• Recording of meeting approved by participants.

Conflicts of interest and agenda review

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:

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:

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.