2025-10-09: DEUSG Virtual

Opening

2 min

Shane Byrnes

SNOMED Forums - Review of Open Discussions

20 min

All

The DUSG meeting focused on reviewing and prioritizing various topics related to substances coordination, classification, and modeling, with discussions on handling substances in multiple extensions, active ingredients, and rounding rules. The team explored challenges in classifying organisms versus substances, particularly for active ingredients in medical products, and agreed on the need for guidance to ensure consistency in classification. Updates were provided on modeling and standardization topics, including dose form concepts, multi-component clinical drugs, and the potential collaboration on blood-related products hierarchy, with participants encouraged to explore the new editorial guide and submit topics for discussion at the upcoming Antwerp meeting.

Topic Backlog - Review of Backlog Items

20 min

All

AI summary of call:

Substances Coordination and Prioritization Review

The DUSG meeting focused on reviewing open topics and discussions from the year, ensuring nothing was overlooked and prioritizing items as needed. Shane led the group through the topic backlog, discussing substances coordination, which was divided into three categories: substances in multiple extensions (completed), substances in one extension (work ongoing with the Soman International Content Team), and ongoing substance coordination. Guillermo raised a concern about substances accepted for international relief but detected as ingredients in other medicinal products, proposing a collaborative approach to address this issue. The group agreed to discuss collaborative authoring approaches and substance-level considerations, as well as the inclusion of microorganisms and natural products as active ingredients, with Linda suggesting the use of forums for people to pose range changes and follow up at the meeting in Antwerp.

Classifying Organisms vs Substances in DL

The team discussed challenges in classifying organisms versus substances, particularly for active ingredients in medical products. They explored how to handle cases where only parts of plants or organisms are used, with Stuart suggesting a need to draw a clear line between substances and organisms. The group agreed that guidance is needed to ensure consistency in classification, and Alejandro proposed considering a property chain or similar approach in DL to allow for the use of parts or organisms with similar results.

Modeling and Rounding Rules Discussion

The team discussed several topics related to modeling and rounding rules. Shane suggested breaking down complex topics into smaller chunks for discussion. Guillermo proposed sharing the Canadian rounding algorithm and example code to help predict international release results. The group agreed to create a forum post to gather examples of rounding issues and discuss guidance gaps. Linda mentioned that adding dose form after transformation to the dose form concept model was a priority. The team confirmed this topic was scheduled for discussion at the upcoming Antwerp meeting. Guillermo expressed a desire to move forward quickly on the less granular clinical drug analysis, suggesting it could be discussed in Denver if he couldn't attend the Antwerp meeting.

Clinical Drug Classification Analysis

Guillermo presented an analysis of clinical drugs, focusing on precise active ingredients and their relationships with base substances (BOSs). He explained that they have identified 1,700 substances with clarified active ingredients and 6,600 where the active ingredient matches the BOS. Guillermo detailed their classification system for substances with one to five ingredients, noting that substances with one or two ingredients can be reviewed manually. He highlighted that about 1,900 substances have a BOS that is a modification, which presents challenges for classification. Guillermo concluded that they are focusing on "EC pockets" for the Antwerp project and will address other pockets later, with plans to develop a testing extension for Antwerp.

Pharmaceutical Substance Classification Discussion

The group discussed the classification of pharmaceutical substances, focusing on the distinction between bases and modified substances. Guillermo explained the difference between base width mode and modification mode, and the need to cross-check classifications with real products. Julie raised concerns about the ambiguity of high-level concepts across different countries, particularly regarding amitriptyline hydrochloride. The group agreed to prepare proposals for unambiguous naming of concepts and submit them to the forum for discussion.

BOSS and PAI Semantics Review

The team discussed challenges with maintaining clear semantics around BOSS and PAI, particularly as new substances have been introduced since 2017. Guillermo explained they are preparing a report to profile international release usage and content, noting the need to normalize data across different countries while considering local requirements. The group also discussed elemental substances, with Matt agreeing to share the analysis on a discussion forum and Stuart raising concerns about potential overlaps between medicines and pathology uses of substances.

Model Improvement and Distribution Discussion

The team discussed the need to ensure their model improvements do not inadvertently break others, with Stuart and Matt agreeing to move the discussion to forums for further input. Nicki confirmed she would add replacement values to a briefing note, which Emma and Karen had reviewed, and the document would be redistributed with a revised release date of January 1st. Guillermo explained that dehydration subsumption options, previously implemented in Canada, could be shared in Excel format, but IP issues regarding Islamic content distribution needed to be considered. Linda clarified that Option 3 involved adding the is hydrate of relationship to the substance hierarchy and creating precise active ingredient property chains.

Modeling and Standardization Updates

The team discussed several modeling and standardization topics, including dose form intended site versus route administration, which Nicki noted requires community feedback before proceeding. Linda highlighted multi-component clinical drugs as a priority for Canada, confirming it would be discussed at the upcoming Antwerp meeting. The team also reviewed the value range of hasContainerType, which was marked as complete but could be reopened for additional feedback, and Guillermo mentioned lateral promotions from Australia that could be shared in the forums for potential international release.

Product Hierarchy and Collaboration Updates

The meeting focused on updates and discussions regarding various topics, including feedback on forum posts, the need for a cleanup of the pharmaceutical/biological product hierarchy, and the potential collaboration on the blood-related products hierarchy with other organizations. Participants agreed to explore the requirement for tracking blood products and to investigate past discussions and potential collaborations. The group also discussed the new location of the editorial guide, which has been moved to a more user-friendly platform with improved search functionality and AI integration. Participants were encouraged to explore the new guide and to submit any topics for discussion at the upcoming meeting in Antwerp.

Editorial Guide

5 min

Alejandro Lopez Osornio

Editorial Guide is now on SNOMED Docs Site with the other Guidelines

Reminder National Extension Model is now in Domain Specific Modelling ->Pharmaceutical and Biologic Product

AOB

5 min

All

• Topics for Antwerp

Topic Backlog

• Substances Co-ordination (MF/2025 Priority topic)

  • Step 1: Substances in multiple extensions Complete

  • Step 2: Substances in one extension. Underway

  • Step 3: Ongoing Substance Co-ordination (capturing at regulator level) Open discussion,

• Medicinal Product promotion co-ordination (Oslo group discussion as linked to substances work + ES) linked to above, include MP containing and MP only when capturing new substances.  

• Increase range of has active ingredient to include microorganisms and natural products (Guillermo, CA, AU) open discussion, forums, suggest examples, Note: increasing range is good, plant versus parts of the plant. - need guidance Whole organism versus part of it. Scope of organisms? Probiotics/live organisms. Dust mites in allergy kits? Emphasis on need for guidance - where is the line? organism live v dead. Link to extracts discussion already on forums.

• Link between Substances and the organism they come from (Cat dander protein → Cat organism) see PCP-6 related to above, may spin off.

• Rounding rules - update on where SI is at with current guidance (Linda, CA) forum on current guieance, members to identify issue areas/gaps, sharing algorithm and example code could support use for processing,

• Adding |Dose form after transformation| to the Dose form concept model (Linda, CA) Scheduled on agenda for antwerp.

Done or in progress:

• Less Granular Clinical Drug Group discussions underway on potential options for modelling Scheduled for Antwerp, Guillermo will share analysis, looking at in stepwise manner.

• Elemental Substances (Matt, AUS) Presentation on challenges shared. For consideration for Forums, to link in pathology group on forums for input, to account for pathology use cases in any potential change.

• Units of Measure - proposal for rationalisation of concepts (Emma, UK) Briefing Note drafted currently on forums, target for 1st Jan BN.

• Hydration Subsumption 'Option 3' proposed by DEUSG for communication/consultation with MAG and EAG implemented in CA, can share. Continue on Forums

• Group Input on Patch Strength Representation Briefing note now being implemented complete

• Dose Form Intended Site v Route of Administration (BEL) Pending implementation use-cases associated with intended site on Forums - linked to Dose based prescribing/dosing instructions.

• Drug extension MRCM attributes (CA, AUS) SI facilitating links with CA and AUS for cross-promotion, next steps: other countries to be invited to add to catalogue for forums: multi-component clinical drugs prioirity.

• Value range of a |Has container type| attribute (Linda, CA) For forums discussion.

• Routes of Administration - Implementation Considerations (Mia, NZ) linked to RoA v Dose Form intended site. + Administration of Drug v Drug therapy (already open on Forums)

• Top level children of 373873005 |Pharmaceutical / biologic product| hierarchy - are members using/how are members using? (AUS) For Forum. Blood products hierarchy out of scope, current status? For Antwerp to explore background information.