2018-09-17 - OBSERVABLE Meeting

1

Welcome & apologies

@Daniel Karlsson

• Remember recording!

2

Conflicts of interest

@Daniel Karlsson

• None stated

3

Previous minutes

@Daniel Karlsson

4

Susceptibility

@Suzanne Santamaria

@Farzaneh Ashrafi

@Daniel Karlsson

@Former user (Deleted)

• Mapping of LOINC component for Susceptibility LOINC terms

• There will likely be a new "diagnostic product" hierarchy parallel to the medicinal product hierarchy, reusing attributes and patterns from that hierarchy. The priority of this work is currently unknown

  • The new category would need modeling guidance (cf. Clinical Drug (CD) Concept - Pattern 1a, permission needed!). Some of the items that should be considered are as follows (from Farzaneh and Toni):

  • Do we need a new semantic tag?

  • Can the concepts be modelled with a single pattern/template or are there multiple patterns/templates needed?

  • Can we reuse of some of attributes in medicinal product and CDs? Do we need to create new ones?

  • Does the hierarchy require groupers?

  • Do any concepts have strength ranges?

  • If a concept specifies more than one substance, does each substance have an associated strength?

  • See this page for discussion: Diagnostic products

  • Draft editorial guidelines: Editorial Guidelines for Diagnostic Products Used for Susceptibility Testing

5

Vital Signs Observables

@Daniel Karlsson

• The SNOMED on FHIR project has been working with the FHIR Vital Signs profile and identified issues in SNOMED CT Observables sub-hierarchies

6

Diastolic arterial pressure 

@Suzanne Santamaria

**See comments added to previous meeting agenda page for more information*

"Diastolic arterial pressure - please can you review current content regarding diastolic arterial pressure and add a new concept for Diastolic arterial pressure. There is a concept that is inactive. This would match 72313002|Systolic arterial pressure (observable entity)|, and thus provide the required Observable targets for all GP composite BP readings.

There are currently two observable entity concepts for the recording of 271649006 | Systolic blood pressure (observable entity) and 72313002 | Systolic arterial pressure (observable entity) but the diastolic observable entity concept (271650006 | Diastolic blood pressure (observable entity)) has the synonym of 2620223019 | Diastolic arterial pressure. Please can you review this concept and add a new concept for Diastolic arterial pressure? 

Primary care composite BP readings (of which there are a few billion to be migrated...) are generally recorded against two READ2/CTV3 codes, one for the systolic and one for the diastolic element. These need mapping to SCT observables. The 'obvious' targets of 271649006|Systolic blood pressure (observable entity)| and 271650006|Diastolic blood pressure (observable entity)| are IMHO in fact inappropriate because they're groupers: they subsume, for example, the notions of target BP. This is potentially a problem in querying contexts; I'd rather move the 'random' BP readings further down the taxonomy. A suitable concept already exists under 271649006|Systolic blood pressure (observable entity)|, but the proposed solution requires the other half instating under 271650006|Diastolic blood pressure (observable entity)|.

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2358-04292017000600005 https://www.ncbi.nlm.nih.gov/pubmed/18469640"

I reviewed the Vital signs I/E document again ( https://snomed.atlassian.net/wiki/x/j4-OBw) and didn’t find this specifically addressed except the mention of the above description. Some questions I have:

• Do we need a concept which is “Systolic arterial blood pressure at single point in time?” or “Random systolic arterial blood pressure?” (and equivalent diastolic arterial pressure)?

• Do we need to reactivate 67726005 |Diastolic arterial pressure (observable entity)|?

• Do we need to remove description “SAP - Systolic arterial pressure” from 271649006 |Systolic blood pressure (observable entity)|?

• What is intended relationship and difference between 271649006 |Systolic blood pressure (observable entity)| and 72313002 |Systolic arterial pressure (observable entity)|? Currently they are supertype-subtype.

• Recommend re-activating of 67726005 | Diastolic arterial pressure (observable entity) | modelled similar to 72313002 | Systolic arterial pressure (observable entity) |

• ..and removal of "diastolic arterial pressure" synonyms from 271650006 | Diastolic blood pressure (observable entity) |

7

Target observables

@Suzanne Santamaria

Two member countries (US and UK) had requested a series of target observables in the past (2011?). The request was "hidden" in a JIRA ticket rather than both being in CRS so they had not been on our radar. They have been added to SNOMED CT for the January 2019 release as: 1) SI and the US agreed to add the content; 2) the precoordination pattern was unblocked by Editorial Panel on 10 September (PCP-5 artf223120-Target range/value for <X> (observable entity). They have been added as primitive to SNOMED CT for now. Daniel indicated they can probably be defined if we continue/resume discussions on the modeling. If we agree upon a model there are some existing "target observables" which could be remodeled as well.

Previous discussions: 2016-10-24--26 - OBSERVABLE Meeting

8

Specimen margin observables

@Suzanne Santamaria

Can 427169006 |Specimen margin close to tumor (observable entity)| be inactivated as duplicate (or ambiguous) with a reference to 371491000 |Specimen margin closest to tumor (observable entity)| ?

9

Face-to-face

@Daniel Karlsson

10

Next meeting

@Daniel Karlsson

• Face-to-face meeting

• 2018-11-19 (or do we want to go back to twice per month?)

• As the LOINC project is on hold, we will shift to monthly Observables calls

11

AOB

@Daniel Karlsson