• Recording of meeting approved by participants.

Conflicts of interest and agenda review

Release of SNOMED Code usage statistics.

Discussion:

UK Primary Care data had been collected 2019-2021 and will be released publicly representing use of SNOMED CT concepts.  A description of the types of data that will be released was presented.  Precision rounded up to the closest 10 for number of uses.

Can be used to guide SNOMED in terms of inactivations and replacements.  Provides analytical support for use of SNOMED CT concepts and relationships amongst them.

A request from Argentina to inactivate concepts related to the legality or illegality of "Induced termination of pregnancy" or "abortion" (disorders).  Briefing note attached.

Decision:

We have received a request for a concept "Patient race not recorded" as a subtype of 312863000|Patient data not recorded (finding)| along with a request to create a new Observable entity and finding value to allow for modeling of concepts related to clinical documentation not being recorded.  

I.E.

INTERPRETS = Demographic detail (observable entity) as well as subtypes specifying the type of demographic information.

HAS INTERPRETATION = Not documented (qualifier value)

This type of concept appears to be a "reason" for missing data as opposed to a NULL value.  FHIR incorporates these "flavors of NULL" in many of their value sets.

Are these really findings?

Decision:

The current definition of the Occurrence attribute is:

"This attribute refers to the specific period of life during which a condition first presents. However, conditions may persist beyond the period of life when they first present."

In many cases, the presentation of a condition occurs after the period of life in which it is observed.  This is especially true when there is a continuum of time periods; where it can be determined that a disorder actually began prior to the time in which it is observed.  New additions to the 282032007 |Periods of life (qualifier value)| hierarchy to support maternal pregnancy and fetal development phases warrants a revision of the definition of this attribute.

A proposed new definition for the Occurrence attribute is:

"This attribute refers to the specific period of life determined to be the period of onset of a condition.  This may be prior to the actual initial observation and conditions may persist beyond the period of life when they first present."

This issue arose during a remodeling of Birth trauma, where it can be determined that the trauma occurred prior to or during delivery of the child, but is not necessarily noticed until after complete delivery.

Decision:

Based on a request from a member country, we seek advice on the potential move of << 281694009 |Finding of at risk (finding)| from the Clinical Findings hierarchy to the Situation hierarchy.

Rationale:

1. "At risk" is an ambiguous term that could mean either "at low(er) or decreased risk" or "at high(er) or increased risk", although it commonly is used to represent "at increased risk"
2. Nearly all of the current "At risk (finding)" concepts are primitive and thus difficult to maintain and of limited analytical use
3. There are a limited number of "At risk (situation)" concepts that are all sufficiently defined using the FINDING CONTEXT = "At risk context (qualifier value)

At risk findings = 254 (5 sufficiently defined, but through multiple primitive parents)

At risk situation = 5

Given the rationale above, it is proposed to inactivate and replace the current finding concepts with new Situation concepts using the terming pattern "At increased risk of X (situation)" based on the change of meaning to be more explicit and the movement to the Situation hierarchy.

Questions:

• Should these concepts be simply moved and remodeled (retaining SCTID)?
• Should these concepts be inactivated and replaced (preferred but potential large impact on users)?
• If inactivated, which inactivation reason would be used given that the existing terms are ambiguous, but are most frequently used to represent only "increased risk".  It is not necessarily of benefit to add both increased and decreased risk concepts where the latter would not be of much clinical use except in a few cases.

Decision:

Measurement Findings:

Proposed changes to FSNs

Update on Positive/Negative findings

• Proposed changes to FSNs: Please read the attached Briefing before the meeting and if possible return your comments for discussion at the meeting.

Decision:

• Update on the Positive/Negative findings with additional examples