April 8, 2019

Call to order and role call

Notice of recording

Conflicts of Interest

• 2019-10 Agenda approved

Following a panel discussion at the ICBO conference in Buffalo Aug 1-2, an agreement in principle for SNOMED to collaborate with the OBO community was reached. Much of the discussion revolved around the current SNOMED CT representation of diseases as subtypes of clinical findings.

There is a clear, mutually exclusive separation in BFO and other disease ontologies based on BFO between "diseases", which are specifically dependent continuents and clinical observations (i.e. findings), which are considered occurrents. The challenges in implementing this notion in SNOMED is explained in:

 https://www.academia.edu/26897896/Scalable_representations_of_diseases_in_biomedical_ontologies.

One differentiating feature discussed in April 2019 for what we call Clinical findings is the notion of temporality, i.e. a findings made at a point in time (an occurrence) whereas a disease is persistent. This is similar to the notions in BFO, but they (and all other disease ontologies) refer to diseases as dispositions (i.e. a realizable entity that is manifested as some abnormal process or structure. For terminologies like SNOMED that do not seek to define diseases, but to identify when a realization of the disease disposition occurs in a patient, this logical representation breaks down.

At the ICBO conference, a paper was presented in which an attempt was made to "BFOize" ICD-10. It was clear to the authors of that paper of the conundrum we face, i.e. that the use of the terms in ICD-10 as dispositions was not appropriate because they had been realized and so they modeled their ICD-10 ontology as processes (i.e. occurrents). This was criticized by a number of the ontologists, but no practical solution to the need for representation of realized dispositions in clinical recording were proposed.

A draft document is being developed by members of the MAG as a response to the issues surrounding the lack of alignment between SNOMED and BFO: 

https://docs.google.com/document/d/1HcBj5bVIg8lB_uyORZU9A_FWKFsw0sxmB6Xg4UYKygk/edit

Proposal:

In light of our desire to resolve the findings/disorders issue, to attempt to align as closely as possible with top level ontologies. One area where this would be of great use is the move by SNOMED to improve coverage of genomics. This would be greatly enhanced by an ability to integrate with the genome ontology.

Discussion:

Decision:

Concern has been expressed about inactivation and replacement terms that from their modeling indicate that they are hypernyms to the replacement concept. The example given was the inactivation of 398042001|Accidental dural puncture (disorder)| as MAY BE 781129002|Accidental puncture of dura during anesthesia (disorder) | due to its positioning under 33211000|Complication of anesthesia (disorder)|, but without addition of the existing description "Accidental dural puncture".

Editorial guidelines from 2010 provided for hypernyms as long as they were noted in the language refset as "near synonymous (depending on context of use)"; however, the notion of near synonymy was not implemented in RF2 and thus there is currently no way to designate descriptions as broader than.

Current editorial policy states that broader descriptions should be inactivated as "not semantically equivalent" or added with the context of use specified.

Current editorial policy is supported by a position paper (SNOMED International Position on the addition of “Patient-friendly terms” (PFT) to the International release of SNOMED CT)

Proposal:

Reintroduce the ability to identify near synonyms assigned to a concept.

Discussion:

Decision: