Inactivation of procedures stating intent

8 December 2021

Feedback on plan to inactivate procedure concepts which specify the intent

@Elaine Wooler

Please post your final responses in the Country response table below. Discussion comments can be made as comments.

Denmark

20211208

DK agrees to the suggestion in the briefing note about inactivation of procedures stating intent as diagnostic or therapeutic and using agnostic procedures instead.

New Zealand

20211214

NZ is in agreement with the proposal to inactivate procedures stating intent (diagnostic/therapeutic).

Netherlands

20211221

Before we can agree with this proposal we need more information as we use diagnostic/therpeutic in our extension. We miss (or can't understand) information from this proposal. These are our questions:

• "Unless there is a clinical reason and the procedure itself changes depending on whether it is diagnostic or therapeutic then the agnostic procedure would be sufficient" → From this statement we understand that the diagnostic endoscopy isn't necessary anymore. Endoscopy is diagnostic (therpautic would be endoscopic procedure with the therapeutic part of the procedure), but 363071007 |diagnostic endoscopy (procedure)| still exists (endoscopy intents was an earlier proposal). Do we understand it correctly that this will be inactivated, because '423827005 |endoscopy (procedure)| is enough as agnostic procedure?

• "and the procedure itself changes depending on whether it is diagnostic or therapeutic" → What difference between therapeutic and diagnostic procedure needs there to be. For example aspiration - there is diagnostic aspiration and therapeutic aspiration. Maybe the amount of fluid that is aspirated is different, but the main different is the intent. Is that still a reason to keep both procedures or will this become one procedure 'aspiration'?

• When is is correct to use diagnostic or therapeutic as intent? When it's stated explicitly in the FSN and there is no agnostic procedure? Do you have any examples. We see some examples in the editorial guide but we are in doubt if the guide is adapted to this proposal. Also examples of using the intent incorrectly would be helpful. 

• Are there more intents on the candidate list to be inactivated, like preventive?

UK

Jan 7, 2021 

We had problems with interpretation of when to use Has intent and this  has been causing problems. We do not receive many requests for procedures with the words "diagnostic" or "therapeutic" in the term, although occasionally it happens.

I have a question about the following : "Unless there is a clinical reason and the procedure itself changes depending on whether it is diagnostic or therapeutic then the agnostic procedure would be sufficient." Does it meant that in these circumstances, Has intent can be added?

It would be very useful if specific examples illustrating different scenarios are added to the guidance to help us with authoring.

600+ endoscopy procedures in core are modelled with Method - Inspection-action in stated view, which seems like an alternative way of saying that this procedure is performed for diagnostic reasons (to inspect something rather than to treat).

Ireland

Jan 12, 2022 

Ireland agrees with inactivating these concepts as they are not currently in use here.

Sweden

Sweden agrees to the suggestion about inactivation of these concepts.

Australia

Jan 14, 2022 

Sound proposal but without knowing which concepts are affected, hard to speak to the impact of the changes. However from a modelling perspective, it definitely makes sense. No objections from our end.

Belgium

20220509

Belgium does agree to the proposed suggestion about inactivating these concepts.

Member countries without a CMAG rep

11 April 2022

Feedback on questions asked at the April 2022 CMAG meeting: 

Questions:

• The following grouper concepts exist under 362961001 |Procedure by
  intent (procedure)|. How useful are these groupers in practice as they do not capture all
  diagnostic and therapeutic procedures and could they be inactivated?

  • 103693007 |Diagnostic procedure (procedure)| - 764 descendants

  • 277132007 |Therapeutic procedure (procedure)| - 2088 descendants

• How useful are the other high level concepts that give little clinical information and have
  few or no subtypes. Examples include:

  • 36219006 |Diagnostic procedure on tibia (procedure)|

  • 39550008 |Diagnostic procedure on iris (procedure)|

@Elaine Wooler

Please post your responses in the Country response table below. Discussion comments can be made as comments.

Denmark

20220519

We know that our analysts would want this type of division, but our clinicians tell us that it is not possible to make this in practice. So the goupers are only useful if the do capture all. As you say this is not the case we would vote that they can be inactivated.

New Zealand

20220607

We agree that separating diagnostic from therapeutic intent is not practical. We agree these may be inactivated.

USA

20220607

Intent is generally not a key element in the description of procedures. (If something in the procedure is intent-specific, it should be described as a characteristic on its own.) This said, diagnostic and therapeutic procedures are heavily used in value sets, in part because of the current hierarchical organization of SNOMED CT. Therefore, substantial work will be required to adjust to the proposed changes.