Inactivation Reason | Association Type | Summary Definition and Usage |
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Ambiguous Concept | POSSIBLY_EQUIVALENT_TO | - The inactivated concept is inherently ambiguous, and each of the potential meanings represented by the concept is semantically identical to at least one other clinical concept..
- It is important to differentiate between inherent ambiguity and "vagueness". If the FSN is vague consider using Meaning Unknown.
- Identify all of the POSSIBLY_EQUIVALENT_TO concepts, the sum of which should be semantically identical to the inactivated concept.
- Only in exceptional circumstances will it be acceptable to have only one POSSIBLY_EQUIVALENT_TO target and that is where the second target concept represents a concept that is considered to be of little or no clinical usefulness.
- Note: Non-synonymous synonyms should be inactivated and resigned before inactivating the ambiguous concept.
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Classification Derived Classification Concept | REPLACED_BY PARTIALLY_EQUIVALENT_TO | - The inactivated concept originates from the “closed world” classification paradigm and as such is inappropriate content for use within the clinical record.
- These concepts often contain the expressions "not otherwise specified (NOS)", "Unspecified", "Otherwise specified", conjunction/disjunction, etc.
- REPLACED_BY should be used where the target replacement concept is of the same semantic category and have the same or less specificity than the inactivated concept. It will often be the same as the inactivated concept minus the "classification tail" of "other" or "NOS", etc.
- PARTIALLY_EQUIVALENT_TO should be used where there is a conjunction, (with or and) and must include all of the elements of the conjunction e.g. has a cardinality of 2 or more.
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Concept Moved Elsewhere | ALTERNATIVE No suitable replacement identified | - The Applies where jurisdictional control of a concept passes between extensions, or between the international edition and an extension (e.g. veterinary extension)
- Where the meaning of the concept to be inactivated is strictly jurisdictional e.g. relates to specific forms, branded products, legal entities, etc, no replacement is required and, therefore, no association type is allocated.
- ALTERNATIVE should be used where there is concern that the concept may have been used by members of the community of practice. The ALTERNATIVE substitute concept is offered as semantically "sufficiently similar" to the original concept for some use cases that should be specified by the end-user.
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Duplicate Concept | SAME_AS | - The inactivated concept semantically represents exactly the meaning of the remaining active concept and therefore the association is "SAME_AS".
- Note that the meaning of the concept is based on the FSN but does not imply that the FSNs are identical.
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Erroneous Concept | REPLACED_BY | - The inactivated concept has an FSN which contains an error that when corrected potentially changes the semantic meaning of the concept.
- NOTE: Where the error is grammatical or a spelling mistake which when correct does not change the meaning, the description rather than the concept should be inactivated.
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Meaning Unknown | No association required | - The meaning of the inactivated concept cannot be determined.
- It will normally be necessary to search the clinical literature to establish that this is truly an unknown concept rather than an outdated clinical concept.
- This inactivation reason may be used where the meaning of the FSN is considered to be vague.
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Non-Conformance to Editorial Policy | REPLACED_BY ALTERNATIVE No suitable replacement identified | - The inactivated concept does not comply with the current or updated Editorial Policy and when updated to comply with the .
- Where conformance to editorial policy potentially changes the semantic meaning of the concept.meaning of a concept and it is possible to replace this with a concept that is semantically very close to the inactivated concept the association should be REPLACED_BY. e.g. a radiological procedure which in practice almost exclusively uses contrast but this wasn't included in the FSN would be inactivated and REPLACED_BY the new concept in which the FSN clearly states the use of contrast.
- Where the change to editorial policy results in a change in scope of SNOMED CT then it may be possible to provide a target replacement that is similar to but less specific than the inactivated concept and therefore the association would be ALTERNATIVE. e.g. where branded products were considered out of scope for SNOMED CT an ALTERNATIVE would be the generic product.
- In some instances, a suitable replacement cannot be identified e.g. should a decision be taken to count occupations as out of scope for SNOMED International Edition.
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Outdated Concept | REPLACED_BY POSSIBLY_REPLACED_BY No suitable replacement identified | - The inactivated concept is an outdated concept that is no longer considered to be clinically acceptable or semantically interoperable internationally.
- A REPLACED_BY association would be used where there exists a concept that is semantically similar to or more general than the inactivated concept for the purposes of data healing and analysis of historical data.
- Where there has been an update to a disorder classification, a substance or organism originally believed to be a single entity has, following further study, been reclassified as 2 or more substances or organisms. Where 2 or more potential replacements exist use POSSIBLY_REPLACED_BY for each of the target concepts.
- In some circumstances, an outdated concept simply falls into disuse without any appropriate replacement.
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