Jim Case

This meeting is being recorded to ensure that important discussion points are not missed in the minutes.  The recording will be available to the SNOMED International community.  Joining the meeting by accepting the Zoom prompt declares that you have no objection to your comments being recorded

Jim Case

None stated.

Combined procedures

Jim Case

Alejandro Lopez Osornio

A question submitted via Freshdesk asked the proper way to represent "Combined procedures".  These often represent two or more atomic procedures performed during the same encounter or surgery. 

E.G. 16180003 |Laryngotomy with removal of tumor (procedure)|

       78165004 |Take-down of arteriovenous shunt with creation of new shunt (procedure)|

Many procedures of this type involve endoscopy of some type.  

SNOMED no longer allows for combined disorders where there is no common causal relationship between the two, except in rare instances where two concepts are generally temporally associated with a potential underlying cause (e.g. diarrhea and vomiting).  For procedures, SNOMED has good coverage of the atomic procedures involved in such combined procedures . However, there are potentially many hundreds of these types of concepts that could be added based on the current modeling of these as a Procedure with two relationship groups representing the two different atomic procedures.  As Alejandro Lopez Osornio has pointed out in the Freshdesk response, these can also be represented simply as a post-coordinated expression using the "+". e.g. 61561005 |Incision of larynx (procedure)| + 370612006 |Excision of neoplasm (procedure)|.

Due to the relatively unbounded set of combined procedures that can be modeled, what should be the editorial policy related to future requests for combined procedures?  The requester expressed a desire to not have to record two separate procedures as they are temporally linked.

Discussion:

Nicola Ingram

Jim Case

The Netherlands have pointed out the inconsistency with the following two concepts:

85232009 |Left heart failure (disorder)| - has synonym, Left ventricular failure.

367363000 |Right ventricular failure (disorder)| - has synonym, Right heart failure

Their cardiology experts advise left/right heart failure can be caused by ventricular or valve disease. They have suggested the following structure with three new concepts:

Left heart failure (disorder)

-Left ventricular failure (disorder)

Right heart failure (disorder)

-367363000 |Right ventricular failure (disorder)|

A position paper posted earlier this year proposing new definitions are consistent with the Netherlands cardiologist view.

https://confluence.ihtsdotools.org/pages/viewpage.action?pageId=82894146&preview=%2F82894146%2F125995123%2FUniversal+definition+and+classification+of+heart+failure.pdf

UNIVERSAL DEFINITION OF HF
HF is a clinical syndrome with current or prior

Symptoms and or signs (Table 6) caused by a structural and/or functional cardiac abnormality (as determined by EF <50%, abnormal cardiac chamber enlargement, E/E′ >15, moderate/severe ventricular hypertrophy or moderate/severe valvular obstructive or regurgitant lesion)
and corroborated by at least one of the following:
Elevated natriuretic peptide levels (for values refer to Table 7)
Objective evidence of cardiogenic pulmonary or systemic congestion by diagnostic modalities such as imaging (e.g. by chest X-ray or elevated filling pressures by echocardiography) or haemodynamic measurement (e.g. right heart catheterization, pulmonary artery catheter) at rest or with provocation (e.g. exercise).

A briefing note has been prepared to address potential changes (see PDF in meeting files).

We have received comments from the CMAG.  The US Comments expose the complexity of the issue:(Changes to the Universal Definition and Classification of Heart Failure - Impact on SNOMED CT)

Discussion:

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:

Edits have been made based on comments from the MF

Decision:

Final draft has been recirculated to the MF for comments by Jan 31.  Will then be sent to the SMT for final approval.

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:

"X of person" was introduced to support the SUBJECT_RELATIONSHIP_CONTEXT of Situations.  Monique van Berkumwill look for some history on why they were added. Suggested that the ECE might have some history on these.  Question is whether we need to separate out the relationship values from "persons" as a class?

Background - https://confluence.ihtsdotools.org/download/attachments/17039782/Subject%20relationship%20context%20values_EDC_20060127.doc?api=v2

The main distinction made in the reference paper is that between an "Entity" and the "Role" played by an Entity.  However, this distinction is not made within the person hierarchy, with << 444148008 |Person in family of subject (person)| primarily representing roles that Person entities play being in the same Person hierarchy. Since the 444148008 |Person in family of subject (person)| is primarily used as values for the SUBJECT RELATIONSHIP CONTEXT attribute, we can question why it is in the Person entity hierarchy.

A question raised by the reference provided is whether a well established role (e.g. father) can also exist as an entity?  Can a father exist as a standalone entity without the establishment of a relationship to another entity?

Decision:

Background will be investigated.  The person hierarchy needs some review and rationalization.

Background document posted above.  Will review for next meeting. Make sure page is open for viewing by the EAG.  

• Monique van Berkumto investigate history of "X of person" concepts.

Next call tentatively on March 23.