1

Welcome and role call

BGO, all

2

 Allergy/hypersensitivity editorial guidelines

BGO

• Update on allergy/hypersensitivity model and allergy to x revision project

• Input from Allergy-hypersensitivity clinical reference group

  • The term "pseudoallergy" is obsolete as discrete pathophysiologic mechanisms have been identified. Recommendation is to replace with non-allergic hypersensitivity which will align more closely with WAO/EAAAI nomencalture

• BGO to propose revision of model for pseudoallergy to include more granular pathophysiologic processes.

  • Discussion centered around need for test environment to evaluate new roles, domains and ranges, etc.. Jim Case suggested a test project for each release cycle and said would need dialogue with Rory Davidson. Yongsheng Gao will follow-up.

As requested, a new Author Testing project is created for development and testing concept model project. This project disabled MRCM and promotion.

https://authoring.ihtsdotools.org/#/project/AUTHORTEST

3

Concurrent vs. co-occurrent

BGO

• Question as to whether to use co-occurrent vs. concurrent in FSNs for pattern 2 and 3 combined disorders

• See attachment/comments

• Group approved continued use of co-occurrent in FSN ("with" and "and" for PTs)

• Existing 3 concepts with concurrent in FSN need to be revised

• What about spell checker in SCA that prompts for spelling correction when co-occurrent entered?

4

Modeling fetal and maternal related concepts

PBR

Alternate model using occurrence role

Tabled for a future meeting

5

Alternate model for complications 

YGA

Define complications using complication (attribute) - unapproved. Use GCIs to define Complications as of disorders or procedures 

Yongsheng Gao presented model for assigning complications for the due to pattern based on a new attribute and using GCIs. Group feeling was that although this process would address 99% of existing content, it would still require judgement to address the 1% of combined disorders modeled with due to that are not complications. Examples included myocardial ischemia due to coronary artery obstruction and gout due to elevated uric acid (dsorder due to a clinical finding).

6

Complications and sequela

BGO

• Assigning a parent of Complication for co-occurrent and due to pattern

From editorial guidelines:

Complications and the co-occurrent and due to pattern

A parent of 116223007|Complication (disorder) should not be assigned to combined disorder concepts modeled using the co-occurrent and due to pattern as there is no mechanism to indicate that only the resultant condition represents the complication.

• For all causative conditions that are systemic and non-curable, model as co-occurrent and due to. o Example: 21921000119103 |Dementia due to Pick's disease (disorder)|=Dementia co-occurrent and due to Pick’s disease

• Issue identified is that in some cases it would be desirable to assign Complication as an additional parent to a co-occurrent and due to pattern.

  • Example: Diabetic complications

• See attached for proposed model

Bruce Goldberg and Jim Case felt that proposed model would capture appropriate inferfences and that editorial guidelines should be revised to delete the statement that "A parent of 116223007|Complication (disorder) should not be assigned to combined disorder concepts modeled using the co-occurrent and due to pattern"

7

Modeling of CVAs due to thrombosis/embolus - follow-up

BGO, PBR

• Proposed model was to use specific artery/vein thrombosis concepts as value of due to along with an associated morphology of 78195007 |Occlusive thrombus (morphologic abnormality). Issue raised that occlusive thrombus (morphologic abnormality) as residing in role group 0 would refer to theCVA rather than the thrombosis. Suggested solution is to create specific occlusive artery/vein thrombosis concepts as the value of due to

• Revised model presented. Same parents inferred as original model. Question of need to revise model as it would require creating many new precoordinated classes

• Questions also arose as to the overloading of the morphology hierarchy with structures that increasingly specify a simple morphology by including an underlying cause such as Hemorrhagic infarct (morphologic abnormality)

• It was suggested that guidelines need to be developed for when to use a highly specific morphology vs a simple morphology with additional relationships in order to define certain concepts

• Question arose as to use cases for developing above guidelines

  • Modeling consistency

  • Queries/data aggregation

Tabled for a future meeting

8

Sepsis/organ dysfunction syndrome

YGA

• There are 43 subconcepts under 238151006|Sepsis-associated organ dysfunction (disorder)|. They need to be reviewed and revised following the Editorial Guide on X with Y associations. Some specific issues need to be addressed:

1. Which pattern should this concept and its subconcepts belong to, e.g. due to vs. co-occurrent and due to?

2. Should these be implemented as description changes of FSNs or inactivation of concepts?

3. Should 238151006|Sepsis-associated organ dysfunction (disorder)| be subconcept of 91302008|Sepsis (disorder)|?

4. Should 91302008|Sepsis (disorder)| is a subconcept of 238149007|Systemic inflammatory response syndrome (disorder)|?

5. Should sepsis is a subconcept of 238147009|Organ dysfunction syndrome (disorder)|?

6. Should 76571007|Septic shock (disorder)| is a subconcept of sepsis?

Revised definitions of sepsis and changes to modeling and terming as described in the attached file approved by group

9

Traumatic amputations

BGO

• Model Using morphology or amputation due to trauma?

Jim Case felt morphology should be used until the time when a pathological process of trauma is approved as using due to will miss important inferences.

10

AOB, adjourn

ALL

• Next meeting August 28, 2017 20:00 UTC