The objective of this page is to provide an overview of the inactivation values which are currently available in the International Edition, and provide a definition of their meaning. This document is intended to serve as a common point of reference for discussions aimed at clarifying potential enhancements to the inactivation values or associated process.
Concept Inactivation Values
The following concept inactivation values have been extracted from the July 2020 Release of the International Edition (< 900000000000481005 | Concept inactivation value (foundation metadata concept) |).
Where a concept's inactivation can be assigned to one of these reasons, it is asserted by adding an entry in the 900000000000489007|Concept inactivation indicator attribute value reference set (foundation metadata concept)| where the referencedComponentId is the ID for the inactive concept, and the linkedComponentId is one of the metadata conceptIds below:
| Term | ConceptId |
|---|---|
| Pending move (foundation metadata concept) | 900000000000492006 |
| Component moved elsewhere (foundation metadata concept) | 900000000000487009 |
| Limited component (foundation metadata concept) | 900000000000486000 |
| Erroneous component (foundation metadata concept) | 900000000000485001 |
| Ambiguous component (foundation metadata concept) | 900000000000484002 |
| Outdated component (foundation metadata concept) | 900000000000483008 |
| Duplicate component (foundation metadata concept) | 900000000000482003 |
| Nonconformance to editorial policy component (foundation metadata concept) | 723277005 |
The existence of one further 'none of the above - no stated reason' reason is thus only implied but does not have (or, technically, need) an explicit metadata concept associated with it.
Instead, this lack of an explicit reason is encoded only by means of the absence of any of the 8 possible flavours of recorded association (above) for the relevant inactive concept within the 900000000000489007 cResfet.
Definition and Use
| Value | Definition | Comments / Questions |
|---|---|---|
| Pending move | Glossary Definition
UNDER RF2: The state of an active component that is thought to belong in a different Module and/or in a different Extension or Edition from that in which it currently resides, while awaiting transfer to that new Module and/or locus of editorial control. A new Concept and associated Descriptions may be added from the beginning with this Status where a missing SNOMED CT Concept is urgently required to support the needs of a particular Extension or Edition but where there is an expectation that another module (especially the International Edition) will at a later date also add semantically identical content. Existing Concepts that have already been released as an ordinary active concept may also be given this status if it becomes recognized that they should be moved to a different Extension or Edition or to the International Release. Terminology Services Guide
UNDER RF2: The Concept is active but in the process of being proposed for a move to another locus of editorial control, and so within a different Module and Extension or Edition from that were it now resides. If the move is accepted and completed, the conceptId will remain active and with the same identifier, but be listed in some other module. It will also no longer have this status but may instead be forever assigned to the status Component moved elsewhere (q.v.) in the donor module - though this step is largely redundant under RF2. By contrast, if the proposed move is rejected, the conceptId remains active and within the module it was always in, and loses this status. Editorial Guide N/A | This used? And does this mean that the |concept inactivation indicator attribute value reference set| contains references to active components which are pending move? JR: Yes, it is used extensively but usually only by NRCs. Whenever they create a concept within their extension but believe that it has validity and applicability on the wider international stage, this status is used to flag that they have proposed it for promotion to the International Edition. EXAMPLES (FROM THE UK Extension) 20160401 1024551000000109|Under care of hospital-based diabetes specialist nurse (finding)| |
| Component moved elsewhere | Glossary Definition
The state of a component that is now inactive in its original module but that has been moved to another Module and in a different Extension or Edition, where it is now active. Concepts or Descriptions may be moved from an Extension or Edition as 'content donor' to the International Release as 'content recipient', or in the opposite direction from the International Release as 'content donor' to an Extension or Edition as 'content recipient', or between one Extension or Edition and another. Such moves typically occur if responsibility for supporting the Concepts changes to another organization; this change of responsibility is ultimately already recorded by means of changes in Module. However, the 'donor' module can optionally and additionally also record the fact of responsibility having been handed off elsewhere, using this status. Terminology Services Guide
The concept may or may not become inactive in its original module: it may be best practice for it to do so, particularly in the special case where it moves down the dependency tree, but (unlike RF1) this is not strictly technically required. Under RF2, correct use of the "component moved elsewhere" status is a matter for urgent clarification, especially if in fact most components with that status should now remain active in their original source module. Editorial Guide
| EXAMPLE(S): 332570000 |Dermablend cover cream 28.4g (product)| 20180731 10079006|Infection caused by Cysticercus cellulosae (disorder)| |
| Limited component | Glossary Definition N/A Terminology Services Guide The Concept is of limited value as it contains classification categories such as 'Not Elsewhere Classified' which do not have a stable meaning within SNOMED CT . Until 2010 concepts with this status were regarded as active but since then they have been marked as inactive. Editorial Guide No longer in use and no requirement to retain | EXAMPLE(S): 218584008 |Adverse reaction to blood or blood products NOS (disorder)| 20170731 197752005|Nephropathy induced by unspecifed drug, medicament or biological substance (disorder)| |
| Erroneous component | Glossary Definition N/A Terminology Services Guide The Concept has been made inactive because it contains an error. Editorial Guide
| EXAMPLES: 20170731 103642003|Reactive cellular changes associated with intrauterine contraceptive device (morphologic abnormality)| |
| Ambiguous component | Glossary Definition N/A Terminology Services Guide The Concept has been made inactive because it is inherently ambiguous either because of an incomplete fully specified name or because it has several associated terms that are not regarded as synonymous or partial synonymous. Editorial Guide
| EXAMPLE(S) 182120006 |Foot bone: [other] or [metatarsals &/or phalanges] (body structure)| |
| Outdated component | Glossary Definition Terminology Services Guide The Concept has been made inactive because it is an outdated concept that is no longer used. Editorial Guide The concept has been made inactive because it is an outdated concept that is no longer used | EXAMPLE(S): 384900005 |Haloperidol 100mg injection solution ampule (product)| 20170731 103112000|Lymphocyte antigens CD10+ CD20+ (substance)| WAS_A 105590001|Substance (substance)| |
| Duplicate component | Glossary Definition N/A Terminology Services Guide The Concept has been made inactive because it has the same meaning as another Concept . Editorial Guide | EXAMPLE(S) (with active duplicate): 20180731 102266007|Kosher diet (finding)| SAME_AS 765025006|Kosher diet (regime/therapy)| |
| Nonconformance to editorial policy component | Glossary Definition N/A Terminology Services Guide N/A Editorial Guide Applies to a concept which does not adhere to the Editorial guidelines | EXAMPLES(S): 32059002 |Actinium-225 (substance)| 20180731 10243007|Benzoic and salicylic acid ointment (product)| |
| Reason not stated | Glossary Definition None of the above Terminology Services Guide The Concept has been made inactive but the reason for this inactivation is either unknown, not one of the codeable reasons (above) or was for some other reason not recorded. | EXAMPLES (there were 6,969 examples in the July 2018 International Edition) 105636004 20180131 Disease of possible viral origin (disorder) |
Description Inactivation Values
The following description inactivation values have been extracted from the July 2019 Release of the International Edition (< 900000000000493001 | Description inactivation value (foundation metadata concept) |)
| Term | ConceptId |
|---|---|
| Concept non-current (foundation metadata concept) | 900000000000495008 |
| Inappropriate component (foundation metadata concept) | 900000000000494007 |
| Pending move (foundation metadata concept) | 900000000000492006 |
| Component moved elsewhere (foundation metadata concept) | 900000000000487009 |
| Limited component (foundation metadata concept) | 900000000000486000 |
| Erroneous component (foundation metadata concept) | 900000000000485001 |
| Outdated component (foundation metadata concept) | 900000000000483008 |
| Duplicate component (foundation metadata concept) | 900000000000482003 |
| Not semantically equivalent component (foundation metadata concept) | 723278000 |
| Nonconformance to editorial policy component (foundation metadata concept) | 723277005 |
Definition and Use
| Value | Definition | Comments / Questions |
|---|---|---|
| Concept non-current | Glossary Definition N/A Terminology Services Guide The Description is still active but the Concept it refers to is now inactive. Editorial Guide N/A | Why does this value exists? It does not make sense to have a description inactivation value which is used for Descriptions that are still active. It is the general principle that descriptions that are associated with a concept when this is being inactivated, are retained active. This is to enable display of terms associated with inactive concepts. JR: I had thought it was only an RF1 throw-back; at some point early in the RF1 design, somebody decided that it would be useful (though obviously not strictly technical necessary...) to flag the active descriptions of an inactive concept so that they directly indicate that they belong to an inactive concept. No idea what the use case for this bit of denormalization was. But in RF2 at least it seems that there are many inactive descriptions assigned to this reason whose underlying conceptId is in fact still current: EXAMPLES (where conceptId itself is also inactive) 20160131 3085007011 Remaining Fallopian tube - open: [clipping] or [ringing] (procedure) (176944004|Remaining Fallopian tube - open: [clipping] or [ringing] (procedure)|) |
| Inappropriate component | Glossary Definition N/A Terminology Services Guide The Description has been made inactive because the associated term is does not describe the associated Concept . Editorial Guide |
EXAMPLES (with conceptId and its FSN): 20170131 189596019 Epileptic seizures (84757009|Epilepsy (disorder)|) |
| Pending move | Glossary Definition The state of a component that is thought to belong in a different A new Concept and associated Descriptions may be added with this Status where a missing SNOMED CT Concept is urgently required to support the needs of a particular Extension. Existing Concepts are also given this status when it is recognized that they should be moved to a different Extension or to the International Release. Terminology Services Guide The Description is still active but it is in the process of being moved to another Editorial Guide N/A | Same question applies here as to "concept non-current". AFAIK Individual descriptions are never moved on their own, without also moving the concept they are attached to. I can't think of a valid reason why or circumstance where you would ever want or need to. Therefore, if you want to know whether a given active descriptionId happens to be attached to a conceptID that is itself pending move, you can look that up. SO this is another bit of RF1 Convention denormalization, I think. EXAMPLES (from UK NRC, which has 53,026 instances): 20161001 2660031000000116 Primary lower subciliary and transconjunctival blepharoplasty with fat excision and canthal sling (procedure) |
| Component moved elsewhere | Glossary Definition The state of a component that has been moved to another Concepts or Descriptions may be moved from an Extension to the International Release, from the International Release to an Extension or between one Extension and another. Moves occur if responsibility for supporting the Concepts changes to another organization. Terminology Services Guide The Description has been moved to another Module, where it remains active Editorial Guide | EXAMPLES: 20170131 350802019 Arteriovenous malformation (234141001|Congenital arteriovenous malformation (disorder)|) |
| Limited component | Glossary Definition N/A Terminology Services Guide The Description refers to a Concept that has limited status. Note: This value should not be used in future releases as Limited status Concepts are now inactive. However, this value may appear on retrospective data in a full release . Editorial Guide | Why is limited component still an active concept in the International Edition? JR: Same reason as above: lots of components in this status. More to the point, why bother denormalising the tables to directly flag descriptionIds with an indirected conceptId in this status? EXAMPLES (with conceptId and its FSN): 20170401 436411000000111 Interventions associated with transplantation of kidney NOS (262181000000103|Interventions associated with transplantation of kidney NOS|) |
| Erroneous component | Glossary Definition Terminology Services Guide The Description has been made inactive because it contains an error. Editorial Guide A component contains a technical error Example: Case significance changes, Alpha where the lower case a should have been used Spelling errors, a description where Asthma is misspelled Assthma |
..was I think scrubbed because it is strictly a hypernym. Was replaced by 3677843019 Traumatic bone cyst of jaw. And 130540017 Neurasthaenia ...is fine as a spelling, just maybe a bit outdated as a synonym specifically of dysthymia/depressive neurosis. Its now I think associated more with chronic fatigue syndrome, though in fact SNOMED has decided nobody really can agree WHAT it means and so it currently isn't available anywhere in SNOMED as a word within an active description on an active concept. Plenty of use of the word, though, in relatively recent medical literature, though... EXAMPLES (where conceptId itself remains CURRENT): 20170731 185462016 Salmonella typhi H antibody assay (122243000|Measurement of Salmonella enterica subspecies enterica serovar Typhi H antibody (procedure)|) |
| Outdated component | Glossary Definition N/A Terminology Services Guide The Description has been made inactive because it is an outdated name or spelling that is no longer used. Editorial Guide A component is no longer current, useful, appropriate or acceptable Example: The synonym Funny looking kid was inactivated from 112630007 |Abnormal facies (finding)| |
EXAMPLES (where ConceptId remains CURRENT): 20170131 755339016 Malignant tumor of pharynx (disorder) (363507003|Malignant neoplasm of pharynx (disorder)|) |
| Duplicate component | Glossary Definition N/A Terminology Services Guide The Description has been made inactive because it duplicates another Description . Editorial Guide N/A |
JR: Barely ever used: n=302 162248005 543372010 Has prickling sensation (finding) EXAMPLES (where conceptId itself remains CURRENT): 20160731 248806011 Supervisor - housekeeping (159717004|Housekeeping supervisor (occupation)|) |
| Not semantically equivalent component | Glossary Definition N/A Terminology Services Guide N/A Editorial Guide A description does not represent the same meaning as the concept's Fully Specified Name (FSN) Example: The FSN Removal of device (procedure) has the synonym, Replacement of prosthetic device (procedure). The synonym has a more specific meaning than the FSN, so it should be inactivated |
EXAMPLES (with conceptID and FSN) 20170731 1233611015 Immunotactoid glomerulonephropathy (73305009|Fibrillary glomerulonephritis (disorder)|) |
| Nonconformance to editorial policy component | Glossary Definition N/A Terminology Services Guide N/A Editorial Guide A component fails to comply with the current editorial guidance Example: The concept Urine: turbid (finding) was inactivated and replaced by 167238004 |Turbid urine (finding)| |
15001 FSNs were inactivated this way by July 2018 20180731 3567548019 (370183008) Product containing only magnesium salicylate 545 mg/1 each oral tablet (clinical drug) |
Notes on inactivation of descriptions | When there is more than one reason to inactivate a description, the order of preference for the inactivation value is as follows:
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8 Comments
Jeremy Rogers
The usage or popularity of each these reasons has been variable over time, with several of the reasons being used intermittently for "Extinction Level Events" in which the number of inactivations attributed to that reason is, for one release only, orders of magnitude larger than the normal background rate for that inactivation reason.
Peter G. Williams
Jeremy Rogers , I'm just now catching up on this sub-group's work as we're looking to repair some legacy historical associations and hopefully removing the "WAS A" associations at the same time since they're redundant given the existence of the full relationship file (ie so you can work out the last known parents).
Something that's particularly nasty is encountering circular references where concepts A and B are both inactive and both claim the other as a SAME_AS target. Which is true, but doesn't meet the requirement of telling an implementer what active concept they should be using instead! My suggestion - in the absence of an author manually determining a better association - would be to replace the inactivation indicators as "AMBIGUOUS" and use a "POSS_EQUIV_TO" the common parent, which is what the WAS_A association is pointing to. Jim Case thought you might consider this to be a bad idea and if so I wonder if you could say why? Thanks!
Brian Carlsen
Peter,
I'd suggest a general QA rule for the release be that the endpoint of a historical relationship must be an active concept (e.g. no recursion).
I also am thinking that there can't be too many cases of the thing you're finding (A → sameAs→B, B → sameAs → a). I'd rather see human review of these cases than an algorithmic rule that may or may not do something useful. Though, perhaps I'm mistaken and there are thousands of these kinds of cases.
Brian
Jeremy Rogers
Brian,
There are rather more of these direct reciprocal SAME_AS pairs than you might imagine; over 6000 of them in the International Edition alone.
I've listed a few below. However, in attempting to navigate from an inactive code along potentially chains of more than one stated historical association, the problem is actually worse even within the IE alone: there are cycles where in order to return to the code you started from you must traverse more than two (reciprocal pairs of) SAME_AS relationships. And once you add in 3rd party extensions to the mix, the idea that the data will out of the box always deliver a direct historical association refset entry from each inactive code to one or more stated active codes is IMHO impossible to achieve in teh general case. A mathematical proof of that assertion would of course be nice, but is beyond me. Suffice it to say that, in the historical association reviews we've already done, we've certainly found several instances of this pattern:
Inactive Core Concept: A MOVED_TO External namespace:X
Inactive Concept:B in External namespace:X MOVED_FROM Inactive Core Concept: A
Inactive Concept:B in External namespace:X SAME_AS Active core Concept: C
..from all of which we can reason that actually there should be an association:
Inactive Core Concept: A SAME_AS Active core Concept: C
...but the information needed to infer that is not present in the International Edition. There are more complicated examples, once you add extensions into the mix.
So my view is that although the Int Edition, by virtue of being self-contained and "at the top of the tree" can consider implementing a more rigorous set of historical associations wherein everything resolves to an inactive concept within the same self-contained release, this logic is in fact of rather limited help to any implementation that deals with the Int Edition plus any other content. You can't get away from the need to have an iterative algorithm to unravel the combined historical associations.
Its therefore more important that we determine how this algorithm should work and promote the need the need to run one as part of the wider standard.
But (climbs back onto traditional soapbox...) defining such an algorithm necessarily includes designing a system of historical associations whose individual and combined (chained) semantics are understood, and which are then asserted correctly by authors. We now have very strong evidence that we do not really currently have either of these necessary properties.
Matt Cordell
I like the idea of some more QA rules too. Cardinality is an aspect too. Particularly a concept should only have a single "SAME AS" association.
I'd kind of like to see a useful association for everything that's inactivated. But beyond the "duplicates" and "ambiguous".
Maybe there are two confidence levels of association - Something like "SAME AS" - high confidence automated interpretation. "Possibly" - low confidence, requires human/use case specific. etc
Slight detour - Looking at the example above, reminds me I've noticed what feels like some overzealous/questionable inactivations lately that have bugged me.
For example: Ambiguous:
20180131 105443000|Death of parent (event)| MAY_BE 160430005|Mother deceased (situation)|
20180131 105443000|Death of parent (event)| MAY_BE 160436004|Father deceased (situation)|
I don't see how the original event was Ambiguous? Is this implying any concept with subtypes is ambiguous?
Or are events being deprecated and replaced by situations? If so, why was 398033008|Death of relative (event) | not replaced by 740604001|Family member deceased (situation)|?
Peter G. Williams
We have QA including cardinality, activeness and invariant checking (specifically that the HistAssoc is appropriate for the Inactivation Indicator), but it only checks for concepts that have been "touched" in the current release. When we originally ran the rules across all of core SNOMED we came across the sort of numbers that Jeremy Rogers mentions and we closed the lid on that can of worms and backed away slowly. We are now returning to the can.
All the changes we're going to make in this area will be reviewed by an author. I think in the first instance I'll be producing a report that says "This is what I found, here's the issues, here's what I propose doing unless you tell me otherwise" and if an author can improve on the automated suggestion then we'll do that by preference.
Matt Cordell your question about events being replaced with situations would be an ecumenical matter. I'll flag that up to Monica Harry.
Matt Cordell
Thanks Peter, I can sympathise with backing away from the legacy problems and QA .
Haha, and yes you're right to defer my other comment. It's somewhat off topic, but been an ongoing problem (ConceptId churn and FSN changes..) so I took the opportunity get some attention
Monica Harry - I'm not specifically/necessarily concerned about events, but inactivations in general (see above link)
Yongsheng Gao
Hi Matt Cordell, Monica mentioned about your comments on events. This was a project for improving the clarity and consistency for representing similar concepts related to death. We hope it could facilitate users for selecting codes for data entry and analysis. The 'death of parent' could be the mother, father, or both of them. It could be a grouper or classification concept that does not matter which parent was deceased. In a clinical record, 'mother deceased' or 'father deceased' would be more accurate. Yes, these events have been deprecated and replaced by situations. Thanks for spotting the concept 'death of relative' which should be replaced. More information and discussion can be found in the inception and elaboration document at the following link.
https://confluence.ihtsdotools.org/display/shareit/18777631/ZFM772132c14ef9430fbf06881b81604f10WPD/Artf222723_CTP%20Project-Clarify_Policy_for_Events_Combined%20Inception-Elaboration%20Phase%20v2.0.docx?version=1