Decisions & Recommendations

2015-10-27

1. Restrictions on laterality be relaxed.

2. IHTSDO should add lateralized concepts as needed and not proactively pre-coordinate every laterality.

3. The AG unanimously recommended laterality Option 4, which is essentially the same idea as option 3 but implemented with a new attribute like “has laterality” that users add to the same role group instead of having it outside the same role group.

The early decision was reviewed at a number of the following EAG conference calls and it was decided to use the current capabilities in the terminology to support lateralized content.

Decision: The addition of pre-coordinated structures using the existing "LATERALITY" attribute was approved in light of the timeframe for support of nesting.

• Editors to add pre-coordinated lateralized body structures to the terminology as needed to fully define concepts in other hierarchies

2015-12-10: The suggested modeling change will be managed as part of the effort to create clarity re: use of substance vs product concept as attribute values to define concepts in other hierarchies (associated with the Drug - International Release Model and Content project). Details can be found on the following Confluence site:
https://confluence.ihtsdotools.org/display/DIRMC

New attributes to describe temporal context

Discussion related to the need for representing temporal context beyond the existing AFTER relationship. Initial proposal was to add temporal values to the OCCURRENCE range. This was not accepted.

Later discussion included the creation of new temporal attributes to distinguish between causality and temporality of combined disorders.

• Create specific temporal concepts under ASSOCIATED WITH, including:

TEMPORALLY RELATED TO

BEFORE

DURING

Add AFTER as a subtype of TEMPORALLY RELATED TO

• Update MRCM to support the new attributes and ranges

• Content will be incrementally updated based on approved combined disorder editorial guidance, as discovered.

2015-10-27

2015-11-30

No decision at the 2015-10-27 meeting. Additional input from implementers will be sought.

2015-11-30 discussion

1. Retire the concepts as ambiguous (and this was the most radical solution).
2. Add them to the findings hierarchy but keep them as siblings to the lateralized structures, which unlinks them from bilateral, left and right.
3. Leave them where they are.

• Inactivate existing unilateral concepts, replacing them with specific lateralized content

• Inactivate WAS-A relationships and point to next higher concept as an IS-A relationship

This is an "english-language" issue as it does not affect translations. While it has been the standard for SNOMED CT for over 10 years, recent changes to the FSN naming patterns has resulted in a large number of "non-user-friendly" FSNs, especially for combined disorders. The addition of descriptions with these terms was proposed as being of little value.

The determination of when a description matching the FSN provided value would be left up to the editor. The authoring tool would still create one when a new concept was created, but the retention of that description would not be mandatory

• Have the technical services group update the validation rules of the authoring tool to allow for a concept to be saved without a description matching the FSN.

More evaluation is needed because it was about more than just URLs. There were a lot of issues around text definitions that need to be discussed.

Discussion page created.

• Editorial guide to be updated reflecting the policy on the use of slashes in FSNs. See section 7.2.2.6

The Oxford comma is a comma added after the penultimate term in a list, e.g. For example "Disorder of head, neck, and shoulders". The purpose if its use is to make explicit the fact that the terms are part of a list. The editorial guide is silent about its use, but the example provided does not use the Oxford comma.

There are currently 347 FSNs in SNOMED CT that use the Oxford comma. Most of these are terms obtained from other terminology, such as ICD and nursing. There are 2500 that contain comma delimited lists but do not use the Oxford comma.

Should SNOMED CT be consistent in the use of this grammar mark or maintain fidelity to the original source of the terms that do use it?

Acknowledged that for primitive hierarchies, grouper terms are necessary to navigate and organize the hierarchy.

Decision: Primitive groupers may be added to top level hierarchies that d not have a supporting concept model.

For hierarchies with a concept model the usefulness of fully defined groupers is limited to convenience groupings based on preferred classifications (e.g. disorder by site), Primitive intermediate groupers, while discouraged, are sometimes necessary when the concept model is not robust enough to support the full definition of a subset of terms. However, they add a substantial management burden.

Decision: Fully defined intermediate groupers may be added if they provide demonstrable benefit to organizing and navigating the terminology. Intermediate primitive groupers will only be added on a case by case basis and by approval from the Head of Terminology or the Principle Terminologist.

• Editorial tracker item needed.

• Tracker item created - IHTSDO - 834

2017-03-30

2017-04-25

A proposal for review and revision of the following types of disorders was discussed:

• Disorders DUE TO another disorder
• Disorders AFTER another disorder
• Disorders AFTER a procedure
• Disorders DUE TO a procedure
• Disorders DURING a procedure

The initial document was taken through a number of revisions and approved by the Head of Terminology in September, 2017

Complete

In process

2017-03-30

2017-04-25