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JIRA ISSUE: https://projects.jira.snomed.org/browse/IHTSDO-111

REVIEWS ON THIS DOCUMENT ARE LOCATED:  JIRA IHTSDO-111 (artf233909) Review concept 23968004 Colectomy (procedure) and its 103 descendants Documentation Review

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Title

Review the concept 23968004|Colectomy (procedure) and its 103 descendants, improve modelling and remove duplication in the hierarchy.

Version Information

Document review

Statement of problem as requested or initially identified

SIRS Request ID 5985

“359571009 | Right colectomy (procedure) and 235326000 | Right hemicolectomy (procedure) are the same thing. See in comparison to left hemicolectomy concepts. Right colectomy has a synonym of right hemicolectomy as well as having the subtype with the same name. The UK has a preference for 'hemicolectomy' as the definitive term. Please retire left colectomy and right colectomy in favour of L and R hemicolectomy and make siblings under colectomy.

Needless elaboration of terms is leading to problems for users in analysing and discriminating between different subtypes of open/endoscopic. 235326000 | Right hemicolectomy (procedure) does not subsume laparoscopic concepts (e.g. 50774009 | Laparoscopic-assisted right colectomy) that are elaborated under its parent. Left and right colectomy are not aligned directly under 23968004 | Colectomy (procedure) as 43075005 | Partial resection of colon (procedure) intervenes for the left concept. Please consider removing ambiguities for users and aligning left and right as siblings whether left and right colectomy are retained or hemicolectomy is asserted alone.”

Relevance to International edition

23968004|Colectomy (procedure) and its subtypes are released concepts in the international edition of SNOMED CT.  This is a quality issue that impacts on end users.

Related changes impacted by this content development request

None identified.

Agreed scope statement

Review the modelling on the concept 23968004|Colectomy (procedure) and its subtypes, retire duplication where found, improve stated IS_A relationships and ensure each concept is modelled with the correct attribute and value pairs in order to improve subsumption.

Identify additional changes       

Additional changes to concepts outside of the hierarchy 23968004|Colectomy (procedure) are recommended and these are listed in the accompanying spreadsheet tab 7.  In summary these related changes or items for further review include:

1. Consider addition of a new concept Colonic pouch (morphologic abnormality) as child of 256874006|Intestinal pouch (morphologic abnormality) in order to fully define existing content.

2. It is not clear what is intended by ‘with anastomosis’ and which structures are involved this requires further review in a separate project.

3. 173977007|Creation of ileostomy (procedure) and its subtypes require further review with the aim to fully define the supertype and sub concepts.

4. It is not clear what is intended by ‘with stoma’ – is this construction or creation of stoma or something else? This requires further review in a separate project.

Solution proposed

Colectomy is an operation to remove all or part of the colon http://www.medicinenet.com/script/main/art.asp?articlekey=12529

Hemicolectomy is removal of left or right side of colon http://dictionary.reference.com/browse/hemicolectomy

Other resources consulted

http://emedicine.medscape.com/article/1535001-overview

http://ether.stanford.edu/abdominal_surgery_rotation/documents/Colon%20surgeries%20vm%20071512.pdf

The SIRS request originates from the UKTC, their customer is a Clinical Information Development Department at an NHS Trust that has implemented SNOMED CT for recording diagnoses and procedures.  It is reported that the duplication between 359571009 | Right colectomy (procedure) and 235326000 | Right hemicolectomy (procedure) is causing problems with analysis and confusion for end users who are required to select the appropriate concept.

In the editing environment it is noted both concepts have the same effective from date in SNOMED CT:

235326000|Right hemicolectomy (procedure) effective 31 Jan 2002

359571009|Right colectomy (procedure) effective 31 Jan 2002

359571009|Right colectomy (procedure) does not have an active CTV3 (UK Read code) map however 235326000 | Right hemicolectomy (procedure) is mapped to an active CTV3 code X20XI. This would suggest that the duplication between the two concepts may have occurred at the time that CTV3 and SNOMED RT were merged with the first release of SNOMED CT in 2002.

It is noted that the original requester has a preference to retire left colectomy and right colectomy in favour of 2 concepts left hemicolectomy and right hemicolectomy, however this proposal will result in additional churn for end users.  The terms left colectomy and left hemicolectomy are synonymous and therefore the decision about which concept to retire should be based on which course of action is the least disruptive to end users.

Left hemicolectomy does not currently exist as a fully specified name, it is a synonym on 82619000|Left colectomy (procedure).  There are editorial restrictions for the replacement of a released fully specified name.  This would mean that the concept 82619000|Left colectomy (procedure) would need to be retired and replaced with a new concept Left hemicolectomy (procedure).  Therefore it is recommended that 82619000|Left colectomy (procedure) be retained.

359571009|Right colectomy (procedure) is already a released concept and has the synonym Right hemicolectomy, it is preferable to retire 235326000|Right hemicolectomy (procedure) and mark this as a duplicate concept.

A review of the hierarchy has been undertaken and the required changes are listed in the accompanying spreadsheet with additional supporting information about each proposed change

Summary of required changes:

1. 1.     Spreadsheet TAB ONE

PROBLEM: Much of the existing subtypes of 23968004|Colectomy (procedure) have a stated IS_A relationship to a fully defined concept.

SOLUTION: In order to align with the process of quality improvement that is being undertaken by the IHTSDO Content Team, any concepts that have a stated parent that is fully defined in this hierarchy will be reviewed.  Where a concept has a stated parent that is fully defined, this will be replaced. 

The stated IS_A relationship for the concept 23968004|Colectomy (procedure) and all subtypes will be replaced with IS_A 71388002|Procedure (procedure). 

There are four concepts that are exceptions to the above because they require a stated primitive parent and these are listed in tab one of the spreadsheet.

It is not currently possible to fully define some of the existing concepts for example 446222007|Hand assisted laparoscopic left colectomy (procedure) cannot be fully defined and has a sibling 446228006|Hand assisted laparoscopic extended left colectomy (procedure) which should be its subtype.

1. 2.     Spreadsheet TAB TWO

PROBLEM: Duplication in the hierarchy and at least one erroneous concept.

SOLUTION: It is recommended that seven concepts be retired and these concepts are listed in tab two of the spreadsheet with accompanying notes about the reason for retirement in column B. 

For example the concept 275015005|Swenson Hirschsprung proctect (procedure) contains a truncation in the FSN which is not conformant with editorial policy and renders the concept ambiguous. 

1. 3.     Spreadsheet TAB THREE

PROBLEM: Synonymy between Right colectomy and Right hemicolectomy, end users would expect to see these two variations of descriptions appearing in the same concept to aid searching.  The issue is the same for Left colectomy and Left hemicolectomy.

SOLUTION: It is recommended that 14 released concepts have the addition of a new description these concepts are listed in tab three of the spreadsheet.

1. 4.     Spreadsheet TAB FOUR

PROBLEM: Existing content that is currently primitive can be made fully defined.

SOLUTION: A total of 31 concepts may be marked as fully defined after changes to the modelling.  The concepts are listed in tab four of the spreadsheet with additional modelling notes in Column B to explain changes required.  

1. 5.     Spreadsheet TAB FIVE

PROBLEM: Existing content that cannot be fully defined but can be improved by the addition of a primitive parent and/or additional relationship groups.

SOLUTION: It is recommended that 7 concepts will retain their primitive status but require some additional changes to improve the current modelling.  These concepts are listed in tab five of the spreadsheet with additional supporting notes in Column B. 

As an example 73509004|Partial colectomy with skin level colostomy (procedure) has two stated parents 43075005|Partial resection of colon (procedure) and 398740003|Colostomy (procedure). 

43075005|Partial resection of colon (procedure) will be fully defined as a result of the changes outlined above in Tab Four. 

If two new relationship groups are added to 73509004|Partial colectomy with skin level colostomy (procedure) and a stated parent of IS_A 71388002|Procedure (procedure) is assigned, the concept will be classify as below

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1. 6.     Spreadsheet TAB SIX

PROBLEM: Anatomy concept required to fully define once concept.

SOLUTION: A single new concept can be requested for the anatomy hierarchy this is listed in tab six of the spreadsheet with the recommendation listed in Column B.

1. 7.     Spreadsheet TAB SEVEN

PROBLEM: Associated issues noted whilst undertaking a review of the hierarchy.

SOLUTION: Other required changes or items for consideration are noted in tab seven of the spreadsheet with accompanying notes in Column B.  These changes are recommended for content mainly outside of the hierarchy 23968004|Colectomy (procedure) but that impact in some way on this hierarchy.

Outcome of Proposed Changes to Hierarchy 23968004|Colectomy (procedure):

Outcome of Proposed Changes to 359571009|Right colectomy (procedure)

Stakeholder input

SIRS request ID 5985, National Release Centre UKTC, consultation regarding this Fast track project and also investigation of the origins of the issue undertaken with stakeholder February 2016.

Impact assessment

The overall quality of content in the hierarchy 23968004|Colectomy (procedure) will be improved.

Risk assessment

All changes proposed above have been tested in the workbench UAT environment see screenshots.

Approval process 

Priority         

?High

Specify the basis for the above priority assignment

Potential duplication and suboptimal modelling in the hierarchy 23968004|Colectomy (procedure) which is a quality issue that impacts end users and implementers.

Content editing

Changes to be made in accordance with proposed solution as set out in the attached spreadsheet.  The changes will require the effort of one editor making edits directly into the tooling.

Details of content changes

1. Where possible all concepts that are descendants of 23968004|Colectomy (procedure) will have a stated IS_A relationship to 71388002|Procedure (procedure)

2. Duplication between 359571009 | Right colectomy (procedure) and 235326000 | Right hemicolectomy (procedure) wil be resolved

3. 23968004|Colectomy (procedure) will have the correct descendant concepts as asserted by relationship groups and the classifier

4. 359571009|Right colectomy (procedure) and 82619000|Left colectomy (procedure) will be direct descendants of 23968004|Colectomy (procedure)

5. 43075005|Partial resection of colon (procedure) and 26925005|Transverse colectomy (procedure) will be remodelled to become fully defined, this will ensure that the classifier can assign the correct descendant concepts

6. Additional descriptions will be added to existing concepts where required to provide consistency and improve end user searching

7. Any descendant concepts of 23968004|Colectomy (procedure) that can currently be fully defined using available attributes and values will be fully defined as a result of this project

Manual quality check

Changes as outline above will be implemented.  Peer review prior to release.

Automated quality check

Maven batch QA

Publish to release branch

July 2016 release

Attachments

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