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ItemsHierarchy/TopicEARLY VISIBILITY OF PROPOSED CONTENT CHANGES

Planned Release timing

(*this is provisional only and is subject to change)

1.Clinical Finding

Update for Concepts Using 'Caused by'

Clinical finding concepts containing "Caused by" in their FSN will be reviewed and will be updated (if applicable) according to the editorial guidelines related to causation here. 

There is one area where work is still in progress:  

  • Clinical finding caused by radiation.
2024 International Release
2.Procedure

Update Hierarchy 363680008|Radiographic imaging Procedure (procedure)|and Descendants

A Briefing Note documenting the proposed changes for the hierarchy 363680008|Radiographic imaging procedure (procedure)| and descendants was shared with the Editorial Advisory Group, Clinical Leads Group, Member Forum, Content Managers Advisory Group, and other key stakeholders in July 2023.

Feedback was received from a wide range of stakeholders. In response to this feedback, the proposed changes to the hierarchy have been modified. These modifications will address issues raised in the feedback.

This Informational Briefing Note summarizes the changes that will be implemented.

Implementation of the content changes will commence in Q4 2023. The updates will be implemented in sub-hierarchies and promoted over a number of international monthly releases until complete.

Ongoing in phases across 2024 International Releases

Please see item below - Mammography and digital breast tomosynthesis

3.Content Improvement

Updates to the Inactivation Reason and Historical Association for 'On Examination' and 'Complaining of' Inactive Content

Many of the 'on examination' and 'complaining of' concepts were previously inactivated with the inactivation reason of |Moved elsewhere| with a historical association value |Extension Namespace 1000000|.

This content will be updated with an inactivation reason of |Non-conformance to editorial policy| and a historical association of |Alternative| to a suitable international concept. 

Q2-Q3 2024 International Release
4.Social Context

Ethnic/Racial Group Social Context Content Inactivation

Inactivation of Race and Ethnicity concepts

Based on discussions with the Member Forum, all The subtypes of 372148003 |Ethnic group (ethnic group)| and most subtypes of 415229000 |Racial group (racial group)| will be inactivated as they are out of scope for the International Edition.  A briefing note is available here.

In discussion - to be determined

release.

While all subtypes of 372148003 |Ethnic group (ethnic group)| will be inactivated, the top level concept will be retained for extensions to add their local concepts.

All subtypes of  415229000 |Racial group (racial group)| will be inactivated except for the following:

  • 413464008 |African race (racial group)|
  • 413773004 |Caucasian (racial group)|
  • 413582008 |Asian race (racial group)|
  • 413491005 |American Indian race (racial group)| 
  • 414752008 |Mixed racial group (racial group)|
  • 415794004 |Unknown racial group (racial group)|
  • 1336109002 |Pacific islander (racial group)|

A briefing note is available here.

Q2 2024 International Release
5.Clinical Finding/Procedure

Patient/Subject concepts in the Clinical finding and Procedure Hierarchies

Concepts in the Clinical finding and Procedure hierarchies that contain the explicit context of patient or subject will be inactivated and replaced with concepts without this explicit context. For further information please see briefing note.

On hold - to be determined
6.Annotation

OWL Axiom Expressions for Annotation Properties

The new annotation properties are represented in the OWL expression axiom refset as follows:

  • The 1295447006 |Annotation attribute (attribute)| is correctly represented as subClassOf

    • 01300ccd-d1d7-417d-a70a-f688e72c4d8c 20231201 1 900000000000012004 733073007 1295447006 SubClassOf(:1295447006 :246061005)

  • All subconcepts of 1295447006 |Annotation attribute (attribute)| are represented as "SubAnnotationPropertyOf", instead of "subClassOf" as they previously were

    • e6cd65fe-cb81-4db4-9ac4-040dc74fce28 20231201 1 900000000000012004 733073007 1295448001 SubClassOf(:1295448001 :1295447006)

    • 3729ce47-a96e-4dc7-9eff-83c34740c414 20231201 1 900000000000012004 733073007 1295449009 SubClassOf(:1295449009 :1295447006)

These axiom updates are published in the March 2024 International Edition release. The authoring tool has been updated to ensure all new subconcepts of 1295447006 |Annotation attribute (attribute)| are represented as SubAnnotationPropertyOf(). Other tools will be updated to correctly consume the updated syntax. This will be carefully tested and rolled out over the next few months.

Q2 2024 International Release
7.Clinical Finding

Inactivation of Mechanical Complication of <x> Device

In October 2023 the Editorial Advisory Group made a decision that the concepts that represent a mechanical complication of <x> device are ambiguous. Following this a briefing note was shared with the community of practice to both inform and collect feedback. This feedback has been reviewed and the work will be proceeding. The concepts will be inactivated as ambiguous with a historical association to 473023007 |Complication associated with device (disorder)| or a suitable subtype.

Q2-Q3 2024 International Release
8.Procedure

Inactivation of 410770002 |Administration of anesthesia for procedure (procedure)| and Subtypes

A Briefing note was presented to Anesthesia CRG with a proposal for review and remodeling of 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy.

As part of that proposal, inactivation of 410770002 |Administration of anesthesia for procedure (procedure)| hierarchy was agreed.

This inactivation will affect 410770002 |Administration of anesthesia for procedure (procedure)|and subtypes, and 10745231000119102 |Cardiac arrest due to administration of anesthesia for obstetric procedure in pregnancy (disorder)|.

Concepts in 410770002 |Administration of anesthesia for procedure (procedure)|hierarchy will be inactivated with Inactivation reason = Outdated component and Replaced by 399097000 |Administration of anesthesia (procedure)|.

For 10745231000119102 |Cardiac arrest due to administration of anesthesia for obstetric procedure in pregnancy (disorder)|FSN will be changed to 10745231000119102 |Cardiac arrest due to administration of anesthesia in pregnancy (disorder)| and value for 42752001 |Due to (attribute)| will be changed to 399097000 |Administration of anesthesia (procedure)|.

Q2 2024 International Release
9.Dose Forms

Pharmaceutical Dose Forms with Two or More Intended Sites

Pharmaceutical Dose Forms with more than one intended site will use “and” in their descriptions and include all intended sites in the model. By representing combinations of intended sites as a conjunction ('and' in the description) this will facilitate searching by end users. The concepts are logically modeled as conjunction.

Existing dose forms with "or" will be updated to "and" in their descriptions, this will be included in the Editorial Guide.

9 clinical drugs using these dose forms will correspondingly have their descriptions updated to 'and'.

Note - pharmaceutical dose forms with two or more administration methods:
As this is a less common requirement any requests for this type of dose form will be reviewed on a case by case basis.

Q2/Q3 2024 International Release
10.Clinical Finding

Substance Abuse/Use

There has been a shift from the term "substance abuse" to a more nuanced understanding of substance use disorders in this domain which is reflected in both ICD-11 and DSM-5 indicating a greater emphasis on the spectrum of substance-related problems.  Several members have expressed the need for content updates to incorporate this change and to simplify the translation process.  Consequently, efforts to revise the content associated with 66214007 |Substance abuse (disorder)| will begin and is expected to be completed by the end of Q2. 

An example of the content structure and terming using opioid use is shown. Specifically, descriptions will be added with “harmful pattern of X substance use” replacing the term “abuse” in the FSN and PT however the “abuse” descriptions are persisted as synonyms to facilitate searching.  In most cases there is no change in meaning, therefore the concepts will not be inactivated.  Approximately 100 existing concepts relating to “abuse” will be affected together with the addition of new concepts to represent “harmful episode” and the higher level “Disorder caused by X substance”.


Q2 2024 International Release
11.Clinical Finding

Inactivation of Complication Disorder Concepts (371 concepts)

The inactivation of concepts that reference “complication” without specifying the nature of the complication is planned. 

The primitive “Complication (disorder)” grouper was inactivated in 2022 due to a lack of consistency or definition of what would properly be assigned as a subtype.

The concepts will be inactivated with inactivation reason “Classification derived concept” and replacement by the parent concept. 

For further information please see this briefing note. 

June 2024 International Release
12.Observable Entity/Procedure

Update Role Grouping for Observable Entity and Evaluation Procedure Concepts

Currently, Observable Entity concepts’ attributes are self-grouped  in the international edition. Based on recommendation by the Modeling Advisory Group (MAG), the policy has changed to group these attributes together in order to support modeling concepts with multiple observations and address inconsistent modeling between evaluation procedures and observable entities.

The same changes will be applied to the concepts in the evaluation procedure hierarchy that are modeled with applicable self-grouped attributes. Please see this briefing note for details. 

July 2024 International Release
13.Procedure

Angioplasty procedures

In response to several enquiries from members about the apparent duplication of concepts and descriptions for procedures representing 'Percutaneous transluminal angioplasty' an analysis of the content in this area is underway. It is expected to result in inactivation of duplicates, updates to the descriptions of published concepts and remodeling to represent the imaging guidance aspect where appropriate.

After the analysis of the impact has been completed, a Briefing Note will be dispatched to provide details of the changes. Examples of potential duplication:

  • 3261007| Angioplasty of subclavian artery (procedure)
  • 418738003 | Fluoroscopic angioplasty of subclavian artery (procedure)
  • 175454003| Percutaneous angioplasty of subclavian artery (procedure)
  • 431485005 Percutaneous transluminal angioplasty of subclavian artery using fluoroscopic guidance (procedure) - correct term.
Q3 2024 International Release
14.

Substance


Antibody to X Organism

The descriptions for the children of 312301006 |Infective organism antibody (substance)| (antibody to X or X antibody) will be updated as per editorial guidelines where applicable.

Q2 2024 International Release
15.

Procedure

Update 71651007|Mammography (procedure)| and Descendants

As part of the content update being undertaken for: 363680008|Radiographic imaging Procedure (procedure)| and Descendants (please see item 2 above for details).

Content changes will be undertaken for 71651007|Mammography (procedure)| and subtypes.

A new concept will be added as the supertype - Imaging of breast (procedure).

New imaging actions will be added:

  • Mammographic imaging - action (qualifier value)
  • Mammographic digital tomosynthesis - action (qualifier value)

These new actions will distinguish mammography from the less specific action 278110001 |Radiographic imaging - action (qualifier value)|.

71651007|Mammography (procedure)| and subtypes will be modeled with the new imaging action Mammographic imaging - action (qualifier value). 

NOTE: this change will result in some of the current subtypes of 71651007|Mammography (procedure)| moving up the hierarchy to become subtypes of Imaging of breast (procedure). For example, 709657006|Fluoroscopy of breast (procedure)| will become a subtype of Imaging of breast (procedure) and not 71651007|Mammography (procedure)|.

450566007|Digital tomosynthesis of breast (procedure)| will be sufficiently defined by the new imaging action Mammographic digital tomosynthesis - action (qualifier value) and remain a subtype of 71651007|Mammography (procedure)|.

June 2024 International Release
16.

Procedure

Review 1263452006 |Anesthesia and/or sedation procedure (procedure)|

A review of the 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy is in progress, the focus is on:

  • Inactivation of Classification derived components.
  • Review of the current model and possible addition of 363703001 |Has intent (attribute)| to the model.
  • Review of current classification of groupers.
Q2-Q3 2024 International Release
17.

Procedure

Review 48537004 |Bypass graft (procedure)| 

A review of the 48537004 |Bypass graft (procedure)| hierarchy is in progress, the focus is on:

  • Improving consistency of descriptions.
  • Improving definitions for different types of concepts in the hierarchy (bypass vs shunt)
  • Correct use of the term “graft” within the descriptions.
  • Correct modeling of 260686004 |Method (attribute)| in the hierarchy.
  • Review of the need for 360021005 |Bypass - action (qualifier value)| and 424208002 |Shunt - action (qualifier value)|in the model and testing of 245854003 |Proximal anastomosis (qualifier value)| and 245855002 |Distal anastomosis (qualifier value)| as new 260686004 |Method (attribute)| values in the hierarchy.
  • Review for a consistent and appropriate usage of 425362007 |Surgical insertion - action (qualifier value)|and 129407005 |Grafting - action (qualifier value) in the model.
  • Review for re-classification of 129376004 |Construction - action (qualifier value)| as a direct subtype of 129284003 |Surgical action (qualifier value)|.
  • Given the complexity of some concepts in the hierarchy, potential duplicate, erroneous, or outdated concepts will be identified.
Q2-Q3 2024 International Release
18.

Procedure

Review Use of 424876005 |Surgical approach (attribute)| 

A review to generalize 424876005 |Surgical approach (attribute)| to allow non-surgical procedures to be modeled with a subtype of <<103379005 |Procedural approach (qualifier value)| is in progress. 

  • This issue is under review by the Editorial Advisory Group.
  • Currently, 424876005 |Surgical approach (attribute)| is restricted to subtypes of 387713003 |Surgical procedure (procedure)|.  However, the values represented by the 103379005 |Procedural approach (qualifier value)| subhierarchy are applicable to concepts that are not subtypes of Surgical procedure and could potentially be used to define "non-surgical" procedure concepts.
  • The impact of MRCM rule for using 116688005 |Procedure approach (attribute)| with domain constraint:  << 71388002 |Procedure (procedure)| and range constraint:  << 103379005 |Procedural approach (qualifier value) is under review. This change would allow Non-surgical procedures to be modeled with a generic Procedure approach attribute.
Q2-Q3 2024 International Release
19.

Procedure

Review 1287742003 |Radiotherapy (procedure)| 

A review of 1287742003 |Radiotherapy (procedure)| hierarchy is in progress, the focus is on:

  • Review of the devices and systems used in the hierarchy for update and to correct subsumption.
  • Review of the impact of changing the Method (attribute) value from 129445006 |Administration - action (qualifier value)| to 129382001 |Destruction - action (qualifier value)| within the hierarchy.
  • The correct type of energy used for these procedures should be 125576007 |Ionizing radiation (physical force)|.
  • Addition of 424832003 |Surgical introduction - action (qualifier value)|or subtypes and 410675002 |Route of administration (attribute)| role group as needed for proper classification.
Q2-Q3 2024 International Release
20.

Procedure

Review 424226004 |Using device (attribute)| vs. 363699004 |Direct device (attribute)| for Modeling of Repair Procedures

424226004 |Using device (attribute)| and 363699004 |Direct device (attribute)| are used interchangeably for modeling of repair procedures within the Repair group of relationships.

  • 363699004 |Direct device (attribute)| should be used when grouped with 260686004 |Method (attribute)| = << 257903006 |Repair - action (qualifier value)|.
  • Exceptions were found where the device is used to perform the procedures but are not involved directly in the Repair action itself. e.g. 82830000 |Robotic arm, device (physical object)|
  • New model is being tested.
Q2-Q3 2024 International Release
21.

Morphologic Abnormality

Update << 1187137001|Squamous intraepithelial neoplasia (morphologic abnormality)|

The << 1187137001|Squamous intraepithelial neoplasia (morphologic abnormality)| subhierarchy will be updated to properly represent the two common grading systems used globally.

For further information please see this briefing note.

June 2024 International Release
22.

Body Structure

Update for Cardiac Wall and Cardiac Segment

A proposed new model for this area of content is available here.

Further information is available in this briefing note.

Q3-Q4 2024 International Release
23.

Social Context

Inactivation of 60134006 |Life style (life style)| and subtypes

60134006 |Life style (life style)| and subtypes will be inactivated as these concept refer to findings about behaviors that an individual has engaged in and not lifestyle. 134436002|Lifestyle (finding)| will also be inactivated.

June 2024 International Release

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