• Recording of meeting approved by participants.

Conflicts of interest and agenda review

The following is a list of recommendations from the EAG that have been implemented in SNOMED CT since October 2020:

• Spinal cord injuries and spinal cord syndromes have been remodeled to reflect the distinction between the structural damage and the clinical manifestation. - completed
• The concept inactivation workgroup has finalized recommendations for revised and additional inactivation reasons and clarification on the use of historical relationships - in progress
• Pathologic fractures have been remodeled so that they no longer classify as traumatic injuries - completed
  • Renaming Pathologic fracture due to neoplastic disease concepts - completed
• The primitive "Sequela" concept has been inactivated and content using Sequela as a stated parent have been remodeled with "Disease" - completed
• Approved new definitions for Poisoning, Overdose and Intoxication.  Content is being remodeled to adhere to these definitions - in progress
• Approved modeling proposal for combined disorders - in progress
• Approved new model pattern for "Aplasia", Congenital absence and "Agenesis" - completed
• Provided guidance on the potential inactivation  of duplicate Computed Tomography combine procedures - completed
• Provided guidance on remodeling/inactivation of "Positive/Negative" findings - in progress
• Provided guidance on the use of "unambiguous" acronyms (i.e. do not require expansion in a non-FSN description) - in progress
• Provided guidance on the use of HAS_CHARACTERISTIC generic attributes for use by extensions in their drug models - in progress
• Provided guidance on consistent naming of Specimen vs. Sample in the Specimen hierarchy - in progress
• Approved an ECE proposal for a new model for "Pressure ulcers"; renamed to "Pressure injuries" - in progress
• Approved proposed editorial guidance for naming of lateralized procedures - in progress
• Provided guidance and approved renaming of "Angiography" procedures for consistency - in progress

Decision:

Will be modeled as a degenerative disorder out from under osteoarthritis using a morphology of "degeneration".  Will create a combined morphology of "inflammatory degeneration" to support the remodeling of osteoarthritis.  Results of remodeling will be made available to the EAG members.  Potential to make this available via the TS browser. 

Issues have arisen with the remodeling of subtypes of 116223007 |Complication (disorder)|, based on earlier agreed decisions from EAG.

Proposal for revision of the “Complication” hierarchy

Based on agreed proposals, editorial guide will need to be updated.

Discussion:

Decision:

Consensus is to proceed with the modeling recommendations as described in the accompanying document.

See attached document for review:

Modeling issues related to maternal periods

Complications related to pregnancy

Discussion:

Decision:

A draft document for review that outlines the requirements for external editors (non-SNOMED staff) to work within the International release is available for review.  This document will also be provided to the Member Forum and the CMAG.

2021-10-18: Comments received from four member countries of the CMAG, all positive. Request for more detail in some areas of the document.

Requirements for external editors of SNOMED CT International Release

Discussion:

Decision:

A question from a member country on when to use "X (person)" vs. "X of subject (person)" has exposed issues with determination of equivalence in information models that either split the relationship from the condition vs. using a precoordinated Situation concept to represent the SUBJECT RELATIONSHIP CONTEXT.

Discussion:

Decision:

Freshdesk ticket from member country:

"Our expert group have questioned the concepts 57797005 |Induced termination of pregnancy (disorder)| and all the child concepts as to why these are in the ‘disorder’ hierarchy as they are actually procedures? I actually agree, it seems a bit strange? There are synonyms as ‘termination of pregnancy’ which insinuates a procedure and that are the same as 386639001 |Termination of pregnancy (procedure)| which sits in the procedure hierarchy."

This hierarchy includes 196 concepts, which fall into the following categories

• Induced termination of pregnancy during a particular gestation period (e.g. 6251000119101 |Induced termination of pregnancy in first trimester (disorder)|
• Induced termination of pregnancy with a "complication" that occurs DURING or AFTER the procedure.  (e.g.  609514009 |Induced termination of pregnancy complicated by vaginal damage (disorder)|)
• Induced termination of pregnancy performed "legally" or "illegally" (e.g. 49632008 |Illegally induced abortion (disorder)|)

Most of these have been in SNOMED since the 20020231 release. 

Questions:

• Should some of these concepts that refer solely to the procedure be moved to the procedure hierarchy?
• Should history concepts be created for each procedure (many already exist; e.g. 713649008 |History of induced termination of pregnancy (situation)|)?
• Should the complication related concepts be retermed with a focus on the resulting disorder DUE TO the procedure (e.g. Vaginal damage due to induced termination of pregnancy))?

Discussion:

Decision: