Paul Amos communicated that he would not be able to make the call.

•  Toni Morrison will provide link to the issue log

Substance hierarchy redesign

Substance disposition proposal (see attached document)

Comments from EAG regarding the proposal were sought.

BGO had a question about the use of the HAS DISPOSITION relationship; where would it be used? JCA stated it would be solely used for substances. WRT to substances associated with allergens, how would these be used when the substance had a disposition other than allergen. A substance has a disposition, whether it is being used in another context or not. Disposition is a defining attribute for substances.

• Jim Case will prepare a briefing note for the MF to inform them of the proposed changes

Issue: In some casecases, the representation of FINDING SITE at the proper level of granularity requires multiple body structures. E.g.:

Update on ongoing issues with ECE

• Model for complications and sequela incl. postoperative complications
• Final approval on editorial guide updates for combined disorders
  • Result of combine disorder naming exercise
• Updates to allergy models
  • Allergy to substance
  • Allergic disorder caused by substance
  • Pseudoallergy to substance
  • Intolerance to substance
  • SNOMED allergy content and ICD-11

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The proposal under consideration is:

"If two body structures are needed to fully define the finding site for a condition, then a combined anatomic structure shall be created to represent that body structure."

For example: A new body structure "Bone structure of distal phalanx of great toe (body structure)" would be created to support the modeling of the concept above.

Discussion: PAM supported this approach by email. BGO supports this change as well. YGA was asked about his support and he also supported the new guidance.

•  Jim Case will send a edit to the Editorial guide editor to get this guidance implemented.
•  Monica Harry to work with technical writer to add this proposed (and accepted) wording to the guide where appropriate.

Create a table of mandatory grouping of relationships.  Rationale – needed for template based authoring, provides internal consistency of model patterns, allows for batch editing due to consistency.

See initial review from Daniel Karlsson and Yongshen Gao

The grouping patterns are currently being defined in the groups of templates, but there has been no general guidance for how relationships should/must be grouped. This would define mandatory grouping as well as addressing exceptions to grouping in particular subhierarchies. These would provide guidance for the templates being created.

This is project that is currently not resourced, but will be put on the list of needed edits for the revision of the editorial guide.

•  Jim Case will address this when the technical writer comes on board to begin the comprehensive editorial guide review.

•  Jim Case A summary of the options for "Disease in remission" from the Inception document and the pros and cons for each including modeling examples will be developed for additional review.

Update on ongoing issues with ECE

Discussion:

Complications and Sequellae

Proposal made by BGO to model both "Complications" and "Sequellae" using the combined disorder patterns and following the FSN naming conventions for those concepts. Add descriptions that include the terms "Complication" or "Sequellae" as synonyms (or preferred terms where required) and retire the top level concepts of "Complication" and "Sequellae". This is still being discussed within the ECE. JCA leaned towards eliminating the primitive concept "Complication" due to its inconsistent use and to also look at the relationship of these to "Secondary disorders". Whether this fits with Sequellae needs more discussion. Bruce will update after the next ECE call.

Allergy model:

A revision to the proposed allergy model using the application of the HAS REALIZATION attribute to model "Allergy to X". A quesion about how the current concept model for Substances might impact this proposed model. BGO said he did not think it would have a deleterious effect. There would be some value is using the HAS DISPOSiTION attribute in substances to limit which substances might be used as values for "Allergy to X"; however, this might be an unnecessary complication.

Awaiting additional input from Stefan Shultz on the representation of the top level concepts of hypersensitivity condition, allergic condition and pseudoallergic condition.