Actions:
Summary
Please see attached briefing note.
Relevant documents
Actions:
| Date | Requested action | Requester(s) | Response required by: | Comments |
|---|---|---|---|---|
| 8 December 2021 | Feedback on plan to inactivate procedure concepts which specify the intent | Please post your final responses in the Country response table below. Discussion comments can be made as comments. |
Country response
| Country | Date | Response |
|---|---|---|
| Denmark | 20211208 | DK agrees to the suggestion in the briefing note about inactivation of procedures stating intent as diagnostic or therapeutic and using agnostic procedures instead. |
| New Zealand | 20211214 | NZ is in agreement with the proposal to inactivate procedures stating intent (diagnostic/therapeutic). |
| Netherlands | 20211221 | Before we can agree with this proposal we need more information as we use diagnostic/therpeutic in our extension. We miss (or can't understand) information from this proposal. These are our questions:
|
| UK |
| We had problems with interpretation of when to use Has intent and this has been causing problems. We do not receive many requests for procedures with the words "diagnostic" or "therapeutic" in the term, although occasionally it happens. I have a question about the following : "Unless there is a clinical reason and the procedure itself changes depending on whether it is diagnostic or therapeutic then the agnostic procedure would be sufficient." Does it meant that in these circumstances, Has intent can be added? It would be very useful if specific examples illustrating different scenarios are added to the guidance to help us with authoring. 600+ endoscopy procedures in core are modelled with Method - Inspection-action in stated view, which seems like an alternative way of saying that this procedure is performed for diagnostic reasons (to inspect something rather than to treat). |
| Ireland |
| Ireland agrees with inactivating these concepts as they are not currently in use here. |
| Sweden | Sweden agrees to the suggestion about inactivation of these concepts. | |
| Australia |
| Sound proposal but without knowing which concepts are affected, hard to speak to the impact of the changes. However from a modelling perspective, it definitely makes sense. No objections from our end. |
| Belgium | 20220509 | Belgium does agree to the proposed suggestion about inactivating these concepts. |
| Member countries without a CMAG rep |
Follow up on this topic at 2022-04-11 - CMAG Meeting
Actions:
| Date | Requested action | Requester(s) | Response required by: | Comments |
|---|---|---|---|---|
| 11 April 2022 | Feedback on questions asked at the April 2022 CMAG meeting: Questions:
| Please post your responses in the Country response table below. Discussion comments can be made as comments. |
Country response
| Country | Date | Response |
|---|---|---|
| Denmark | 20220519 | We know that our analysts would want this type of division, but our clinicians tell us that it is not possible to make this in practice. So the goupers are only useful if the do capture all. As you say this is not the case we would vote that they can be inactivated. |
| New Zealand | 20220607 | We agree that separating diagnostic from therapeutic intent is not practical. We agree these may be inactivated. |
| USA | 20220607 | Intent is generally not a key element in the description of procedures. (If something in the procedure is intent-specific, it should be described as a characteristic on its own.) This said, diagnostic and therapeutic procedures are heavily used in value sets, in part because of the current hierarchical organization of SNOMED CT. Therefore, substantial work will be required to adjust to the proposed changes. |
4 Comments
Matt Cordell
I just want to clarify what the proposal is because it meanders and gets confusing as it's not clear if some of the less specific language is deliberate or not...
Is it:
For endoscopic procedures, the Therapeutic/Diagnostic distinction doesn't provide much value, especially for endoscopic procedures. Endoscopy on it's own can only be diagnostic. And when there's another action (not "inspection") it's something more than diagnostic.
The numbers of affected concepts quoted in the proposal are only for procedure concepts with the "Diagnostic/Therapeutic" in an English term.
There are over 3000 concepts procedures that use "Diagnostic/Therapeutic" intent property. Less than 100 of which are endoscopic procedures modelled as such.
Although the Editorial rules suggest intent "is used to define procedures that may be done for either a diagnostic or a therapeutic reason" there are over 2000 procedures that use other intents (screening, prophylaxis and guidance)
For Example:
314613007 |CT guided drainage of pancreatic lesion|
275978004 |Screening for colon cancer|
312452009 |Aspirin prophylaxis|
726636007 |Prophylactic bilateral mastectomy|
24623002 |Screening mammography|
420848008 |Antimalarial prophylaxis|
171137005 |Bacterial meningitis screening|
Will all this content be inactivated too?
Elaine Wooler
Thank you all for your comments which are as always very helpful and we appreciate the time spent to respond. As mentioned in the background this is a follow-on from the briefing on the proposed inactivation of endoscopy procedures stating intent in the description which was previously supported by Member Forum and CMAG representatives.
This originated from a request for Diagnostic colonoscopy in addition to the existing concept 73761001 |Colonoscopy (procedure)| and agreement was that adding this would cause confusion.
The concepts to be reviewed in this current proposal are all procedures that contain diagnostic or therapeutic in the description. It is not the intention to inactivate all concepts using 363703001 |Has intent (attribute)|with value of diagnostic or therapeutic as some are correctly modelled in this way e.g. 274432006 |Therapeutic aspiration of ovary (procedure)| which differs from the diagnostic procedure 274389009 |Diagnostic aspiration of ovary (procedure)| In addition procedures that are inherently diagnostic or therapeutic will continue to be modelled this way. A wider review may be required at a later stage regarding the use of the Intent attribute, but this current proposal is more limited in scope.
A further comment was received directly asking how content in the “Procedure with explicit context (situation)” hierarchy will be handled when either “Diagnostic” or “Therapeutic” appears in the name or is referenced through the 363589002 |Associated procedure (attribute)| relationship. The following concepts were given as an example:
ConceptID Description
164713001 Neurological diagnostic procedure - not done (situation)
164715008 Neurological diagnostic procedure - done (situation)
These will be looked at on a case by case basis depending on current editorial guidance on what is allowed in the International Edition. For example - <procedure> done/not done (situation) is no longer allowed – see the Axis modification section of the Editorial Guide https://confluence.ihtsdotools.org/display/DOCEG/Situation+with+Explicit+Context+Modeling and https://jira.ihtsdotools.org/browse/PCP-224 . This content would likely be inactivated as non-conformance to editorial policy.
If the pattern in the situation with explicit context hierarchy is still allowed then the concept would be considered for inactivation in a similar way to the procedures, with inactivation and replacement with an intent agnostic concept unless there is as clinical use case.
Please also note for clarification that intents other than diagnostic and therapeutic are out of scope for this current review.
Elze de Groot
Hi Elaine Wooler, some additional questions. We saw in the new release that some concepts with therapy in the FSN had the intent removed (for example 367336001 |Chemotherapy (procedure)| while others still have therapeutic intent in the definition (for example 416608005|Drug therapy|). So therapeutic intent is already removed in concepts, but what do we have to expect in the next releases?
And what will happen with the grouper concepts diagnostic procedure and therapeutic procedure? Will they be inactivated as well? Because alot of therapeutic or diagnostic concepts will not be descendant anymore because they don't have the intent anymore (like endoscopy and endoscopic procedure).
Elaine Wooler
Hi Elze de Groot
In the next releases we are working initially on diagnostic and therapeutic endoscopy content which was the subject of the initial briefing on this topic and content will be replaced by intent agnostic procedures many of which already exist. The work is expected to take place across 1-2 monthly releases the first being the March 2022 release. Further work will take place to review the remaining content with diagnostic or therapeutic in the FSN in the same way and across several releases (425 concepts with Diagnostic, 243 with therapeutic).
The intent attribute was inactivated from 367336001 |Chemotherapy (procedure)| following a request from a member. This was to ensure it was consistent with existing guidance:
"Typically it is used when a procedure may be done for either a diagnostic or a therapeutic reason. It is not normally used to define procedures that are always inherently diagnostic, such as biopsies, or always inherently therapeutic, such as fixation of a fracture."
Chemotherapy is inherently therapeutic so does not require the intent attribute.
Regarding the grouper concepts 103693007 |Diagnostic procedure (procedure)| and 277132007 |Therapeutic procedure (procedure)| I think it would help to discuss these with the group along with some related issues we would like the groups input on, so Cathy is going to schedule this for your April meeting. I'll prepare a presentation in advance of the meeting.