum|: 272741003 |Laterality| = 7771000 |Left|)}
- Malignant tumor of right ovary
- Other Example - Emergency excision of appendix
- 80146002 | Excision of appendix | :
260870009 |Priority| = 25876001 |Emergency|
- Other Example - Fracture of bone
- 125605004 |Fracture of bone|: 363698007 |finding site| = 84167007 |Foot bone|
- 125605004 |Fracture of bone|: {363698007 |finding site| = 84167007 |Foot bone| }
- 125605004 |Fracture of bone|: {116676008 |Associated morphology| = 72704001 |Fracture|,
363698007 |finding site| = 84167007 |Foot bone| } - 64572001 |Disease|: {116676008 |Associated morphology| = 72704001 |Fracture|,
363698007 |finding site| = 84167007 |Foot bone| }
| | The items below are currently on hold | | URIs for Extended Editions |
| ON HOLD - How to refer to an 'extended edition' using a URI - e.g. "International Edition plus the following 2 nursing modules: 733983009 |IHTSDO Nursing Health Issues module|and 733984003 |IHTSDO Nursing Activities module| Use Case - Need to execute an ECL, that refers to "^ 733991000 | Nursing Health Issues Reference Set (foundation metadata concept) |" and/or "^ 733990004 | Nursing Activities Reference Set (foundation metadata concept) |", where the substrate includes the international edition, plus the modules that include these reference sets July 2020 International Edition URI: http://snomed.info/sct/900000000000207008/version/20200731 July 2020 International Edition + nursing modules URI ?? - For example: | Expression Templates | | - ON HOLD WAITING FROM IMPLEMENTATION FEEDBACK FROM INTERNAL TECH TEAM
- WIP version - https://confluence.ihtsdotools.org/display/WIPSTS/Template+Syntax+Specification
- Added a 'default' constraint to each replacement slot - e.g. default (72673000 |Bone structure (body structure)|)
- Enabling 'slot references' to be used within the value constraint of a replacement slot - e.g. [[ +id (<< 123037004 |Body structure| MINUS << $findingSite2) @findingSite1]]
- Allowing repeating role groups to be referenced using an array - e.g. $rolegroup[1] or $rolegroup[!=SELF]
- Allow reference to 'SELF' in role group arrays
- Adding 'sameValue' and 'allOrNone' constraints to information slots - e.g. sameValue ($site), allOrNone ($occurrence)
- See changes in red here: 5.1. Normative Specification
Examples: [[+id]]: [[1..*] @my_group sameValue(morphology)] { |Finding site| = [[ +id (<<123037004 |Body structure (body structure)| MINUS << $site[! SELF ] ) @site ]] , |Associated morphology| = [[ +id @my_morphology ]] } - Implementation feedback on draft updates to Expression Template Language syntax
- Use cases from the Quality Improvement Project:
- Multiple instances of the same role group, with some attributes the same and others different. Eg same morphology, potentially different finding sites.
Note that QI Project is coming from a radically different use case. Instead of filling template slots, we're looking at existing content and asking "exactly how does this concept fail to comply to this template?" For discussion: | Scg expression |
|---|
[[0..1]] { [[0..1]] 246075003 |Causative agent| = [[+id (< 410607006 |Organism|) @Organism]] } |
Is it correct to say either one of the cardinality blocks is redundant? What are the implications of 1..1 on either side? This is less obvious for the self grouped case. Road Forward for SI- Generate the parser from the ABNF and implement in the Template Service
- User Interface to a) allow users to specify template at runtime b) tabular (auto-completion) lookup → STL
- Template Service to allow multiple templates to be specified for alignment check (aligns to none-off)
- Output must clearly indicate exactly what feature of concept caused misalignment, and what condition was not met.
Additional note: QI project is no longer working in subhierarchies. Every 'set' of concepts is selected via ECL. In fact most reports should now move to this way of working since a subhierarchy is the trivial case. For a given template, we additionally specify the "domain" to which it should be applied via ECL. This is much more specific than using the focus concept which is usually the PPP eg Disease. FYI Michael Chu | | Description Templates | Kai Kewley | - ON HOLD
- Previous discussion (in Malaysia)
- Overview of current use
- Review of General rules for generating descriptions
- Removing tags, words
- Conditional removal of words
- Automatic case significance
- Generating PTs from target PTs
- Reordering terms
- Mechanism for sharing general rules - inheritance? include?
- Description Templates for translation
- Status of planned specification
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