Date
2020-09-02
Time:
1600 - 1800 UTC
0900 - 1100 PDT
Zoom Meeting Details
Topic: SNOMED Editorial Advisory Group Conference Call
Time: Sep 2, 2020 09:00 AM Pacific Time (US and Canada)
Join from PC, Mac, Linux, iOS or Android:
https://snomed.zoom.us/j/95255747097?pwd=Tys5VHNqVTBCWFFuODVnR09sS2JTUT09
Password: 614983
Attendees
Chair:
AG Members
Invitees:
Observers:
Meeting Files:
Objectives
- Obtain consensus on agenda items
Discussion items
| Item | Description | Owner | Notes | Action | |
|---|---|---|---|---|---|
| 1 | Call to order and role call | Start recording! | |||
| 2 | Conflicts of interest and agenda review | No conflicts noted | |||
| 3 | Morphology (disorder) concepts | Jim Case | SNOMED CT currently has a large number of disorder concepts that solely represent morphologies. E.g. 416462003 |Wound (disorder)|; 416439000 |Lipogranuloma (disorder)|). While all of these are SD by simply using DIsease + morphology, other than as grouping concepts, are these valuable clinical terms? With the advent of ECL it is a simple query to identify all concepts that fit into these morphologies. What should be the editorial guidance for the creation/maintenance of these terms? Additionally, there are of over 5400 "grouper" terms in SNOMED CT. Many of these are abstract and are useful for navigation but should not be used in clinical recording. There has been some interest in providing these as an exclusion refset to prevent them from being selectable for clinical use. However, some of the terms do have limited clinical usefulness (i.e. patient reported clinical findings). It has been suggested that a task for the EAG would be to identify: 1) which terms in the list have clinical usefulness, 2) which terms provide meaningful navigational usefulness and 3) which terms should be inactivated. File link: SNOMED CT Grouper sheet Discussion: Many concepts originated from early version of SNOMED. Due to the original structure of SNOMED they were part of the older structure. For some uses, it may be used if we do not have a precoordinated concepts for all body sites that the morphology may be applies to. May be valuable in decision support. Most users focus on disorders rather than morphology. Since SNOMED is not used natively in many implementations, this may be an issue. They are doing no harm and are useful in some scenarios, so we will retain them for the time being. WRT the grouper sheet - there are a number of patterns. The original intention of the list was to provide an exclusion set that could identify terms that should not be used in the clinical record. There are those that would like groupers removed and those that see them as potentially useful when vague content is needed due to lack of data to support for more detailed findings/procedures. The focus of use cases should be useability in a broad set. One of the uses is convenience in selecting a set of terms for value sets. One criteria for inclusion would be the ability to sufficiently defined. They do have value as organizing terms. The issue trying to be resolved is the reduction in the number of intermediate primitives. One consideration is to create a set that can be excluded from the classifier without removing them from the terminology. Another approach is to assign them as an additional axiom (SUBCLASS OF) and eliminate them from the primary axiom. Will discuss approaches internally and come back to the group. | ||
| 4 | ECE Topics | Bruce Goldberg | Combined disorder model revisited DUE TO relationships may hide other relevant relationships from the classifier that would be better explicitly stated in an axiom Discussion:
Example of gout: Many manifestations of gout are appropriately modeled as both the deposition morphology and the inflammatory morphology. Example of cerebrovascular accident: DUE TO Spontaneous event. Pathologic fracture, 3 models proposed. One suggestion is that the range of the DUE TO attribute be expanded to allow for Morphologic abnormality. Another suggestion is the addition of another axiom. WRT pathologic fracture, it would not be appropriate to use the morphology as the value for the DUE TO. Some of the DUE TO relationships represent a precondition that must occur prior to the actual event or disorder. Pathological fractures are not spontaneous, but just a lower level of trauma sufficient to affect the weakened bone. There is concern that the addition of the DUE TO Spontaneous event possibly misrepresents the true nature of the fracture. In the literature, pathologic fractures are not classified as traumatic injuries. Many in the group feel that these should still be classified as subtypes of traumatic injury. Discussion evolved into one about the value to the asserted DUE TO relationship when two conditions are co-occurrent. There may or may not be causal relationship. The use of co-occurrent simply means two conditions occur at the same time without asserting causality. One argument in favor of retaining DUE TO relationships is to retain harmony with ICD, which uses DUE TO extensively. Making an explicit statement of causality is helpful. This may be an issue that needs resolution on a domain-by-domain basis to determine the proper modeling pattern. This is difficult to manage at the terminology level because they are really clinical statements. No consensus reached. EAG members asked to review the modeling examples for Pathologic fractures and make recommendations on the optimal pattern to move this part of the QI revision forward. Remainder of the topics will be continued at future meetings | ||
| 5 | Next meeting | EAG | Meeting adjourned at 10:58 PDT Would the group be willing to meet for another 2 hour block the week of Sep 7 to catch upon urgent topics? Specifically, questions about the proposed devices model. Discussion: EAG members available for another call Sep 9 at the same time fro two hours |