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

Jim Case

None recorded

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• Evaluation procedures to Observable Entity - Based on community feedback, this proposal has been retracted.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• Inactivation of "Role groupers" from substances and products - based on community feedback, this proposal has been retracted.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, change to Classification derived concept - in progress
• Bypass graft revision proposal - document under review by the EAG

Nicola Ingram 

Jim Case 

Based on the feedback received regarding the proposed inactivation of role groupers in the substance and medicinal product hierarchies, a Briefing Note describing the inactivation of medicinal product role groupers is attached.

Discussion:

This document is informational only

Decision:

N/A

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 available at:

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

Discussion:

Decision:

Victor Medina 

Jim Case 

At the March 2024 EAG call, the group asked for an impact analysis of the change from Surgical approach to a more general Procedure approach.  The results of that analysis are presented in the attached document.

Discussion:

Decision:

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. 

Victor Medina 

Jim Case 

Jim Case 

Victor Medina 

There is an inconsistency in our review of nontraumatic vs. spontaneous injury. In some cases SNOMED makes a distinction between them:
1296953008 |Nontraumatic rupture of extensor tendon of left hand (disorder)|
321371000119100 |Spontaneous rupture of extensor tendon of left hand (disorder)|

whereas in other cases we treat them as synonymous:


In determining the meaning of nontraumatic vs. spontaneous, we have found that nontraumatic means injury not caused by an external force and could occur with or without premonitory signs or symptoms, whereas "spontaneous" injuries usually refer to acute injuries without premonitory signs or symptoms.

The primary question is whether in general clinical practice this distinction has value, and if so, 1) should SNOMED explicitly separate out concepts where spontaneous injury is expressed as a synonym for nontraumatic and 2) should SNOMED create nontraumatic injury concepts as parents to spontaneous injuries where a nontraumatic parent does not currently exist?

A discussion page has been set up to solicit comments from the EAG (Re: Nontraumatic vs. Spontaneous injury)

The discussion brought out a number of meaningful points.

• These terms are most often used interchangeably to mean an injury that does not occur as a result of external force
• While a differentiating definition can be developed based on premonitory signs or symptoms, that distinction is often ignored by clinicians
• It is unclear what the additional benefit is of making the distinction from a clinical perspective

If it is thought that these should be distinct, then much more specific definitions need to be developed and published.

If it is not thought that the distinction is clinically meaningful, then what should SNOMED select as the FSN and PT and should all existing differentiated concepts be merged?  Should a nontraumatic and spontaneous description be a consistent feature of these concepts?

Discussion:

Decision:

Jim Case 

May 27, 2024