Time:
1030 - 1400 PST
1330 - 1700 EDT
1730-2100 UTC
Zoom Meeting Details
Topic: SNOMED Editorial Advisory Group
Time: Oct 23, 2023 10:30 Pacific Time (US and Canada)
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https://snomed.zoom.us/j/82233252652?pwd=Q7vaRKFqZGeNNMbM2bu49v1QdSbahI.1
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Attendees
Chair:
AG Members:
Invitees:
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Apologies:
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Meeting minutes:
The call recording is located here.
Objectives
- Obtain consensus on agenda items
Discussion items
| Item | Description | Owner | Notes | Action |
|---|---|---|---|---|
| 1 | Call to order and role call | 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 |
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| 2 | Conflicts of interest and agenda review | |||
| Modeling of "No known X" | Inconsistent representation of "No known...(situation)" with proposed remodeling. See attached document. | |||
| Transplantation vs. grafting and Terming of Transplantation concepts | Briefing note for changes in the taxonomic location of 129407005 |Grafting - action (qualifier value)| and 410820007 |Surgical transplantation - action (qualifier value)| is attached. Comments on proposed changes are requested. Ancillary to the change in the Action hierarchy, there are concerns about the current terming of many transplantation concepts, where the precise meaning is unclear. Most of these concepts have the form "Transplantation of....". In the case of solid organs, the intended meaning is clear, i.e. transplantation of a donor organ to a recipient; however, for transplantation of tissue concepts, the intended meaning is unclear. Does it mean "Transplantation from X" or "Transplantation to X", and is the type of tissue implied Examples: 119661004 |Transplantation of tissue of hand (procedure)| 119717000 |Transplantation of tissue of nose (procedure)| Does 69428003 |Transplantation of uterine tissue (procedure)| mean transplantation of donor uterine tissue to the uterus of a recipient? Is this even a real procedure or just a grouper for the single subtype? For the most part, this type of concept represents a grouper for subtypes such as "surgical transfer", "Surgical advancement" and "Surgical recession", which do not involve a donor-recipient relationship. If these serve only as "action" groupers and do not represent real procedures, should they be retained or inactivated? If retained, is the FSN clear? Discussion: Decision: | |||
| Leakage of device | ||||
| Evaluation procedures to Observable Entity | A briefing note circulated in August proposed a movement of evaluation procedures, initially focused on laboratory procedures, from the Evaluation procedure hierarchy to the Observable entity hierarchy. This proposal was a result of many years of discussion about the duplicative nature of Evaluation procedures, inconsistency in modeling of clinical findings using the INTERPRETS relationship and a divergence of the representation of these types of concepts from other observation standards such as LOINC and NPU. There was substantial opposition to this proposal from member countries that have long used Evaluation procedures for ordering. A presentation explaining the rationale is attached and will be used to inform the discussion. Discussion: Decision: | |||
| 6 | Severity as a defining attribute | Jim Case | The attribute 246112005 |Severity (attribute)| is an approved defining attribute for Clinical findings in the MRCM; however editorial guidance has been rather ill-defined in relation to the use of this attribute due to the subjectivity of assigning a severity to a clinical finding (i.e. "Severity is defined relative to the expected degree of intensity or hazard of the Clinical finding that is being qualified.") Modeling Generally, 246112005 |Severity (attribute)| is not used to model concepts precoordinated in the International Release, but there are some exceptions. A valid exception requires an internationally accepted definition that can be consistently applied and used reliably for international comparison. Even though a reference may be internationally sourced, its use may not always be uniformly applied by multiple countries. Classifications of severity that represent variation in clinical presentations and enact limitations with age ranges, sex, or pregnancy status, do not apply universally to all patients of all ages, prove problematic, and may not be generally useful. The requestor is responsible for obtaining permission for use in SNOMED CT if required by the international body. Issue The issue to be discussed originated at the April 2023 business meeting where it was noticed that some diseases (e.g. Severe asthma) were primitive concepts and thus it is not possible to identify the duplications and subsumptions in postcoordinated expressions that use the severity attribute. As an alternative to precoordination in the international release, this attribute can be used as a qualifier in postcoordination. However, beware that postcoordination of severity results in the same irreproducibility issues as pre-coordination. The use of the SEVERITY attribute is complicated by the lack of knowledge about the ordinal scale from which the selected severity originated. For example, the source severity value set may have different sets of values such as: • mild / moderate / severe The current editorial guidance for the use of the SEVERITY attribute has a modeling note attached: The question is, given its common use in clinical practice, should the restrictions on the use of SEVERITY in the International release be relaxed, allowing for any concept that explicitly states severity in the FSN have a severity relationship assigned, with the caveat that interpretation of the intended meaning is subjective? I.e. the notion of severity exists and is commonly used, but may not be interpreted the same by everyone. Discussion: Comment from Feikje Hielkema-Raadsveld - The notion of severity is highly subjective. But it seems strange to ban it from modelling, yet allow it in the FSN. And a whole lot of other things (disease vs. finding, heh) are just as subjective. I think I would be in favour of relaxing the modelling restrictions on severity, but we would need strong guidance on when it is okay to use it, and when it should be avoided. For instance, 722401001 |Severe fever with thrombocytopenia syndrome virus| - should one apply a severity there? To the fever, or the whole? Or is it a particular disease that could have its own severity? I am what the others’ reactions will be. Historically there are many reasons why it was originally removed, however, many disorders that are by nature "severe" that would not classify under them because the FSN does not contain the word "Severe". This would require a review of many terms that would be expected to classify under a supertype. There are defined uses for severity. In cases where these definitions exist, an authoritative text definition must be included. However, this does not guarantee that all of the appropriate subtypes would properly classify unless the subtypes are specifically defined with a severity relationship. Suggested there be a review of terms that currently have a severity relationship to determine whether such an authoritative definition exists. The current use of Severity relationship in SNOMED is limited to two concepts and they are problematic. Decision: |
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| 8 | AOB | EAG | ||
| 9 | Next meeting | EAG | Meetings will continue on the fourth Monday of the month and may be cancelled if necessary. | |