• Recording of meeting approved by participants.

Conflicts of interest and agenda review

This is a general issue in the use of ordinal and nominal observables.  The use of DUE TO is suboptimal.  

Concern about defining findings using the INTERPRETS/HAS INTERPRETATION where adjectives are used as the value.  This is a question/answer boundary issue.  The top level concept of finding of at risk is too vague to be useful. There is some ambiguity as to whether low, moderate and high mean absolute or relative to the population.  There is a concern about the meaning of qualifiers other than high risk (i.e. low, moderate, etc.).  What is the context?  Does "increased" risk mean "high" risk?  Does "low" mean lower than the general population or some other cohort? Need to reevaluate the qualifier value hierarchy to ensure consistency in the representation of the relative values.

Some of the risk "due to" are not needed and may be inactivated.

The full model currently being used for "At risk" concepts is defined in the template located at: At [qualifier] risk of [finding/event] (finding) - Ready for review

There was consensus that the Example 2 model was preferable to model 1 (using DUE TO), but there are questions about the meaning of INTERPRETS/HAS INTERPRETATION in the context of risk factors.   The definition of INTERPRETS is "This attribute refers to the entity being evaluated or interpreted, when an evaluation, interpretation, or judgment is intrinsic to the meaning of a concept."  Thus, in the case of 80943009 |Risk factor (observable entity)|, the entity being evaluated is the specific risk factor related to the HAS REALIZATION value (i.e. the disorder or finding being realized).  The definition of HAS INTRPRETATION is "This attribute refers to and designates the judgment aspect being evaluated or interpreted...". In the case of 714664001 |At increased risk of ulcer of foot due to diabetes mellitus (finding)|:

Foot ulcer is the realization

The entity being evaluated (INTERPRETS) is 80943009 |Risk factor (observable entity)| with Diabetes mellitus (judgement) as the value of HAS INTERPRETATION

Need additional examples of where the need for expansion of the HAS INTERPRETATION  would be needed. Jim Campbell will provide a paper describing additional examples and uses for expanding the range.

Continued to next call.

Should "Mechanical complication of device" be a disorder or a finding?

Current situation:

111746009 |Mechanical complication of device (disorder)| has 216 subtypes, all of which refer to a failure of a device without specifying a deleterious effect on the patient. 

       e.g. 285961000119107 |Mechanical breakdown of prosthetic heart valve (disorder)|

We also have disorder concepts that refer to a patient condition due to mechanical failure of a device 

       e.g. 5053004 |Cardiac insufficiency due to prosthesis (disorder)|

Without specifying the resultant condition associated with device mechanical issues, is it appropriate that these are represented as patient disorders, or should they be findings that may be related to disorders in the patient?

Discussion:

No time to discuss. Continued to next call.

It was suggested at a recent Modeling Advisory Group meeting that SNOMED should consider inactivating the 363743006 |Navigational concept (navigational concept)| hierarchy.  A list of 635 primitive concepts that are unable to be defined due to their highly contextual use.  The concern is that because they are more or less "orphan" concepts, and provide no analytical advantage, they would be discouraged from use in medical records.  However, because many of these descriptions are those that are commonly used in clinical records, with organizationally specific meaning, they are being entered into EHRs.

UK has high usage of a few of these:

CONCEPTID             FSN                                                                                                                         USAGE 2011-2022

394617004              Result (navigational concept)                                                                                 48,227,610

160237006              History/symptoms (navigational concept)                                                             10,146,392

309157004              Normal laboratory finding (navigational concept)                                                 581,209

267368005              Endocrine, nutritional, metabolic and immunity disorders                                   160,475

243800003              Test categorized by action status (navigational concept)                                      108,176

250541005              Biochemical finding (navigational concept)                                                           100,632

It is unclear how these are used in clinical records although from the above list it appears they may be used as document headers .  An inquiry to the UK resulted in an interesting observation that some of these highly used concepts are primarily found in only one of two major primary care systems, and some that were not used much a decade ago are beginning to increase in usage. It was proposed to SNOMED that aside from the highly used concepts above, the remainder of the navigational concepts could be inactivated without much impact on users.  However, we would need to consider carefully before inactivating the above concepts without suitable replacements due to their high, albeit incorrect, usage.

Question: Should these be replaced with Record artifact concepts or something else?

Discussion:

The NL and AU have not approved the use of navigational concepts.  IMO does not recommend use of these. The more general question is whether to inactivate navigational concepts as a whole.  The consensus was that that these should be inactivated. Because there are concepts of high use in the UK, they will be contacted and informed of the impending inactivation.  Potential replacement concepts for the high use concepts include:

394617004  Result (navigational concept)    → 423100009 |Results section (record artifact)|

160237006  History/symptoms (navigational concept) → 371529009 |History and physical report (record artifact)|

309157004  Normal laboratory finding (navigational concept) → None (laboratory is a vague concept)

267368005  Endocrine, nutritional, metabolic and immunity disorders → None (arbitrary grouping)

243800003  Test categorized by action status (navigational concept)  → None (meaning unclear)

250541005  Biochemical finding (navigational concept) → None (context dependent)