Date 20170928
1600-1730 UTC
Zoom Meeting Details
SNOMED Int'l Editorial Advisory group
SNOMED International - Editorial advisory group conference call
UTC
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Observers:
Apologies
Meeting Files
Meeting minutes
Objectives
- Obtain consensus on agenda items
Discussion items
Item | Description | Owner | Notes | Action |
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1 | Call to order and role call | JCA |
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2 | Conflicts of interest | JCA | None. | |
3 | Procedure with clinical focus vs. Procedure for indication | JCA | 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. |
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4 | "Primary" priocedures | JCA | Primary procedures – what is the use case for calling out a procedure as “primary” when we have the “unstatused” procedure? https://jira.ihtsdotools.org/browse/PCP-81 (currently closed as pattern not allowed). The current block to addition of these types of terms was challenged by the UK. Discussion points:
For these reasons, the addition of “primary” procedures either makes existing procedures ambiguous ( they can mean procedures with any revision status), or they become abstract grouper concepts, that should not be used in clinical records, or they represent two ways to represent “primary” procedures. Ancillary question: There are currently 415 "Primary X (procedure)" concepts. If this pattern were disallowed, what would we do with the existing content? There are a number of concepts of this type that serve as ancestors for concepts related to the first stage of a multi-stage surgical regime. |
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5 | ECE Update | BGO |
The third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) published in 2016 state sepsis is a multi organ dysfunction syndrome due to an infection. Proposed model isA MODS co-ocurrent and due to infectious disease. Ensuing discussion brings up the following points which need to be resolved: 1. Organ dysfunction can persist after infection resolves, therefore not necessarily co-occurrent and thus co-occurrent and due to modelling pattern may not be appropriate.
Certain arthritis conditions can be represented as a joint inflammation as well as a systemic/multisystem disorder. In SNOMED they are modeled in terms of the joint inflammation This could give rise to inheritance issues if fully modeled when calling out specific manifestations of the multisystem disorder (e.g.193250002 |Myopathy due to rheumatoid arthritis (disorder)| .
Proposed model was to use specific artery/vein thrombosis concepts as value of due to along with an associated morphology of 78195007 |Occlusive thrombus (morphologic abnormality). Issue raised that occlusive thrombus (morphologic abnormality) as residing in role group 0 would refer to theCVA rather than the thrombosis. Suggested solution is to create specific occlusive artery/vein thrombosis concepts as the value of due to. Same parents inferred as original model. Question of need to revise model as it would require creating many new precoordinated classes.
Input from Allergy-hypersensitivity clinical reference group | |
6 | Findings related to skin wounds | JCA | 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. | |
7 | Specimen from subjects other than the patient | JCA | 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? | |
Future meetings | JCA | SNOMED International Business Meeting - Bratislava, Slovakia. Full day meeting Tuesday October 24. |
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