SNOMED CT Editorial Advisory Group

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Time:

0900 - 1230 BST

0800 - 1130 UTC 


Zoom Meeting Details

Jim Case is inviting you to a scheduled SNOMED International Zoom meeting. 

Topic: SNOMED EAG Face to face meeting London
Time: Apr 16, 2024 09:00 London

Join from PC, Mac, Linux, iOS or Android: 
https://snomed.zoom.us/j/89827589410?pwd=nPOQj9SzZnrFpeA5lsIov90Lvt22Og.1
    Password: 848732




Attendees

Chair:

AG Members:

Invitees:

Victor Medina 

Observers



Apologies:


Meeting Files:

View file
nameDraft Briefing note_ Remodeling of 48537004 _Bypass graft (procedure)_ hierarchy.pdf
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View file
nameIHTSDO-1258_Remodeling of 1263452006 _Anesthesia and_or sedation procedure (procedure)_ hierarchy.pdf
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View file
namePotential adverse reaction concepts.xlsx
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Meeting minutes:

The call recording is located here.


Objectives

  • Obtain consensus on agenda items

Discussion items

ItemDescriptionOwner

Notes

Action
1Call to order and role call

Jim Case

This meeting is being recorded to ensure that important discussion points are not missed in the minutes.  The recording will be available to the SNOMED International community.  Joining the meeting by accepting the Zoom prompt declares that you have no objection to your comments being recorded


  •  Recording of meeting approved by participants.
2

Conflicts of interest and agenda review

Jim Case

None recorded


3EAG item status since October 2023

Jim Case 

Here is the status of items brought to the EAG since October 2023:

  • Modeling of "No known X" - Ongoing. revision of Context values has not progressed.  Consensus on approach not yet reached
  • Transplantation vs. grafting and Terming of Transplantation concepts - solid tumors have been remodeled, grafts and tissue transplantation are in progress
  • Mechanical complication of device - Inactivation of grouper concepts, as recommended by the EAG is underway
  • Evaluation procedures to Observable Entity - Based on community feedback, this proposal has been retracted.  Evaluation procedures will remain, although new laboratory evaluation procedures will not be added.
  • Replacement of "Surgical approach" with "Procedure approach - in testing for impact analysis
  • MRCM change and revision of Physical object hierarchy - request for access to a non-promotable project in the SNOMED authoring platform is in process
  • Updating of Neuroendocrine tumors.  Part of Histology update project - work completed
  • Inactivation of "Role groupers" from substances and products - based on community feedback, this proposal has been retracted.  Inactivation of newly constructed Product role groupers is out for community comment
  • Adverse reaction usage - Concepts that have a CAUSATIVE AGENT value from the 373873005 |Pharmaceutical / biologic product (product)| hierarchy have been remodeled and promoted.  A spreadsheet with concepts using CAUSATIVE AGENT values from the substance hierarchy has been circulated for EAG review
  • Inactivation of 370115009 |Special concept (special concept)| - Had been on hold pending focused input.   Briefing note has been prepared. 
  • Creation of new top level hierarchy for Generic products -  proposal in development
  • Inactivation reason review - 
  • Bypass graft revision proposal - document under review by the EAG


Adverse reaction subtypes

Jim Case 

On the January EAG call, it was agreed that all disorder concepts with a CAUSATIVE AGENT relationship value derived from the 373873005 |Pharmaceutical / biologic product (product)| hierarchy should be modeled as subtypes of 281647001 |Adverse reaction (disorder)|.  Upon further review of the content, there are a number of substances that could also fit under this grouper term.  A spreadsheet with a listing of disorders with a CAUSATIVE AGENT  value derived from the substance hierarchy was sent out for review by the EAG.  This had a column suggestions as to which concepts should or should not be subtypes of 281647001 |Adverse reaction (disorder)|.  The spreadsheet is attached to the agenda.available at:

https://docs.google.com/spreadsheets/d/1P1D5rEU-fBwkWak_ldhszerwMq8PKCOw/edit#gid=1482910902

Discussion:


Decision:



Bypass graft revision proposal

Victor Medina 

Jim Case 

As part of the QI project, substantial changes to the representation of bypass grafts and shunts have been proposed.  A briefing note (attached) and a detailed document for the proposed changes (referenced in the briefing note) are provided.

Discussion:

2024-03-11 How are bypass concepts without definition of proximal and distal targets going to be modeled?  A: Need review.  How are proximal and distal defined?  A: It is based on either anatomic position or flow of contents. Definitions for proximal and distal anastomosis will be provided.

Concern about creating intermediate primitives as this complicates the assignment of parents.  Also need to make sure the definitions are clear.  Where do "-stomy" concepts fit into this proposed model. 

Decision:

2024-03-11 Comments will be added to the document by the EAG members. 



Remodeling of 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy

Victor Medina 

Jim Case 

The current concepts 1263452006 |Anesthesia and/or sedation procedure (procedure)| and 410011004 |Administration of anesthesia AND/OR sedation (procedure)| are disjunctive groupers.  The attached document provides details on proposed changes to this hierarchy that improves the modeling and specificity of anesthetic and sedation procedures.  The proposed changes have been reviewed and accepted by the Anesthesia CRG.  Key elements include:

  • Inclusion of a HAS INTENT relationship to specify the nature of the anesthesia or sedation (e.g. local, regional, general)
  • Inactivation of "anesthesia for X" type concepts
  • Remodeling concepts to adhere to templates

Discussion:


Decision:



USING DEVICE vs. DIRECT DEVICE use in procedures

Jim Case 

Victor Medina 

During QI review of procedures, inconsistencies were revealed in the use of USING DEVICE and DIRECT DEVICE in procedures.  The current definitions for these attributes from the editorial guide: 

Direct device

Direct device (attribute) represents the device on which the method directly acts.

Using device

Using device (attribute) refers to the instrument or equipment utilized to execute an action. It is used when the device is actually used to carry out the action, that is the focus of the procedure. If the device is simply the means to access the site of the procedure, then Using access device is the appropriate attribute.

Examples of inconsistencies:
175254001 |Repair of pulmonary artery using prosthesis (procedure)| = Using device -> Prosthesis device.
771713005 |Open repair of inguinal hernia using sutures (procedure)| = Using device -> Surgical suture, device.
719263004 |Repair of parastomal hernia using mesh patch (procedure)| = Direct device -> Hernia surgical mesh.
719290008 |Repair of umbilical hernia using surgical mesh (procedure)| = Direct device -> Hernia surgical mesh.
238190005 |Repair of incisional hernia using synthetic patch (procedure)| = Using device -> Prosthetic patch.

We would like to come up with more specific editorial guidelines related to what is meant by "the device on which the method directly acts".  In general, parameters could include things such as "materially changed by the procedure", "remains in the body following the procedure", etc.  The use of the word "using" in FSNs can bias a content author to use the attribute USING DEVICE when the more appropriate DIRECT DEVICE should be used.  A broader application of DIRECT DEVICE in procedure modeling could have large impacts on the number of concept affected, but would resolve the current inconsistencies.

USING DEVICE and USING ACCESS DEVICE are also inconsistently used and sometimes incorrectly.  In a review of procedure subhierarchies (e.g. arthroplasty), USING ACCESS DEVICE was modeled in the surgical action RG, when in many cases the device does not act as an access to the surgical area, but plays another role, (e.g. illumination).  An evaluation of the current benefits of USING ACCESS DEVICE over USING DEVICE  is underway.  

While it is not part of this topic, we expect the same issues to be present related to USING SUBSTANCE and DIRECT SUBSTANCE

Discussion:


Decision:



9AOBEAG



10Next meeting

Jim Case 

May 27, 2024




...