SNOMED CT Editorial Advisory Group

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Date: 2022-09-26

Time:

1030 - 1200 PDT

1730 - 1900 UTC

1830 - 2000 BST


Zoom Meeting Details



Attendees

Chair:

AG Members

Invitees

Observers


Apologies:



Meeting Files:

View file
name20220818 BN Nerve Palsy - Updated Definition and Modeling.pdf
height250


Meeting minutes:

The call recording is located here.


Objectives

  • Obtain consensus on agenda items

Discussion items

  • Proposed changes to FSNs: Please read the attached Briefing before the meeting and if possible return your comments for discussion at the meeting.
  • This meeting will address the following issues:
    • Concepts representing "borderline" levels
    • Concepts representing "therapeutic medication levels"
    • Concepts representing "Abnormal" or "outside reference range" levels

Decisions to date:

  1. Following the discovery of a decision made in 2010 that within the context of measurement findings "increased" = "above reference range" and "decreased" = "below reference range" the EAG members agreed to support a change in FSN rather than inactivation.
  2. In the rare event that a user has interpreted and used one of these concepts to represent a relative increase or decrease in measured value; advise use of 442387004 |Increased relative to previous (qualifier value)| and 442474009 |Decreased relative to previous (qualifier value)| with clear FSN e.g. Increased blood glucose level relative to previous level (finding) for implementation at the local level.
  3. There was agreement that the notion of "normal" is context dependent and similarly "within reference range' should be interpreted within the context of the whole clinical record. Therefore, it was agreed that concepts representing "within reference range" will have their FSN/PT updated and a synonym description of "normal" should be retained or added as appropriate.

Discussion:

It is agreed that the replacement of FSNs is less destructive than inactivation and replacement of concepts.  This is only relevant where current content is modeled with above and below reference range.  Concepts that are inherently ambiguous are still used in clinical recording.  Adding forced meaning to these might make them less useful.  Suggested to identify these concepts using a refset that they are problematic from an interpretation point of view. 

This project was an effort to reduce the ambiguity of existing concepts to ensure clarity of meaning.  Retention of ambiguous content may provide clinical recording simplicity but may be in conflict with precision.  There is a conflict between the utterances used in clinical recording and the desire to provide structured analytical data.  The issue may be exposed when looking at new technologies that go from speech to text to coding...

Suggested that the ambiguity can be resolved by using other "imprecise" terms such as "increased" for "above reference range" and "increasing" for "increased relative to prior measurement". Alternative description types may assist in representing broader or ambiguous descriptions.  Another suggestion is to allow for these imprecise concepts, but mark them as such within the terminology.

Decision:

Topic not completed.  Carried over to next meeting.

ItemDescriptionOwnerNotesAction
1Call to order and role call

Jim Case

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.
2

Conflicts of interest and agenda review

Jim Case

None noted.


3Welcome new membersJim Case 

Welcome to the new members of the EAG: Feikje Hielkema-Raadsveld , John Snyder , Matt Cordell 

We would like to express our gratitude for the service of our departing members Keith Campbell and Jeremy Rogers.

3

Measurement Findings:

Proposed changes to FSNs

Paul Amos
4Reevaluating "History" vs. "Past history" situation conceptsJim Case 

Currently, most "417662000 |History of clinical finding in subject (situation)|" concepts (~1000) are modeled with a TEMPORAL CONTEXT of 410513005 |In the past (qualifier value)|.  The exceptions are "Family history of X" concepts.  While this makes sense in the context of procedures, it is not so clear with clinical findings.  In many cases clinical history involves conditions that are both current and in the past (e.g. history of cough for last 10 days).  While we have a few concepts that specifically state "Past history", for the most part History of clinical findings represent conditions that were in the past and do not represent ongoing clinical conditions.  

It is recommended that these concepts be remodeled with a new TEMPORAL CONTEXT, either the existing 410511007 |Current or past (actual) (qualifier value)|, or a new "Current and/or past (qualifier value).  As this change is more general than the current modeling, it should ahve no impact on the taxonomic structure of the hierarchy.

4Reactivation guidanceJim Case 

In the course of reterming FSNs as part of the Quality Improvement project, there are occurrences where the change in the FSN to conform to editorial policy results in a validation error identifying an inactive concept with the same FSN.  The error is:

An FSN must be unique within all active FSNs across all concepts. This term already exists against inactive concept <SCTID>.

There had been general guidance provided for this that the inactivated concept with the proper FSN would be reactivated and replace the concept with the improper FSN; however, in many cases this would result in frustration for users, as it would result in the inactivation and replacement of a concept with the concept that it replaced in the first place. 

Recognizing the need to minimize the impact on users, it is important to take into account the fact that time plays an important role in which concept to inactivate and which one to retain. One consideration is which term has had the "greater opportunity" to be used in health records.  This includes when a concept was introduced into the terminology, how long it was active and when it was inactivated.

Guidance is needed for instances where duplicate FSNs are created as part of the reterming of active concepts to align with the quality improvement project.

Options include:

  1. Reactivate the original concept with the proper FSN regardless of when and how long it has been inactive.
  2. Only reactive the original concept if it has been inactive for less than a specified period of time (e.g. 5 years)
  3. Never reactivate the original concept, whilelist the validation error.
  4. Retain or reactivate the concept that had the longest period of active status.
  5. Others? 
5Modeling of "Palsy" conceptsPaul Amos 

A query has arisen internally regarding the definition and modeling of 784289008 |Nerve palsy (disorder)|.

The attached Briefing Note details the issues and asks the question; Does "Nerve palsy" have the same meaning as "Mononeuropathy"?  Proposals for an updated definition and modification to the modeling, depending on the answer to the above question, have been presented. Please review the briefing note and contribute your thoughts and comments at the meeting.

Discussion:

Decision:


10AOBEAG



11Next meetingEAG

SNOMED Business meeting Monday Sept 26.









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