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ItemsHierarchy/TopicEARLY VISIBILITY OF PROPOSED CONTENT CHANGES

Planned Release timing

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

1.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

*See item 15 below - Remodel 241686001|Dual energy X-ray absorptiometry (procedure)| and Subtypes


2.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. 

Q4 2024 International Release
3.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
4.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 “X substance use disorder 


October 2024 International Release
5.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. 

Beginning June 2024 International Release and then subsequent releases until complete
6.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.
Q4 2024 International Release
7.

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.
Q4 2024 International Release
8.

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.
Q4 2024 International Release
9.

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.
Q4 2024 International Release
10.

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.
  • Radiotherapy procedures will be modeled with 260686004 |Method (attribute)| = 129445006 |Administration - action (qualifier value)| and 424244007 |Using energy (attribute)| =  125576007 |Ionizing radiation (physical force)|.
  • Changes in the model for the associated subhierarchies: 152198000 |Brachytherapy (procedure)|, 33195004 |External beam radiation therapy procedure (procedure)|, 169331000 |Combined radiotherapy (procedure)| and 399315003 |Radionuclide therapy (procedure)| for correct subsumption.
  • Inactivation of 257863009 |Radioactive destruction (qualifier value)| and Brachytherapy - action (qualifier value).
Q4 2024 International Release
11.

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.
Q4 2024 International Release
12.

Substance

Update << 385420005 |Contrast media (substance)| and Modality Specific Contrast

The 95 subtypes of 385420005 |Contrast media (substance) will be updated. New substance concepts including groupers will be required, with the following groupers being added: 

  • New concept - Update 419098001 |X-ray contrast media (substance)| to Radiographic imaging contrast media (substance) and new - subtypes for iodinated contrast media, including iodinated ionic and iodinated non-ionic contrast ionic contrast media substances, iodinated high or low osmolality and barium based contrast media.
  • New concept - Magnetic resonance imaging contrast media (substance) and - subtypes for Gadolinium-based contrast media, Iron-based contrast media, Manganese-based contrast media, Paramagnetic contrast media, Superparamagnetic contrast media.
  • New concept - Ultrasound contrast media (substance)

The following procedures will be updated with the new modality-specific contrast media substances mentioned above:

  • 38 procedures <1295466006 |Plain X-ray with contrast (procedure)|  
  • 228 procedures < 51619007 |Magnetic resonance imaging with contrast (procedure)|
  • 22 procedures < 443631006 |Ultrasonography with contrast (procedure)|
November 2024 International Release
13.

Procedure

Proposed New Model for Solid Organ and Tissue Transplant Procedures

Feedback is requested for a proposed new model for solid organ and tissue transplant procedures.

Please see briefing note here. Deadline to submit feedback is 15 June 2024.

2024 International Release
14.

Clinical Finding/Observable Entity

Inactivation of 302081005|Finding of sex of baby (finding)| and Subtypes

302081005|Finding of sex of baby (finding)| and subtypes will be inactivated, 'baby' may mean fetus, neonate, infant.
New observable entity concepts will be added to represent ‘Sex of fetus’ and ‘Sex of neonate’.
The existing observable entity concepts 268476009 Sex of baby (observable entity) and 281053000 Sex of baby at delivery (observable entity) will be inactivated with historical associations to the new observable concepts.

October 2024 International Release
15.

Procedure

Remodel 241686001|Dual energy X-ray absorptiometry (procedure)| and Subtypes

As part of the ongoing work to update hierarchy 363680008|Radiographic imaging Procedure (procedure)| and descendants (see item 1 above), 241686001|Dual energy X-ray absorptiometry (procedure)| and descendants will be remodeled along with associated finding and situation concepts.

A new imaging action will be added - Dual energy X-ray absorptiometry imaging - action (qualifier value)|

The following concepts will be inactivated:

  • 241685002 |X-ray photon absorptiometry (procedure)|
  • 277458000 |Single energy X-ray photon absorptiometry (procedure)|

The editorial guide will be updated.

October 2024 International Release
16.

Descriptions Update

Forward slash in FSN

A review has commenced of those concepts with a forward slash in their FSN.  Editorial guidance exists disallowing the use of forward slashes in FSNs, and we have commenced a systematic review of those existing terms containing them.

Many areas are excluded for example, medicinal products where strength /1 is the denominator, assessment scales, explicit "and/or", gene names, enzyme and other substance naming, organisms, ratios, per in units (or future consideration), intervertebral structures, content added with an Orphanet map and others. The review is ongoing.

If the meaning is clear i.e. single meaning there is no change but groupers, disjoint ('or)' terming and ambiguous terms will be reviewed and possibly inactivated or have a new replacement FSN without a forward slash. Subject matter experts are being consulted as part of this work.

Q4 2024 International Release

Q1 2025 International Release

17.

Descriptions Update

Inactivation of Descriptions with Asterisk

Eight concepts containing an asterisk instead of a superscript to represent "power of," e.g. 277288007 |10*9/liter (qualifier value)|, will be inactivated with reason ambiguous. New replacement concepts will be created, e.g. 1348323004 |10^9/liter (qualifier value)|.

The concepts scheduled for inactivation and replacement are all subtypes of 282409001 |Nominated concentrations (qualifier value)|).  Editorial guidance is available here.

October 2024 International Release.

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