SNOMED CT Editorial Advisory Group

Page tree

You are viewing an old version of this page. View the current version.

Compare with Current View Page History

Version 1 Next »


Time:

0900 - 1030 PDT

1700 - 1830 UTC 


Zoom Meeting Details


Attendees

Chair:

AG Members:

Invitees:

Victor Medina 

Observers



Apologies:


Meeting Files:

Meeting minutes:

The call recording is located here.


Objectives

  • Obtain consensus on agenda items

Discussion items

ItemDescriptionOwner

Notes

Action
1Call to order and role call

Jim Case

This meeting is being recorded to ensure that important discussion points are not missed in the minutes.  The recording will be available to the SNOMED International community.  Joining the meeting by accepting the Zoom prompt declares that you have no objection to your comments being recorded


  • Recording of meeting approved by participants.
2

Conflicts of interest and agenda review

Jim Case

None recorded



TRAG discussion on "withdrawn" reason for inactivation

Jim Case 

TRAG disucssion page located at:

Potential for adding a "withdrawn" reason for inactivated content



5Change Surgical approach to Procedure approach

Victor Medina 

Jim Case 

At the March 2024 EAG call, the group asked for an impact analysis of the change from Surgical approach to a more general Procedure approach.  The results of that analysis are presented in the attached document.

Discussion:

Why were there no classification changes when sufficiently defining a large number of currently primitive concepts?  

The group would like to see the results on this for the non-surgical procedures.  Not sure that the benefits of this generalization are sufficient.  There may be additional impacts when this attribute is applied to existing sufficiently defined concepts.

There is always an implicit approach in procedures. There are questions about reproducibility.  Are some approaches solely surgical?

Decision:

Distribute list of non-surgical procedures affected by this change

  • Victor Medina to distribute a list of non-surgical procedures affected by the proposed change
6Bypass graft revision proposal

Victor Medina 

Jim Case 

As part of the QI project, substantial changes to the representation of bypass grafts and shunts have been proposed.  A briefing note (attached) and a detailed document for the proposed changes (referenced in the briefing note) are provided.

Discussion:

2024-03-11 How are bypass concepts without definition of proximal and distal targets going to be modeled?  A: Need review. How are proximal and distal defined?  A: It is based on either anatomic position or flow of contents. Definitions for proximal and distal anastomosis will be provided.

Concern about creating intermediate primitives as this complicates the assignment of parents.  Also need to make sure the definitions are clear.  Where do "-stomy" concepts fit into this proposed model. 

2024-04-16:

Added document with proposed definitions for bypass, shunt, bypass graft, shunt with graft, anastomosis, etc.

Decision:

2024-03-11 Comments will be added to the document by the EAG members. 

2024-04-16: Proposed definitions will be revised based on input and resubmitted to the EAG for review.  

7Remodeling of 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy

Victor Medina 

Jim Case 

The current concepts 1263452006 |Anesthesia and/or sedation procedure (procedure)| and 410011004 |Administration of anesthesia AND/OR sedation (procedure)| are disjunctive groupers.  The attached document provides details on proposed changes to this hierarchy that improves the modeling and specificity of anesthetic and sedation procedures.  The proposed changes have been reviewed and accepted by the Anesthesia CRG.  Key elements include:

  • Inclusion of a HAS INTENT relationship to specify the nature of the anesthesia or sedation (e.g. local, regional, general)
  • Inactivation of "anesthesia for X" type concepts
  • Remodeling concepts to adhere to templates

Discussion:


Decision:


8USING DEVICE vs. DIRECT DEVICE use in procedures

Jim Case 

Victor Medina 

During QI review of procedures, inconsistencies were revealed in the use of USING DEVICE and DIRECT DEVICE in procedures.  The current definitions for these attributes from the editorial guide: 

Direct device

Direct device (attribute) represents the device on which the method directly acts.

Using device

Using device (attribute) refers to the instrument or equipment utilized to execute an action. It is used when the device is actually used to carry out the action, that is the focus of the procedure. If the device is simply the means to access the site of the procedure, then Using access device is the appropriate attribute.

Examples of inconsistencies:
175254001 |Repair of pulmonary artery using prosthesis (procedure)| = Using device -> Prosthesis device.
771713005 |Open repair of inguinal hernia using sutures (procedure)| = Using device -> Surgical suture, device.
719263004 |Repair of parastomal hernia using mesh patch (procedure)| = Direct device -> Hernia surgical mesh.
719290008 |Repair of umbilical hernia using surgical mesh (procedure)| = Direct device -> Hernia surgical mesh.
238190005 |Repair of incisional hernia using synthetic patch (procedure)| = Using device -> Prosthetic patch.

We would like to come up with more specific editorial guidelines related to what is meant by "the device on which the method directly acts".  In general, parameters could include things such as "materially changed by the procedure", "remains in the body following the procedure", etc.  The use of the word "using" in FSNs can bias a content author to use the attribute USING DEVICE when the more appropriate DIRECT DEVICE should be used.  A broader application of DIRECT DEVICE in procedure modeling could have large impacts on the number of concept affected, but would resolve the current inconsistencies.

An example of where this is an issue is described in the attached document related to the modeling of hernia repair.

USING DEVICE and USING ACCESS DEVICE are also inconsistently used and sometimes incorrectly.  In a review of procedure subhierarchies (e.g. arthroplasty), USING ACCESS DEVICE was modeled in the surgical action RG, when in many cases the device does not act as an access to the surgical area, but plays another role, (e.g. illumination).  An evaluation of the current benefits of USING ACCESS DEVICE over USING DEVICE  is underway.  

While it is not part of this topic, we expect the same issues to be present related to USING SUBSTANCE and DIRECT SUBSTANCE

Discussion:


Decision:



9Nontraumatic vs spontaneous injuryJim Case 

There is an inconsistency in our review of nontraumatic vs. spontaneous injury. In some cases SNOMED makes a distinction between them:
1296953008 |Nontraumatic rupture of extensor tendon of left hand (disorder)|
321371000119100 |Spontaneous rupture of extensor tendon of left hand (disorder)|

whereas in other cases we treat them as synonymous:


In determining the meaning of nontraumatic vs. spontaneous, we have found that nontraumatic means injury not caused by an external force and could occur with or without premonitory signs or symptoms, whereas "spontaneous" injuries usually refer to acute injuries without premonitory signs or symptoms.

The primary question is whether in general clinical practice this distinction has value, and if so, 1) should SNOMED explicitly separate out concepts where spontaneous injury is expressed as a synonym for nontraumatic and 2) should SNOMED create nontraumatic injury concepts as parents to spontaneous injuries where a nontraumatic parent does not currently exist?

A discussion page has been set up to solicit comments from the EAG (Re: Nontraumatic vs. Spontaneous injury)

The discussion brought out a number of meaningful points.

  • These terms are most often used interchangeably to mean an injury that does not occur as a result of external force
  • While a differentiating definition can be developed based on premonitory signs or symptoms, that distinction is often ignored by clinicians
  • It is unclear what the additional benefit is of making the distinction from a clinical perspective

If it is thought that these should be distinct, then much more specific definitions need to be developed and published.

If it is not thought that the distinction is clinically meaningful, then what should SNOMED select as the FSN and PT and should all existing differentiated concepts be merged?  Should a nontraumatic and spontaneous description be a consistent feature of these concepts?

Discussion:


Decision:


10AOBEAG

It is planned to increase the use of the Discussion section of the EAG Confluence site to allow for a more straightforward consolidation of comments solicited from the EAG regarding topics under consideration as well as publishing the outcome of the discussion and the planned implementation of decisions made, if applicable.  This will require some modifications to the discussion section to allow for the assignment of statuses to discussion pages, which will be requested from the SI technical team.


11Next meeting

Jim Case 

May 27, 2024















  • No labels