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

2

Conflicts of interest and agenda review

@Jim Case

None recorded

3

TRAG discussion on "withdrawn" reason for inactivation

@Jim Case 

TRAG discussion page located at:

Potential for adding a "withdrawn" reason for inactivated content

Additional discussion page: Proposal to increase the level of metadata available for authors to log decisions made during content authoring

Discussion:

Need a clearer definition of what is meant by "active" content.  Does it require an effective time to be active?  One use case is translation or mapping to unreleased content.  Would the notion of "never activated" be an acceptable alternative?  Should this content ever be referenced in release files?  While the daily build is a useful tool for previewing new content, it should not be used as a basis for "early" translation or mapping.  The content should be used "at your own risk".

Decision:

General consensus  is that prerelease content should not be used in production and thus the need for a "withdrawn" identifier is not needed.  Need to be more explicit that prerelease content is subject to change or deletion.

4

Proposed policy for Assessment Instruments in SNOMED CT International release

@Jim Case 

Find attached a proposed policy related to Assessment instruments.  Comments from the EAG members are solicted.

Discussion:

While the underlying principles are OK, it does not address the lack of ability to perform analytics on individual components of an assessment instrument.  The key issue is the permission to use copyrighted material.

Explanation of the reasons for adding the three types was provided.  Usage data on the score observables was requested

Decision:

No issues with document as proposed.

5

Briefing Note regarding the inactivation of therapeutic role groupers in the Medicinal Product hierarchy. 

@Nicola Ingram 

Informational only:  Based on the discussion during the EAG meeting in London, the following Briefing note is distributed.

Discussion:

Concern about potential misunderstanding of the use of the term "role groupers".  Suggest clearer phrasing to represent the fact that the inactivation are grouping concepts as opposed to the removal of role groups (or relationship groups) from the model.

There is an ongoing issue with substances that are really products acting as groupers of other substances without a link to a product, which is correct.  Another approach is needed.

Decision:

No objections  to proposal

6

Updated Briefing note for transplantation procedures

@Nicola Ingram 

An updated Briefing note for transplantation procedures of both solid organs and tissues is provided.

Discussion:

Questions to be sent to @Nicola Ingram and @Jim Case for discussion and clarification at a future EAG call

Decision:

7

Reterming of "Percutaneous transluminal angioplasty " concepts

@Monica Harry 

A proposed re-terming of angioplasty concepts due to inconsistencies that have lead to the creation of duplicate concepts.

https://docs.google.com/presentation/d/1_Zv9sasfB-elzwNiZgUC-nrdmgx-Sew74pchOxqsyVM/edit?usp=sharinghttps://docs.google.com/presentation/d/1_Zv9sasfB-elzwNiZgUC-nrdmgx-Sew74pchOxqsyVM/edit?usp=sharing

Discussion:https://projects.jira.snomed.org/browse/GC-287 Need consistent FSNs to represent variations. 

There is sufficient evidence that many of the similar terms are in fact duplicates.  Suggest that the action could be "compression" as it is the plaque that affected rather than a repair of the vessel. Because not all angioplasties are percutaneous, can we say that the existing angioplasty concepts represent a percutaneous transluminal angioplasty?  Likewise, since not all PTAs are done using fluoroscopic guidance, can we make the assumption that the existing concepts all use fluoroscopic guidance?   

The concepts that were created back in 2002, all represented fluoroscopic guidance as ultrasound was not an option.  We need a clear definition for existing concepts to determine whether we can inactivate concepts as duplicates.  We can only model the content to the level that they are represented by the FSN.  

The generic term "angioplasty" is almost universally understood to be a PTA in the general literature.  Question the need for a generic grouper as it can lead to misuse.  This raises the issue around groupers that may be useful for analytics but should not be used in clinical records due to their inherent vagueness.  (outstanding issue)

Decision:

8

Change Surgical approach to Procedure approach

@Victor Medina 

@Jim Case 

At the March 2024 EAG call, the group asked for an impact analysis of the change from Surgical approach to a more general Procedure approach.  The results of that analysis were presented at the April 2024 meeting.  At the April face-to-face meeting a list of non-surgical procedures that might benefit from this change was requested and is attached (download to view as spreadsheet).  

Open

Discussion:

Decision:

2024-04-16: Request to distribute list of non-surgical procedures affected by this change

2024-06-03:

9

Bypass graft revision proposal

@Victor Medina 

@Jim Case 

As requested from the EAG, a list of definitions has been developed that will guide content authors in the correct modeling of concepts related to bypass, bypass graft, shunt, etc.:

Proposal for definition of concepts under 48537004 |Bypass graft (procedure)|.
Proposal for Definitions.

• CONSTRUCTION OF BYPASS. Surgical creation of a passage to carry contents
  around a part of a structure in its normal route and back to a structure in its
  normal route.

• CONSTRUCTION OF BYPASS USING GRAFT. Surgical creation of a passage, using a
  biological or synthetic material, to carry contents around a part of a structure in its
  normal route and back to a structure in its normal route.

• CONSTRUCTION OF SHUNT. Surgical creation of a passage allowing contents to
  move from one structure to another, not following its normal route.

• CONSTRUCTION OF SHUNT USING GRAFT (SYN: INTERPOSITION SHUNT). Surgical
  creation of a passage using a biological or synthetic material, allowing contents to
  move from one structure to another, not following its normal route.

• INTERPOSITION GRAFT. A surgical repair, using a biological or synthetic graft, of a
  structural defect that does not allow tension-free anastomosis.

• ANASTOMOSIS. Surgical procedure to create a cross-connection between
  channels, tubes, fibers, or other parts of a network.

Discussion:

Decision:

2024-03-11 Comments will be added to the document by the EAG members. 

2024-04-16: Proposed definitions will be revised based on input and resubmitted to the EAG for review.  

2024-06-03:

10

USING DEVICE vs. DIRECT DEVICE use in procedures

(Information only)

@Jim Case 

@Victor Medina 

Following discussion at the last EAG meeting and the document provided by @Monique van Berkum (Unlicensed) (attached), new proposed definitions and examples for:

USING DEVICE

DIRECT DEVICE 

USING ACCESS DEVICE

will be presented to the EAG for discussion at a future meeting

Discussion:

Decision:

11

AOB

EAG

12

Next meeting

@Jim Case 

July 22, 2024 - pending availability of members