Date: 2018-01-26
1600 UTC
Zoom Meeting Details
SNOMED Int'l Editorial Advisory group
SNOMED International - Editorial advisory group conference call
UTC
Please join my meeting from your computer, tablet or smartphone.
https://snomed.zoom.us/j/680315399807454545
Attendees
Chair:
AG Members
Meeting Files
View file | ||||
---|---|---|---|---|
|
Objectives
- Obtain consensus on agenda items
Discussion items
Item | Description | Owner | Notes | Discussion | Action | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Call to order and role call | JCA |
| |||||||||||||
2 | Conflicts of interest Approval of minutes from Bratislava | JCA | No conflicts reported | No conflict of interest reported. |
| |||||||||||
3 | ECE Update | BGO |
|
See Events, Conditions, Episodes Project Group meeting agenda 2-12-2018 | ||||||||||||
4 | Drug Model Update | TMO | Toni Morrison to provide an update on the status of the drug project | Document with schedule and content changes attached to minutes. There will be changes to the MRCM including GCIs and role chaining that facilitate the modeling of drug products. This is needed to support the flattening of the substance hierarchy but still allow hierarchical representation in other hierarchies that use these substances as defining relationships. These changes also allow for multiple sufficient definitions. | ||||||||||||
5 | Observables Model Update | DKA | Not available | |||||||||||||
6 | Revision of editorial guidance for PATHOLOGICAL PROCES concerning "Inflammation (qualifier value) | JCA | Current editorial guidance on the use of the Pathological Process Value = 257552002 Inflammation (qualifier value) The current editorial guidance on the use of this process value eventually resulted in the need to distinguish between process and structure in the Morphologic abnormality hierarchy. E.g. 23583003 |Inflammation (morphologic abnormality)| vs. 409774005 |Inflammatory morphology (morphologic abnormality)|. There is a tracker item: IHTSDO-558 Initial draft Fast track document : https://drivedocs.google.com/open?id=1eNWTLxES-4OGsqhj-q0PXTT2u_IAWLOe/document/d/1r1x9hoW4S4s5gO0Ce9pHth6ofkI6UJhfzfEUtS1l-8U/edit Questions:
This notion is critical to the continued improvement of content in SNOMED CT; however, it adds substantial complexity and will require clear and possibly extensive guidance to ensure consistent application. Templates may be the most efficient way to guarantee compliance. | Examples of where additional pathological process values include the hypersensitivity condition subhierarchy and the use of "Pathological development process" for congenital malformations. Expanded range of PATHOLOGICAL PROCESS may allow for a substantial number of currently primitive concepts to become fully defined. Many current morphology concepts conflate process and structure. Many of these may have originated from early versions of ICD-O. There are not many "process" concepts in SNOMED, but these may be needed in the future. One question is whether we should investigate the defining of the structures based on the processes that lead to the structure. Another suggestion is that it may not be necessary to do a full reconstruction of pathological processes, but do a focused effort on areas that have been problematic due to the lack of a defining process. In other words, add them as needed to meet a particular modeling problem. There are a number of "idiopathic" diseases, which really indicates an "unknown" process. It is not a negation of the other process, it is just an indication of a lack of knowledge of the specifics of the process. This would indicate a positive assertion of being unknown. Any changes to pathological process may have broad ranging impacts on the terminology. Does it need external review and approval? Input from the group is that there should not really be substantial taxonomic changes, only clarification and improvement. |
| |||||||||||
7 | Disorder without disorder | JCA | Common pattern in classifications such as ICD. Currently all are primitive in SNOMED CT. One potential modeling pattern proposed is the use of the Situation model with one "known present" relationship group and one "known absent" relationship group. The problem with specific negation is that it is silent about other clinical aspects that may be of significance. What is the purpose of calling out one specific clinical manifestation? Comments solicited from, CMAG: Use of concepts representing the presence of a disorder without a second disorder | Current modeling of disorder with disorder is in Clinical findings, whereas these would need to be located in the Situation hierarchy. Opinion from CMAG is that this is primarily a construct used to map to ICD, but not used much in clinical practice. Jeff PiersonSees these as primarily classification concepts. Would be useful to see how often these are used for clinical recording. Jeremy Rogers agreed with this, not very useful clinically except in very specific cases. Procedure without procedure is a more common pattern used by surgeons. Generally thought that these were useful only for ICD mapping. Guillermo Reynoso suggested that this should in general be handled at the information model level. Q: What should we do with the current content that is all primitive? The best way to express this is to override the default context by an explicit wrapper in the information model. It would be important to try to remove this implicit context in future redesigns of SNOMED CT. |
| |||||||||||
8 | Lexical inconsistencies | JCA | We received a comment from a dutch lexographer: Dear fellow terminologist(s), | Guillermo Reynoso mentioned that while this is primarily an English language issue, it does affect translations and the consistent use of the hyphen (not the dash or the em-dash as they require extended character set) is preferable. Would need to develop editorial rules on how to apply these consistently to the terminology, including guidance on no spaces before and/or after the hyphen. Capitalization issue: This is a legacy issue that originated with the initial SNOMED content from the 1960s. Many translations do not use initial capitalization. Recent changes to case significance may make this a difficult issue to resolve. This should have been corrected prior to the history tracking. Suggested that we remove the current requirement to have an initial capital for new concepts moving forward and living with the "sins of the past". Fixing this would require changes to over 1 million descriptions and this would be too much churn for little value. Rationale is that this change would make SNOMED consistent with ISO 704. |
| |||||||||||
97 | Specimen from subjects other than the patient | JCA | Currently we have many concepts in the specimen hierarchy that include “from patient”as well as those that do not include it as an ancestor. Since the subject of record is the default for specimens, we would like to retire these apparent duplicates, but then we run into the problem of specimens derived from other sources such as donors or normal control patients. They cannot be subtypes if the intended meaning is “subject of record”..or can they, since the context is implied? How do we structure the specimen hierarchy to account for this? What are the analytical implications of having different sources for specimens as subtypes of one another? Tracker:
| No testing of options for this item has been performed since the last meeting. Issues still remaining:
The "soft" default of specimens originating from the patient is where the problem lies. Currently, the organization of the values for SPECIMEN SOURCE causes some specimens from patients to not classify under the grouper term "Specimen from patient". Suggestion to make a more general term "Patient from specimen or donor", but that would only address two of the SPECIMEN SOURCE types. KCA mentioned the many issues with the "soft default'. For the most part, these specimens are used as coming from the patient. However, does the FSN then need to be changed to reflect that these are from the patient? Does the PT need to reflect explicitly that it comes from the patient? Should every Specimen have the SPECIMEN SOURCE explicitly defined? Often this context comes from where the concept is used within the record. The history of these terms may provide some of the reasoning as to why these terms were created. For example, the restrictions in where codes could be used in earlier versions of HL7 v2 (i.e. prior to v2.5) meant there was not place to provide additional information around the specimen. KCA suggested that these then be segregated into a module so that they can eventually be segregated away from the core. Non-patient oriented specimens are the major issue now and many of the use cases still use the older transport structure, meaning they need pre-coordinated content. What are the requirements for the addition of these terms and what is the major function of the core to address these requirements? More modern transport mechanisms such as FHIR, do not need this level of pre-coordination. Comments from IMO indicated that most users of the terminology are not sufficiently sophisticated to use either terminology or model based post-coordination. The long-standing practice of using unspecified Specimens provides substantial challenges to revising this to make it explicit as it would result in a large number of changes that may impact implementers. | ||||||||||||
810 | What is an "infected prosthesis" | JCA | Update: Proposed model (Infected Prosthesis) was tested and reviewed by the ECE. Construction has been performed and editorial guidance will be updated as necessary | 10 |
| 9 |
| |||||||||
11 | “Acquired” disorders testing | JCA |
Update: A grouper "period of life" term encompassing all stages of life (Postnatal (qualifier value)) after birth was created. Over 100 concepts with the string "Acquired" were reviewed and fully defined using the OCCURRENCE attribute. There were no adverse impacts from this initial test. One conditional issue relates to the ability to define terms with the string "juvenile". The definition of juvenile differs in age ranges from jurisdiction to jurisdiction. Likewise the definitions of age ranges for "childhood" and "adolescent". There is an inactive concept 282035009 - Juvenile (qualifier value) that was once a subtype of "Period of life", but was inactivated as duplicate to 59223006 - Juvenile (finding). The process to progress this needs to be determined. | 2017-11-03: A related tracker exists: PCP-71. The work related to this item will be linked to that tracker. Issue identified during testing was the perceived need for the concept "juvenile", which is an inactive concept. Concern about how many concepts will be affected. Will all concepts that are known to be acquired have this attribute added? No, only concepts that need a differentiation between a congenital and acquired form. It may not even be necessary to have as many periods of life as we currently have. While the results of testing are encouraging, it is better to have another attribute that can be role grouped than to create a primitive parent to be used as an IS A due to the advantages that come out of classification. The current testing has resulted in very few changes to the existing taxonomy, but makes the content more maintainable. Juvenile concepts may still be needed, but can be put off for later consideration (can be modeled with postnatal until then). |
| |||||||||||
12 | Update of EAG Workplan | JCA | Review and revision of current workplan | Continued to next call due to lack of time. |
| |||||||||||
13 | Use of the Oxford comma in FSNs | JCA | The Oxford comma is a comma added after the penultimate term in a list, e.g. For example "Disorder of head, neck, and shoulders". The purpose if its use is to make explicit the fact that the terms are part of a list. The editorial guide is silent about its use, but the example provided does not use the Oxford comma. There are currently 347 FSNs in SNOMED CT that use the Oxford comma. Most of these are terms obtained from other terminology, such as ICD and nursing. There are 2500 FSNs that contain comma delimited lists, but do not use the Oxford comma. Question: Should SNOMED CT be consistent in the use of this grammar mark or maintain fidelity to the original source of the terms that do use it? | KCA expressed support for the Oxford comma. The question being whether there should be a retroactive application to FSNs. It does not change the meaning so would not be considered as a requirement for inactivation and replacement. JRO was not in favor of using the Oxford comma where it does not add value. The challenge is to provide editorial guidance on what the conditions are that require its use or non-use. | 14 | AoB | Group | Placement of "conditions" and "predispositions" as clinical findings as opposed to disorders. - BGO Device disorder vs. device failure |
| 15 | Future meetings | JCA | Next conference call TBD |
|