In reviewing some recent requests for amputation procedures, I have run up against a conundrum that I would like input on. There are currently several procedures representing amputations of lateralized body structures, but without specifying the precise laterality. Back in 2015-16 we inactivated concepts that specified "unilateral" procedures as being both ambiguous and a threat to patient safety if added to an EHR. While the existing procedures that do not specify laterality act as organizational groupers, they too seem to pose the same threat to patient safety.
We have received a number of requests for lateralized amputation procedures which are correctly classifying under these ambiguous groupers, but highlight the potential issue with these concepts. Example:
46028000 |Amputation of hand (procedure)|
895522007 |Amputation of left hand (procedure)|
895473002 |Amputation of bilateral hands (procedure)|
895523002 |Amputation of right hand (procedure)|
895473002 |Amputation of bilateral hands (procedure)|
Many of the existing laterality agnostic procedures are long-standing within the terminology, having been extant since the initial 20020131 release.
The questions I have related to the importance of having groupers like this in the age of ECL vs. the patient safety risk of using these in a medical record. Is it more important to have a hierarchical structure vs. a flatter structure that requires more precision in the use of the terminology?
With disorders, this does not seem to be as big an issue, but with procedures, it strikes me as being significant. As SNOMED is meant to be a clinical terminology, i.e. used in contemporaneous recording of data, ambiguous terms in procedures could cause problems.