Jim Case

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Jim Case

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Source: Freshdesk ticket 

EAG -Angiography_arteriography Briefing note September 1st 2021.docx

Angiography_Arteriography EAG 20210901_MHA .pptx

Discussion:

20210901: Over 500 procedures with a direct site of "Artery", but are named "Angiography".  Propose to rename these as FSN using "Arteriography" with a PT of "Angiography".  This will result in a sizeable number of changes to FSNs and descriptions.

Question: Is there a pattern in where we have used Angiography, when we are focused on an artery?  Is venography just a convenient by-product? 

Are we just using "angiography" as a convenient mechanism due to the general perceived synonymy in common use?  Will it cause problems down the road if we need to make the distinction?  

Because of the use of both "angiography" and "arteriography" synonymously, should we have both represented as descriptions but not to make "angiography" the preferred term when the focus is an artery.

Proposed that in the description that the artery be specified if the description contains "Angiography".

Alternative proposal is that we do not use "Arteriography" in the FSN.  Angiography would be used as long as the specific artery is specified.  This would be the same for the PT. Arteriography would be added as a synonym where appropriate.

20210922: 

Decision:

Concepts with "arteriography" in the FSN will be renamed "Angiography of X artery", with "Angiography of X artery" as the PT.  Arteriography of X artery will be added as a synonym.

The presence of "angiogram" description has previously been approved for the ones that are present, but we will go out for comment prior to inactivation of these "-gram" terms.

2021-09-13: A revised document was circulated modifying the editorial proposal to retain the terms containing "angiogram" due to their high clinical usage and value for concept retrieval.

2021-09-22: Will retain the "-gram" descriptions for those that have them, but will not create new ones.

• Monica Harry to make changes to the FSNs as approved.

Paul Amos

Jeremy Rogers

Jim Case

Inactivation of Ambiguous Concepts - review of comments and problematic examples

From Jim Case  Ambiguous concepts identified by member

208493001 |Open fracture finger distal phalanx, multiple (disorder)|

208488004 |Open fracture finger middle phalanx, multiple (disorder)|

208482003 |Open fracture finger proximal phalanx, multiple (disorder)|

These are confusing concepts and it is unclear from the current wording what is intended.  As one would expect, these are most likely derived from ICD-9 (e.g. 816.13 Open fracture of multiple sites of phalanx or phalanges of hand), which is also open to interpretation.  In the recent remodeling of these concepts, the representation in some cases is that multiple phalanges or digits are involved, in other cases such as abrasions and open wounds, they are modeled as multiple morphologies on a single digit.

Given that the original source of these concepts was ambiguous as to whether one or more digits were involved, these concepts should be inactivated as ambiguous and replaced with concepts with more specific FSNs, i.e.

"Open fracture of distal phalanx of multiple fingers" and "Multiple open fractures of distal phalanx of finger".  The latter is an example of a concept that most likely would never occur, (multi-fragmentary fractures occur) but would need to be created in order to conform to the requirements associated with AMBIGUOUS inactivation reason from the concept inactivation workgroup.  Thus it too would be inactive (Paul Amos, what would be the inactivation reason?)

Useful references: Traumatic Finger Injuries: What the Orthopedic Surgeon Wants to Know and Distal phalanx, distal and shaft, multifragmentary

Discussion:

20210901: Three options:

1. Inactivate as a classification concept
2. Create a non-useful concept and inactivate as "Non-conformant"
3. Create a new concept that represents comminuted or multi-fragmentary to support the alternative interpretation.

Issues with tooling prevents option 2. from being implemented at this time.  Interim solution would be to inactivate with one replacement and then return to these after the tooling solution is implemented. 

Decision:

• Paul Amosto add related presentation to the meeting notes

Osteoarthritis: A majority of descendants of Osteoarthritis (disorder) are not kinds of osteoarthritis. Model needs to be revised.

Discussion:

Bruce Goldbergpresented a discussion related to deposition and degeneration.  Recommended moving Deposition out from under Degeneration.

Osteoarthritis has multiple child concepts that are not considered to be osteoarthritis.  This is due to the current definition of Osteoarthritis.  Current thought is that osteoarthritis is more than just degeneration of the joint.  It is a complex disorder.  Because of the complexity is it not possible to SD Osteoarthritis. Proposed remodeling will move hundreds of inappropriate concepts out from under Osteoarthritis.

Suggest creating new morphology = Inflammatory degeneration. The inflammatory aspect of this disorder is variable, but it is considered an arthritis, which requires an inflammatory morphology.  Some comment that common use of arthritis (inflammatory) and osteoarthritis do not consider them related.

Need a common parent for osteoarthritis and rheumatoid arthritis?  

As this is a high use area of content, we must carefully consider the impact on users.   Suggested that there be a site where the impact of the proposed changes can be viewed.  Will bring this up to the technical team to determine options for interim viewing.

Deposition_degeration_osteoarthritis.pptx

• Jim Caseto discuss with tech team how to make proposed changes viewable to EAG.
• Bruce Goldbergto make proposed changes for evaluation of impact.

Philip Brown

Jim Case