SNOMED CT Editorial Advisory Group

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Inactivation ReasonAssociationDefinition

Outdated

REPLACED_BY 

POSSIBLY_REPLACED_BY

No suitable replacement identified

The inactivation reason “Outdated Concept” explicitly states that the inactivated concept (A) is an outdated concept that is no longer considered to be clinically acceptable or semantically interoperable internationally. It is possible that the original meaning of the outdated concept could be “REPLACED_BY” concept (B) that is semantically similar to or more general than the inactivated concept for the purposes of data healing and analysis of historical data.

However, in some circumstances, there will be no suitable replacement concept and therefore no historical association is provided.

Guidance
  • Is the concept outdated?
    Careful research is needed to clearly differentiate between a true duplicate, where there is semantic equivalence between the two concepts, and where there is a true evolution in the understanding of the concept, and therefore, an evolution in the meaning, that warrants a more appropriate “REPLACED_BY” target concept.
  • Annotation
    Provide evidence/reference that the concept is outdated
  • Dropdown list (Where no replacement is appropriate)
    • No suitable replacement concept identified
  • Additional notes
    • Where there has been an update to a disorder classification, a substance or organism originally believed to be a single entity has, following further study been reclassified as 2 or more substances or organisms.
    • Use Outdated Concept with a historical association to 2 or more POSSIBLY_REPLACED_BY target concepts.
    • It is also possible that outdated clinical concepts simply fall into disuse without any appropriate replacement, and therefore no historical association should be provided.
    • Simple renaming of drugs or organisms where the meaning is unchanged should be dealt with by updating the FSN only using ‘Outdated component’ as the association type on the inactivated FSN description.

Examples

Panel
titleReclassification following phylogenetic analysis

Outdated concept: 

  • Concept
    t114457004 |Klebsiella ornithinolytica (organism)|
    • REPLACED_BY:
      Concept
      t416832000 |Raoultella ornithinolytica (organism)|
  • Annotation:
    Following phylogenetic analysis Klebsiella ornithinolytica was reclassified as Raoultela ornithinolytica


Panel
titleAn operative procedure that is no longer considered clinically acceptable

Outdated concept: 

  • Concept
    t58337008 |Transorbital leukotomy (procedure)|
    • REPLACED_BY: No suitable replacement identified

  • Dropdown list (Where no replacement is appropriate)
    No suitable replacement concept identified

  • Annotation:
    Also known as “Ice pick lobotomy”, as this was the instrument used in the procedure, last performed by Dr. Freeman in 1967. 

Resolving sequences of Historical Associations

The intention is that functionality to resolve sequences of Historical Associations will normally

...

 Outdated Concept

...

REPLACED_BY association reference set (foundation metadata concept)

POSSIBLY_REPLACED_BY association reference set (foundation metadata concept)

Additional notes:

Examples:

Semantic meaning the same but FSN different:

235998001 Perinephric abscess (disorder) - inactivated
SAME_AS
80640009 Perirenal abscess (disorder)

Both concepts had an effective date of 2002-01-31 and so the decision was based on current clinical usage and the retained concept already had a synonym of Perinephric abscess.

Identical FSN but different semantic tag:

145857006 Soft tissue X-ray abnormal (situation) - inactivated
SAME_AS
168711005 Soft tissue X-ray abnormal (finding)

Managing incoming historical associations:

...

be seamlessly integrated into the tooling so as to present to the user the appropriate updated historically association to be allocated.

Whenever an already stated “REPLACED_BY” target itself also becomes inactive - whether at the same release or later, identifying the replacement for the original concept, should follow the combinatorial logic stated below.

Combinatorial Logic - REPLACED_BY

(A) REPLACED_BY (B) and (B) SAME_AS (C) implies (A) REPLACED_BY (C)

(A) REPLACED_BY (B) and (B) REPLACED_BY (C) implies (A) REPLACED_BY (C)

(AIntEd) REPLACED_BY (BIntEd) and (BIntEd) MOVED_TO (CNRC) implies (AIntEd) MOVED_TO (CNRC)

(A) REPLACED_BY (B) and (B) POSSIBLY_EQUIVALENT_TO (C, D) implies (A) POSSIBLY_EQUIVALENT_TO (C, D)

(A) REPLACED_BY (B) and (B) WAS_A (C AND D) implies (A) WAS_A (C AND D)

Whenever an already stated “POSSIBLY_REPLACED_BY” target itself also becomes inactive - whether at the same release or later, identifying the replacement for the original concept, should follow the combinatorial logic stated below.

Combinatorial Logic - POSSIBLY_REPLACED_BY

(A) POSSIBLY_REPLACED_BY (B OR C) and (B) SAME_AS (D) implies (A) POSSIBLY_REPLACED_BY (C OR D)

(A) POSSIBLY_REPLACED_BY (B OR C) and (B) REPLACED_BY (D) implies (A) POSSIBLY_REPLACED_BY (C OR D)

(AIntEd) POSSIBLY_REPLACED_BY (BIntEd OR CIntEd) and (BIntEd) MOVED_TO (DNRC) implies (AIntEd) POSSIBLY_REPLACED_BY (CIntEd)

(A) POSSIBLY_REPLACED_BY (B OR C) and (B) POSSIBLY_REPLACED_BY (D OR E) implies (A) POSSIBLY_REPLACED_BY (C OR D OR E)

(A) POSSIBLY_REPLACED_BY (B OR C) and (B) POSSIBLY_EQUIVALENT_TO (D OR E) implies (A) POSSIBLY_REPLACED_BY (C OR D OR E)

(A) POSSIBLY_REPLACED_BY (B OR C) and (B) WAS_A (D AND E) implies ((A) POSSIBLY_REPLACED_BY (C) OR (A) WAS_A (D AND E))

Note: Once MOVED_TO the NRC we (,  SNOMED International ) have no knowledge of what has happened to BIntEdBIntEd