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Zoom Meeting Details

Topic: SNOMED Editorial Advirory Group Conference Call
Time: Apr 6, 2020 11:00 AM Pacific Time (US and Canada)

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The call recording is located here.


  • Obtain consensus on agenda items

Discussion items

1Call to order and role call

Start recording!


2Conflicts of interest and agenda reviewNo conflicts noted 
3Angiography substantive change

The following inquiry was sent to DICOM and the UKTC (NICIP)for input:

We have received a CRS request from a member country to add Using substance (attribute) Contrast media (substance) to 418272005 |Computed tomography angiography (procedure)|.

The current definition of the concept 418272005|Computed tomography angiography (procedure)| is method computed tomography and procedure site blood vessel structure. The concept does not include using contrast in its definition but has more granular subtypes which do include contrast.

The CRS request is only for the attribute Using substance (attribute) = Contrast media (substance) to be added to 418272005 |Computed tomography angiography (procedure)| but this would impact many subtypes. Before we make any changes to this area of content could you please offer an opinion on these questions below

77343006|Angiography (procedure)| does this use contrast in all cases?

Does CT angiography use contrast in all cases?

Are there imaging modalities that do not use contrast for angiography - for example can magnetic imaging angiography be carried out without using contrast? See for example concept 437731000119100|Magnetic resonance angiography of head without contrast (procedure)|.

A revision of the Editorial Guidance will be required in order to make information about this area of content clearer and this is planned for a future release however it would be really helpful if we could have an opinion relating to the questions outlined above.

A summary of the responses and impacts on the terminology is found at:

Comments have been submitted by Jeff Pierson and Jeremy Rogers . Additional input requested prior to acceptance or modification of the proposal.

Most essential question is whether, given the proposed changes, inactivation and replacement is necessary?


JPE, PAM, BGO, KCA: Assume that contrast was implied and rename and remodel appropriately GRE: Propose USING PRODUCT as a new attribute. This will require revision of other procedures that have USING SUBSTANCE.

Propose that we might be able to use the existing substance for the immediate short term. Procedures are not yet in scope for the QI project.

Unanimous consensus that this would be a short term pragmatic fix. This will need to be readdressed when a formal revision of procedures are undertaken. Need to make it clear to extensions the impact of this change. Need to take into consideration a clean up of the hierarchy where contrast is not necessarily required.

7/26/2020 - Modeling revisions under development

  • Maria Braithwaite Rename concepts and do not inactivate as "Contrast is assumed". Use substances to model instead of products
7Additional description typesJim Case

As discussed in KL. Need a list of proposed description types to send to tech services for implementation. Guidance on use will need to be developed. Current use cases to consider are:

Implemented and populated in the International release:

  • near synonym - these can be either "broader than" terms or non-semantically equivalent but related terms (e.g. vaccination (procedure) vs. immunization (a process following vaccination or administration of immunoglobulin)
  • hypernyms - are these different than "near synonyms"

Implemented but NOT populated in the International release (i.e., for use in extensions)

  • search terms - colloquial terms - provided as an option for extensions, not populated in the international release
  • "Patient-friendly" or consumer terminology
  • abbreviations/truncation/acronym - abbreviated form

Issues within our current synonyms was identified in an AMIA paper in 2003:


GRE: Not necessary to distinguish hypernyms and near synonyms. Consider a separate extension for "patient-friendly" terms. Need a separate language refset.

How to identify near synonyms? GRE: Had done some work 10 years ago. May be useful to get an idea of scope.

Want to avoid contaminating the terminology with non-synonymous descriptions. Do these need another description type or just a mechanism to segregate the descriptions from the main branch? Adding to another language refset would require modifications of the AP UI.

There is a risk in adding near synonyms if those descriptions are used in the EHR UI. Suggestion that we need to distinguish the near synonymy, e.g. broader than or narrower than. Narrower than are not synonymous at all as they are specializations of the parent.

Use the definition from ISO 25964-1:2011 as a guidance for defining near synonymy.

Discussion continued to next call without resolution

  • GRE: Post spreadsheet with multiple synonyms
8ECE UpdateBruce Goldberg
  • Injury model
    • Proposed model for injuries that are unspecified as to being traumatic or nontraumatic and can be either
    • Revisit complication model for disorders due to procedures
  1. Injuries.pptx
  2. Procedure complications.pptx
  3. Injuries.pdf


Injury model: Proposal to add morphologies that are considered injuries by the WHO under Damage, to be consistent with ICD.

No negative comments. Best we can do given what we have in the concept model. Lots of discussion around the imperfection of the model, but no better approach with current constraints of the concept model. Can we broaden the interpretation of Damage to include more morphologies? Need to test.

Procedure complications: Review of slide deck. GRE: Not clear that this is reproducible and may require remodeling in the future. The decision of what is a complication is a subjective assessment and is difficult to capture in the model.

BGO: Surgical complication is almost any deleterious effect after a surgical procedure. Commonly used. Nonsurgical procedure complications are the problem areas.

Alternative is to represent these as they are written out, i.e. do not assume that something is asserted to be a complication or sequela.

What does the assignment of a primitive sequela add, given that concepts will classify under other appropriate parents? May not be any...need to test.

9Impact of concrete domainsJim Case

Questions for group:

With the adoption of concrete domains, would replacement of relationship values from concepts to concrete values require inactivation and replacement of concepts?

Would adoption of concrete domains be sufficient rationale to inactivate concepts representing numbers? Is there a use case for retaining the concepts?

Report consensus back to TRAG


GRE: From the semantic aspect, there is no shift in meaning. There are technical aspects that need to be addressed, such as the history. Propose not to inactivate and replace, just remodel with a data property. Unanimous agreement.

However, if extensions do not convert to data properties, there will be issues with classification until they switchover. Change should be synchronized in order to avoid this. Need to provide sufficient time for extensions to change to concrete domains. May need to retain the concept based numeric values until a switchover occurs at all levels.

10Morphology (disorder) conceptsJim Case

SNOMED CT currently has a large number of disorder concepts that solely represent morphologies. E.g. 416462003 |Wound (disorder)|; 416439000 |Lipogranuloma (disorder)|). While all of these are SD by simply using DIsease + morphology, other than as grouping concepts, are these valuable clinical terms. With the advent of ECL it is a simple query to identify all concepts that fit into these morphologies.

What should be the editorial guidance for the creation/maintenance of these terms?

Additionally, there are of over 5400 "grouper" terms in SNOMED CT. Many of these are abstract and are useful for navigation, but should not be used in clinical recording. There has been some interest in providing these as an exclusion refset in order to prevent them from being selectable for clinical use. However, some of the terms do have limited clinical usefulness (i.e patient reported clinical findings). It has been suggested that a task for the EAG would be to identify: 1) which terms in the list have clinical usefulness, 2) which terms provide meaningful navigational usefulness and 3) which terms should be inactivated.

File link: SNOMED CT Grouper sheet


Continued to a future meeting

11Next meetingEAG

April business meeting has been canceled. Next call in late April


Potential agenda items:

  • Update from concept inactivation group
  • Update from source of truth project