1

Call to order and role call

Jim Case

This meeting is being recorded to ensure that important discussion points are not missed in the minutes.  The recording will be available to the SNOMED International community.  Joining the meeting by accepting the Zoom prompt declares that you have no objection to your comments being recorded.

Minutes generated from transcript by Claude.AI and edited by Jim Case

2

Conflicts of interest and agenda review

Jim Case

None recorded

3

Summary of discussions since October 2025 meeting

Jim Case

• Bypass graft and shunt modeling - discussed multiple times and resolution close

• Endoscopy procedure modeling - approach has been endorsed and modeling underway

• adding gene names to SNOMED CT - approach endorsed and over 600 genes have been added

• attributes to support modeling of deficiency and excess concepts - appraoch endorsed and remodeling underway. Early visibility published.

• Container modeling - new attributes added, Content being revised as a collaborative editing project.

• Reattachment, reimplantation, replantation, refixation - still under discussion

• Recanalization of blood vessel - pending further discussion

• Traumatic and non-traumatic injury - difficult topic, no resolution at this time

• Proposed revision of the Situation hierarchy - Problem statement developed, awaiting resources to complete analysis and provide solution.

• Observable entity vs. Evaluation procedure - another challenging discussion with no formal resolution

• Digit of hand vs. finger - actively being discussed on SNOMED forums

• Linking substance to organisms - proposed solution being tested by collaborative author

• The use of conjunctions in Endoscopy and Procedure concepts - approach has been endorsed and rework of desciptions is underway.

• Replacement procedures - Remodeling option selected and is being tested.

• Surgical vs. nonsurgical procedures - revisitation of topic. A proposal covering affected content, dependencies, implementation impacts, and mitigation options is underway.

4

Metastatic morphologic abnormality and metastatic disorder modeling

Nicola Ingram

Jim Case

Summary: SNOMED CT currently represents metastatic behavior as a subhierarchy of 99 morphologic abnormalities under 14799000 |Neoplasm, metastatic|, used to model 966 disorder concepts. OHDSI and the Histology Content Quality Project Group have flagged this as a modeling error: metastatic behavior is a pathological process, not a morphology, and conflating the two axes has produced inconsistent modeling and data-retrieval problems for secondary users. Only 6 of the 99 concepts actually correspond to an ICD-O "/6 Metastatic" code, undercutting the main justification for retaining them.

This mirrors the 2022 Primary and metastatic malignancy project, where "primary" morphologies were replaced with a Pathological process attribute — that project's metastatic half was never completed. This BN proposes finishing it.

Three options are presented:

1. Housekeeping only — freeze further growth of the subhierarchy; no remodeling.

2. Retain morphologies, fix disorder modeling — remodel all 966 disorders to use plain histologic morphology + Pathological process attribute; stop using metastatic morphologies in disorder modeling but keep them as a reporting layer.

3. Complete and inactivate — remodel all 966 disorders as in Option 2, and inactivate all 99 metastatic morphologies (historical association to the plain morphology). No ICD-10 mapping impact under any option.

Recommended by the Pathology Clinical Reference Group: Option 3.

Decision needed from EAG/CMAG/Member Forum: whether the full /6 hierarchy is in scope for inactivation, preferred option, whether all 966 disorders should be remodeled, and any implementer impact.

Full Briefing note attached.

Discussion:

Decision:

5

Osteochodrosis, osteochondritis,

Monica Harry

Deferred to a later date.

Discussion:

Decision:

6

Temporal context

Jim Case

John Snyder

Temporal context values (410510008) returns to EAG following the unresolved discussion in items 4 and 7 of the 26 September 2022 meeting. A consolidated analysis — combining usage figures corrected for national extension content, a reanalysis under SNOMED CT's open-world semantics, and an independent usage study (Snyder, September 2026) — finds that most of the apparent redundancy in the hierarchy is addressable through documentation rather than removal: only 2 of the 12 concepts are genuinely eliminable, the attribute's own definition has described an unbuilt "future" branch since at least the 2015 Technical Implementation Guide, and none of the 12 concepts carry a textual definition linked from the concept itself. Proposed definitions, a maintenance/inactivation recommendation, and a future-context representation proposal are available in the supporting analysis document. EAG input is requested on the questions below ahead of a formal Briefing Note.

Questions for EAG:

• Should explicit textual definitions be adopted for each Temporal context value and linked from the concepts themselves, rather than remaining only in the Editorial Guide's general attribute-level description?

• Should 410588008 |Past – time unspecified| and 410585006 |Current – time unspecified| be inactivated, given near-zero usage at both International and extension scope?

• Should 6493001 |Recent| retain its second parent, 7389001 |Time frame|, or should that relationship be removed as a modelling error?

• Should 410589000 |All times past| and 708353007 |Since last encounter| be re-parented directly under 410513005 |Past|, bypassing 410586007 |Specified time|?

• Should authoring guidance discourage direct assignment of 410510008 |Temporal context value| itself, currently used directly on 25 concepts?

• Should future-oriented situations continue to be represented via Finding context / Procedure context rather than by adding a "Future" value to Temporal context value?

• Should the family history "Current or past" ambiguity flagged in 2022 (item 4) be scoped as a dedicated remodelling project, addressed through post-coordination guidance only, or left as-is?

• Should the 194 SWEC concepts with more than one relationship group be enumerated and reviewed for genuine multi-context disjunction, separate from the associated-finding decomposition pattern already identified in the fracture/pathological-fracture family?

Full analysis document and presentation attached.

Discussion:

Decision:

7

Immunization vs. vacciantion

Jim Case

Seeking EAG endorsement of the permanent policy for handling “immunization” descriptions on vaccination concepts under 33879002 |Administration of vaccine to produce active immunity (procedure)| in SNOMED CT, and to determine whether a Briefing Note to the wider Community of Practice is required before any implementation proceeds.

Full EAG briefing nore attached

Discussion:

Decision:

8

Plastic procedures

Victor Medina

EAG to review and provide input on a proposed restructuring of the action/Method qualifier hierarchy around 286553006 |Plastic operation (qualifier value)|, to resolve the naming and modelling inconsistencies raised by the Netherlands. The proposal repositions 286553006 |Plastic operation (qualifier value)| in the hierarchy, introduces one new concept, relocates one existing concept, and defines a mechanical, reproducible rule for classifying affected content, rather than resolving the naming inconsistency by author judgement on a case-by-case basis.

Draft briefing note attached.

Discussion:

Decision:

9

Finger vs. digit discussion

Yongsheng Gao

Jim Case

The ongoing discussion on finger vs. digit will be continued in the Joint Advisory Group meeting on Wednesday. A review of the comments on the forum and the MAG discussion.

Summary of options:

Two models were presented: an exclusive model (Option 1) and an inclusive model (Option 2), the latter offered in three implementation variants.

• Option 1 (exclusive model): Keep “finger” meaning digits 2–5. Add approximately [n] new “digit of hand” concepts where an inclusive grouper is needed, and revise FSNs to state “excluding thumb” explicitly.

• Option 2a (inclusive model, full replacement): Inactivate the affected “finger” grouper concepts and replace them with new “digit of hand” concepts, keeping “finger” as a synonym. Concepts naming a specific digit are unaffected.

• Option 2b (inclusive model, FSN reinterpretation): Reinterpret existing concepts through FSN updates alone, inactivating only the approximately [n] concepts that would become duplicates. Meaning-changing FSN edits depart from current editorial policy, which requires inactivation and replacement.

• Option 2c (inclusive model, hybrid):

  • In the Body Structure hierarchy, formally inactivate and replace the affected concepts, so the corrected meaning propagates through classification via defining relationships.

  • In the Clinical Finding, Procedure and Observable hierarchies, apply FSN updates only. Existing records against those concepts will take on the inclusive meaning without a historical association signalling the change.

10

Reattachment, reimplantation, replantation, refixation.

Victor Medina

Origin: CRS request 974415 (Netherlands), which reports inconsistent use of Reattachment and Replantation and questions the modeling of 82254000 |Refixation (procedure)|.

Summary

SNOMED CT currently treats four related surgical actions inconsistently. The literature distinguishes them as follows:

• Reattachment is the umbrella term: reconnection of partially or completely detached tissue.

• Replantation is microsurgical reattachment of a completely amputated part with vascular anastomosis.

• Reimplantation is the return of a structure that was intentionally detached as part of a planned procedure.

• Refixation is not a standard surgical term.

Three problems follow from the current content:

1. “Replantation” is a synonym of 278312000 |Reattachment - action|. As a result, the two terms are used interchangeably across the 371547003 |Reattachment procedure| subtypes.

2. 129337000 |Reimplantation - action| sits only under Implantation - action, which doesn’t capture its prior removal step.

3. 82254000 |Refixation (procedure)| is inconsistent with its only child, 1253002 |Refusion of spine|, which is modeled with Method = Fusion - action.

Proposal

• Keep Reattachment - action under Repair - action, and remove its “Replantation” synonym.

• Create a new Replantation - action under Reattachment - action, and remodel about 35 “Replantation of X” procedures to use it.

• Place Reimplantation - action under Reattachment - action as a sibling of Replantation - action.

• Assess remodeling Reimplantation - action as a combined Removal + Implantation action, which affects about 52 procedures.

• Review the descriptions of the 23 direct subtypes of Reattachment procedure. For each, retire the replantation synonym or create a distinct “Replantation of X” concept.

• Inactivate 82254000 |Refixation (procedure)|, and remodel Refusion of spine as “Revision of fusion of spine”.

• Review dental reimplantation case by case.

Input requested from EAG

1. Should Replantation - action be created as a subtype of Reattachment - action?

2. Should Reimplantation - action be reclassified under Removal - action and Implantation - action?

3. Should 82254000 be inactivated and Refusion of spine remodeled as a revision procedure?

Impact: About 110–115 concepts. Post-coordinated expressions and national extensions using these actions will need alignment review. Implementation would span at least two authoring cycles, with the release date to be confirmed after EAG feedback.

Briefing note and detailed analysis attached.

Discussion:

Decision:

AOB

None.

Next meeting

Jim Case 

TBD