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 1700-1830 UTC

 1800-1930 BST

 1000-1130 PDT 

GoToMeeting Details

Topic: SNOMED EAG Conference Call
Time: Sep 25, 2019 10:00 AM Pacific Time (US and Canada)

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Meeting ID: 745 439 388

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Meeting Files:

Meeting minutes:

The call recording is located here.

The edited transcript is located here.


  • Obtain consensus on agenda items

Discussion items

1Call to order and role call


2Conflicts of interestNone. 

Approval of minutes from April 2019 Business meeting

Agenda changes

Edited transcript is located here

Request to let Daniel Karlsson go first in the agenda.

  •  Approval of minutes
  • Agenda change approved
4X, not Y organismFarzaneh Ashrafi
  • From Freshdesk ticket
  • There was an agreed set of editorial principles accepted in 2014 by the Microbiology Reporting project group for concepts representing "X, not Y (organism)" i.e. when a laboratory report indicates a class of organisms described by the exclusion of specific Linnaean or non-Linnaean classes. The guideline specifies "accommodating these in the Organism hierarchy (based on reasonable use cases to avoid a combinatorial explosion), but making them primitive super class in between the species (or species subtype e.g. Haemophilus influenzae, not B)
  • The current content does not conform to these guidelines
  • Need to define what is meant ontologically by "X, not Y (organism)" in light of the limitations of our DL profile

Observable Entity and Microbiology Test Results


  • Suggested that the use of disjoint classes may resolve this issue. Prior testing of this axiom resulted in poor performance for classification.
  • Consensus that these concepts need to be in the Organism hierarchy
  • Requested Farzaneh Ashrafi solicit additional information from submitter as to the intended meaning of X, not Y. Does this mean "Any X species except Y" or is it just a specific exclusion?
  • Non-Linnaean concepts not specifically discussed.
  • This was considered a low-priority, high effort task that will need to be scheduled during a content development cycle.

  • Farzaneh Ashrafi - Solicit additional information from submitter on the intended meaning of X, not Y
  • Jim Case to ask Monica Harry about resources available to address the restructuring of "X, not Y" organisms
5ECE updateBruce Goldberg
  • Follow-up of fracture model from last call
  • Simple co-occurrence (with Paul Amos ) - follow-up discussion from August 28 call
    • Three scenarios where the use of the pattern can be justified. The distinction between syndromes and diseases with multisystem involvement requires that intermediate primitives be used in the latter. The definition being developed was discussed and the scope of what should be included as an approved co-occurrence pattern.
    • Question posed as to the need for the "Multisystemic manifestation" concepts for disorders named by their primary clinical sign, if that primary clinical sign is always present? What is the need to call out these other signs specifically in another subhierarchy? Current rationale is to identify multi-system disorders that are not specified as such in their FSNs (e.g. Rheumatoid arthritis)
  • Bruce Goldberg to generate a list of potential multi-system disorders needing additional "extra-X" parents.

6Observables updateDaniel Karlsson
  • What do we mean by "function" in Observable entities?
  • Use of observables to define define findings

HL7 statement model proposal:

  • Daniel Karlsson Evaluate the need for a hierarchy of processes that could be used to define “ability” observables and would allow for useful taxonomic groupings.

  • Bruce Goldberg to evaluate the inactivation of 289908002 |Pregnancy, function (observable entity)| and recreate it as a finding without the word “function”.

7Abdomen anatomy revisionYongsheng Gao

Comments and approval of revisions to the anatomic representation of "abdomen" to support diagnostic imaging


Clinical core content identificationJim Case

At the April London business meeting, it was determined that an approach to the identification of the recommended content of the proposed clinical core be determined by a set of both inclusion and exclusion criteria.

Agreed inclusion criteria:

  • global applicability
  • contextless
  • clinically oriented (including content from foundation hierarchies needed to define concepts)
  • supported by a clinical use case
  • used to align with other terminology standards (e.g. ICD)

Exclusion criteria include:

  • administrative, operational or status concepts
  • situations with explicit context
  • combined disorders
  • Implicit or explicit negations/absence
  • Inverse concepts (cooperative vs uncooperative)
  • Pre-coordination of laterality
  • Pre-coordination of severity
  • Specific top-level hierarchies - all except Pharmaceutical/biological product and Substance are currently passively maintained
    • Environment or geographical location (environment / location)
    • Organism (organism)
    • Pharmaceutical / biologic product (product)
    • Physical force (physical force)
    • Physical object (physical object)
    • Record artifact (record artifact)
    • Social context (social concept)
    • Staging and scales (staging scale)
    • Substance (substance)

Discussion 2019-08-28: Additional high level exclusion criteria

  • Need to specifically define what is meant by "clinically-oriented" - again, might be easier to exclude what is not clinically oriented. Focus should relate directly to the "life phase" of the patient or procedures that address the "life-phase" of the patient.
  • How much of the foundation should be actively maintained as part of the clinical core?
  • How much of the international release is empirically defined?
  • Is the potential membership of the "problem list" candidates for the clinical core?
  • Suggested that we focus on those concepts that can have full DL definitions, consistent with a single ontological view

Discussion 2019-09-25: Tabled for lack of time. Will be discussed in KL

9Findings/disorders and notes from the ICBO conferenceJim Case

Following a panel discussion at the ICBO conference in Buffalo Aug 1-2, an agreement in principle for SNOMED to collaborate with the OBO community was reached. Much of the discussion revolved around the current representation of diseases as subtypes of clinical findings. There is a clear, mutually exclusive separation in BFO and other disease ontologies based on BFO between "diseases", which are specifically dependent continuents and clinical observations (i.e. findings), which are considered occurrents. The challenges in implementing this notion in SNOMED is explained in

As we had initially discussed, one differentiating feature of what we are calling findings is the notion of temporality, i.e a findings is made at a point in time (an occurrence) whereas a disease is persistent. This is similar to the notions in BFO, but they (and all other disease ontologies) refer to diseases as dispositions (i.e. a realizable entity that is manifested as some abnormal process or structure. For terminologies like SNOMED that do not seek to define diseases, but to identify when a realization of the disease disposition occurs in a patient, this logical representation breaks down.

At the ICBO conference, a paper was presented in which an attempt was made to "BFOize" ICD-10. It was clear to the authors of that paper of the conundrum we face, i.e. that the use of the terms in ICD-10 as dispositions was not appropriate because they had been realized and so they modeled their ICD-10 ontology as processes (i.e. occurrents). This was criticized by a number of the ontologists, but no practical solution to the need for representation of realized dispositions in clinical recording were proposed.

Regardless, it would be of some benefit, in light of our desire to resolve the findings/disorders issue, to attempt to align as closely as possible with top level ontologies. One area where this would be of great use is the move by SNOMED to improve coverage of genomics. This would be greatly enhanced by an ability to integrate with the genome ontology.

A draft document is being developed by members of the MAG as a response to the issues surrounding the lack of alignment between SNOMED and BFO:


Neuralgia – finding or disorder.pptx

Findings and Disorders thread.doc


Keith Campbell expressed concern regarding "the notion that finding vs diseases may be differentiated by the notion of temporality, I believe there will be great difficulty applying such rules, and it will result in a false dichotomy… And will also result in no practical benefit the use of SNOMED in any way…"

Discussion 2019-09-25: Tabled for lack of time. Will be discussed in KL

10Potential agenda items for KLEAGAgenda items requested from the EAG members
11Next meetingEAG October Business meeting