Overview of Event, Conditions and Episode Policy Recommendations
BGO made a presentation. He worked presented the workplan, then spoke about the during, during AND/OR after to associated with role hierarchy.
JMI asked if BGO had spoken to the Anesthesia SIG on that because they had been doing work on that.
- BGO to speak to Andrew Norton about Anesthesia SIG work concerning temporal model.
JCA said he disliked "and/or."
KCA said he had discomfort with "associated with." If someone has diabetes and HIV, is a symptom associated with one or the other?
JCA said he was in favor of more robust temporal, they had temporal association but not necessarily a causal relationship. KCA then you could look at patterns by data mining but you should not presume a causal relationship. JCA said "most likely due to" is what the causation indicates.
- JCA suggested that BGO bring back to the ECE group that relaxing the view of causality was, at least in KCA's opinion, not a good thing. If you want to identify co-occurance of 2 disorders and not specifically identify causality, the relaxation may lead to over-interpretation of causality.
JCA said the caused by presented a problem because sometimes medical knowledge shows that they are not caused by, but his hope (perhaps naive, he said) was that if you say something is due to, then medical knowledge had proven that causation.
- On ECE guidance, Eric said they should determine whether to use the Oxford comma. JCA said ed guidance for FSNs is grammatical standard and apply that consistently throughout the terminology.
There was a discussion about trademark names.
- JCA said there should be an action to look at acronyms as trademark names for things like assessment instruments in order to come up with a policy.
We could include those acronyms as an alternative description but at this point wouldn't be in the FSN, but that's just at this point.
JCA asked if the ECE had definitive recommendations they would like to see applied to the Editorial Guide? BGO said no, but the recommendations would be revised. JCA asked in the meantime, while the recommendations were being revised, there was guidance in the Editorial Guide and a fair number of Co-occurrent and Co-occurrent Due To that were being added, so what was the recommendation from the ECE group for the editors, because there was a backlog on those items. BGO said many more terms used Co-occurrent rather than Co-occurrent Due To because people were hesitant to assign causality, so he thought the approach might be to move more towards that and eliminate the use of Due To. He thought the guidance should be if one was not sure of direct causality to use Co-occurrent. JCA asked if the ECE would be making that into a formal recommendation to put into the Editorial Guidance? BGO indicated that it would. JCA encouraged them to prepare that guidance quickly so that it could be implemented.
- ECE to make formal recommendations for Editorial Guidance on Co-occurent and Co-occurrent due to.
JCA wondered aloud if the team would have to look through all the Co-occurrent and Co-occurrent Due To's to make sure they were not overmodeling. JCA said an analysis should be done. BGO said he would do that.
- BGO to do an analysis of existing Co-occurrent and Co-occurrent Due To
BGO asked if they were okay with the stating in the Editorial Guidance that Due To is strictly due to direct causality. JCA said that was the proposal that KCA was making. PAM asked if there was guidance on the level of "knowing" in order to use "due to." BGO said it was based on a literature review.
KCA proposed using Due To as an attribute that can be used in describing relationships in instances but not the term as a precoordinated expression in SNOMED. The connection is then made by the physician and not SNOMED. Leave it in the realm of instances and clinicians. JCA said there had been other contexts like this, and he asked if there was a class that represents the universe of instances of Due To. If you say yes, you can identify causality in an instance, should there be a class that represents that. Due To does not say 100 percent of time it's due to, just an instance. KCA agreed with that, but said that by putting the concept in, it's ripe for misuse. He raised the question of when is a finding a disease? He said it was a value judgment. We wanted physicians to be able to make that value judgment, but if it was enshrined in the terminology, it put the burden in the wrong place. KCA said ideally they would want to get rid of most or all of the Due To's and allow physicians who really needed to use Due To to use it but to not give them a shortcut that would affect the validity of the data.
- JCA said there should be an evaluation of Due To's, and that would be one of their many things to follow-up on.
Break