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1700 - 1830 UTC 

Zoom Meeting Details

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

Topic: SNOMED Editorial Advisory Group Conference Call
Time: Mar 11, 2024 09:00 Pacific Time (US and Canada)

Join from PC, Mac, Linux, iOS or Android:
    Password: 351999


  • 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 recorded

3Inactivation reason review

During Concept inactivation, the SNOMED International Authoring Platform presents users with a list of Concept Inactivation Indicators that includes "Classification derived concept", but the concept that's used in the RF2 is actually 1186917008 |Classification derived component|.    The thinking behind that concept creation was that this inactivation indicator could also be used when inactivating descriptions in certain scenarios (although this has not been implemented in the AP), as reflected in the dual parents for that concept: 

Questions for the EAG to consider:

  1. Is there a need for a description inactivation reason for classification derived descriptions?
  2. If so, should this inactivation indicator be used as is, or should a new separate one be created?
  3. If not, should this inactivation indicator have the description parent removed, and be renamed as "Classification derived concept"

Whatever the outcome, the Authoring Platform could/should be brought into line so that the user interface and the various Inactivation Indicator concepts align (see MAINT-2481 - on hold pending discussion)


The concept was initially defined as being available for use as either a concept or a description inactivation.  

The number of classification derived descriptions is small.  Suggested that Nonconformance or other inactivation reason be used.  

The context of where this is used would provide the information needed to determine whether it is a concept or a description. 

What were the old reasons used to inactivate descriptions of this type?  

There have been some suggestions to renaming the description to make it clearer as to what this means, i.e. the concepts or the description were derived from an alternative classification system.

New issue: Question as to the potential use of the subtypes of "Inactive value"


Agree that we change the term in the tooling to "component" in place of "concept". 

Agree to add a definition to the inactivation concept and note in the editorial guide.

Allow this inactivation reason to be used for descriptions as well.

8MRCM 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 

11/27/2023 Discussion:

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.

11/27/2023 Decision:

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


Feikje Hielkema-Raadsveld and Daniel Karlsson have reviewed the comments from Monique van Berkum (see attached document) and while not disagreeing that the current state of containers would benefit little due to the small number of affected concepts, with new requests for container types coming in as part of European health projects that for allow better maintenance of a growing area of the terminology.  It is felt that the discussion of whether creating a concept model for containers is more in scope for this discussion than perhaps the model itself.  Examples of new container types that would benefit from a concept model would be helpful.

2024-03-11 discussion:

Feikje Hielkema-Raadsveld presented a set of examples of how these new relationships might be used.

Monique van Berkum expressed concern about whether the relationships could be determined from the FSN.  Concern about whether or not this could be consistently added to existing concepts.  Feikje Hielkema-Raadsveld mentioned that it is the new concepts that have been requested where the information is clear would be the target for this.

The number of variants is very large, but could be restricted only to those that have been explicitly requested. How would we apply this to existing concepts given their vague FSNs?

There are a number of issues in the substance hierarchy that would be affected. 

Suggested that there be some specific use cases included in the proposal.  One use case would be to provide additional information to the labs on the specific container characteristics that might impact interpretation of the test results.  There is not enough information in the LOINC code to provide this information.  

What is the advantage of having a model over a text definition?  Analytical use case to identify classes of containers as well as eliminating intermediate primitives. 

There are no other standards available that provide this information. 

The additional challenge is how to represent the older content.  

The existing structure of containers is in need of review to provide a better hierarchical structure of existing terms, regardless of whether a concept model is approved. 

Proposed to provide a set of examples of a new model to demonstrate the benefits.


Investigate the potential for setting up a non-promotable project to test a new concept model for containers.  Determine whether it would be in the managed service or the international release.  

Bypass graft revision proposal

As part of the QI project, substantial changes to the representation of bypass grafts and shunts have been proposed.  A briefing note (attached) and a detailed document for the proposed changes (referenced in the briefing note) are provided.


How are bypass concepts without definition of proximal and distal targets going to be modeled?  A: Need review.  How are proximal and distal defined?  A: It is based on either anatomic position or flow of contents. Definitions for proximal and distal anastomosis will be provided.

Concern about creating intermediate primitives as this complicates the assignment of parents.  Also need to make sure the definitions are clear.  Where do "-stomy" concepts fit into this proposed model. 


Comments will be added to the document by the EAG members. 

Update on impact of replacing surgical approach with procedure approach

A document describing some of the impacts of the proposed replacement of 424876005 |Surgical approach (attribute)| with the currently unapproved 116688005 |Procedure approach (attribute)| is attached.




10Next meeting

April 16 business meeting