2016-10-25 Editorial Advisory Group Face-to-Face Meeting, Wellington

• Approve minutes from 06/27/2016
  
  

Review of decisions coming out of the Drug Model discussion on Sunday.

Meaning of Product

Clarification of the meaning of "Product" in SNOMED CT - Current definition from the Editorial Guide July 2016: "This hierarchy was introduced as a top-level hierarchy in order to clearly distinguish drug products (products) from their chemical constituents (substances). It contains concepts that represent the multiple levels of granularity required to support a variety of uses cases such as computerized provider order entry (CPOE), e-prescribing, decision support and formulary management. The levels of drug products represented in the International Release include Virtual Medicinal Product (VMP), Virtual Therapeutic Moiety (VTM), and Product Category.”

Question: The prescribing use case was deemed out of scope at the initial drug model meeting in Copenhagen, April 2015. Do we need to revise this description in light of the current definition and the ongoing discussion?

Question: Given the proposed draft drug model for extensions, is there a need for the creation of new semantic tags that differentiate between abstract, generic and trade products?

Question: Are trade products in scope? Decision: No they are not.

Policy decisions:

a)     The implicit meaning of existing “products” (e.g. aspirin) is “Product containing X". This aligns with the modeling as sufficiently defined using existential restrictions and ingredients.

b)    The FSNs for those concepts have been or will be revised to unambiguously represent that meaning.

c)     This editorial policy will be communicated to NRCs through the Drug Model Project. It is also decided that the pharmacy level use case is not supported, so the need for universal restrictions will be resolved by other means.

Question: BGO had some questions about the impact of these decision on reactions to combined products. Currently this proposal does not address the issue that BGO needs to resolve.

• Need to combine the discussions on the drug model to a single site
• Develop actions from the combined discussion (actions proposed by GRE)
• If we change the FSN, is it a technical correction or retire and replace? 
• KCA to ask John Kilbourne to look at current distribution of abstract vs. prescribable vs. dispensible drugs.
• Communicate policy decisions to NRCs.

Policy on addition of assessment tool responses to the International edition.

IHTSDO currently accepts "names" of assessment instruments and staging scales; however, there is nothing in the editorial guide that specifically addresses the responses to assessment instrument questions. As many of these are extremely context dependent, being tied specifically to the particular instrument, what should be the policy of IHTSDO to requests to add assessment instrument responses to the International release.

Example: Requests to add responses to Tinetti balance assessment tool.

Proposed general guidance:

• Only assessment instruments in the public domain should have their response values added
• Response values must adhere to current FSN naming guidelines. Verbatim responses from the assessment will be added as PTs.
• Assessment responses will be added under an assessment specific "grouper" term to facilitate navigation
• IP-restricted assessment values may only be added upon permission of the pubisher. It is the responsibility of the requester to secure that permission

• JCA to develop draft editorial guidance for acceptance of assessment instrument responses.

Update on ongoing issues with ECE

• Model for complications and sequela incl. postoperative complications
• Final approval on editorial guide updates for combined disorders
  • Result of combine disorder naming exercise
• Updates to allergy models
  • Allergic disorder caused by substance
  • Pseudoallergy to substance
  • Intolerance to substance
  • SNOMED allergy content and ICD-11

Revisit of this issue following decision on laterality. From the discussion held in Uruguay:

• The Unilateral concepts were confusing both from a clinical usage and terminological aspect.
• Having these concepts located in the Situation with explicit context hierarchy while lateralized concepts are was not helpful, he said. User feedback showed confusion.
• In the short term it was suggested that we remove them from the situation hierarchy, providing a clear message to users, and eventually getting rid of them.

In light of the approval of lateralized content into the International release, is there a compelling reason to keep these concepts (approx. 325).

Related to the acceptance of lateralized content. There are a few morphologic abnormality concepts that contain the string "bilateral":

Bilateral hypoplasia (morphologic abnormality)
Bilateral hyperplasia (morphologic abnormality)
Bilateral traumatic amputation (morphologic abnormality)
Bilateral congenital dislocation (morphologic abnormality)
Bilateral congenital failure of fusion (morphologic abnormality)
Bilateral partial congenital dislocation (morphologic abnormality)
Complete bilateral congenital failure of fusion (morphologic abnormality)

These have been rarely used, but can be replaced by individual relationship groups representing both sides.

Recommendation: Inactivate these concepts as redundant.

Continuation of discussion around proposal to eliminate the requirement for a matching description to the FSN:

• Gain consensus on final proposal
• Convey tooling requirements (if any) to Development Team

Disjunctive components

Final agreement

Review of disjunctive representations:

1. Use of "+": Combined components, being added as primitive combined concepts as a short term resolution.
2. Use of "&": Usually used as part of a panel, out of scope for the RII/IHTSDO agreement
3. Use of "&/or": Under review by RII as potentially erroneous. Out of scope for addition to SNOMED CT.

Impact of this is that a number of LOINC terms become ineligible for addition to SNOMED CT.

Also need naming conventions for FSNs that replace "special characters" with plain text.

• Gain consensus on final proposal
• Communicate proposal to RII/IHTSDO EPG (JCA)
• Develop naming standard for FSNs

The IHTSDO Editorial Panel would like guidance on the creation of a policy regarding the addition of fully defined "grouper" concepts that are not clinically useful, but are used primarily for navigation of the hierarchy. For example "Procedure on vena cava" without any specifics as to the nature of the procedure.

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