2022-09-26 - CMAG Meeting

5 mins

• Apologies - nil
• Declarations of Interest:
  • None at meeting.
  • Request to CMAG reps to review and update DOI page by 31st October

Potential inactivation: << Finding reported by subject or history provider (finding)

See slide 6 for examples. Issues include broadness, vagueness. 

Similar content - Complaining of concepts previously inactivated. 

Discussion: 

• Subtypes: Some concepts have.
  • Impact of removing groupers on searching raised.
  • Concepts did come from READ version 2 and would have had subtypes in the past. Changes since that time have resulted in these subtypes moving to other places in the hierarchy.  
• Symptom vs sign
  • Symptom - a finding reported by the patient, can't be objectively evaluated
  • Sign - a finding that can objectively seen and evaluated by a clinician
• Normally difference managed in an information model. 
  • Concepts very old - from the time of impoverished information models where the ability to note this wasn't available. 
• Part of QI work.
• Impact of this work on the |Finding informer| attribute? Something for the information model?
  • Attribute is infrequently and inconsistently used. 
• Impact on OHDSI? 
• Used by one member in their GP refset. Comments will be added to the confluence page.
• Usage data from UK available. 

Feedback due: 30th November

Confluence link: Symptom Content - Potential Inactivation

Background provided:

Work stems from a freshdesk ticket asking about the presence of this content in both the finding and situation hierarchies. Most is in the finding hierarchy.  

Discussed at EAG in April: 2022-04-05 SNOMED Editorial Advisory Group Meeting

Objection to move presented by Nursing CRG. Please see documents attached to this page:

1. Original discussion at EAG in April 2022
2. Response from Chief Terminologist

Current content includes type of risk e.g. increased, decreased and also concepts without specification of level of risk. The latter are usually understood to mean increased risk.  

Main issues: Ambiguity of at risk of <x> and content is primitive.

Options to manage content presented to CMAG (yet to be presented to EAG). Examples were shown using authoring platform. 

• Keep in Finding hierarchy with new concept model to support defining of content. Includes using the Has realisation attribute and extending the range of values permitted. 
• Move to Situation and use model to represent to type of risk. Would require additional concepts as subtypes of 410519009 |At risk context (qualifier value)| 

Ability to express the idea of quantifying risk was raised in discussion. Concrete domains could be used for numbers but not for ranges. 

Question raised on using the information model re degree of risk- how far should SNOMED go in that area? 

Some content is highly used in nursing community. 

EAG to discuss options following input from users. A proposal will sent out to the CMAG, MF Community of Practice prior to changes being made. 

Straw poll on which solution:  10 for findings, 8 for situations.

1. Briefing note: Delivered/ not delivered concepts - plan for inactivation
   • Background: Obstetric content from ICD-9-CM, where discharge note included if patient had delivered or not. Focus on discharge not management. ICD-10 and ICD-11 do not include this content. Difficult to define in SNOMED. 
   • Inactivations:
     • Concepts which include delivered would have two historical associations - Mother delivered (finding) and the base concept representing the disorder.
     • Concepts where delivery had not occurred would have one historical association to the base concept representing the disorder.
   • Approximately 250 concepts. 
   • Looking for feedback or concerns. Please provide prior to 23rd October.
   • Discussion:
     • Question on mapping re ICD-9 retrospective data.  SNOMED International does not provide an ICD-9 mapping. Understand that the issue relates to ICD-9-CM specifically. 
       • For one country, they can manage this in their own extension. 
2. Terms of reference - review by group due 31st October. 
   • Review of CMAG Terms of Reference
3. 2023 work plan -review by group due 31st October
   • Any additional items group should be looking at?
   • CMAG 2023 Work Plan
4. CRS guideline updates - updated promotion process discussed. See slide 10. Template for use between extensions is present in the CRS Customer Guidance Appendix B. 
   • New automated process for managed service customers a way forward.
   • For those with 6 monthly releases the system doesn't account for needing to hold (concept needs to be publish in extension first) before submitting the automated requests. Causes an issue with keeping track of concepts needing promotion and storing of reference material/re-finding reference material to support request to international. Issue has been raised with Managed Service by two countries. One suggestion raised by Terrence from Managed Service was the creation of a draft CRS. Elaine Wooler advised she hasn't found an issue with that.

• Malignancy
  • See 2022 Informational Content Briefing Notes re Inactivation metastatic disorders and update. 
    • Overview of briefing note given. 
    • Timescales not advised at the time. Now added to 2022 Early Visibility Release Notifications
      • Primary: December 2022
      • Metastatic: March 2023
    • Question on inactivation numbers: expected to be low. See briefing note and early visibility for details. 
• No future meetings scheduled at this point in time. 
  • Will look at the potential to have a meeting at the April business meetings, if required.