Decisions & Recommendations

Laterality

2015-10-27

1. Restrictions on laterality be relaxed.

2. IHTSDO should add lateralized concepts as needed and not proactively pre-coordinate every laterality.

3. The AG unanimously recommended laterality Option 4, which is essentially the same idea as option 3 but implemented with a new attribute like “has laterality” that users add to the same role group instead of having it outside the same role group.

The early decision was reviewed at a number of the following EAG conference calls and it was decided to use the current capabilities in the terminology to support lateralized content.

Decision: The addition of pre-coordinated structures using the existing "LATERALITY" attribute was approved in light of the timeframe for support of nesting.

Implemented and ongoing

Phyiscal object as Specimen substance

2015-10-27

Currently, Device specimen is a subtype of specimen; however not all physical objects that may be specimen substances may be devices. Recommendation to relax the range to include all physical objects.

Tracker item:

2015-12-10: The suggested modeling change will be managed as part of the effort to create clarity re: use of substance vs product concept as attribute values to define concepts in other hierarchies (associated with the Drug - International Release Model and Content project). Details can be found on the following Confluence site:
https://confluence.ihtsdotools.org/display/DIRMC

Pending

New attributes to describe temporal context

2015-10-27

Discussion related to the need for representing temporal context beyond the existing AFTER relationship. Initial proposal was to add temporal values to the OCCURRENCE range. This was not accepted.

Later discussion included the creation of new temporal attributes to distinguish between causality and temporality of combined disorders.

TEMPORALLY RELATED TO

BEFORE

DURING

Add AFTER as a subtype of TEMPORALLY RELATED TO

Completed

Application of ECE guidance retrospectively: maintenance of existing descriptions that may be ambiguous

2015-10-27

Presentation outlined existing issues with content that does not conform to proposed naming and modeling for combined disorders as recommended by ECE

In progress

Unilateral Concepts

2015-10-27

2015-11-30

No decision at the 2015-10-27 meeting. Additional input from implementers will be sought.

2015-11-30 discussion

1. Retire the concepts as ambiguous (and this was the most radical solution).

2. Add them to the findings hierarchy but keep them as siblings to the lateralized structures, which unlinks them from bilateral, left and right.

3. Leave them where they are.

In progress

SNOMED CT Interface or Reference Terminology?

2015-10-27

As part of the SNOMED CT design, interface terminology is wholly supported by SNOMED CT and the may be represented as a dialect. The way one should implement an interface terminology is by implementing a dialect of SNOMED CT, not by doing an ongoing mapping that would never be semantically sound and that would cause a number of other problems.

Completed

WAS-A relationships

2015-11-30

Add to the Editorial Guide guidance on retirement of WAS-A relationships. The WAS-A should be removed and the target concept should be linked to the next proximal higher concept in the hierarchy.

Pending batch update

Need for description that matches FSN

2016-01-22

This is an "english-language" issue as it does not affect translations. While it has been the standard for SNOMED CT for over 10 years, recent changes to the FSN naming patterns has resulted in a large number of "non-user-friendly" FSNs, especially for combined disorders. The addition of descriptions with these terms was proposed as being of little value.

The determination of when a description matching the FSN provided value would be left up to the editor. The authoring tool would still create one when a new concept was created, but the retention of that description would not be mandatory

Complete

Use of URLs in concept definitions

2016-01-22

More evaluation is needed because it was about more than just URLs. There were a lot of issues around text definitions that need to be discussed.

Discussion page created.

Pending

Use of Slashes in FSNs

2016-02-29

JCA said the final recommendation on use of slashes in FSNs was documented on the discussions page. 

Complete

Use of the Oxford comma in FSNs

2016-04-19

The Oxford comma is a comma added after the penultimate term in a list, e.g. For example "Disorder of head, neck, and shoulders". The purpose if its use is to make explicit the fact that the terms are part of a list. The editorial guide is silent about its use, but the example provided does not use the Oxford comma.

There are currently 347 FSNs in SNOMED CT that use the Oxford comma. Most of these are terms obtained from other terminology, such as ICD and nursing. There are 2500 that contain comma delimited lists but do not use the Oxford comma.

Should SNOMED CT be consistent in the use of this grammar mark or maintain fidelity to the original source of the terms that do use it?

Pending

Evaluation of the use of DUE TO

2016-04-19

Based on work done by the ECE, there is a need to do a historical review of the use of the DUE TO relationship to ensure that the causality is supported by the current literature.

Pending

Addition of "grouper" terms to hierarchies

2016-04-19

Acknowledged that for primitive hierarchies, grouper terms are necessary to navigate and organize the hierarchy.

Decision: Primitive groupers may be added to top level hierarchies that d not have a supporting concept model.

For hierarchies with a concept model the usefulness of fully defined groupers is limited to convenience groupings based on preferred classifications (e.g. disorder by site), Primitive intermediate groupers, while discouraged, are sometimes necessary when the concept model is not robust enough to support the full definition of a subset of terms. However, they add a substantial management burden.

Decision: Fully defined intermediate groupers may be added if they provide demonstrable benefit to organizing and navigating the terminology. Intermediate primitive groupers will only be added on a case by case basis and by approval from the Head of Terminology or the Principle Terminologist.

Pending

Use of Non-ASCII characters

2016-04-19

Use of non-ASCII characters, such as "em-dash" and "en-dash" in descriptions was discussed and general consensus was that these should be supported.

Pending

Moving concepts between hierarchies without replacement

2016-04-19

Agreed that a simple editorial policy regarding conditions under which concepts could be moved without inactivation and replacement. Examples include Findings to Situation, Evaluation procedures to Observable entity, etc.

Pending

Word order variants

2016-04-19

There is no general policy for acceptance of word order variants, although it is discussed in a number of areas of the Editorial Guide. A section under 7.4 General rules for naming conventions for specific hierarchies should be added to specify when word order variants are allowed.

Pending

Lymphadenopathy

2016-04-19

Clinical interpretation/usage of terms vs. way they were represented in the terminology is causing inference issues.

Pending

Extending the range of pathological process

2016-08-22

Needed to support remodeling of Congenital malformations and inactivation of duplicate "Congenital X (morphologic abnormality) concepts

Complete

Addition of diagnostic imaging concepts with multiple body sites

2016-08-22

Decision:

IHTSDO will not accept concepts with multiple body sites

Complete

Editorial Guidance on Numeric Ranges in the FSN

2016-08-22

Ranges to use the word "to" to separate numbers, e.g. 2 to 2.5 mg

Question remains as to whether to include the unit after the first number, i.e. 2 mg to 2.5 mg

Organizational groupers

2016-10-25

Decisions:

• Groupers are allowed so long as they fulfill the minimum requirements of being fully defined, have no stated subtypes.

• Existing groupers must be remodeled to fulfill these criteria.

Complete

FSNs, Preferred Terms, Synonyms and Tooling

2016-10-25

The naming standards being applied to FSNs in some cases leads to "non-user friendly" terms. What is the need for a duplicate description of these terms if they do not provide usefulness in clinical records.

Decisions:

• The need for duplicate description of the FSN term is no longer required if it does not provide usefulness.

• Tooling needs to be updated to not throw an error when a duplicate term is not proesent

• The decision to remove a duplicate term is made by the editor creating the concept

Complete

Assessment instrument responses

2016-10-25

IHTSDO currently accepts "names" of assessment instruments and staging scales; however, there is nothing in the editorial guide that specifically addresses the responses to assessment instrument questions.

Proposed general guidance:

• Only assessment instruments that allow "unrestricted use" should have their response values added

• Response values must adhere to current FSN naming guidelines. Verbatim responses from the assessment will be added as PTs.

• Assessment responses will be added under an assessment specific "grouper" term to facilitate navigation

• IP-restricted assessment values may only be added upon permission of the pubisher. It is the responsibility of the requester to secure that permission

In progress

Disjunctive components

2016-10-25

 LOINC parts that contain the “+” sign have been identified as meaning “either or both”, which is not supported by the current DL constructs in SNOMED CT. 

Decisions:

• disjunctive concepts that have been added to the substance hierarchy be inactivated

• any observables that might have used these concepts be modeled without the component hierarchy as be added as primitive concepts to the core

• Combined substance allergies will be remodeled as primitive concepts with the CAUSATIVE AGENT relationships removed.

Complete

Arteriography vs. Arteriogram

2017-01-20

-gram and -graphy are used interchangeably, but there is also guidance that says only use one. So editorial guidance was needed.

Decision: Use the verb (-graphy) for the FSN and include the noun (-gram) as a synonym.

To be accurate the finding site should be "Vascular structure of X organ", for angiography, Impact of such a change needs testing

Complete

Semantics and placement of "Care plan for X" or "X care plan"

2017-01-20

@Jim Case recommended writing up a fast track to provide clarity on current ambiguous content would be retired, renamed and replaced in the record artifact [hierarchy] to provide structure around the existing content, then bounce off the Content Managers AG. The AG agreed.

Review of the initial briefing note to the CMAG questioned the need to add the term "document" to the FSN when the semantic tag proposed was (record artifact). A note to the CMAG was sent modifying the proposal to remove the term "document" from the FSN.

Complete

Extension of range of SPECIMEN SUBSTANCE to physical object

2017-02-17

Given that "devices" submitted as specimens are sufficiently defined by using the relationship SPECIMEN SOURCE IDENTITY = <<Device

Extending the range of SPECIMEN SOURCE IDENTITY to include <Physical object would allow for new specimen concepts that were not devices to be modeled.

In progress

"X in remission"

2017-02-17

Existing Inception document: Modeling "disease in remission"

Related issue: IHTSDO-407 Frequencies and Courses

Need to evaluate/test the proposed options for addressing this. Solution must be applicable to general notion of disease phases.

Pending

Guidance for creation of new anatomy concepts

2017-02-17

Proposed editorial guidance:

"If two body structures are needed to fully define the finding site for a condition, then a combined anatomic structure shall be created to represent that body structure."

In progress

Addition of "X disorder at Y level"

2017-03-30

Concepts from ICD-11 beta of the pattern "X disorder at Y level" (e.g. Skin laceraction of arm at wrist level). Precedent for this are terms added from ICD-9.

EAG felt the terms were ambiguous

Decision: Because of the perceived lack of usefulness of these terms for data entry and the need to create and maintain a mapping to ICD-11 limits the value in adding them to SNOMED CT.  They may be good candidates for an extension or another moduleID.  They will not be added to the International release.

Complete

Clarification on "substantive change"

2017-04-25

Batch changes to the terminology as part of the quality improvement process may lead to changes in terming, location within a hierarchy or addition/removal of ancestors or descendents.

SNOMED Int'l needs to develop a more robust policy related to what is a substantive change and what is the notfication/approval process needed to be completed before the change can be released.

In process

Editorial policy on relationship groups

2017-04-25

Initial proposed grouping guidance has been added to the SNOMED International Editorial Guide for four hierarchies: Clinical findings (disease only), Procedures, Situation with explicit context, and Observable entity. As we begin developing concept models for additional top level hierarchies, there is a need for additional guidance on how to create relationship groups with approved attributes.

In process

"Intolerance"

2017-04-25

Discussed in detail at the ECE meeting. Proposal to add a new PATHOLOGICAL PROCESS = Intolerance was not agreed to, requiring Intolerance to substance to remain primitive. Consideration of the severity of the intolerance was brought up but not resolved. Referred back to the ECE for final proposed resolution.

Pending

Modeling of "Complications and sequela"

2017-03-30

2017-04-25

A proposal for review and revision of the following types of disorders was discussed:

• Disorders DUE TO another disorder

• Disorders AFTER another disorder

• Disorders AFTER a procedure

• Disorders DUE TO a procedure

• Disorders DURING a procedure

The initial document was taken through a number of revisions and approved by the Head of Terminology in September, 2017

Complete

In process

Proposed policy: Allowance of Extensions to Modify Core Content

2017-03-30

2017-04-25

Extensive discussion on the interpretation of Clause 4.1 of the SNOMED CT® AFFILIATE LICENSE AGREEMENT. Based on discussions by the EAG members and input from extension managers, a substantial relaxation of the changes extensions may apply to the core, provided the changes are represented in RF2 within the extension moduleID. The essential requirement of no direct changes to the core content components was not changed

In process

Policy on acceptance of "Patient-friendly terms" into the International release

2017-03-30

2017-04-25

General agreement that patient-friendly terms are not universal and that the current "dialect " capabilities in SNOMED allow for extension of the core content to accommodate this type of content.

Complete

Combined disorder modeling

2016-10-25 to 2017

Multiple reviews by the EAG as well as testing of patterns by the editorial staff has been performed. While there are still some difficulties in the consistent representation of combined disorders, due to their very nature, the patterns are being applied to existing content.

Complete

Pre-coordination of Procedure with procedure indication

2017-09-28

General agreement that the indication for the procedure should not be pre-coordinated with the procedure itself. Systems should leverage the supporting information model to capture the relationships (e.g. CIMI, FHIR).

One exception to this is whether the indication actually changes the way a procedure is performed (such as a surgical approach). However, this would only apply when the concept model does not support modeling the change in procedure.

Pending