1

Welcome and role call

BGO

2

Review of previous meeting minutes and actions

User-friendly names as additional descriptions for co-occurent and co-occurrent and due to patterns

BGO

BGO

BGO

• Addition of during and during and/or after roles to associated with role hierarchy

  • Proposal endorsed by anesthesia SIG

• Combined disorders

• See under discussion page

  • X co-occurrent with Y --→ X and Y

    • Asthma co-occurrent with allergic rhinitis --→ Asthma AND allergic rhinitis

    • Asthma co-occurrent with chronic obstructive lung disease

      • Asthma AND chronic obstructive lung disease

      • Asthma-chronic obstructive lung disease overlap syndrome

  • X co-occurrent and due to Y --→ X and Y due to Y

    • Intestinal obstruction co-occurrent and due to hernia --→ Hernia AND intestinal obstruction due to hernia

Advised to confirm that anesthesia SIG comfortable with perioperative complication as during and/or after surgery as opposed to before, during and/or after surgery.

BGO to present topic at anesthesia SIG meeting 7/26/2016

To finalize during IHTSDO business meeting in Wellington, Oct. 2016

Approve ?

3

Complications and sequelae

BGO

• General agreement that complications assert causality and that sequelae are complications that always follow their cause

• Complications and sequelae can be due to diseases, procedures, devices, substances/products and thus defining them at the highest level (Complication (disorder), Sequelae (disorder) would require an approach analogous to that proposed for secondary disorders (i.e. GCIs)

• Can define complication of disorder as Complication due to disease and Sequela of disorder as Sequela after disease. Procedure complications can be defined in a like manner (after allowing procedure in range for due with due to being interpreted as direct causality for this specific case)

• Sequela of disease/procedure will not be subsumed by Complication of disease/procedure because due to and after are siblings

• Adding both due to and after roles for defining Sequelae of diseases/procedures will result in correct subsumption and assertion of causality for sequelae

Agreed upon following:

1. Complications always imply (direct) causalityand may occur during, after or during and after their cause

2. Sequelae are complications that necessarily follow their cause

3. Model for complications:

   1. X (complication) due to Y (cause=procedure, disorder)

4. Model for sequelae:

   1. X (complication) due to Y (cause=procedure, disorder) | after Y (cause=procedure, disorder)

Additional discussion:

1. Secondary disorders may mean the same as complications

2. Complications/sequelae of devices needs further investigation

3. Should due to + after roles be grouped

5

Alternate allergy model

BGO

• Request by JCA to change model for allergic disposition to include pathological process=allergic process and causative agent in the role group instead of after=allergic sensitization (disorder) and causative agent

  • Limited testing performed by JCA in SCA UAT and by BGO in WB UAT and both models show same inheritance patterns

Approve ?

6

Combined disorders - Question from Phil Brown

BGO

"With the ICD 11 work we are now in a position that we have considerable pressure to start to enter some of these combined disorder concepts to achieve harmonisation.
I wonder if an interim approach could be considered of ‘least harm’ if the definitive approach is still undergoing iteration? I was thinking that perhaps JUST the primary causative disorder should be given an is_a relationship with interim guidance that when searching a database for a concept or hierarchy both is_a and causing (reverse- due to) relationships should form part of the query".

Consensus among attendees was if what Phil meant by primary causative disorder is just the primary disorder i.e model all combined disorders for now as X due to Y and document co-occurrence if required separately, this would be an acceptable interim approach.

Approve ?

6

Face to face meeting in Wellington - Oct. 2016

BGO

• Granted permission to hold a full day meeting in Wellington

• Planning committee aware of potential overlapping meetings. Will try to accommodate once close to finalizing agenda

• Potential topics for discussion

1. Finalize editorial guidelines for combined disorders

b. Discuss test methodologies. 
i. Two kinds of test 
1. Consistency 
a. Review authors consistency test 
2. Correct subsumption 
ii. ? interface with consultant group looking at this 
1. Wait for their solution? 
iii. Use SCA UAT or Protege 
c. User friendly names for co-occurrent and co-occurrent and due to patterns 
d. Domain-specific guidelines for combined disorders 
i. Choose from NHS FP/GP refset and KP top diagnoses 
1. AIDS 
2. Dentistry 
a. Periodontal disease 
b. Gingival disease 
3. Diabetes 
e. Plan for remediating existing combined disorder content (FSNs, PTs/synonyms, modeling) 
2. Complex combined disorders (>2 conditions) ? 
3. Expressing temporal sequences by extending the range of the occurrence attribute (or creating a new attribute) to include temporal periods such as those relating to pregnancy and childbirth and to clearly define the boundary between use of this method and the use of the associated with role hierarchy with new roles added. 
4. Secondary disorders 
5. Allergy 
a. Model for allergic conditions (i.e. allergic X) 
i. Current model is X and due to some allergic reaction (caused by Y allergen) 
1. Should this be co-occurrent and due to 
2. Should this be modeled as X and pathological process some allergic process ?

Draft Agenda For Oct. 2016 IHTSDO business meeting

1. Testing of combined disorder model

   1. Consistency

      1. Review of authors' test

   2. Accuracy

      1. Meet with consultant terminologist group working on developing test plan

      2. Interim solution - use SCA UAT or Protege to detect incorrect subsumption

2. Finalize editorial guidelines for combined disorders for presentation to EAG

3. Development of domain-specific guidelines for modeling combined disorders

   1. Crowdsourcing decisions regarding causation and co-occurrence among clinical specialist within a particular domain

   2. Initial domains

      1. AIDS

      2. Dentistry

         1. Periodontal disease

         2. Gingival disease

      3. Diabetic complications

   3. Other candidates from:

      1. Authors' modeling test

      2. KP top 2500 diagnoses

      3. NHS GP/FP refset

   4. Yong to identify domain representing a complex (>2 condition) disorder

4. Secondary disorders (and complications/sequelae?) - Yong

5. Allergy

   1. Model for allergic disorders (conditions) as an example of when it may be difficult or unnecessary to distinguish between a pathological disposition and pathological process

 AOB

 All

 Request from SSH to start meeting 1 hour earlier

Adjourn

Next meeting August 8th, 2016 19:00 UTC