Amendment History

Review Timetable

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Table of Contents
1 Glossary
1.1 Domain Terms
2 Introduction
2.1 Purpose
2.2 Audience and stakeholder domain
2.2.1 Input from stakeholders
3 Statement of the problem or need
3.1 Summary of problem or need, as reported
3.1.1 Tracker Item
3.1.2 IHTSDO Nursing SIG Review of 43741000
3.2 Summary of requested solution
3.3 Statement of problem as understood
3.4 Detailed analysis of reported problem, including background
3.4.1 Hierarchy 276339004
3.4.2 Inpatient and outpatient environments – descriptions and definitions from healthcare sources
3.4.3 Site of care
4 Risks / Benefits
4.1 Risks of not addressing the problem
4.2 Risks of addressing the problem
5 Requirements: criteria for success and completion
5.1 Criteria for success/completion
5.2 Strategic and/or specific operational use cases
6 Solution Development
6.1 Initial Design
6.1.1 Issue 1 - Inpatient environment/outpatient environment
6.1.2 Issue 2 - Site of Care
6.1.3 Enhanced Editorial Description of Hierarchy
6.1.4 Significant design or implementation decisions / compromises
6.1.5 Evaluation of Design
6.2 Iteration One – from this point onwards to be elaborated after first review…
6.2.1 Outline of revised design
6.2.2 Significant design or implementation changes
6.2.3 Evaluation of Revised Design
6.3 Iteration Two ..
7 Recommendation
7.1.1 Detailed design final specification
7.1.2 Iteration plan
8 Quality program criteria
8.1 Quality metrics
8.1.1 Quality metric 1
8.1.2 Quality metric 2
8.2 Use case scenarios
8.2.1 Scenario One
8.2.2 Scenario Two
8.2.3 Scenario …
8.3 Test cases
9 Project Resource Estimates
9.1 Scope of construction phase
9.2 Projection of remaining overall project resource requirements
9.2.1 Expected project resource requirement category
9.2.2 Expected project impact and benefit
9.2.3 Indicative resource estimates for construction, transition and maintenance:

Glossary

Domain Terms

Introduction

Purpose

The purpose of this project is to consider the Tracker item IHTSDO-903: artf222647 'Review concepts: environments' and to set out what actions might be taken with some evaluation of their relative desirability. This item identifies a need to consider the adequacy of subsumption of inpatient and outpatient categories in the hierarchy 276339004 | Environment (environment). The title of the Tracker item could be read as a review of the whole Environment hierarchy whereas the description is more specific.. This project will attempt to define a realistic scope for review that could support a definable work package to meet URU criteria and if possible to better support implementer requirements if these can be identified.

Audience and stakeholder domain

The audience for this document includes all standards terminology leaders, implementers and users but is especially targeted at those stakeholders wishing to record sites and settings in which care or treatment takes place for such purposes as care planning, resource planning, audit, billing, outcomes analysis etc.
A further significant audience is the community of SNOMED authors that may be requested to implement the recommended specification.

Input from stakeholders

It has not been possible to engage stakeholders apart from the IHTSDO Nursing SIG.

Statement of the problem or need

Summary of problem or need, as reported

Note: throughout the text 'the hierarchy' generally refers to the 'Environment' hierarchy but excluding the geographical and geopolitical subtypes; in addition 'the SIG' means 'the Nursing SIG'.

Tracker Item

IHTSDO-903 artf222647-'Review concepts: environments' sets out the following:
"Review environments and hierarchy
Inpatient and outpatient are broad categories that everyone understands
Should they aggregate all possible environments that are either in or out of hospital, or just those that are locations of care. (Is a city street an outpatient environment)
Examples:
Inpatient environment (environment) - how this is different from Hospital AND/OR institution (environment)
Outpatient environment (environment) - valid but it is vague, not a limit to what could be a subtype of this (House is an outpatient environment)
A number of clinically based settings with "outpatient" in the string already exist [e.g.Hospital-based outpatient department (environment)]"
The number of affected concepts identified in the tracker item is 1095 which appears to be the entirety of the Environment hierarchy.
Unfortunately there is no specific indication of what issue might have given rise to the raising of a Tracker item

IHTSDO Nursing SIG Review of 43741000 | Site of care (environment)

It would not be possible to consider the Tracker item without including the project that
IHTSDO Nursing SIG have been conducting on 'Site of Care' that includes Inpatient/Outpatient environment. It would appear that this project prompted the Tracker item but this hasn't been confirmed. Some information on this project was made available for this review following discussion with the Chair of the SIG.
The SIG reviewers propose some definitions:
inpatient environment: a location where the subjects of care have been admitted to the facility. outpatient environment: a location where the subjects of care have not been admitted to the facility.
They also identify the following "challenges"

• "Some care environments exist in inpatient and outpatient
• Other categories emerged besides the above:

Ambulatory
Ambulatory/Outpatient
Community
Department
Institution
Transport
Home
Navigational
Care, not environment"
There is no further detail available to support an analysis of how the hierarchy might be inadequate.

Summary of requested solution

Only the above description is available and a question is asked about inpatient and outpatient categories but no solution is set out.

Statement of problem as understood

The problem appears to be that sites of care are inadequately classified in general and the Nursing SIG also wants to classify sites specifically by inpatient/outpatient axis only (but without any mention of primary, secondary care sector context, day-case, ward attender, other unit attender profiles). The list of "other categories" is heterogenous and not consistently of an inpatient/outpatient type of setting or site. The definitions given above clearly use 'site', 'location' and 'facility' and would want all physical premises and facilities to be defined under these concepts. The alternative interpretation of outpatient/inpatient environment is as care settings or contexts independent of the building, department, ward etc in which the care takes place. Despite this being a valid meaning to be taken from the wordings the SIG have opted to take these concepts as meaning the buildings etc. Yet their "other categories" indicate that they could see other definitional axes for classifying environments. The SIG also indicates that 43741000 | Site of care (environment) should subsume more environment concepts.

Detailed analysis of reported problem, including background

Hierarchy 276339004 | Environment (environment) – Definitions and Descriptions

The word 'environment' has a broad range of usages and to get a sense of the complexity some definitions are listed below.

Definitions of environment from https://www.vocabulary.com/dictionary/environment

From these it can be seen that there is a wide range of meanings and subtypes of environment, many with relevance to clinical practise but the room for distinction in particular between physical and conceptual/social/cultural condition is not taken very far in SNOMED and without editorial clarity some distinctions may have been muddled over time, although this is not surprising where there is a dearth of evidence of hierarchy development based on use case.

Description of the hierarchy

Among the direct subtypes of 276339004 | Environment (environment) are:
440654001 | Inpatient environment (environment)
440655000 | Outpatient environment (environment)
The first has no subtypes and the second, only two ('Mobile clinic' and 'Outpatient freestanding dialysis treatment facility'). That is, these concepts do not, for our purposes subsume any other concepts that either explicitly or implicitly are plainly one or the other, for example
331006 | Hospital-based outpatient rheumatology clinic (environment).
Section 6.8.9 of the SNOMED CT Editorial Guide describes "Environment and geographic location" under 'Other hierarchies'.
"The | Environment or geographical location | hierarchy includes types of environments as well as named locations such as countries, states, and regions."
It provides some examples:
"Examples of Environment and geographic location concepts:
Canary islands (geographic location)
California (geographic location)
Rehabilitation department (environment)
Intensive care unit (environment)
The top level concept 308916002 | Environment or geographical location (environment / location) subsumes:276339004 | Environment (environment) and 223496003 | Geographical and/or political region of the world (geographic location) thus immediately separating out instances of the geopolitical classes 'country', 'state' 'county' etc. from environments of other types. This project is not concerned with 223496003 | Geographical and/or political region of the world (geographic location) (<<) and no further reference will be made to this sub-hierarchy..
No further information is provided in the main section of the Editorial Guide. Section 5.1.2 Allowable Ranges for Concept Model Attributes identifies that 276339004 | Environment (environment) (<<) is a permitted value for the following and for no other attribute:
118170007 | Specimen source identity (attribute) that defines Specimen (specimen).
The 'Environments and geographical locations' hierarchy has no defining attributes and all concepts are Primitive. The immediate subtypes of Environment (environment) have below them a largely single 'flat list' structure with no multiple supertypes; intentionally so, no doubt, because of the lack of model/definition.

Inpatient and outpatient environments – descriptions and definitions from healthcare sources

Definitions of inpatient and outpatient
USA: Medicare says in a patient handout:
"You're an inpatient starting when you're formally admitted to a hospital with a doctor's order. The day before you're discharged is your last inpatient day.
You're an outpatient if you're getting emergency department services,
observation services, outpatient surgery, lab tests, X-rays, or any other
hospital services, and the doctor hasn't written an order to admit you to a
hospital as an inpatient. In these cases, you're an outpatient even if you spend the night at the hospital."
While more formally, Centers for Medicare and Medicaid Services (CMS) under the 'Final Rule' defined an admission for financial purposes:
"An inpatient admission is appropriate and payable under Medicare Part A when:

• The patient is formally admitted to the hospital pursuant to an order for inpatient admission by a physician or other qualified practitioner1 eligible to admit;
• The order is present in the medical record and is supported by the physician admission and progress notes; and
• The physician certifies the services are required to be provided on an inpatient basis, and the certification must include:
• The order for inpatient admission;
• A documented reason for the inpatient hospitalization for either inpatient medical treatment or diagnostic study, or special or unusual services for cost outlier cases; and
• A statement that the inpatient hospital services were provided in accordance with new section 42 C.F.R. §412.3 (i.e., the order)."

From these examples, definitions concerning inpatients and outpatients are commonly important more for payment purposes and for recording and reporting aggregated activity than for defining aspects of care.
There may descriptions of treatment settings and levels of care, for example the National Eating Disorders Association (US) describes:
"Several types of treatment centers and levels of care are available for treating eating disorders. Knowing the terms used to describe these is important because insurance benefits (and the duration of benefits) are tied not only to a patient's diagnosis, but also to the type of treatment setting and level of care.
"Treatment is delivered in hospitals, residential treatment facilities, and private office settings. Levels of care consist of acute short-term inpatient care, partial inpatient care, intensive outpatient care (by day or evening), and outpatient care. Acute inpatient hospitalization is necessary when a patient is medically or psychiatrically unstable. Once a patient is medically stable, he/she is discharged from a hospital, and ongoing care is typically delivered at a subacute care residential treatment facility. The level of care in such a facility can be full-time inpatient, partial inpatient, intensive outpatient by day or evening, and outpatient. There are also facilities that operate only as outpatient facilities. Outpatient psychotherapy and medical follow-up may also be delivered in a private office setting. The treatment setting and level of care should complement the general goals of treatment."
The North Texas Help organisation describes mental health care settings including
"Outpatient Settings – While there is wide variety in the types of outpatient settings, they all involve office visits with no overnight stay. Some are based in community mental health centers; others are located in general hospitals where individuals visit an outpatient clinic for an appointment. In addition, many individuals in need of mental health counseling or treatment go to private offices to see a mental health clinician who is in solo or group private practice."
There is no one outpatient location that can be isolated as the locus of care here. The care is itself outpatient care.

There may be different interpretations of 'inpatient' in different care sectors in some countries. For example an inpatient admission in a mental health unit may be recorded by default as a detention in some systems although voluntary inpatient admission is also possible.
Ambulatory and outpatient
In some services (and often in SNOMED) these are treated as synonymous but in others they identify distinct process paths for service users.
405607001 | Ambulatory surgery center (environment)
Synonym: Outpatient surgery center
Interestingly as a pointer to potential differences of viewpoint affecting the definitions here, Gary Winzenread of Coredata healthcare innovations (Ohio, US) (in a blog not in any academic paper – merely as an instructive example) shows that sectors can see these settings in very different ways:
"The directors I was talking with were using the term [care coordination] in a decidedly "inpatient" way, with a focus on utilization and discharge management into the outpatient setting. Our team was using the term in an "outpatient" way, focused on managing patients between events at different locations across long term-care paths for complex specialty conditions. The timing is quite different: we view care coordination in terms of months and years, while they think of days or weeks.
We both used the term "care plan," but with starkly different meanings; they are thinking of follow-up care to an inpatient event, while we think of 12-month or even multi-year plans designed to cure cancer and support survivors well into the future."
With this in mind we should be wary of imposing any further definition of what outpatient or inpatient environment 'means' as a single solution.
Physical facilities, virtual settings, environments and evaluative findings of environments
The above Nursing SIG draft definitions beg a further question as there is a further clear division to be seen when analysing the content of the sub-hierarchy. This is the distinction between physical locations and virtual milieus. For example 285201006 | Hospital environment (environment) has under it many clear pysical locations such as 224885007 | Hospital consulting room (environment), 225746001 | Ward (environment). In other hierarchies can be found concepts that describe a milieu or conceptual setting in which an individual may be found, cared for or treated, to a degree that can be intellectually abstract to a significant degree e.g. 285140009 | At risk environment (environment), 224798007 | Familiar environment (environment), 285117005 | Noisy environment (environment) . These could be seen more accurately as findings where they appear to be the outcome of an environmental evaluation rather than neutral settings or milieus.
'Outpatient environment'/inpatient environment could be virtual/conceptual milieus with a possible use as identified by the nursing SIG as a means of indicating whether a care regime is undertaken within an outpatient or inpatient context. But it is not clear what resourcing inferences can be drawn from these on a consistent international basis and while the use of these concepts is legitimate (to stand for whatever internal costing schedules are set for various care packages) the request seems to require some elaboration of different departments in SNOMED to support these cost comparisons.
The Tracker description poses a problem not only in attempting to identify physical environments that are definitively in/outpatient environments but those milieus which are clearly excluded from this need for definition. When describing inpatient/outpatient environment the SIG refers to "location" and doesn't seem to take into account that an outpatient environment can be abstract; outpatient care can take place with a patient being treated on a continuing regime in the community, while being seen on an outpatient basis without it always having to be entirely care in an outpatient unit.
What emerges are two strands to the issue:

1. whether to attempt subsumption of environments within the hierarchy on an in/outpatient basis
2. whether any content revision is required to make the management of 'sites of care/care settings easier whatever the outcome of 1.

Site of care

The Nursing SIG observed inconsistent subsumption under 43741000 | Site of care (environment). This is, as they say, a concept that might well appear under-considered as a heading. But from another perspective, the concept looks slightly odd as something to subsume some environments and not others in a somewhat arbitrary way. It is ambiguously termed as either an actual 'site' or as an observable entity/record artifact that might be expected to take a value of an 'environment' concept. Given that almost anywhere could be conceived of as a site of care it is a dubious grouper and seems to be outside the scope of the terminology model.
Also problematic is that all the sites potentially classifiable as 'site of care' could also be 'site of incident', place where casualty/victim was found etc. So highway or farm could be used for where a person is found and in need of clinical intervention whether they are treated there or not. Various domestic environment concepts might have other uses such as in identifying type of domicile for care planning. A case can therefore be made for avoiding the definition of sites only as sites of care and a more neutral classification could be more desirable.
One could make various ingenious cases for competing ontological frameworks for environments that might make better sense of the unclear lists but without any evidence to support one or another (or indeed a significant business use case driver) there seems little that can be done to significantly reorganise the hierarchy, considering the potential disruption that might conceivably be caused where the hierarchy has been implemented by vendors or end users in systems.

Risks / Benefits

Risks of not addressing the problem

It would appear to make the task that the Nursing SIG has set itself more difficult if content alignment isn't improved although if the SIG were to approach organising environments by subset/refset to suit the specific use case then this could be mitigated.

Risks of addressing the problem

There is a risk that by altering concepts existing implementatio subsumption may be disrupted but this not quantifiable as little is known of where environments are relied on.

Requirements: criteria for success and completion

Criteria for success/completion

Hierarchy purged of misaligned content
Semantic definitions improved and separated from each other with more clarity.

Strategic and/or specific operational use cases

The hierarchy is not part of current priorities and any proposals would need to have a low impact on existing editing resources engaged in higher priority projects.

Solution Development

Initial Design

Issue 1 - Inpatient environment/outpatient environment

The original problem was cited as being about inpatient and outpatient environments but the Nursing SIG review of Site of Care makes this issue subordinate to improving site of care subsumption. The inpatient/outpatient issue will be considered before going onto 'site of care' more broadly.
Options

1. Define all (care/treatment) environments along inpatient/outpatient environment categories
2. Reject the proposal
   1. Propose enhanced editorial description of hierarchy
   2. Propose a refset solution in implementations

A solution that would meet the request is to move inpatient environment and outpatient environment to under 43741000 | Site of care (environment) and then classify existing subtypes under these categories.
Problems with defining locations as one or the other of inpatient/outpatient settings.
'In/outpatient' may not be the only categories that could apply and they are not a pure, exclusive binary. Even for locations that are clearly inpatient locations, outpatient or daycase stays are not precluded. It is beyond the scope of the terminology to speculatively define all the ways a physical location might be used. All potential care setting types would need to be created as high level concepts within the hierarchy and then all environments given all realistic supertypes. Entirely primitive semantic types such as environment cannot support implementations and use cases by piling on ever more complex subsumption. Changing use cases would quickly overtake such attempts to manually define content and render the hierarchy out of date and unuseable. While current definition is meagre it is at least safe in use.
It is difficult to see what can be gained from for example classifying 418518002 | Dialysis unit (environment) as both an inpatient environment and an outpatient environment or a day-case environment, yet all activities and more might take place there.
Resource planning is cited by the SIG as needing the definition of inpatient or outpatient setting but in the examples of say stroke rehabilitation or diabetes education then the in/outpatient status of the patient can be captured through the admission and discharge processing that takes place. If care packages are intrinsically different or require different inputs because performed in a hospital or at home or in a clinic then this could be reflected in the detailed categorisation of the care packages as regime therapies rather than flagging the environment as the context.
Many environments in the hierarchy are milieus or intangible environments without a physical presence. In order to define physical environments there would need to be a clear distinction excluding virtual settings. The solution is not sustainable.
Therefore the proposal to define locations under the existing inpatient/outpatient concepts should be rejected.
Inpatient/outpatient environment is ambiguous as to whether setting or site. A clean and reasonably constrained way of solving the definitional issue and confusion is therefore to either remove subtypes from the two concepts because there is a perhaps mistaken interpretation that these can define physical care locations or disambiguate these to 'Inpatient care setting' and 'Outpatient care setting'. This would allow for subtypes of the two existing concepts to be moved elsewhere (under facilities headings.
This does then raise a further question about content such as 285202004 | Community environment (environment) and 272497004 | Residential environment (environment)) etc. as to whether further distinctions between physical community facilities and conceptual community settings is possible but significant reorganisation seems hard to justify.
Although disambiguation may be desirable, there is no demonstrated use case and so only removal of subtypes is recommended.
Recommendation: Reject classification of settings and site/facility environments under inpatient/outpatient environment concepts as they currently stand.

Issue 2 - Site of Care

The Nursing SIG review identifies that many sites of care are not subsumed by 43741000 | Site of care (environment)
Options

1. Reject proposals
2. Revise 'site' subsumption

For reference, the following is the list of immediate subtypes of 276339004 | Environment (environment):
276339004 | Environment (environment)
285202004 | Community environment (environment)
288500009 | Geographical environment (environment)
285201006 | Hospital environment (environment)
440654001 | Inpatient environment (environment)
440655000 | Outpatient environment (environment)
285128009 | Personal environment (environment)
224777007 | Physical environment (environment)
257557008 | Place (environment)
43741000 | Site of care (environment)
This seems to be ontologically flawed in places as there is much overlap and needless ambiguity (and perhaps redundancy) in category, for example between physical environment and hospital environment. It is likely to have come about through organic development over time rather than design. There might be various use cases for restucturing this hierarchy but in the absence of a clear strategic use case this cannot be recommended.
Option 1 Reject Proposals
There isn't a very strong case for making changes because of the lack of clear use case and the risk that alternative approaches while meeting one requirement might thereby fail to meet another.
Option 2 Revise 'site' subsumption (AKA 'failing to resist the temptation to improve ontology')
As 43741000 | Site of care (environment) subsumes many concepts under 108343000 | Hospital AND/OR institution (environment) (<<) and 33022008 | Hospital-based outpatient department (environment) (<<) it seems odd that it does not also subsume 285201006 | Hospital environment (environment) (<<). But putting all sites under Site of care seems to over-define the concepts. 'Hospital-based outpatient department' may be a site of care but it could have other uses in records (perhaps a patient has collapsed there for example) and goes a long way to precoordinating environment with the event/procedure that is located there. This seems something for the broader information model in a record. While combinatorial explosion is somewhat less of a concern here than in other areas the possibilities for combining site and what is undertaken or found at the site are huge and is unjustified precoordination. Site of care as set out in section 3.4.3 above is problematic as it precoordinates an activity with a site. The concept cannot define all environments where care or treatment may take place; that would be an absurdity and the concept could justifiably be moved to the record artifact or observable entity hierarchies and 'site of care' left to definition in a wider information model. This possibility is not pursued here but could be in further elaborations if deemed appropriate.
Recommendation: Reject classification of all sites under a definition of 'site of care'

Further minor/incidental improvements

There is scope for minor improvements with a focus on the Site of Care issue that would help users without huge disruption.

Further moves of UK specific healthcare organisations content to UK extension.

223926002 | Health boards of Northern Ireland (environment)
223927006 | Eastern health and social services board (environment)
223910003 | English health authorities (environment)
Recommendation: move content to UK management.

Quality improvement on set of inadequately termed concepts

901005Helicopter-based care (environment)
2961002Aid car-based care (environment)
11424001Ambulance-based care (environment)
39176004Airplane-based care (environment)
66280005Private home-based care (environment)
Care is a procedure not an environment.
Recommendation: These concepts should have clearer FSN/Preferred Terms or be replaced by two concepts each; 'Xxxxxxxx-based care (regime/therapy)' and 'Xxxxxxxx care setting (environment)' (removing '-based' from the latter).

Clinics

Not all clinic environments are subsumed under 257585005 | Clinic (environment).
e.g.
73644007 | Hospital-based outpatient endocrinology clinic (environment) et al
67190003 | Free-standing clinic (environment)>>
Recommendation: Move all 'clinic' content to this parent concept.

Enhanced Editorial Description of Hierarchy

If some ontological ordering is undertaken there would be a need to describe the model used in the Editorial Guidance for the hierarchy. It is difficult to prescribe this before the final design iteration but it would as a minimum describe the geographical, evaluative, site and setting differentiations and a need to avoid unwarranted classification by procedure/finding as these are recordable elsewhere.

Significant design or implementation decisions / compromises

The poor evidence for use case means that extensive reorganization has been ruled out.

Evaluation of Design

In essence the solution is to reject any changes in subsumption and indeed to rectify some supertyping that has led to the proposals being legitimized. However some further housekeeping changes are postulated.
These solutions seek to balance the need for stability and neutrality with making some quality improvements to assist implementers and end users. It is acknowledged that the hierarchy remains confusing in places in its classification framework. However some of the confusion may be caused by classification beyond the pure text wordings.. That is why some modest additional editorial coverage is advisable as part of the solution. The request appears to seek definition of the environment hierarchy so as to inform a resource model or to drive care/monitoring packages. These definitions are beyond the scope of the terminology as they can vary hugely. In reviewing the hierarchy in this context, what became clear was that in fact that more neutrality in the hierarchy was desirable not less, mainly to allow more flexibility in use but also in part to remove any possibility of the existing, possibly 'beyond-scope', definitions leading users into unwarranted inferences or over-confidence in their inferences being shared between services.

Design Risks

Iteration One – from this point onwards to be elaborated after first review…

Outline of revised design

Redesign the Solution Identify objectives of iteration, and the major changes to previous design
Communicate the revised design

Significant design or implementation changes

Evaluation of Revised Design

Exceptions and Problems

Design Strengths

Design Weakness

Design Risks

Iteration Two ..

Recommendation

Detailed design final specification

Design the Solution Identify major design elements and how they collaborate to realize the scenario
Communicate the design

Iteration plan

Quality program criteria

Quality metrics

Quality metric 1

Quality metric 2

Use case scenarios

Create Test Cases: Review the requirements to be tested as set out in the Inception Phase document. Identify and outline relevant Test Cases. Identify test data needs. Share and evaluate the Test Cases

Scenario One

Expected Setting

Data capture requirement

Data retrieval requirement

Scenario Two

Expected Setting

Data capture requirement

Data retrieval requirement

Scenario …

Test cases

Project Resource Estimates

Estimate project size; Forecast project velocity and duration
Evaluate risks; Establish costs and articulate value; Plan deployment; Outline project lifecycle

Scope of construction phase

Optionally:
Skills required
Solution Specification (Elaboration)
Implementation
Outline of work packages
Preventing recurrence of problem
Division of project into stages

Projection of remaining overall project resource requirements

Expected project resource requirement category

Is it "fast track" or does it require project management?

Expected project impact and benefit

Updated view of impact and benefit, organized by stage if the project is to be staged

Indicative resource estimates for construction, transition and maintenance: