Jim Case

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Jim Case

Feikje Hielkema-Raadsveld 

Inconsistent representation of "No known...(situation)" with proposed remodeling.  See attached document.

Nicola Ingram 

Jim Case 

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?

Also the model based on EAG feedback would include Procedure site - direct and Procedure site - Indirect. For further discussion does (a.) the transplanted body structure = the Procedure site - direct (b.) Procedure site - indirect is this the location in which the transplanted organ is placed.

However many transplanted body structures including tissues do not currently exist. For transplants involving whole organs and tissues harvested from donors is a Procedure site - direct of < 24486003 |Structure of transplant (body structure)| correct (e.g. 81510007 |Structure of transplanted heart (body structure)?

Use of Procedure site - direct and Procedure site - Indirect i.e. no Direct substance (attribute) differs from very similar grafts and flap reconstructions that use  Method (attribute), Procedure site - Direct (attribute)  and Direct substance (attribute) . 

Discussion:

Cathy Richardson 

First discussed by EAG on 2023-04-04:

Summary of the initial discussion:

Mechanical complication concepts are classification derived (ICD-9, ICD-10, and ICD-11) and refer to injury or harm to a patient caused by a failure, breakdown, or malfunction of a device.  Coding guidance indicated that (for ICD-11) the disorder caused by the mechanical complication should be coded first and then associated with the device. Thus, the intended meaning of these concepts imply a disorder in the patient due to some issue with the device. The actual terms are index terms in the ICD.  Example:

PK91.22 Cardiovascular devices associated with injury or harm, mechanical or bioprosthetic valves (ICD-11)

This would suggest that these concepts are correctly placed in the taxonomy, and they are currently mapped to ICD disorders (i.e. injury or harm to patient) but are possibly not modeled sufficiently to express the implied meaning. 

Implantable devices might be considered as a type of body part, thus a disorder of the device would of necessity cause a problem in the patient and should be a disorder. While there may not be a morphological abnormality, there is an abnormality of the device. Is a new attribute needed to represent device abnormality?  This discussion is restricted to medical devices and not transplanted tissues and organs.

Discussion:

Jim Case 

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:

Victor Medina 

Jim Case 

Meetings will continue on the fourth Monday of the month and may be cancelled if necessary.