1

Welcome and role call

@Bruce Goldberg

2

Recap of decisions reached at Fall business meeting in Vancouver

@Bruce Goldberg

Summary of main outcomes:

1. The co-occurrent and due to pattern for modeling disorder combinations will be retired.

   1. Allowable associations patterns are temporal relationships (after, during before, temporally related to) and causal relationships (due to, causative agent)

   2. Simple co-occurrence (see below)

2. Stroke model approved (see below for latest iteration)

3. Sources of truth

   1. @Bruce Goldberg and @Jeff Piersonto develop matrix for Primary and secondary sources for each top level hierarchy (or subhierarchy)

4.  Complex skull fractures 
   
   

   1. 20 disorder concepts (see list in attache .pptx) involving skull fractures with intracranial injury, with or without loss of consciousness for a time period, and some indicate the return to pre-existing conscious level.

   2. 40 additional concepts in SNOMED which include the "return to pre-existing conscious..."

   3. Concepts in question are classification-derived phrases
      Representation of levels of consciousness has changed between ICD-9, ICD-10 and ICD-11
      Modeling of complex associations with > 2 conditions is currently out of scope for modeling
      Recommendation:
      Inactivate these concepts

• Attendance list

• Complex skull fractures.pptx

• Evaluating sources of truth for elucidating the meaning of concepts.pptx

• Ranking system for Source of Truth 2018.xlsx

• Re-examination of co-occurrent and due to pattern.pptx
  
  
  

3

Secondary disorders

@Bruce Goldberg, @Yongsheng Gao

There are a large number of disorder concepts that refer to "Secondary" or "Secondary to". A query was sent to the WHO ICD MSAC (Medical and scientific advisory committee):

It is unclear from the [ICD-11] definitions associated with the various conditions that use the term "secondary" as to whether it refers to simple co-occurrence or some level of causality, or both, as most of the definitions define secondary disorders as "disorder secondary to X" which is not very helpful.
This is important from the SNOMED point of view as we are trying to separate out causality from simple temporal relationships. If by "secondary"; ICD actually means a "Complication X due to disease Y", then we would reconsider many of the terms we have that currently make a distinction between ""Complication" and "Secondary".
There is also a question concerning the phrase ‘associated with’. As it is ambiguous, it is desirable that this phrase be deprecated.

Implications on modeling and terming of existing content as part of the QI project need to be discussed and recommendations provided to the content team.

• WHO ICD-11 guidance.docx

• Model "secondary" disorders using GCIs with causative relationships (due to, causative agent)

  • Secondary diseases.pptx

Discussion around varying uses of "secondary". Agreement that given the ambiguity of the word and its use in SNOMED, when the intent is to represent a causal sequence an FSN such as that suggested in the attached slide deck should be used. A parent of complication should be used in the definition of subtypes of "Secondary" X

Group agreed that use of GCIs to model "Secondary" X was appropriate

4

Modeling of cerebrovascular accident

@Bruce Goldberg

@Phil Brown

• Revised model approved during Vancouver meeting

  • Needs more testing

• Cerebrovascular accident.pptx

@stefan.schulz pointed out that GCIs may not be required for cerebrovascular accident as this can be fully defined as an acute non-traumatic brain injury with neurological dysfunction and subtypes defined with an appropriate due to relationship. This needs further discussion as acute non-traumatic brain injuries with neurological dysfunction may not fully define the meaning of a cerebrovascular accident e.g. brain metastases, infections or toxins. Stroke seems to imply a primary vascular cause.

5

Modeling of injuries

@Bruce Goldberg

• Proposed model for modeling traumatic and non-traumatic injuries

• Injuries.pptx

Group agreed in principle to modeling injuries with an associated morphology of damage (for unspecified injuries) and with a role group consisting of damage and a pathological process of traumatic or non-traumatic for traumatic and non-traumatic injuries respectively

6

Allergy topics

@Bruce Goldberg

• Hypersensitivity/Allergy/Intolerance (to substance?)

• Allergic contact hypersensitivity

  • Should include after exposure to X event as well as causative agent for situations in which X is other than a substance an the allergen substance has been elucidated?

    • Complication +/- sequela?

• Allergy questions.pptx

Tabled for next call

7

AOB, adjourn

ALL

Next call December 10 at 20:00 UTC