Jim Case

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Jim Case

None stated.

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

Discussion:

2021-09-22

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.

Discussion: 

Should spondylosis be a subtype of Osteoarthritis?  Literature uses spondylosis synonymously with osteoarthritis of spine.  Ankylosing spondylitis is a subtype of arthritis, but osteoarthritis is not modeled as an arthritis.  What is the result of moving spondylosis out from under osteoarthritis?  The literature is mixed as to whether it is an arthritis or osteoarthritis.  It is often described as a disorder of spine (bony structure).  Can be viewed as an end stage of chronic arthritis with no remaining inflammatory component?  Do we agree that spondylosis is a degenerative disorder.  

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.

• Jim Caseto implement changes and make available for review in the TS browser.

Philip Brown

Jim Case

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

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.  

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:

These have been of long-standing concern about the proper location.  Most look like they should be procedures.  

The notion of legal and illegal abortion is still something that is of concern, but should it be as part of the international terminology as this is a jurisdictional issue. Some expressed that this determination does not belong in the International release.  There are many aspects of induced termination that affect the risk of the procedure.  This cannot be captured within a single procedure.  The issue is the risk associated with the procedure that affects the outcome.  The method used, etc. is all of importance.  Best represented by a clinical statement model.  

Many of these originated with ICD-9 and have been carried through to ICD-10 including legal or illegal. 

The distinction of medical vs. surgical needs to be made where needed. Would this require the use of GCIs to represent the distinction?

The notion of legality should be represented with an alternative representation. It is important that we represent the environment in which the procedure is performed as well as the skill of the provider and the devices/medications used. Look at existing content for concepts related to the state of the patient as well as the procedures.

Need to look at the hierarchy above Induced termination of pregnancy as well for potential procedures. <<363681007 |Pregnancy with abortive outcome (disorder)|

Decision:

Will ask Jeremy Rogersfor frequency of use to determine value.  Will check on the impact of reterming on the complication concepts?

Most agree that these look like procedures then we will do an evaluation of what needs to be moved.  

The notion of "legal" or "illegal" is important for medical care, but not pre-coordinated with the procedure. Extensions may add this notion back if they find it necessary.

Need terming guidance to make the naming of these concepts consistent (continued use of "abortion"?)  

• Jeremy Rogers to provide statistics on use

Next call tentatively on Nov 24.  Time to be determined