This was initiated from a request for “Reduction of soft tissue for auricular prosthesis”.  There is currently the concept 410771003|   Surgical procedure for clinical finding and/or disorder (procedure), which has 156 direct descendents.  The use of the HAS FOCUS attribute allows for the reason for the procedure to be modeled.  A recent set of diagnostic imaging procedures that included the reason the procedure was being done resulted in an editorial decision to disallow the future addition of precoordinated reasons for procedure.  Recent discussions with editors have questioned whether this is necessary given the spate of requests for this type of concept. 

Concerns from the HoT include:

1) the potential high number of precoordinated terms that would be created if every reason for a procedure were allowed;

2) the reason for a procedure should be captured as a separate clinical finding to document that the “diagnosis” has been established. Precoordinating the reason precludes the need for separately documenting that the condition exists in the patient;

3) some reasons provided for procedures may be so vague as to provide little additional information.  

6

A number of requests related to findings related to surgical skin wounds and pressure injury findings reveal an issue with current structure.  Most of the requested terms are Findings related to skin wounds, but currently 262526004 |Wound of skin (disorder)|is a disorder, so cannot be used as a parent for findings related to skin wounds.  There is currently 225552003 |Wound finding (finding)|, but it is not specific to skin.  262526004 |Wound of skin (disorder)|currently has 65 immediate subtypes, many of which could reasonably be viewed as findings (e.g. “Abrasion of X”).  

Need to make a determination of whether observations related to wounds (i.e. color, discharge, odor) should be placed in a subhierarchy different from the "Wound (disorder)" itself.

Currently we have many concepts in the specimen hierarchy that include “from patient”as well as those that do not include it as an ancestor.  Since the subject of record is the default for specimens, we would like to retire these apparent duplicates, but then we run into the problem of specimens derived from other sources such as donors or normal control patients. 

They cannot be subtypes if the intended meaning is “subject of record”..or can they, since the context is implied?  How do we structure the specimen hierarchy to account for this? 

What are the analytical implications of having different sources for specimens as subtypes of one another?