Call to order and role call

Jim Case (JCA) welcomed everyone. Attendees are listed at 2016-08-22 Editorial Advisory Group Conference Call. Keith Campbell was unable to attend but sent comments in advance of the meeting.

Approval of prior minutes

Approved.

Disjunctive components (LOINC)

Daniel Karlsson (DKA) from the Observables project gave a presentation using slides previously posted on the agenda page. He said there were a number of LOINC terms in the cooperative area in the current agreement to be mapped to SCT expressions. There were 814 LOINC terms, but some of those used a plus sign in a different way and should not be counted. He estimated that there were 700-800 LOINC terms in scope. The problematic ones, he said, were where there was a component and a union of different substances. It could be any or all of those substances, meaning it would be a disjunctive statement.

There were several possible solutions, DKA said. A disjunction was not really an alternative, so that could be ruled out pretty quickly, he said. Another alternative would be to continue to manually maintain the observables. However, that strategy had been shown to introduce some inconsistencies in the substance hierarchy, so it was not a perfect solution either. Another alternative was to extract the subset, classify the terms using a more expressive classifier, and export the result back as primitives. Within that solution were two alternatives, which he described. 

JCA asked for clarification: one of the options would be to represent them in a more robust environment like Protege and then integrate them back in? DKA said yes, one alternative would be to introduce the concepts as new substance concepts. JCA asked whether there had been an testing on the impact that would have on classification. DKA replied that he did not think the impact would be large since the concepts would mainly be used as observables. However, they would show up, looking strange as substances in the middle of the hierarchy. 

Toni Morrison (TMO) said she would be uncomfortable introducing such concepts into a foundational hierarchy and she was unsure of what it would mean elsewhere. The concepts could not be used to model products, and she was not sure how they would model through when modeling allergies. She thought some testing would be needed. DKA said they would behave like intermediate primitive groupers. That was not a great solution, he continued, but they would be generated using a more expressive logic, so it would not be a manual curation of the groupers. TMO asked how someone using SNOMED CT would know that they were not supposed to model with them. DKA replied that he did not think they would be forbidden from being used, but you could not use them to postcoordinate new concepts. He added that the list of 814 would seem pretty random out of context.

Guillermo Reynoso (GRE) said it was difficult enough to clean up the substance hierarchy and adding this kind of contractors into the hierarchy would be difficult to deal with. He suggested having an extension without putting them into the core. Making it more useable for this particular use case, he said, made it less useable for everyone else. 

DKA said he assumed that the solution would be to make the observables primitive. One could classify those using more expressive logic behind the scenes.

Yongsheng Gao (YGA) said it would be difficult to maintain in the core, and substances did not even have a model so it would be hard to maintain regardless of the solution. He said he preferred to look at the EL use of GCI to achieve the goal.

Paul Amos (PAM) said that if he found something like that in his patient's notes, it would be really unhelpful and not give him confidence that he knew the patient's problem. In the laboratory it would be more narrowed down and then would go in the patient record well enough, and he could accept some ambiguity in the laboratory record, but he would prefer it to be in an extension. PAM added that they had spent a lot ot time trying to get rid of and/or in ICD, and if it were used now, it could open the floodgates. He suggested working with Regenstrief to adjust its model rather than bending to Regenstrief's model.

BGO thought the best approach involved making them primitive and inserting the individual components manually, and he would keep them in the core.

DKA said he was not sure what to keep in the core - they are all expressions and not SNOMED CT concepts, so the full observables would never be according to the agreement in the core. JCA replied that BGO's point had been that the disjunctive substances would be in the core. 

Responding to a question, DKA said the hierarchies that would be impacted were substances, cells and organisms.

JCA said he wanted a summary of the currently supported options for the next call. If they could not finish the topic there, they could discuss it in Wellington. He asked how critical the answer was to the LOINC modeling group's work. Farzaneh Ashrafi (FAS) said the candidate baseline was scheduled for February.

JCA summarized the main ideas: (1) just model them as primitive in the core and assign the subtypes manually (in substances they would have to do that anyway because there was no model); (2) create an extnsion that could be used in conjunction with the core. DKA added another option: (3) make the 814 observables primitive - there would not be a component in there, it would be part of a primitive component.

JCA said those three options would be discussed next time. He asked about the impact of going ahead and making them primitive in the initial release and revising them at a later date. FAS said the team could do that and had done that before, but she wondered what DKA thought of that solution. DKA agreed that that was the least work-intensive solution.

• LOINC modeling team to take the 814 disjunctive concepts and make them primitive in the initial release, then revise them as necessary based on further modeling discussions.

Editorial Guidance on Numeric Ranges in the FSN

GRE said they had had pushback in the past of including em dash and dashes, particularly when copy/pasting from Word. They created coding problems, and they had had to roll back releases because of the problem.

JCA asked if the to...from would require new attributes to make them work. GRE replied that representing them as 2 to 2.5 mg is clearer. Part of the problem, he said, was in searching. 2mg was harder to find than 2 mg, so it was better to have a space between the number and the unit.

JCA said that sounded fairly straight-forward to automate so long as the Members were alerted that the descriptions would be inactivated and replaced. 

There was a question about Keith Campbell's (KCA's) discussion point on bracketed ranges, but JCA was not able to find it for the discussion.

TMO asked if there needed to be a number with each unit in the range. JCO said he felt like it should be yes, and yet from a readability perspective it was not necessary, unless perhaps people were searching and expecting the unit within one space.

PAM asked if it should be 2 or 2.0. TMO said the general consensus was no trailing 0. JCA said 0 in that case was not trailing, it was significant. TMO said that as a pharmacist she would never put it on there because it was easy to miss the decimal. PAM pointed out that it had meaning because 2.0 could mean 2.1 but it would not mean 2.9.

GRE said he thought it had to be both unambiguous and human readable.

BGO said he agreed with GRE's suggestion of 2 to 2.5 kg. JCA asked if a unit was needed after the first 2. BGO said he did not see the benefit of that. JCA pointed out that if you were searching for 2 kg, with the unit adjacent to your number, you would not find it.

The group agreed that TMO, with help from BGO and perhaps others, would come up with some more examples. PAS raised the issue of whether there were ranges that combined different units and JCA replied that they would have to look at the examples.

• TMO to collect some more examples of numeric ranges in FSNs for further discussion.

Addition of diagnostic imaging concepts with multiple body sites

JCA showed a discussion on the topic from Monica Harry (see Should we continue to add diagnostic imaging of multiple body sites)

BGO wondered if the examples had come from CMT. JCA said on a CMT call, they had discovered that they were primarily created as convenience ordering mechanisms as opposed to distinct and unique concepts, but verification would be needed.

Mary Gerard (MGE) said she did not think that the examples came from CMT. She said KP had sent some examples of the same modality on adjacent body parts and she had been told that they could model on that. 

GRE said the point was whether they were part of the same procedure and if there was coherence in putting them together. He was reluctant to add all possible combinations. There should be some kind of line about when they can be part of the same idea so that you are not trying to express 3 different ideas in the same sentence.

JCA said the discussion was reminiscent of panels in the laboratory space. For example, if you have a number of things you want run on the same patient, you create a panel of things that needed to be done and they are performed in separate procedures in the lab. He agreed with GRE what you did not want to open the door without some guidelines to large and complex sets of combined orders in the diagnostic imaging space, but what was the reasonable line to draw in the sand