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8th April 2019  -  13:30 - 18:00 GMT - Catered break 15:00-15:30

Room: Adelphi 1, Waldorf Hilton hotel, London + Conference Call (

9th April 2019  -  09:00 - 12:30 GMT - Catered break 10:30-11:00

Room: Mackenzie, Waldorf Hilton hotel, London + Conference Call (




  • Briefly discuss each item
  • Agree on the plan to analyse and resolve each issue, and document the Action points
  • All those with Action points assigned to them to agree to complete them before the next face to face conference meeting

Discussion items


Thanks to our members for all of their help. Welcome to our observers!



Conclusion of previous Discussions topics

3Naming convention of new OWL refset fileAll

As most of you know, new OWL refset files are being planned for introduction in future International Edition releases - for those who haven't heard about this here is some background reading: SNOMED CT Logic Profile Enhancement 

We need to agree on the best naming convention for the new OWL refset file, and also on the best location within the release package. 

The current naming convention proposal is as follows: 


As for the location, there are two choices - as it's technically a refset the obvious place is to put it in the Refset/Content folder. 

However, there is also an argument for keeping the Owl Refset in the Terminology directory. This is because it's an axiom refset, and as such is distinctly different from any other reference set. In addition, the content of the Terminology directory is actually incomplete without it, due to the fact that it's the new format of stated relationships. Therefore there's a school of thought that suggests that we should organize the files by their meaning rather than their format. 

In the Alpha release of the Drugs package, the following naming conventions were applied:

  • xder2_sRefset_OWLOntologySnapshot_INT_20180228.txt
  • xder2_sRefset_OWLAxiomSnapshot_INT_20180228.txt

...and they were placed in the Terminology folder.

Is everyone comfortable with this approach?

  • Everyone is happy with the Terminology folder as the correct location
  • Andrew Atkinson to propose to the Project team that we add the "Stated" back in, and to change the prefix to SCT instead of DER



  • The proposition to add "Stated" back in was rejected, due to the potentially misleading nature of the files, which will not always necessarily contain stated content.

  • The proposition to change the prefix to SCT was accepted, and published as such in the July 2018 International Edition:

    • sct2_sRefset_OWLAxiomSnapshot_INT_20180731.txt

    • sct2_sRefset_OWLOntologySnapshot_INT_20180731.txt

  • Harold would like to discuss the format of the refsets, in order to see if we can streamline them at all....

  • Any issues experienced?

  • We would still like to combine the refset files into one - therefore we can still use the same naming format and create it as:

    • sct2_sRefset_OWLSnapshot_INT_20180731.txt

  • AAT sent to Linda/David for review on  ...

  • David/Linda both agreed with the combination of the refsets into one file, but would prefer a slightly refined naming convention:

    • sct2_sRefset_OWLExpressionSnapshot_INT_20180731.txt

  • Andrew Atkinson to COMMUNICATE this out in advance of the Jan 2019 release to make sure everyone is aware

  • Andrew Atkinson communicated it out in advance and published as planned in Jan 2019.

  • Any issues, or can we close this down?

  • All confirmed we can close this down



Active discussions

6Spanish Member Collaboration Process refinementsSpanish Edition users only

There will be a presentation at 17:10 by Arturo Romero Gutierrez, to walk through the improvements to this process that have been discussed and agreed since the inception of this new process, and what the Spanish Edition users need to commit to in order to be contributing part of this process.

Everyone welcome to stay and participate!

  • Presentation from Arturo
  • Agreement from all Spanish Edition users who were present (Alejandra, Suzy + Alejandro) to collaborate and contribute to the refined process
  • We now need to formalise the process and distribute the document out to all interested parties for final sign off
7Visibility of TRAG recommendations


This was a query raised in the Member Forum in April 2018 - Suzy introduced the topic on behalf of the requesting member.

AAT spoke to Linda about what she needs...

Suzy to provide more feedback to the MF on regular updates to the Release AG

  • Andrew Atkinson to create a new page for Linda, with "TRAG Decisions" listed. This will be kept in line with all future TRAG meetings, and will therefore provide one location for people to search when looking for final decisions made by the TRAG.
  • Page created - ask Linda and others for feedback: TRAG - Recommendations made
  • Feedback good on this page, therefore Andrew Atkinson sent to Linda Parisien for review on  .....
  • Linda confirmed she was happy with the page via email on  
  • However Andrew Atkinson to ALSO make the recommendation to have visibility of the outcome of decisions that are cross-advisory group and have to be made at SMT level...... confirmed that wherever possible we will include that information.
  • More feedback required based on first 6 months usage....
  • Linda Parisien confirmed that all is good and so this can be closed down...
8Proposed deprecation of the CTV3 Identifier simple mapAllDue to it coming to the end of its useful life, SNOMED International would like to propose planning for the deprecation of the CTV3 Identifier simple map (that currently resides in the RF2 International Edition package) as of the January 2020 International Edition. 

Some Member countries have already identified the reduction of the effectiveness of the product, and have already put plans in place to withdraw support for the CTV3 Identifiers from 2020 onwards. 

The TRAG therefore need to discuss whether or not there are any apparent problems with the proposed deprecation, and if so how they can be mitigated. 

We must also discuss the most effective method to pro-actively communicate out announcements to the community to warn them of the upcoming changes, in order to ensure that everyone who may still be using the Identifiers has plenty of notice in order to be able to make the necessary arrangements well in advance. 

Finally, we will need to decide on the best method for extricating it from the package, in order to ensure the smoothest transition for all parties, whilst remaining in line with the RF2 standards and best practices. 
  • So the plan would be to follow the same deprecation process as we did with ICD-9-CM (ie)
    • move all of the content to a Static Package in July 2020, and inactivate all of the content
    • publish the reasons for inactivation in the historical associations
    • Release Notes similar to ICD-9 = SNOMED CT ICD-9-CM Resource Package - IHTSDO Release notes
    1. Date of the files should be before the July 2020 edition (so say 1st June), in order to prevent inference of dependency on the July 2020 International edition
      1. So we set the effectiveTime of the Static package to be inbetween the relevant international edition releases (eg) 1st June
      2. This is to ensure that it's clear that the dependency of the Static package will always be the previous International Edition (here Jan 2020), and not continually updated to future releases
      3. It cannot therefore have an effectiveTime of July 2020 (as we would normally expect because we're removing the records from the July 2020 Int Edition) as this would suggest a dependency on the July 2020 content which doesn't exist
      4. It also can't have an effectiveTime of Jan 2020 as we need to distinguish between the the final published content which was Active in Jan 2020, and the new static package content where everything is Inactive.
    2. Inside the files should be all International edition file structures, all empty except for:
      1. Delta ComplexMap file needs to be cleared down (headers only), as no change in the content since the Jan 2020 files, so no Delta
      2. Full and Snapshot ComplexMap files exactly as they were in Jan 2020 release (including the effectiveTimes)
      3. ModuleDependency file needs to be blank, as CTV3 was in the core module (not in its own like ICD-10 is), and therefore the dependency of the core (and therefore the CTV3 content) module on the Jan 2020 edition is already called out in the Jan 2020 ModuelDependency file, and therefore persists for the static package too.
      4. Date of all of the files inside the package should be the new date (1st June)
      5. But all effectiveTimes remain as they were in Jan 2020
      6. Leave refsetDescriptor records as they are in the International edition
      7. RELEASE Notes Should describe all of the thinking we went through when creating this package, why the moduleDependency file remains blank, and why we’ve wiped the Delta, etc (see above)
    • RT Identifier Refset deprecation:

      We need additional comms around the July 2017 release, in addition to the usual Release Notes wording, in order to confirm what is happening and the rationale behind it.

      To re-iterate what was discussed on the previous call, Legal counsel confirmed that from a legal perspective, he doesn’t consider that it’s either necessary (or even advisable) for us to send CAP any further communications on this matter.  Legal counsel is confident that the informal discussions that we’ve already had with them (in order to remind them about what they need to do), are sufficient to cover our legal obligations, given that the licence is theirs and not SNOMED International's.  Therefore we no longer need to send a formal letter to CAP.

  • Andrew Atkinson to begin formal deprecation process if everyone is in favour of the refined process to use to deprecate??

9National pre-release processes- Joint work item with the CMAG

Suzy to provide update on progress...

Suzy introduced the topic and gave a brief update on agreed scope and timelines. Also requested any input that people not already involved might feel would be useful and appropriate

Who's already involved? Anyone would like to become involved as we've still only had one call about this, so still a good time to join in? Some people (Feikje etc) were particularly interested in the Continuous Delivery discussions, so we'll fold that in later...

Adding Matt Cordell (currently on CMAG)

  • The working group has not progressed and the priority of this dictates that it is unlikely to do so quickly, so Suzy Roy and Matt Cordell will continue to keep the TRAG informed of progress as and when we need to get involved...
  • The next likely work will be done by Suzy for documenting the US Edition process...
  • We also need to consider the work being done in the Shared Validation Service here, as this will help us to define and standardise National pre-release processes...


Computer readable metadata

* MAG crossover

Suzy introduced the topic for discussion...

Suzy would like to raise the question of creating computer readable metadata, and raise questions such as whether or not to include known namespace & modules? 
Or just the current metadata for the files in a machine readable format? 

Suzy Roy to provide an update on progress:

  • All agreed that whilst this is a large topic, we should start somewhere, and get at least some of the quick wins in (then request the change to content via the CMAG):
  1. Check where the progress with the namespace metadata has got to - can we progress this?
  2. Code systems (and versions) of the map baselines
  3. Common strings such as boiler plate licence text etc
  4. Description of use cases for the various refsets (using the text definition of the Refset concetps themselves) - either json or markdown representation of multiple pieces of info within the same field.
  • Michael Lawley to provide an update from the related MAG topic...
  • TRAG agreed that this should be incorporated into the discussions with the continuous delivery, in order that we can plan the changes here in line with the transition to more frequent releases. To be continued over the next few months...
  • Michael Lawley to kindly provide an update on his work with David to help design and implement the solution - this will now be in the second TRAG meeting of the April 2019 conference, after they have met together....
  • Ideas:
    • Some human readable metadata could potentially live as descriptions (which can then be translated)? David to discuss further...
    • David will mock up something in Json...
  • Michael + David + Harold agreed to create a straw man to put up in the next meeting and take this further...

Reference set metadata

* MAG crossover

Replacement of the Refset Descriptor file with a machine readable Release Package metadata file

See David's proposal here: Reference set metadata (plus sub page here: Potential New Approach to Refset Descriptors)

  • Everyone confirmed no issues with the proposal in principle, in April 2018
  • However, do we consider this to just be relevant to refsets in the International Edition release package?
    • Or to all derivative products as well?
    • Both refsets and maps?
  • Also, are we talking about only human readable descriptive information, or also machine readable metadata such as
    • ranges of permitted values
    • mutability, etc?
  • Michael Lawley to kindly provide an update on his work with David to help design and implement the solution - this will now be in the second TRAG meeting of the April 2019 conference, after they have met together....
  • Michael + David + Harold agreed to create a straw man to put up in the next meeting and take this further...
12Proposal for a complimentary file to the MDRS - the "ECRS" ("Edition Composition Reference Set")

Dion has requested a discussion to clarify the best application of the Module Dependency Reference Set (MDRS) - some background reading before our meeting is here:

Please let me know if you have any questions before our meeting, once you've read through the info, as it would be great for everyone to start on the same page in order to have the most effective discussion on the day. 


  • We need to discuss and agree an approach that allows us to both express the correct moduledependencies + the new module composition (to express which modules comprise the Edition package, for URI purposes).
  • Michael Lawley has written up a proposal and shared this - there has been a lot of feedback on this proposal in the Confluence discussion - so in this meeting we should:
  • a) Ask Michael to walk through the proposal in person to ensure that everyone's on the same page
  • b) Answer the feedback (plus any new feedback)
  • c) Agree what the final proposal should be, and what are the next steps we need to take in order to get it signed off (design authority, etc?)

  • Michael, Dion and Reuben to create the Australian version as an example, in order to include that in Michael's updated version of the proposal document.
  • Linda and David came to the second session in October 2018 and asked for clarification on various points. Michael Lawley will update the proposal document and re-circulate for everyone's consideration, in order that we can then decide whether or not to take this forward...
  • Michael and Linda both confirmed that the use case for this is not a critical priority at the moment, and therefore doesn't need to be actively discussed at the moment, until new cases are proposed...
13Proposal to increase the level of metadata available for authors to log decisions made during content authoring

Jim Case +

Suzy Roy

This is a subject that would be helpful to include Jim in the discussions, as he has some definite opinions on how to improve the metadata in this area. 

Some suggestions would be to make more detailed information available for authors to describe their reasons for inactivation (especially in those areas where currently they are forced to use inactivation reason codes that aren't completely representative of the reasons in that instance).

Adding Jim Case - for further discussion later...


Release packaging conventions and File Naming Conventions


TRAG to review and provide final feedback.

Reuben to provide feedback on progress of the URI specs + FHIR specs updates...

  • Document updated by Andrew Atkinson in line with the recommendations from the last meeting, and then migrated to a Confluence page here: SNOMED CT Release Configuration and Packaging Conventions
  • To be reviewed in detail by everyone, and all feedback to be discussed in the meetings. AS OF OCTOBER 2017 MOST PEOPLE STILL NEEDED TIME TO REVIEW THE DOC - Andrew Atkinson INFORMED EVERYONE THAT THIS DOCUMENT WILL BE ENFORCED AS OF THE JAN 2018 RELEASE AND THEREFORE WE NEED REVIEWS COMPLETED ASAP... so now need to check if reviews still outstanding, or if all complete and signed off??
  • AAT to add in to the Release Versioning spec that the time stamp is UTC
  • AAT to add the trailing "Z" into the Release packaging conventions to bring us in line with ISO8601
  • AAT to add new discussion point in order to completely review the actual file naming conventions. An example, would be to add into the Delta/Full/Snapshot element the dependent release that the Delta is from (eg) "_Delta-20170131_" etc. AAT to discuss with Linda/David. Or we hold a zero byte file in the Delta folder containing this info as this is less intrusive to existing users. Then publish the proposal, and everyone would then take this to their relevant stakeholders for feedback before the next meeting in October. If this is ratified, we would then update the TIG accordingly.
  • AAT to add in a statement to the section 4 (Release package configuration) to state that multiple Delta's are not advised within the same package.
  • AAT to add in appendix with human readable version of the folder structure. Done - see section 7
  • IN ADDITION, we should discuss both the File Naming convention recommendations in the Requirements section (at the top of the page), PLUS Dion's suggestions further below (with the diagram included).
  • Dion McMurtrie to discuss syndication options for MLDS in October 2018 - see hwat they've done (using Atom) and discuss with Rory as to what we can do. Suzy would be interested is this as well from an MS persepctive. UK also interested. This shouldn't hold up the publishing of the document. Discussions to continue in parallel with the creation of this document...
  • Reuben Daniels to raise a ticket to update the fhir specs accordingly
  • Reuben Daniels to talk to Linda to get URI specs updated accordingly.
  • URI Specs to be updated and aligned accordingly - Reuben Daniels to assist
  • ONLY outstanding point from earlier discussing was Dion's point from the joint AG where he talked about nailing down the rules for derivative modules... -
  • Dion McMurtrie to discuss/agree in the October 2018 meetings - REPORT FROM DION??
  • Everyone is now happy with the current version, therefore Andrew Atkinson to publish - we can then start refining it as we use it.
  • Andrew Atkinson to therefore agree all of the relevant changes that will be required as a result of this document internally in SNOMED International, and publish the document accordingly.
  • FIRST POINT WAS THEREFORE TO have it reviewed internally by all relevant stakeholders...
    • This has been completed and signed off
  • Do we consider anything in here needs to be incorporated into the TIG?
    • or perhaps just linked through?
    • or not relevant and just separate?
  • Once all happy, the document will be published and opened up to anyone to view.

IHTSDO Release Management Communication Plan review


This document was reviewed in detail and all feedback was discussed and agreed upon - new version (v0.3) is available for review, attached to the IHTSDO Release Management Communication Plan review page.

AAT has added in details to state that we'll prefix the comms with "Change" or "Release" in order to distinguish between the type of communications. See version 0.4 now - IHTSDO Release Management Communication plan v0.4.docx

Once we've collated the feedback from the revised comms processes that we've implemented over the past year (in the items above), we'll incorporate that into the final version and discuss with the SNOMED International Executive Lead for Communications (Kelly Kuru), to ensure that it is aligned with the new overall Communication strategy. Once complete, the Release Management comms plan will be transferred to Confluence and opened up for everyone to view.

We have publicised the Release Management confluence portal to both NRC's and the end users to get people to sign up as and when they require the information. Do we know of anyone still not getting the information they need?

We also agreed last time that the community needs more visibility of significant, unusual changes (such as bulk plural change, or case significance change). These changes should be communicated out not just when they're assigned to a release, but actually well in advance (ie) as soon as the content team start authoring it, regardless of which future release it will actually make it in. I have therefore created a new Confluence page here: January 2020 Early Visibility Release Notices - Planned changes to upcoming SNOMED International Release packages

I've left the previous items up (from the July 2017 International Edition) because there are no examples yet from the Jan 2018 editing cycle - so please take a look and provide feedback on whether or not this is useful, and how it can be improved.

  • ACTION POINT FOR EVERYONE BEFORE OCTOBER 2018: (Dion McMurtrie, Matt Cordell, Orsolya Bali, Suzy Roy, Corey Smith, Harold Solbrig, Mikael Nyström, Chris Morris)
    The final version of the communication plan needs to be reviewed by everyone and any comments included before we agree the document internally and incorporate it into our communication strategy
  • Suzy Roy will discuss the end use cases of her users with them and come back to use with feedback on the practical uses of SNOMED CT and any improvements that we can make, etc 
  • We may now also need to add a new section in here wrt the comms for the TRAG, so that this is standardised and agreed with the community? Or is it outside of the scope for the Release Communication Plan? This was felt to be out of scope, and should this be restricted only to communication related to actual releases of products.
  • Everyone is now happy with the current version, therefore Andrew Atkinson to publish - we can then start refining it as we use it.
  • Andrew Atkinson to therefore agree all of the relevant changes that will be required as a result of this document internally in SNOMED International, and publish the document accordingly.
  • The feedback has been incorporated and the document refined accordingly.
  • Andrew Atkinson has now sent to the relevant members of the SMT for final sign off....
    • This has now been signed off and is ready for publication
  • Do we consider anything in here needs to be incorporated into the TIG?
    • or perhaps just linked through?
    • or not relevant and just separate?
  • Once all happy, the document will be published and opened up to anyone to view
16What constitutes a true RF2 release?Harold would like to introduce this topic for discussion...
  • Language refset conflicts are not yet resolved - Linda has been discussing this in terms of how to merge Language refsets or dictate whether or not one should override the other in cases of multiple language refsets - in the UK they combine them all into one but this is not ideal either. In translation situations they use the EN-US preferred term as the default where there is no translated term in the local language. Perhaps we need to do a survey on the members and who's using what how.
  • Suzy Roy (or Harold Solbrig) to get Olivier's initial analysis and come back to us on what worked and what didn't, and we can take it from there.
  • Suzy would like to ask Matt Cordell if he can share his ppt from his CMAG extensions comparison project.
  • Matt Cordell will distribute this to everyone for review before the April 2019 meeting.....
  • Harold to continue analysis and report back with the results of reviewing the specific examples that Olivier identified in the next meeting....

Additional, non-defining Relationships

* MAG crossover

TRAG to continue the ongoing discussions. The SEP refsets have now been deployed, so are we happy that this has resolved the majority of the issues, or do we still need to push for a full re-factoring of the anatomy content asap?

No change expected for the Jan 2018 release.   Part-Of relationships will once again become defining once we have the OWL Refset changes in place.   So they will become stated relationships rather than additional.

  • The MAG are proposing that they are perhaps going to put these non-defining relationships into a new Relationships file completely, in order to allow them to be viewed, but to also ensure that it's clear that they are distinct from normal, defining relationships (the MAG discussions are still ongoing on this)........
  • Question is whether or not this will happen before they become inherently redundant as a result of the Anatomy remodelling.
  • Harold confirmed no further progress made on this as yet by the MAG, SO WE JUST NEED TO KEEP AN EYE ON THIS MAG TOPIC AND DISCUSS ACCORDINGLY - Harold Solbrig to update on progress in April 2019 TRAG meeting....
  • For now, everyone is agreed that the SEP refset is covering most (if not all) use cases, and therefore this topic is a very low priority for now, and does not need to be actively discussed unless we have new issues raised in relation to it...

18Discussion of proposed format and packaging of new combined Freeset productAllTo be discussed with the entire group, and recommendations made
  •  Andrew Atkinson to present the current proposal, and gather feedback
  • Feedback:
    • Uncertainty on use cases - however this was mitigated by the specific messaging from SNOMED licensed users to non-licensed recipients...
    • Content
      • DICOM in particular no representative without sub-division, PLUS actually risky with unverified attributes...
      • AAT to discuss further with Jane, etc
    • Using the US PT instead of the FSN (whilst providing less exposure of the IP) prevents visibility of the hierarchy (due to lack of semantic tag) - however the reason for this is because the target users (who are NOT current SNOMED licensed users) will find more use from the PT in drop-downs, messaging, etc than the FSN...
    • Everyone happy with each subsequent release being a snapshot - so additions added but inactivations just removed - as long as we include something in the legal licence statement to state that use of all concepts that have ever been included is in perpetuity (even after they've been inactivated)
      • In addition, Members would also like a Proposal to create an additional Simple refset (full RF2) of the entire GPS freeset in order to enable active/inactive querying etc by licenced users...
        • Potential to automate the creation of this using ECL queries if we ensure all freesets are included in the refset tool..

  • AAT to discuss further with Rory, etc

19Plans for the transition from Stated Relationship file to OWL refset filesAllThis is part of the wider Drugs and Substances improvements that are currently taking place. Other than the obvious content updates, these technical changes are those which will be likely to have the highest impact on those within our AG. 

We need to discuss the plan and ensure that we have answered all of the possible questions in advance, in order that we have a workable plan with no unwanted surprises over the next few release cycles. 

As a starting point, we should discuss the following: 

1. The schedule of changes (see here: January 2020 Early Visibility Release Notices - Planned changes to upcoming SNOMED International Release packages) (ie) 

July 2018 - initial OWL refsets introduced 
Jan 2019 - included in the Release package: a) Stated Relationship file b) the partial OWL axiom refset including all description logic features that cannot be represented in the stated relationship file. 
The Extended OWL refset file will be available on demand. 
July 2019 - the stated relationship file will be replaced by the complete OWL Axiom refset file. The stated relationship file will NOT be included in the international release; however, it may still be available on request to support migration to the OWL Axiom refset. 

2. The communications required to ensure that ALL impacted parties are completely informed of the Schedule, and the changes that they may need to make in order to transition cleanly to the new format. 

3. The technical changes that we need to make to the Release package itself, in order to support the planned schedule. 

For example, when we "replace" the Stated Relationship file in July 2019, do we remove the file from the release package immediately (in Jan 2020 once everyone has had a chance to run the inactivation file through their systems), or do we take the more measured approach of inactivating all records and leaving the inactivated file in the package for, say, 2 years, and then planning to deprecate the Stated Relationship file by July 2021? 

Further, should we be deprecating the file itself at all, or can we see any other (valid) use for the Stated Relationship file (obviously not just repurposing it for a completely different use!)? 
  • Harold Solbrig to talk to Yong and others in the MAG about his proposals for future proofing against the possibility of having multiple ontologies referenced, prefixed axioms, etc.
  • Harold confirmed nothing to report
  • Some opposition to reverting back to having the OWL file on-demand for Jan 2019 - need to discuss through with Kai in tomorrow's session - preference is to release both Stated Rel's + the "addtiional" info only in the OWL files - as with July 2018 release. Is this the current intention?
  • Done - Jan 2019 was implemented as requested - did anyone manage to use it and trial it effectively? Any feedback?
    • YES - Australia downloaded it and trialled it in their systems!
    • Worked well - however they have not got a lot of new validation to cover either the OWL format or the content itself, so these were trials to ensure that they can use it and author against it, rather than testing the actual content of the Axioms...
  • Also, has the decision already been made to NOT create a full history back to 2002 (or 2011 at least)? Sounds like most extensions will do it anyway, so maybe we should? Decision made by content team - no history to be included
  • Discussion on whether or not to go back and re-represent the content all the way back to 2002 in the new complete OWL file:
    • Pros:
      • Prevents the need of new tooling providers to create support for the ols Stated Rel way of doing things
      • If the International Edition doesn't go all the way back then the Extensions are restricted to not doinh it either, if the international Edition does then the Extensions have a choice.
      • Ability to go back through history and analyse prevent modelling decisions (if errors come up in future), even for those authors who haven't heard of Stated Rel's because they've now been deprecated for several years.
    • Cons:
      • Cost involved in creating the pure historical view
      • If the extensions have a choice as to whether or not to go back, then interoperability could be impacted - better to enforce going back if the international edition does.
      • Need to address the issue of some implmentations having both Stated Rel + OWL Axioms in the same full files going forward.
      • Uncertain use cases for most implementers
  • This discussion needs further input in order to enable us to reach an informed conclusion. The relevant internal and external stakeholders (NRC's such as Australia) will take this away and come back with the results of feasibility studies and estimates as to how long the necessary work would take to complete..... a decision must then be made well in advance of the January 2019 International Edition, in order to ensure that we agree on the correct approach before creating the initial Alpha release in November...
    • We are currently proceeding on the assumption that there was no feedback from any sources that supported the retro-fitting of the OWL Axiom files? The major con here is breaking our own regulations on tampering with history - the Stated Relationships should remain in place in order to a) accurately represent history + b) prevent the false impression that extended functionality was available via OWL Axioms before July 2019!

  • We also need to identify as many opportunities as possible to validate the new OWLExpression content - has anyone written anything for this?
    • NO!!!

  • We need to work with the Shared Validation working group to share as many OWL based validation assertions as possible, so that we can all effectively cover:
    • Technical validation of the OWL file structure
    • Content validation of the OWL records
    • Modelling validation post OWL
  • Linda and others are confident that the MRCM validator will cover most modelling scenarios for now, but we'll need to keep extending as we go

  • New idea for an RVF assertion regarding the ordering of OWL records (based on first concept) with disjoints:
    • Michael Lawley suggested it (and Kai agreed) in MAG on 09/04/2019 - So we will discuss with Kai and elaborate first...

More Frequent Delivery


We need to continue discussions on this on-going item, in light of the strategic meeting before the conference. In addition we now have new members with additional experience, and we have also now lived with the more stable International Edition release process for the past couple of years.

Last time we discussed this everyone thought it a good idea in principle, but were concerned that we are not yet in a position to deliver the same level of quality on a daily basis than as on a monthly basis (due to the current gap in our manual/automated testing). Therefore we were going to discuss this once we had further progressed our automated testing - however as the new working group for the RVF service will testify this is a slow process, and therefore it may not be possible to wait for this to be completed in its entirety.

We have identified several additional potential issues with moving to Continuous Delivery, which we should consider before proposing a solution:

  • Perceived quality issues:

    • There would be no time for Alpha or Beta Releases - so all Members would have to be comfortable with issues in Production for until the next interim release

    • All issues that normally get tidied up as part of the normal Content Authoring cycle will become public - they will get fixed quickly but in the meantime there may be an impact to the reputation of the quality of SNOMED CT.

  • Roll up Releases:

    1. The 6 monthly delta releases would need to be relative to the prior 6 month release, and therefore named as such somehow (ie) we would need to somehow make it explicit as to which previous release the delta is a differential to.
    2. Other possibility is that each month is the same interim release, and then every 6 months we also release the Delta's relative to the priori 6 monthly release, in addition to the usual monthly release.  In this case we would need to reserve the 31st Jan + 31st July effectiveTime's /package naming for the 6 monthly roll up releases, so that the users who want to remain on 6 monthly schedule would remain unaffected.
  • The other option is to have no roll up releases at all, thus releasing a stand-alone package every day/week/month, depending on the agreed frequency. The issue with this approach though is that anyone using the Delta files (rather than Snapshot) for uploads would need to keep up with the continuous schedule.



  • Allows people to choose whether or not the users take one release every 6 months, or frequent monthly releases...
  • Derivative maps wouldn't be a huge issue as just release them whenever we had a chance, dependent on whichever edition
  • One of the plus points are that when we're still at 6 monthly releases, if the vendors miss a release its a big deal, whereas if they miss monthly releases then they have a smaller impact


  • One drawback is for the non english speaking members, who need to keep up with translations - shouldn't really have an impact if they keep up with each smaller release.
  • Could be painful for translations when a monthly release happens to contain a drop of a huge project like Drugs or something...
  • What about interoperability issues, with some people taking each monthly release, and others still waiting for every 6 months? ADHA believe this hasn't caused a huge problem for them, just an addition to the existing problem even with 6 monthly releases...
  • Also need to implement the metadata for identifying which dependent release each Delta is relative to...
  • Refsets aren't too much work to keep up to date - however Mapping is a different ball game - this can take some time
  • Maps that are still inherent in the int Edition (ICD-0 ICD-11 etc) are potentially problematic, and the workflow would need to be carefully worked out...
  • If your projects happen to drop in-between the normal 6 monthly releases, then someone who might have taken Jan and July still, might miss out on the important big releases that happen in April and November!
  • Also quality might be an issue - need to have the automated testing completely airtight before we move to continuous delivery! Thereafter you would run all major validation at input stage and ensure authors only ever promote to MAIN when everything perfectly clean. Then we run Daily builds with automated release validation every night, and provides a RAG status on release issues every morning. Then by the end of the month, we publish the last Green Daily build!
  • Andrew Atkinson to continue to feed all of this into the continued internal discussions on whether or not moving to more frequent Delivery is feasible, and if so plan what the timelines would look like:
  • Move to Monthly Releases before we go to full continuous delivery - yes, everyone agreed
  • How do we best automate all of the validation?
    - Best thing is to make the RVF the central source of truth for all International validation.
    -Therefore NRC's like Australia will promote all International related content to the core RVF, and only retain and run validation that is local to themselves.
    -This would mean that whenever they identify a new issue, they can simply promote the new test up to us and we can run it and replicate the issue for ourselves, and therefore fix it quickly.
    -It will also share the burden of maintaining the validation rules.
  • Question: can we do any automation for Modelling issues? ECL? New validation using the editorial rules in the new templates as a basis for automating modelling QA? ECL the best bet - plus MRCM doing well so far - can we extend this? (Australia so far only implemented modelling validation by writing manual rules for known issues)
  • What's the impact of multiple effectiveTimes in Delta files? Should be negligible, Australia and US already implemented with no effect to users (despite initial complaints!)
  • Creation of a bespoke Delta using a new tool - Delta at the International level is very simple, but at the Extension level is much more complex due to all of the dependencies, etc. This could also become more involved when we modularise...
    -Australia intended to build this as well, but it never happended because no one ever requested it in the end!
    -The other issue was the traditional issue of never knowing (in a machine readbale way within the Delta file itself) what the Delta file is a Delta from (ie) is it a delta from the Jan 2014 release, or the July 2016 release, etc.
    -So there as a lot of discussion over whether or not they should create roll up Delta's, or provide the service - but in the end they found that only a few people were actually using Delta's, and those were the people who knoew what they were doing already, and so nothing was ever required!
    -So we need to decide whether or not this is useful...
    -We also need to be wary of the fact that there are two different things to be relative to - so you can have a Delta to a release, or a Delta to a date in time, and they can be very different things.
    -Suzy has always released a delta with multiple effectiveTimes in it (due to the Edition) and no-one has any issues of this ever.
    -If we remove the Delta files completely everyone would definitely need to provide a Service to download bespoke Delta's (both International and local Extension level) - AT THE SAME TIME WE SHOULD FIX THE ISSUE OF LACK OF METADATA PROVIDED FOR WHAT THE BASELINE OF THE DELTA IS
    -For local extensions this service does get a lot more complex than for International, as they need a range of Delta dates PER MODULE, as they have a lot more going on than just the International Edition - so the service would need to be a) clever enough to correctly get the relevant depednencies from all sources, plus b) Validate that the resulting Delta is correct and valid - provide a checksum of some kind (needs to be identified).
  • Release Notes automation - simple, just attach notes metadata to each change in MAIN then export on Release
  • Question: Is it worth starting off with a trial using just Content Requests monthly, and then bring everything else in line once happy? NO! Everyone feels strongly like there would be no benefit to this whatsoever, as the majority of urgent cases in CRS are to do with getting an ID to use in refsets etc before the next 6 monthly release, and as this has already been mitigated due to the new tooling providing those ID's early, there's no benefit in moving to CRS early. Small risk in moving to monthly at all, so better off just moving everything at once to prevent a) confusion for users b) confusion in message about continuous delivery, and c) overhead for SNOMED managing 2 different delivery schedules during the pilot
  • Question: What are the next steps that we need to consider to help move this forward? Central RVF service, communication with community (survey etc)
  • Question: Is everyone happy with the new plan to remove the Delta files from the RF2 packages completely, and just provide the Delta service to create Delta's on the fly? YES
  • Question: How can we get a survey out to as many implementers as possible in order to ask a lot of these questions and get the
  • Question: How do we manage translations? (including the Spanish release) - How do we cope with the likelihood that one month could have only 50 changes, and the next month 50,000 (Drugs project, etc)? - no impact, as should allow for incremental translations - just need to not set expectations with your users that you stay one month behind the International Edition! Just need to decouple the translation release schedule from the International Edition schedule. ARTURO woudl prefer the Spanish edition to also move the Monthly (or even more frequent) releases, but he fully understands the natural latency required for translated Editions, and so understands even if we went to monthly we can't keep up with the monthly content changes
  • Question: How do we manage extensions? Again need to decouple them - MDRS will naturally get a lot bigger - also the versioning process internally currently takes a long tiem and a lot of effort for each upgrade to the new International Edition...
  • Question: How do we manage derivatives? Just keep them decoupled from the International Edition release schedule, and do not set false expectations by promising to keep them closely up to date with monthly International Releases!
  • Question: How do we manage maps? So again there is a natural latency here where we can't keep up to date with monthly releases. WE ALSO NEED TO DEFINE WHAT AN ACCEPTABLE UNIT OF RELEASE IS FOR EACH TYPE F CONTENT CHANGE (so what our concept of "DONE" is for each type of change) - FOR EXAMPLE SOME CONCEPTS SHOULD NOT BE RELEASED UNTILT HE RELEVANT ICD-10 MAP COULD BE CREATED AND PUBLISHED AT THE SMAE TIEM. OTHERS COULD BE RELEASED NO PROBLEM AND WAIT FOR 6 MONTHS FOR THE RELATED MAPS...
  • Question: What questions would we like to ask the vendors and affiliates to a) Ensure we cover off all problems/potential issues, but b) do NOT put us in a position where they think that we might not go ahead with the plans despite their answers.... just wording the survey to ensure that they know we're going ahead, but just want to ensure there's no negative impact to them that might tweak our plans, and c) How much time do they need to adapt to the change for multiple effectiveTimes in the same Delta, and d) How do we promote the benefits? (responsiveness to changes with more frequent releases, improvement to quality with more frequent fixes, etc)

  • Andrew Atkinson to create a survey to provide to everyone so that they can send out to all users and get feedback on the proposed changes (especially multiple effective Times in Delta files, and removal of Delta files - just a service now):
  • TRAG to add/update any of the questions....
  • Andrew Atkinson to refine survey to ensure that it's accessible to those with more limited SNOMED knowledge/experience, as these are the preferable target market for the survey, given that the more advanced users will (or have already) speak up for themselves:
    • GDPR questions - verify with Terance whether or not we just need to provide a link to our data policy (, or if we specifically need to ask the questions (of whether or not they're happy for us to store their data, etc) as questions in the survey? (check box) - If the latter, ask if we have standard legal wording I can use?
    • Small intro - description + pros/cons
    • Couple of fairly wide ranging questions as to whether or not they think they'll be impacted
    • If so, then either fill in the details here (conditional question in google forms) OR please just get in contact with your NRC to discuss
    • Avoid technical language for non native English speakers
    • Suzy to include in her UMLS survey in January
      • Not done yet as she's stuck with red tape in the NLM!
  • Andrew Atkinson refined the survey accordingly, and sent out to TRAG members for final review on 16/10/2018:
  • Andrew Atkinson sent final survey to Terance and Kelly in particular, (from GDPR and comms perspective) to ensure in line with company strategy and verify whether or not they'd prefer this to be an SI survey or NRC surveys?
  • Survey sent to the TRAG to disseminate to their users
  • Survey also sent to Kelly for inclusion in the newsletter, and also on LinkedIn
  • TRAG members to send out the survey...
  • Awaiting all results... ANYTHING BACK YET from anyone?
    • NO!

  • Additional questions:
    • How do we validate translations? (NLP?)
    • Implications (maps, on demand deltas)

      • LARGE impact on MRCM changes - we need to carefully consider whether or not we can publish MRCM concept model changes without first having waited for all of the concepts impacted by them to have been updated as well (so to isolate them all in a feature branch before publishing anything) - HOWEVER, this does restrict the time to market of the new concept model changes that might want to be published before we have time to update all of hte relevant changes...

      • We need to discuss further with Linda, Yong, etc...

    • Impact on NRCs present - how can they help out with testing/validation when Alpha/Beta periods are no longer in place?

    • Vendors (non-NRCs) view of frequent releases

    • VALIDATION advances:

      • OWL testing - anyone worked on this as yet?

      • Template validation - thoughts?

      • Implementation testing feasible? (see Implementation Load Test topic below)

      • Need to identify Modelling areas that need improving - for example where concepts have 2x parents, this is usually an indication of areas that need re-modelling
      • Need automation of the QA system itself - so some quick way to validate RVF + DROOLS Assertions, both old + especially new!

    • We need to re-consider the Critical Incident Policy, UNLESS we can get at least several different entities downloading and testing the monthly releases EVERY MONTH!
      • This is because if someone say only takes the release every 12 months (or even worse 24 months), and then finds a critical issue in a now 2 year old release, we would currently have to recall and republish 24 releases! 
      • Instead, we need to have agreement from the Community on a “Forward Only” approach, whereby any issues found (even Critical ones) are fixed from the next Release onwards (or possibly in several Releases time if they’re low priority issues).  Critical issues would simply have to be communicated out, warning everyone NOT to use any previous impacted releases.
    • Whitelisting - API required?

    1. What should the criteria be that differentiates between what goes in each Edition:
      1. SNOMED CT Core
      2. SNOMED CT International Edition
      3. SNOMED CT Community Edition
    2. What level of quality do we allow into the Community Edition? 
      1. Any quality (quick and sharable) vs validated (slower but better)
      2. One suggestion is that instead of certifying the content, we could certify the authors themselves - so we could differentiate between projects which are authored by newbies, vs those who have say passed our SNOMED CT authoring certification level 1, etc
      3. Another suggestion is that whoever delivers content to the Community content would have to provide the MRCM to support it, + conform to editorial guidelines, etc
        1. So a list of “quality indicators” could be automated against each project (eg):
          1. MRCM compliant
          2. Automated validation clean
          3. Authors have SNOMED CT certification
          4. Peer reviewed
          5. Release Notes
          6. Etc
        2. And then people can make their own minds up about which projects to use based on comparing the quality indicators between projects
      1. For example, what happens if we change something in the core which breaks someone way down deep in the Community Edition?  (Which we can’t possibly test when we make the change in the core)
      2. The idea here would be that whoever creates the branch in the Community Edition then manages and maintains it - so everyone maintains their own branch, and is therefore responsible for resolving the conflicts coming down from the core, etc
      3. Versioning also becomes important, as whoever creates it needs to specify which Versions of each dependency their work is based on - (eg) they would state that their work is based on the 20190131 International Edition, and therefore any impact we have on the downstream community content would only happen when the owners of that content decided to upgrade their depednency(s) to the new version
    4. Promotion criteria important - thoughts?
    5. Do we remove the need for local extensions, as they can then simply become part of the Community Edition, with any local content just existing in a “country specific” edition within the Community Edition
      1. This also provides some level of assurance of the quality of the content in the Community Edition - as these would be assured by the NRC’s (and SI in some cases) and therefore provide a good baseline of high quality content for people to then start modelling against
    6. ModuleDependency is going to be important - 
      1. perhaps we answer this by making the entire Community Edition part of the same module - therefore it will all classify as one entity?
      2. However a lot of people will ONLY want to cherry pick the things that they want to take - so we need a method for taking certain modules (or realms or whatever we call them) and allowing people to create a snapshot based on just that content instead of the entire community edition
    7. Dependencies need to be properly identified:
      1. Could the CORE be standalone and published separately?
      2. Or would the CORE need to have dedpendencies on the wider International Edition, etc?
    8. HOWEVER, how do we classify the entire Community Edition when there could be different projects dependent on different versions of the depenencies (such as the international Edition)?
21Implementation Load TestAll

RVF has now been open sourced to allow people to contribute towards it more easily, so that Implementation issues can be reverse engineered into the assertions. All of the NRC validation systems should remain separate, in order to ensure as great a coverage across the board as possible.

However, it makes sense to ensure the critical tests are included in all systems, in order to ensure that if, say, one NRC doesn't have the capacity to run Alpha/Beta testing for a certain release, we don't miss critical checks out. We are working on this in the Working Group, and also in the RVF Improvement program, where we are including the DROOLS rules, etc. These are also being incorporated into the front end input validation for the SCA.

TRAG to therefore discuss taking the Implementation Load test forward, including the potential to incorporate key rules from NRC validation systems into the RVF. So we should discuss the tests that are specific to the Implementation of vendor and affiliate systems, in order that we can facilitate the best baseline for the RVF when agreeing the generic testing functionality in the Working Group.

  • Matt Cordell will promote some useful new ADHA specific rules to the RVF so we can improve the scope... report back in April 2019
  • Chris Morris to do the same - get the RVF up and running and then promote any missing rules that they run locally.... report back in April 2019

Modularisation of SNOMED CT


Dion McMurtrie completed the Alpha release - did anyone have chance to review it? (I haven't had any requests for access to the remainder of the package)

The subject of Modularisation needs to be discussed between the various AG's who are considering the topic, before we can proceed with the Release-specific sections.

We need to discuss any red flags expected for the major areas of the strategy:

  1. Modularisation
  2. Members who want to abstain from monthly releases, and therefore need to use delta's with mulitple effective times contained within.
  3. Also need to consider if we continue to hold the date against the root concept - works perhaps still for 12 monthly releases, but not necessarily for continuous delivery daily!
  • Understand the Use cases thoroughly, and refine the proposal doc to provide people with more real information - Dion McMurtrie TO PROVIDE THESE USE CASES FOR Andrew Atkinson TO DOCUMENT
  • Does the POC allow for concepts to be contained within multiple modules? NO - BUT DION CAN'T THINK OF ANY CONCRETE EXAMPLES WHERE THIS WOULD BE NECESSARY
  • What about cross module dependencies? Michael Lawley's idea on having a separate Module purely for managing module dependencies

  • THE PERCEIVED BENEFIT OF HAVING A WAY TO REDUCE THE SIZE/SCOPE FO RELEASE PACKAGES IS BOTH a) invalid (due to everyone's experience of being unable to successfully do anything useful with any small part of SNOMED!), and b) easily answered by tooling that using the ECL to identify sub-sections of SNOMED to pull out for research purposes, etc.
  • HOWEVER, KNOWING THE HISTORY OF THIS ISSUE, THIS WASN'T NECESSARILY GOING TO BE THE FINAL WORD ON THE MATTER, SO IS EVERYONE STILL SURE THAT THERE ARE NO KNOWN USE CASES FOR MODULARISATION?? (eg) linking modules to use cases, as Keith was talking about with Suicide risk assessment in Saturday's meeting,etc??
  • This topic came up several times again during other discussions in the October 2019 meetings, and it was clear that people had not yet given up on the idea of Modularisation - we therefore need to discuss further in April 2019....
  • See linked discussions above as well on MDRS, etc.....
23Shared ClassifierAll

TRAG to consider the full implications of the proposal to have a shared classifier.

This has now been given the green light internally - so the question now is how we can help to refine the proposal?

Harold to give an update on the MAG's plans?

  •  October 2018 - Harold Solbrig to give an update on the MAG's plans?
  • This has already been implemented as of Feb 2018 - any concerns?
  • Has anyone used it yet? Not yet, but the accessibility is good, so will report in April 2019 when people have used it in anger....
  • No-one intending to use it as yet, so will close down the discussion point until they do
24Proposed changes to the classification wrapper to support new Drug ModelAll

TRAG to consider the full implications of the proposed changes

Harold to give an update on the MAG's plans?

  •  October 2018 - Harold Solbrig to give an update on the MAG's plans?
  • Can this now be closed down in lieu of the final plan for publishing the Drugs work? Yes!

Concrete Domains

* MAG crossover


The short term proposal of precoordinating the numbers and measures as concepts (and therefore not changing the RF2 format) was generally well accepted, though there were concerns raised regarding the longevity of this approach, and whether or not this addresses the original target of the project (which was to allow a standardised approach across all extensions, instead of perpetuating distinct coding for different users). The other concern raised was that any solution needs to be implemented rapidly, as otherwise the various members will be forced to start/continue implementing their own solutions.

Peter G. Williams, therefore, will take this forward in the Modelling AG and further implementation. The functionality has been rolled in to the wider discussion of enhancing SNOMED’s DL capabilities.    The Modelling AG is planning a targeted discussion on this in June 2017, and will then produce a document which would then be reviewed by the MAG at the October conference.This Proposal document will be shared when complete.

Last update from Peter was that the OWL Refset solution allows us to classify with concrete domains. The thing we’re still discussing, is how to represent that in the release. The currently most popular approach suggested is to create a 2nd inferred file which contains concrete values in the destination column, rather than SCTIDs. This allows them to be added without impact to the current approach i.e. ignore it if you don’t want to use them. The new file would only contain concrete values.

Harold to give an update on the MAG's plans?

  •  October 2018 - Harold Solbrig to give an update on the MAG's plans? No further updates yet, check back in April 2019....
  • Update from Peter Williams after subsequent MAG discussions....
26Discussion on the conflict between Extension content and International content


Jim Case

The answer to this may be quite simple:

  1. If extensions promote content via RF2 delta, we just need to retain all ID's, and only change the ModuleID and effectiveTime, and therefore it is all managed by effectiveTime.
  2. If IHTSDO reject content this is also managed
  3. The only issue then comes if IHTSDO want to change the FSN, then we need a way to manage the change of the meaning of the concept without creating 2 FSN's - as then we need a feedback loop to ensure that it's also corrected at source in the extension as well as in the International edition.

TRAG to continue the discussion and come to a conclusion that will work for all.

  • Has this been answered in its entirety by Jim's new agreed approach? (link here to his final position)
  • Most people consider that Jim's approach covers this under most circumstances. We also need to ensure that we follow the approach listed to the left - so we should confirm all of this has been working in practice since April 2018, and if so close down.
27Member Forum item: "Development of a validation service where releases can be submitted for testing"All

Last meeting the TRAG proposed use cases for creating an actual service (with a user-friendly UI, etc) to enable people to load up their release packages and run them through the standard validation assertions.

Standardisation is the primary use case here - everyone agrees that there is a significant benefit to interoperability by ensuring that all RF2 packages are standard and conformant to the basic standards at least - and so this is a strong business case for the service.

We agreed that whilst we have the appetite to have one, this will be a long term goal - to get us started we should use the open sourced RVF as a basis to refine the rules.

We therefore setup a working group to decide a) What the scope/targets should be b) What technology platform would be most appropriate c) What the high level rules should be (packaging format, content etc) - Working Group: Generic Validation service

The good news is that we've now used the initial discussions we had as part of the working group to refine the requirements for the ongoing RVF improvement program. This is due to complete within the next few months, at which point the working group will meet again in order to begin the full gap analysis between the various streams of validation that we all have.

Liara also discussed validation with ADHA during the London conference - Dion do you have a quick update on where those discussions got up to?

  • Plan is to ensure that the generic service is flexible enough to fail gracefully if certain extensions don't contain some of the expected files, etc.
  • We should also provide a standard Manifest to show what files they should include wherever possible (even if blank)
  • We'll now take this forward with the working group, using the comprehensive list of current SI assertions as the baseline:
  • AAT sent the list out to the working group in October 2018, and requested comparison analysis results to be posted asap, with a view to being able to report back to the TRAG on proposed scope in April 2019...
  • Reports from the comparison analysis from the working group...
    • Suzy...
    • Matt...
    • Chris...
28New refsets release loaded on the SNOMED BrowserThe Canadian NRC has asked Suzy to raise this proposal on their behalf, and so Suzy will present this at the next TRAG meeting: 

1. Before sending the Refsets Release announcement if the refsets could be loaded in the SNOMED Browser, that would be great. This way, stakeholders would be able to browse the content from the tool they are used to. 
2. Add to the announcement that the refsets can be browsed through the Browser as well as they can be accessed through MLDS. 
3. Send the announcement. 

This would require us to include the addition of all refsets to browser into our formal release processes, as so far they have been added as and when available, and on an informal basis (without comms, etc).  So the question here is not whether or not we can do the process above, as this is very simple - it's more a question of whether or not we think having the refsets visible in the browser is a useful feature, and not misleading in any way?
  • Andrew Atkinson to check whether or not the refset function in the browser allows searching?
    • ANSWER - Yes, but in reverse, so you don't go into the Refset and search within the refset, instead you run a normal search for the concept, and then hit the Refset tab on the right, and this shows you all the refsets that this concept is part of. You can also then click on "Open maps for this concept" and get linked through to all maps that contain this concept in the Mapping Tool.
  • Andrew Atkinson to check also if the ECL expression functionality works in the refset section of the browser, as it does in the normal content?
    • ANSWER - Not at the moment - please submit a feature request or build it locally and submit the code for us to incorporate into the browser.
  • Ask Rory if there is a way around the fact that the resets like gp/fp are removed in the rf2 to json representation when the new international editions are loaded?

  • The Release AG agreed that, now that we have all of the refsets uploaded as part of the standard release process, it would be overkill to add the announcement of the browser update to each Production Refset release announcement, to confirm it will be updated in the browser as well (as this can now be taken as read that it will be done as part of the release process)

  • How is it going now with the browser releases happening each time?

  • Linda Parisien confirmed that new process is good and so this can be closed down...

29"Negative Delta" file approachAllThis approach was successfully implemented in order to resolve the issues found in the September 2017 US Edition - is everyone comfortable with using this approach for all future similar situations? If so we can document it as the accepted practice in these circumstances...
  •  NO! Everyone is decidedly uncomfortable with this solution! In particular Keith Campbell, Michael Lawley and Guillermo are all vehemently opposed to changing history.
  • The consensus is that in the particular example of the US problem, we should have instead granted permission for the US to publish an update record in the International module, thus fixing the problem (though leaving the incorrect history in place). This would have been far preferable to changing history.
  • ACTION POINT FOR EVERYONE FOR OCTOBER 2018: (Dion McMurtrie, Matt Cordell, Orsolya Bali, Suzy Roy, Corey Smith, Harold Solbrig, Mikael Nyström, Chris Morris
    We therefore all need to come up with potential scenarios where going forward we may need to implement a similar solution to the Negative Delta, and send them to AAT. Once I've documented them all, we can then discuss again and agree on the correct approach in each place, then AAT will document all of these as standard, proportionate responses to each situation, and we will use these as guidelines in future. If we have issues come up that fall outside of these situations, we'll then come back to the group to discuss each one subjectively, and then add them back into the list of agreed solutions.
  1. Preference now is to retain EVERYTHING in the Full file, regardless of errors - this is because the Full File should show the state at that point in time, even if it was an error! This is because there is not an error in the Full file, the Full file is accurately representing the error in the content/data at that time.
  2. The problem here is that the tools are unable to cope with historical errors - so we perhaps need to update the tools to allow for these errors.
  3. So we need the tools to be able to whitelist the errors, and honestly document the KNOWN ISSUES (preferably in a machine readable manner), so that everyone knows what the historical errors were.
  4. The manner of this documentation is up for debate - perhaps we add it to a new refset? Then we could use something very similar in format to the Negative delta, but instead of it actually changing history retrospectively, we simply document them as known issues, and allowing people to deal with the information in their own extensions and systems in whatever way they feel is appropriate.
  5. Only situation we can think of where we couldn't apply the above gentle response, would be copyright infringement - whereby if we discovered (several releases after the fact) that we had released content that was in direct infringement of copyright, then we would potentially have to revoke all releases since the issues occurred. However, this would raise a very interesting situation where patient safety might be compromised - as if we remove all historical content that contravened the copyright, then we run the risk of patient data being impacted, thus potentially adversely affecting decision support. This is simple to resolve when the problem is in the latest release (simply recall the release), but if found in a 5 year old release for example, it could be very problematic to recall 5 years' worth of content and change it!
  • October 2018 - Guillermo proposed a separate possibility, which is to introduce a new Status (eg) -1 whereby if you find this status in the latest snpashot you would just ignore it - this doesn't however address the use case where there is a legal contravention and you need to physically remove the content from the package - the use case where you would have something that contravenes RF2 paradigm, you can't use the RF2 format to correct something that is RF2 invalid! So this is unlikely to work...
    • Nobody is on board with this idea, as it's too fragile and introduces unnecessary complexity such as we had with RF1...

  • April 2019
  • If we're still all in agreement with this, then steps 1-5 above should all be documented and disseminated to get confirmation of approval from everyone??
  • Did everyone read through everything? Has anyone got any further scenarios that we can include in the documentation?

  • The EAG raised this issue again on 08/04/2109 - Peter to try to make it to the next TRAG to explain the use case that was raised today and elaborate on the new proposal...
  • The TRAG discussed this issue at length, and came to the conclusion that we cannot address ALL potential use cases with a standard, generic, solution (certainly not any of those offered above).
    • Instead the solution in each case should be agreed on given each specific use case that comes up each time
    • So INSTEAD we should update the Critical Incident Policy to very clearly define the process to be followed each time we need to remove something from the Published release(s):
      • Which group of people should make the decision on the solution
      • Perhaps we also provide examples of how each use case might be resolved:
        • For Legal/IP contraventions, we should either remove content from history entirely, or redact it (leave the records in place, but remove all content from fields except for UUID, effectiveTime, moduleID, etc - thus allowing traceability of the history of the components, without including the offending content itself)
        • For Clinical risk issues, we can remove it from the Snapshot, but leave the Full file intact to leave a historical audit trail whilst ensuring that the dangerous content shouldn't get used again (as most people use the snapshot) - see Full file steps 1-5 above, etc
      • How to communicate it out to the users, etc
  • Andrew Atkinson to update the Critical Incident Policy with
    • the various use cases that we've identified so far
    • the governing bodies who should be the deciding entities
    • the process for making the decision in each case
    • including the critical entities that need to be collaborated with in each case (all NRC's, plus 3rd party suppliers (termMed etc) who represent some of them), to ensure the final solution does not break outlying extensions or anything
    • the process for communicating out those decisions to ALL relevant users
30Potential for adding a "withdrawn" reason for inactivated contentAllDiscussions around the future strategy for SNOMED CT have included the potential for adding new statuses for content. 

In particular, many people have suggested that problems are created for those either mapping or translating from content that's still "in development". If (as is often the case) they use Daily Builds etc as input data, they can often get tripped up by content which is created but then withdrawn before it's versioned and officially released. It would be extremely useful to those users to have access to traceability data describing the reasons behind why they were removed, in order to support accurate mapping/translation. 

In another use case, there's the possibility that content needs to be formally withdrawn from the International Edition AFTER it's been officially released. This would be the case if, for example, content has unintentionally been published that breaks the RF2 paradigm, or contravenes licensing laws, etc. In this case mere inactivation is not sufficient, the content instead needs to be completely withdrawn from the releases and sometimes even from history. 

The TRAG needs to discuss all of this and be ready with recommendations if these proposals are taken forward.
  • Use cases:
    • undo a historical issue (that break RF2 paradigm, etc) but don't want to pretend it never happened - in this case we should use the Negative Delta approach - but only used in EXTREME circumstances
    • Legal contraventions - in this case we should use the Negative Delta approach - but only used in EXTREME circumstances
    • Dead on arrival components - it should be okay to have these, and have them openly dead on arrival and therefore inactive to not map to them etc. However it's useful to be able to see these (even though they'd been activated + inactivated within the same release cycle) - so for those people who need to map/translate etc DURING the release cycle, they have to rely on the Daily Build and use live data still in development. Therefore if those concepts disappear by the time of the International Edition it causes problems for those maps/translations already including those concepts.
      • Therefore the best answer is for us to move to having 2x Daily Builds - the existing one + a separate true Daily Builds - where each Daily Build is built relative to the previous Day, and NOT to the previous Published release. This new Daily Build could then be properly relied upon by mapping and translation projects.
      • Can we align this with the transition to the more Frequent Releases?

32AG Declarations of InterestAllCould each of you please go in and update your information? If there has been no change, then you can simply update the last column with the date. 
  •  April 2019
33Any other questions / issues?All