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0900 - 1030 PST

1700 - 1830 UTC 

Zoom Meeting Details

Topic: SNOMED International Editorial Advisory Group
Time: Nov 27, 2023 09:00 Pacific Time (US and Canada)

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  • 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

3Modeling of "No known X"

Inconsistent representation of "No known...(situation)" with proposed remodeling.  See attached document.

Different resolution depending on whether the Situation is a "Finding with explicit context" (allowed range = <<  410514004 |Finding context value (qualifier value)|) or a "Procedure with explicit context" (allowed range - <<  288532009 |Context values for actions (qualifier value)|)?

Proposed definition for "No known" after consultation with EAG members.  Differs from "unknown" in that it implies a reasonable effort to acquire the information, or a lack of evidence to support the issue at hand as opposed to a general lack of information for any reason.  Agreed in the last meeting in Atlanta that it should be a sibling of "Unknown".

Latest proposed Definition:

Subsequent to a reasonable attempt to acquire information, there is no evidence or information that proves the presence of a particular finding, therefore assuming its absence without objective proof.


The is an issue with the application of "No known".  There are many instances where there is no knowledge, but there is a lack of objective knowledge. The question is how much investigation needs to be done to make the statement.  A detailed discussion document on the use of different finding contexts has been provided by Monique van Berkum and is attached to the minutes.  While there may be a clear distinction between "No known" and "Unknown", it is difficult to determine to what concepts these should be applied.  

There is a flavor of bias towards the condition not being there with "no known", whereas "unknown" has no bias in either direction.   How much uncertainty do we want to include in pre-coordinated content?  Suggestion that we should not add new content in this area until we can more precisely represent the underlying meaning of these terms.  Family history is one example where it is never possible to know definitively that a condition has not been in family members.


Topic table for now.  EAG members encouraged to review Monique's document and add comments in preparation for a later meeting. Review the attached document

4MRCM change and revision of Physical object hierarchy
  • A request from multiple member countries to enhance the MRCM in the Physical object hierarchy to support the definition of specimen containers.
  • A request to add a new attribute to the Specimen hierarchy MRCM to support the container in which a specimen is "contained".
  • Briefing note attached 


Requirements were developed with lab specialists to meet their needs.  There needs to be some more specific use cases to make the effort worth it other than just making the hierarchy more manageable.

Additives are substances that would be incorporated into the specimen, whereas the separator attribute represents something that is not incorporated into the specimen. Also suggested that separators should not also be physical objects, but should be substances.  

What is the impact of adding these to other hierarchies that might use these needs to be considered.  

There is some use for the HAS INTENDED SPECIMEN even knowing it is not "always and necessarily true".

How should "spray-dried coating" be modeled in this scenario?  Is it an additive or just a substance coating on the container?  How manufacturers represent the difference between coatings and additives needs to be considered.

Need definitions for each of the attributes that make it clear to modelers what substances are allowed.  

Will the level of effort needed to make these SD be worth the results.


Referred back to Daniel Karlsson and Feikje Hielkema-Raadsveld for revision based on comments from the EAG

5Updating of Neuroendocrine tumors.  Part of Histology update project

Briefing note describing the initial phase of the project to update the Neoplasm (morphologic abnormality) hierarchy to conform to the latest WHO Blue book.


Keeping the existing top level concept, but differentiating the tumors from the carcinomas.  All benign neuroendocrine tumor concepts will be inactivated.  The list of inactivated concepts was displayed and detailed list attached to the minutes. 


Changes to be reviewed by the EAG.  Comments to be sent to Jim Case 

6Inactivation of "Role groupers" from substances and products

Discussion on the briefing note to inactivate role groupers from Substance and Medicinal product (attached)


BN is a consultation. Do people use these role groupers? If not, are they aware of any other mechanism used to assign roles? (an example of a therapeutic role classification is ATC from WHO but others exist).

High-level role groupers in the Substance hierarchy have been intended to support the organization of the hierarchy based on roles. An example of such a role grouper is 373265006 |Analgesic (substance)|. Substance role groupers have been an issue in SNOMED CT for many years. Role based groupers are associated with a particular purpose or outcome. A role does not belong to a substance per se but instead is associated with a manufactured product and its usage. Roles are a function of the way a product is formulated or presented.

In 2018 a solution was proposed to move the role groupers from the Substances hierarchy to the Products hierarchy and specifically the “therapeutic roles” to the Medicinal Product hierarchy. While a small percentage (20%) of the role groupers have been created in the Medicinal product hierarchy (and often without subtypes being assigned, e.g. 53009005 |Medicinal product acting as analgesic agent (product)|), the majority of the role groupers remain in the Substances hierarchy at this time.

Please provide feedback on the proposal.

Send comments to ( ) by December 15th, 2023 31st January, 2024 with the heading attention of Nicki Ingram and Farzaneh Ashrafi.

If further information is required the following 2 files can be forwarded by contacting - attention of Nicki Ingram and Farzaneh Ashrafi : 
SubstanceRoleGroupers_November2023  - 270 concepts

Once the feedback has been analysed then a further BN will be issued.

EAG comments:

The impact of this proposal on the existing PLAYS ROLE relationships has not been discussed in detail, but it is only inferred so would most likely disappear with the inactivation.

This has also been sent to the Nutrition group for comment.  NLM has used these and that may have a significant impact on one of their products. 

The current medicinal product role groupers are very incomplete.  SNOMED has received comments already.

ATC is incomplete as well, so not clear how roles can be defined in SNOMED.  In general we need to know how widely these are used.


request for EAG members to send their feedback to SI.  Report on the results of the feedback will be presented at a later meeting.

7Replacement of "Surgical approach" with "Procedure approach

In May 2023 the EAG discussed the potential for eliminating the distinction of "Surgical procedure" due to the challenges in developing an internationally acceptable definition for what constitutes a surgical procedure.  An ancillary topic that was not discussed in detail was the generalization of the "Surgical approach" attribute and replacement with the unapproved attribute "Procedure approach".  A briefing note describing the issues is attached.

Discussion held in October was not recorded.  Revisiting this.


No time to discuss


EAG members aske to review and add comments based on the briefing note.


Meeting in December cancelled as it is on Christmas Day 

Next meetingEAG

Meetings will continue on the fourth Monday of the month and may be cancelled if necessary.