• Recording of meeting approved by participants.

Conflicts of interest and agenda review

Measurement Findings:

Proposed changes to FSNs

• Proposed changes to FSNs: Please read the attached Briefing before the meeting and if possible return your comments for discussion at the meeting.
• This meeting will address the following issues:
  • Concepts representing "borderline" levels
  • Concepts representing "therapeutic medication levels"
  • Concepts representing "Abnormal" or "outside reference range" levels

Decisions to date:

1. Following the discovery of a decision made in 2010 that within the context of measurement findings "increased" = "above reference range" and "decreased" = "below reference range" the EAG members agreed to support a change in FSN rather than inactivation.
2. In the rare event that a user has interpreted and used one of these concepts to represent a relative increase or decrease in measured value; advise use of 442387004 |Increased relative to previous (qualifier value)| and 442474009 |Decreased relative to previous (qualifier value)| with clear FSN e.g. Increased blood glucose level relative to previous level (finding) for implementation at the local level.
3. There was agreement that the notion of "normal" is context dependent and similarly "within reference range' should be interpreted within the context of the whole clinical record. Therefore, it was agreed that concepts representing "within reference range" will have their FSN/PT updated and a synonym description of "normal" should be retained or added as appropriate.

Decision:

In the course of reterming FSNs as part of the Quality Improvement project, there are occurrences where the change in the FSN to conform to editorial policy results in a validation error identifying an inactive concept with the same FSN.  The error is:

An FSN must be unique within all active FSNs across all concepts. This term already exists against inactive concept <SCTID>.

There had been general guidance provided for this that the inactivated concept with the proper FSN would be reactivated and replace the concept with the improper FSN; however, in many cases this would result in frustration for users, as it would result in the inactivation and replacement of a concept with the concept that it replaced in the first place. 

Recognizing the need to minimize the impact on users, it is important to take into account the fact that time plays an important role in which concept to inactivate and which one to retain. One consideration is which term has had the "greater opportunity" to be used in health records.  This includes when a concept was introduced into the terminology, how long it was active and when it was inactivated.

Guidance is needed for instances where duplicate FSNs are created as part of the reterming of active concepts to align with the quality improvement project.

Options include:

1. Reactivate the original concept with the proper FSN regardless of when and how long it has been inactive.
2. Only reactive the original concept if it has been inactive for less than a specified period of time (e.g. 5 years)
3. Never reactivate the original concept, whilelist the validation error.
4. Retain or reactivate the concept that had the longest period of active status.
5. Others?