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Date: 2023-01-23


0600 - 0730 PDT

1400 - 1530 UTC

Zoom Meeting Details

Hi there, 

Jim Case is inviting you to a scheduled SNOMED International Zoom meeting. 

Topic: SNOMED Editorial Advisory Group - Conference Call
Time: Jan 23, 2023 06:00 Pacific Time (US and Canada)

Join from PC, Mac, Linux, iOS or Android:
    Password: 626212

    Meeting ID: 814 7084 3244

    Password: 626212
    International numbers available:

Or Skype for Business (Lync):

Meeting Files:

Meeting minutes:

The call recording is located here.


  • Obtain consensus on agenda items

Discussion items

1Call to order and role call

This meeting is being recorded to ensure that important discussion points are not missed in the minutes.  The recording will be available to the SNOMED International community.  Joining the meeting by accepting the Zoom prompt declares that you have no objection to your comments being recorded

  • Recording of meeting approved by participants.

Conflicts of interest and agenda review

None noted.

3Intermediate primitive parent and definition status of subtype
Additional evaluation needed. Continued to next call.

Expansion of range for HAS INTERPRETATION

Scenarios where qualifier values are not sufficient; e.g. at risk findings, coma score subscore results

From GC-1248 - Getting issue details... STATUS

In developing the model for defining risk findings, we have run up against an issue with describing the specific risk factor as the range of HAS INTERPRETATION is limited to 

<<  [260245000 |Finding value (qualifier value)||]  OR
 <<  [263714004 |Colors (qualifier value)||]  OR
 <<  [308916002 |Environment or geographical location (environment / location)||]

There are two approaches to modeling specific risk factors.

  • Use the DUE TO relationship to describe the risk factor
  • Use the INTERPRETS = <<80943009 |Risk factor (observable entity)|. HAS INTERPRETATION = <Clinical finding OR <Event OR <417662000 |History of clinical finding in subject (situation)| OR <416940007 |Past history of procedure (situation)|

Example 1:

1184692002 |At increased risk due to lack of fire extinguisher in residence (finding)|

Clinical finding:

   DUE TO Inadequate fire extinguishing equipment in residence (finding)   

   {INTERPRETS =  Risk level,     HAS INTERPRETATION =  Increased}

Example 2:

1184692002 |At increased risk due to lack of fire extinguisher in residence (finding)|

Clinical finding:

   {INTERPRETS =  Risk level,     HAS INTERPRETATION =  Increased}

   {INTERPRETS =  Risk factor,    HAS INTERPRETATION = Inadequate fire extinguishing equipment in residence (finding)}

Currently, there is no way to assign values to the Observable 80943009 |Risk factor (observable entity)| due to the limitations of the range of HAS INTERPRETATION.  Existing use of the 80943009 |Risk factor (observable entity)| has been restricted to a few concepts that also use DUE TO as the relationship to the factor with no HAS INTERPRETATION VALUE (e.g. 1162398002 |Adverse health risk due to mold in residence (finding)|)

There is a similar issue with assigning the values associated with assessment instrument Observables

There is a huge risk in extending the range of HAS INTERPRETATION, but using this pattern is a better representation of the definition than the implied relationship using the DUE modeling pattern.


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.

  • James R. Campbell to write up a more general description of the issue with additional examples.

Mechanical Complication of deviceJim Case 

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?


No time to discuss. Continued to next call.

Potential for inactivation of navigational conceptsJim Case 

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?


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)

  • Jim Case to contact UKTC to inform them of the impending inactivation
  • Jim Case to write briefing note explaining the rationale for inactivation of the Navigational concept hierarchy.

Review of Surgical approach and definition of Surgical procedure

Issue reference: GC-1142 - Getting issue details... STATUS

The summary of the proposal is that many procedures, both surgical and non-surgical can use the same approach (e.g. 386745004 |Transurethral cystoscopy (procedure)|); however, currently the only approach attribute available is 424876005 |Surgical approach (attribute)|, so many non-surgical procedures that include an approach are not modeled with the appropriate APPROACH relationship.   The proposal is to replace this attribute with the more general "Procedure approach".

There are additional questions related to the definition of surgical procedures and what the scope of a surgical procedure should be in the background document .  They are included hereto inform the SNOMED definition of surgical procedure:

  • Should all surgical procedures necessarily involve incision/destruction/cutting?
  • Should closed reductions and manipulations be considered Surgical procedures?
  • Should there be editorial guidance differentiating surgical biopsies from non-surgical ones? Is there such a thing as a non-surgical biopsy?
  • Which “diagnostic” procedures should be considered as Surgical procedures?
  • Does every Surgical procedure necessarily involve anesthesia/sedation?
  • Should suture or repair of tissue, both closed and open, be considered a Surgical procedure?
  • Are percutaneous procedures surgical procedures?
  • Should there be a different modeling approach for Surgical and non-surgical procedures?


There is a question as to the value of defining a procedure as a surgical procedure or just letting the modeling determine. Is it important to make the distinction of a surgical procedure?

SNOMED CT has multiple definitions for surgical procedure. We need to go back to JIRA to see where the determination of only Surgical approach was made.  Because the value of making this distinction is problematic in  modeling concepts as to surgical or non-surgical, we need to evaluate whether we need to maintain this.  In the past there were problems with the generalization of Procedure approach and so some additional testing is needed.

There are current problems with modeling concepts to "force" them to classify under Surgical procedure.  Victor Medina will come up with examples.  There are often modeling inconsistencies needed to make this happen.  There are multiple high level groupers in the navigational hierarchy that classified procedures by approach.

Prior tickets related to topic:


11Next meetingEAG

Next call Feb 27.