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The schedule is already becoming full, will try to put Observables discussions into EAG and PaLM respectively.

Outreach from the Observables group might be a possibility depending on discussion items on CRG agendas. Will be confirmed closer to April.

Nutrition observables

Dietitians are hopeful to have a way to specify the route of delivery in observable concepts to distinguish intake, for example, grams of carbohydrate from parenteral nutrition, other intravenous fluids, enteral nutrition, and orally. Broader concepts that are in process for the January 31, 2020 release, such as, 787764007 |Estimated intake of carbohydrate in 24 hours (observable entity)| would be the parent concepts. The input of this group would be very helpful with regard to the modeling and possible new attributes.

One solution would be to use descendants of 433590000 | Administration of substance via specific route (procedure) | as values of | characterizes |.

Template proposed:

| Observable |:
...
| characterizes | = <433590000 | Administration of substance via specific route (procedure) |
| process output | = <105590001 | Substance (substance) |
...

Observables and Evaluation procedures

Since Observables were introduced into SNOMED CT the demarcation between Observables and Evaluation procedures has been a potential source of variability of SNOMED CT use. In order to progress this issue the group need to agree on what knowledge is needed to inform any future decision.

2019-11-18:

<<404684003 |Clinical finding (finding)| : 363714003 |Interprets (attribute)| = << 386053000 |Evaluation procedure| ==> 7148 concepts

...but also

1350 hits for <<386053000 | Evaluation procedure (procedure) |: [2..*] { 260686004 |Method (attribute)| = <<129265001 |Evaluation - action (qualifier value)| }

3 hits for <<386053000 | Evaluation procedure (procedure) |: [2..*] { 260686004 |Method (attribute)| = <<129266000 |Measurement - action (qualifier value)| }

611 hits for <<386053000 | Evaluation procedure (procedure) |: [2..*] { 246093002 |Component (attribute)| = * }

2019-12-16:

Some more exploration of existing Evaluation procedure content:

(<<386053000 |Evaluation procedure (procedure)| : [2..*] { * = * }) MINUS <<363679005 |Imaging (procedure)|

10 000-ish Evaluation procedures have 2 or more role groups...

<<386053000 |Evaluation procedure (procedure)| : [2..*] { 246093002 |Component| = * }

611 have 2 or more Components, indicating that it could be a panel. However, many examples are just strangely modeled and likely not intended to be panels. Thus, it's not straight forward to identify panel-like procedures among the Evaluation procedure. Sometimes, e.g. 442553005 | Measurement of chloride in peritoneal fluid specimen (procedure) |, additional Components are inherited from ancestors.

(<<386053000 |Evaluation procedure (procedure)| : [2..*] { 246093002 |Component| = * }) MINUS <<122869004 |Measurement procedure|

Even non Measurement procedures have multiple Components...

<<386053000 |Evaluation procedure (procedure)| : [3..*] { 246093002 |Component| = * }

A few have 3 or more components, many of which are in fact panels, but again likely not all of them. E.g. see <67899004 | Complement component, classic pathway (substance) |.

Briefing note should include:

• Current status in regard to overlap
  • Actual concepts
  • Concept models
• Current status in regard to modeling of Evaluation procedures
• Orders and results use of SNOMED CT
  • Actual use of Evaluation procedure concepts for reporting results
  • Actual use of Evaluation procedure concepts for ordering
• Panels vs. single-measurement observables/procedures

2020-01-28:

The issue of panel concepts (sets of distinct Observable entities) was discussed. The current Observables model, by design, does not allow representation of panels.

Many examples of panels are not well-defined, e.g. a Complete Blood Count may contain different observables in different laboratories. The benefit of adding content on the international level is likely limited. However, SNOMED CT should provide the means to represent such panels when there is agreement on meaning on a national, regional or local level.

Several Evaluation procedure concepts contain multiple groups, but all are not correctly modelled.

Piper Allyn Ranallo is  doing a mental health clean up based on Mental & Behavioral CRG work - she has submitted these 4 requests:1. 285231000 some requests for editing and applying the observable entity model to existing content: 285231000 |Mental function (observable entity)|

https://prod-request.ihtsdotools.org/#/requests/view/745433

She would like retain 18373002 , 8373002 |Nervous system function (observable entity)| but add 246464006 |Function (observable entity)| which I can tell her is a redundant parent. She would like to add 718497002 |Inherent location (attribute)| = Brain structure (body structure). I cannot find other similar observables with this type of modelling, advice appreciated.

2. 18373002 |Nervous system , 4065008 |Affect, function (observable entity)|

https://prod-request.ihtsdotools.org/#/requests/view/745436

Similar to above suggestion to add 718497002 |Inherent location (attribute)| = Structure of nervous system (body structure)

3. 311465003 311465003 |Cognitive functions (observable entity)|

https://prod-request.ihtsdotools.org/#/requests/preview/745434

Piper would like to add add 718497002 |Inherent location (attribute)| = Brain structure (body structure). She asks for the plural to be changed to singular function. Definition is good - hope it's not copyright - difficult to judge if this is widely accepted wisdom. Good old Wikipedia has the DSM-5 definition https://en.wikipedia.org/wiki/Cognitive_disorder

4. New definition and new parents for 4065008 |Affect, function (observable entity)| - looks OK (typo in her GB definition = realisation)

. Need advice on applying the model to these function observables.

Next meeting is 2020-02-17 24 20.00UTC