Jim Case

Jim Case

Jim Case

Suzanne Santamaria Toni Morrison

Discussion:

• A question arose as to whether attributes that would represent origin/destination or in/out relationships could be generalized for other uses as well. Not always a 1:1 relationship in anatomy.
• So far, no resolution on how to distinguish between "device" and "equipment". Put on hold for now. Bruce Goldberg recommended getting rid of the distinction within SNOMED CT.

• Editorial policy for simple co-occurrence Editorial policy for simple co-occurrence.pptx
• Traumatic and non-traumatic injury - follow-up Injuries.pptx
• Gout - follow-up Secondary disorders and gout.pptx
• Sources of truth - Jeff PiersonBruce Goldberg
  • KP clinical library

Discussion:

• Simple co-occurrence - three scenarios where the use of the pattern can be justified. The distinction between syndromes and diseases with multisystem involvement requires that intermediate primitives be used in the latter. The definition being developed was discussed and the scope of what should be included as an approved co-occurrence pattern.
• Traumatic and non-traumatic injury -

•  Bruce Goldberg to submit co-occurrence edits to the ed.guide
•  Bruce Goldberg to test the use of DUE TO "event" and full modeling of condition for pathologic fractures as a result of an underlying condition (e.g. osteoporosis)

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Following a panel discussion at the ICBO conference in Buffalo Aug 1-2, an agreement in principle for SNOMED to collaborate with the OBO community was reached. Much of the discussion revolved around the current representation of diseases as subtypes of clinical findings. There is a clear, mutually exclusive separation in BFO and other disease ontologies based on BFO between "diseases", which are specifically dependent continuents and clinical observations (i.e. findings), which are considered occurrents. The challenges in implementing this notion in SNOMED is explained in https://www.academia.edu/26897896/Scalable_representations_of_diseases_in_biomedical_ontologies.

As we had initially discussed, one differentiating feature of what we are calling findings is the notion of temporality, i.e a findings is made at a point in time (an occurrence) whereas a disease is persistent. This is similar to the notions in BFO, but they (and all other disease ontologies) refer to diseases as dispositions (i.e. a realizable entity that is manifested as some abnormal process or structure. For terminologies like SNOMED that do not seek to define diseases, but to identify when a realization of the disease disposition occurs in a patient, this logical representation breaks down.

At the ICBO conference, a paper was presented in which an attempt was made to "BFOize" ICD-10. It was clear to the authors of that paper

of the conundrum we face, i.e. that the use of the terms in ICD-10 as dispositions was not appropriate because they had been realized and so they modeled their ICD-10 ontology as processes (i.e. occurrents). This was

criticized by

a number of the ontologists, but

no practical solution to the need for representation of realized dispositions in clinical recording were proposed.

Regardless, it would be of some benefit, in light of our desire to resolve the findings/disorders issue, to attempt to align as closely as possible with top level ontologies. One area where this would be of great use is the move by SNOMED to improve coverage of genomics. This would be greatly enhanced by an ability to integrate with the genome ontology.

A draft document is being developed by members of the MAG as a response to the issues surrounding the lack of alignment between SNOMED and BFO: https://docs.google.com/document/d/1HcBj5bVIg8lB_uyORZU9A_FWKFsw0sxmB6Xg4UYKygk/edit

Discussion:

Neuralgia – finding or disorder.pptx

Findings and Disorders thread.doc

Comments:

Keith Campbell expressed concern regarding "the notion that finding vs diseases may be differentiated by the notion of temporality, I believe there will be great difficulty applying such rules, and it will result in a false dichotomy… And will also result in no practical benefit the use of SNOMED in any way…"

Continued to next call...