2016-04-19 Editorial AG Meeting Minutes

Updates on previous issues

JCA briefed the group on slashes in FSNs, use of URLs in definitions (see slide below).

JCA said DOIs are persistent even if URLs change, so will use those instead of URLs. There will be a note in the Editorial Guide on how to find them. ISBN is another unique, persistent standard for representation that the organization can use.

JCA said the intent is not to use this as the sole source of a definition, but rather as a reference so that people could go to the source of the definition. Currently, he said, there was a text definition with no source, so this provided a way to point to the source. 

JCA said he had a note to figure out what to do if the source is no longer available.

IGR said there needed to be some guidance written up on GMDN terms for the linkage table. He said there was a proposal underlying concept model for devices that would assist with definitions of the content. There would still be some need for some text definitions. But this would be discussed with the Members. He confirmed that there was an action item to come up with some Editorial Guidance for naming GMDN devices.

TMO noted that slashes were prevalent in the product hierarchy too.

Review of drugs, products and substances

TMO showed some slides.

Substances

TMO said approximately 100 concepts representing role had been retired from the Substance Hierarchy because they were showing erroneous relationships and presenting other problems.

The activation of the new Authoring Tool meant that it was hard to retire concepts so some of that had been postponed until the July 2016 Release.

LOINC had been doing some interesting QA of substances, so that was providing some clean-up work. 

Drug Model

TMO said the RFPs were published on the web and had passed the close date. IGR said it was a 2-week turn around. 

Drug Content

TMO showed the slide below (and other slides that are not shown).

She said product strength involved a high level plan to move concepts into a new module. The team was also working with IHTSDO Technical Services to do some of the work in batches.

Changes in content would begin in development branch May 2016. There would be intermittent previews for review and comment supported by the new authoring tool and terminology server. January 2017 would be the release of an updated hierarchy.

Devices

TMO said the team had been working on migration of the linkage table maintenance to the Mapping Tool. It was receiving and processing monthly updates from GMDN, used to be twice a year and there was a significant lag in seeing it in a SNOMED CT Release. 

Domain Range Changes

TMO said currently did not use SCT as attribute values to define concepts in other hierarchies, and they looked into whether they could do that and why the decision had been made. It had been an intentional decision in 2009 because there was no use case, but the situation had changed. She gave an example of vaccines adverse reaction. She described two different scenarios on a way forward (see slide below).

JCA asked if Option 4 should be reconsidered. 

There was a discussion of using algorithms to handle the changes that would be needed. 

• JCA said the action would be to talk with Yongsheng Gao on his view on the impact of both of the laterality options on the anatomy model.

Overview of Event, Conditions and Episode Policy Recommendations

BGO made a presentation. He worked presented the workplan, then spoke about the during, during AND/OR after to associated with role hierarchy.

JMI asked if BGO had spoken to the Anesthesia SIG on that because they had been doing work on that.

• BGO to speak to Andrew Norton about Anesthesia SIG work concerning temporal model.

JCA said he disliked "and/or."

KCA said he had discomfort with "associated with." If someone has diabetes and HIV, is a symptom associated with one or the other?

JCA said he was in favor of more robust temporal, they had temporal association but not necessarily a causal relationship. KCA then you could look at patterns by data mining but you should not presume a causal relationship. JCA said "most likely due to" is what the causation indicates. 

• JCA suggested that BGO bring back to the ECE group that relaxing the view of causality was, at least in KCA's opinion, not a good thing. If you want to identify co-occurance of 2 disorders and not specifically identify causality, the relaxation may lead to over-interpretation of causality. 

JCA said the caused by presented a problem because sometimes medical knowledge shows that they are not caused by, but his hope (perhaps naive, he said) was that if you say something is due to, then medical knowledge had proven that causation. 

• On ECE guidance, Eric said they should determine whether to use the Oxford comma. JCA said ed guidance for FSNs is grammatical standard and apply that consistently throughout the terminology.

There was a discussion about trademark names.

• JCA said there should be an action to look at acronyms as trademark names for things like assessment instruments in order to come up with a policy. 

We could include those acronyms as an alternative description but at this point wouldn't be in the FSN, but that's just at this point.

JCA asked if the ECE had definitive recommendations they would like to see applied to the Editorial Guide? BGO said no, but the recommendations would be revised. JCA asked in the meantime, while the recommendations were being revised, there was guidance in the Editorial Guide and a fair number of Co-occurrent  and Co-occurrent Due To that were being added, so what was the recommendation from the ECE group for the editors, because there was a backlog on those items. BGO said many more terms used Co-occurrent rather than Co-occurrent Due To because people were hesitant to assign causality, so he thought the approach might be to move more towards that and eliminate the use of Due To. He thought the guidance should be if one was not sure of direct causality to use Co-occurrent. JCA asked if the ECE would be making that into a formal recommendation to put into the Editorial Guidance? BGO indicated that it would. JCA encouraged them to prepare that guidance quickly so that it could be implemented.

• ECE to make formal recommendations for Editorial Guidance on Co-occurent and Co-occurrent due to.

JCA wondered aloud if the team would have to look through all the Co-occurrent and Co-occurrent Due To's to make sure they were not overmodeling. JCA said an analysis should be done. BGO said he would do that.

• BGO to do an analysis of existing Co-occurrent and Co-occurrent Due To 

BGO asked if they were okay with the stating in the Editorial Guidance that Due To is strictly due to direct causality. JCA said that was the proposal that KCA was making. PAM asked if there was guidance on the level of "knowing" in order to use "due to." BGO said it was based on a literature review.

KCA proposed using Due To as an attribute that can be used in describing relationships in instances but not the term as a precoordinated expression in SNOMED. The connection is then made by the physician and not SNOMED. Leave it in the realm of instances and clinicians. JCA said there had been other contexts like this, and he asked if there was a class that represents the universe of instances of Due To. If you say yes, you can identify causality in an instance, should there be a class that represents that. Due To does not say 100 percent of time it's due to, just an instance. KCA agreed with that, but said that by putting the concept in, it's ripe for misuse. He raised the question of when is a finding a disease? He said it was a value judgment. We wanted physicians to be able to make that value judgment, but if it was enshrined in the terminology, it put the burden in the wrong place. KCA said ideally they would want to get rid of most or all of the Due To's and allow physicians who really needed to use Due To to use it but to not give them a shortcut that would affect the validity of the data. 

• JCA said there should be an evaluation of Due To's, and that would be one of their many things to follow-up on.

Break

Content Tracker Review

JCA said the Content Tracker had been moved from Collabnet to JIRA. He showed some graphics that showed status.