As discussed in KL. Need a list of proposed description types to send to tech services for implementation. Guidance on use will need to be developed. Current use cases to consider are:

Implemented and populated in the International release:

• near synonym - these can be either "broader than" terms or non-semantically equivalent but related terms (e.g. vaccination (procedure) vs. immunization (a process following vaccination or administration of immunoglobulin)
• hypernyms - are these different than "near synonyms"

Implemented but NOT populated in the International release (i.e., for use in extensions)

• search terms - colloquial terms - provided as an option for extensions, not populated in the international release
• "Patient-friendly" or consumer terminology
• abbreviations/truncation/acronym - abbreviated form

Issues within our current synonyms was identified in an AMIA paper in 2003:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1480077/pdf/amia2003_0949.pdf

Discussion:

GRE: Not necessary to distinguish hypernyms and near synonyms. Consider a separate extension for "patient-friendly" terms. Need a separate language refset.

How to identify near synonyms? GRE: Had done some work 10 years ago. May be useful to get an idea of scope.

Want to avoid contaminating the terminology with non-synonymous descriptions. Do these need another description type or just a mechanism to segregate the descriptions from the main branch? Adding to another language refset would require modifications of the AP UI.

There is a risk in adding near synonyms if those descriptions are used in the EHR UI. Suggestion that we need to distinguish the near synonymy, e.g. broader than or narrower than. Narrower than are not synonymous at all as they are specializations of the parent.

Use the definition from ISO 25964-1:2011 as a guidance for defining near synonymy.

Discussion continued to next call without resolution

NEW

Summary of comments from CMAG:

In general, most extensions are already using a mechanism to manage patient-friendly terms within their extension and do not have an immediate need for a specific description type to be created. They did not address the issue of the value of near-synonymy and did not specify any other description types that might be useful. They also did not feel it was necessary to specifically call out abbreviations or truncations.

Questionable synonym review - termMED 2009

Proposal from Head of Terminology:

Add a single new description type representing "near synonymy" (name to be decided). Restrict its use to "broader than" concepts where the specificity is implied in clinical settings, or non-semantically equivalent but related terms, such as the outcome of a process.

Alternatively, add single new description type of "Hypernym" which expressly represents the broader than notion.

Both of these alternatives would require some detailed editorial guidance on when to allow the addition of these types of descriptions.

Determine whether it would be beneficial to repeat the work done by Guillermo and his group to reflect the extensive changes that have occurred in the terminology since the initial effort in 2009.

04/29/2020 Discussion:

For translations, having the designation of near synonymy is of benefit so that they can be ignored. This may be a patient safety issue. There must be a way to identify non-synonymous descriptions. GRE recommends that addition of two description types: Near synonym for use within the international release and "entry-type" description for use within extensions. The number of issues WRT near synonymy is related to the number of descriptions associated with a concept.

JRE: Favors hypernym. There are all types of non-synonymous acceptable descriptions.

KCA: Prefer accepted language for describing these. Hypernym and hyponym, but use should be discouraged. Provide a path to create new concepts from these descriptions.

GRE: Near synonym is the term that is described by the ISO standard. We need to enforce that superclasses and subclasses should not have the same description.

DKA: Synonymy is continuous as opposed to discrete, and is context dependent. There is a mechanism to handle this in language refsets rather than trying to create a new description type. Another issue, getting inter-rater agreement as to what does or does not qualify as a true synonym would be difficult.

AHO: We should not encourage the creation of these near synonyms. By creating new description types we might be creating a mechanism for users to request or create these.

GRE: The MAG/EAG discussion expressed a preference for a new description type over using language refsets. The International edition could adopt a policy of not accepting new near synonyms.

PAM: Concern is how this would be used by the editors. The distinction of whether to include a description as a true or near synonym is context dependent.

The question is what to do with the existing descriptions that we have that are non-synonymous. We need a pragmatic approach to determine whether a description represents the meaning by the FSN. A prior definition from ISO stated the issue of synonymy as being context dependent and continuous. There is a use case for near synonym in searching.

YGA: If searching is the primary use case, then we should mark descriptions in this way. We should get rid of non-synonyms, but keep search terms available because of their utility.

No resolution: discussion continued....

Does the HAS INTERPRETATION range need to match the SCALE of the Observable used as a value for INTERPRETS?

https://docs.google.com/presentation/d/143fQMaHsV9NTwK0ZdEpNLE2fsgefU6-vKANl7hT7ptY/edit?usp=sharing

Doodle poll to be sent out for meeting in May

Discussion:

Potential agenda items:

• Update from concept inactivation group
• Update from source of truth project