SNOMED CT Editorial Advisory Group

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Inactivation ReasonAssociationDefinition

Classification Concept 

REPLACED_BY

The inactivation reason “Classification Concept” explicitly states that the inactivated concept originates from the “closed world” classification paradigm and as such is inappropriate content for use within the clinical record. The inactivated concept (A) may be linked to one or more active concepts (B and/or C…) using historical associations as determined by the type of classification concept and associated guidance given below.

Please note that this inactivation reason replaces "Limited Component" and historical association "WAS_A".

Guidance
  • Identification of "Closed World content"
    The donor 'terminologies' to SNOMED CT were often themselves an early evolution of classifications of mortality and morbidity used for statistical analysis and reporting. To support the closed world view it was necessary to include options that catered for disorders that were known but not currently included within the classification. These concepts can usually be identified by the inclusion of “other specified”,  “not otherwise specified”, or “not elsewhere classified”, etc. While many of these concepts have already been inactivated, a few remain, and others such as "...without.." and concepts that are complex combinations of clinical phenomena still exist and will over time be removed.

  • Editorial guidance for specific classification types
    As each classification type is identified, editorial guidance will be provided giving the reasons for inactivation and advice on how to assign an appropriated "REPLACED_BY" historical association.
    Each type of classification concept will be identified within the authoring tool by a drop-down list e.g.:
    • The concept contains "Not Otherwise Specified"
    • The concept contains "Not elsewhere Specified"
    • The concept contains "Without"

Not Otherwise Specified
  • Concepts that contain the ending "Not Otherwise Specified" are used within the closed world environment to enable the recording of conditions that exist but are not currently specifically identified within the current version of the classification in use. In the open world view adopted by SNOMED CT, this concept could represent any disorder represented by the concept without the addition of the "Not Otherwise Specified"
  • The recommended REPLACED_BY concept for "xxx not otherwise specified" is "xxx" as this represents our current open-world understanding of the meaning of the inactivated concept:
    • "xxx" may already exist as a current supertype or be found elsewhere within SNOMED CT
    • If "xxx" does not exist, it should be created as a new concept
  • Annotation
    Authors may wish to add additional notes for specific inactivations.

Example

Concept with "NOT Otherwise Specified"

Classification concept:

Resolution

Managing Incoming Historical Associations

The intention is that this functionality will be seamlessly integrated into the tooling so as to present to the user the appropriate updated historically association to be allocated.

Whenever an already stated “REPLACED_BY” target itself also becomes inactive - whether at the same release or later, identifying the replacement for the original concept, should follow the combinatorial logic stated below.

Combinatorial Logic - REPLACED_BY

(A) REPLACED_BY (B) and (B) SAME_AS (C) implies (A) REPLACED_BY (C)

(A) REPLACED_BY (B) and (B) REPLACED_BY (C) implies (A) REPLACED_BY (C)

(AIntEd) REPLACED_BY (BIntEd) and (BIntEd) MOVED_TO (CNRC) implies (AIntEd) MOVED_TO (CNRC)

(A) REPLACED_BY (B) and (B) POSSIBLY_EQUIVALENT_TO (C, D) implies (A) POSSIBLY_EQUIVALENT_TO (C, D)

(A) REPLACED_BY (B) and (B) WAS_A (C AND D) implies (A) WAS_A (C AND D)

Note: Once MOVED_TO the NRC we (SNOMED International) have no knowledge of what has happened to BIntEd

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