2016-10-25 Editorial Advisory Group Face-to-Face Meeting, Wellington

1

Call to order and role call

JCA

2

Conflicts of interest

JCA

3

Approval of 20160822 and 20160928 minutes

JCA

4

Disjunctive components

Final agreement

JCA

Review of disjunctive representations:

1. Use of "+": Combined components, being added as primitive combined concepts as a short term resolution.

   1. Discussion at the meeting resulted in a recommendation to not add disjunctive components with "+" and to model the observables that would have used these concepts as primitive without the component relationship

   2. Concepts with "+" that have been added to the International release will be retired as "erroneous"

2. Use of "&": Usually used as part of a panel, out of scope for the RII/IHTSDO agreement

3. Use of "&/or": Under review by RII as potentially erroneous. Out of scope for addition to SNOMED CT.

Impact of this is that a number of LOINC terms become ineligible for addition to SNOMED CT.

Also need naming conventions for FSNs that replace "special characters" with plain text.

5

Drug model content

TMO

Review of decisions coming out of the Drug Model discussion on Sunday.

Meaning of Product

Clarification of the meaning of "Product" in SNOMED CT - Current definition from the Editorial Guide July 2016: "This hierarchy was introduced as a top-level hierarchy in order to clearly distinguish drug products (products) from their chemical constituents (substances). It contains concepts that represent the multiple levels of granularity required to support a variety of uses cases such as computerized provider order entry (CPOE), e-prescribing, decision support and formulary management. The levels of drug products represented in the International Release include Virtual Medicinal Product (VMP), Virtual Therapeutic Moiety (VTM), and Product Category.”

Question: The prescribing use case was deemed out of scope at the initial drug model meeting in Copenhagen, April 2015. Do we need to revise this description in light of the current definition and the ongoing discussion?

Question: Given the proposed draft drug model for extensions, is there a need for the creation of new semantic tags that differentiate between abstract, generic and trade products?

Question: Are trade products in scope? Decision: No they are not.

Policy decisions:

a)     The implicit meaning of existing “products” (e.g. aspirin) is “Product containing X". This aligns with the modeling as sufficiently defined using existential restrictions and ingredients.

b)    The options for resolving the current ambiguous FSNs will be sent to the MF for selection of the preferred approach (i.e. renaming or retirement).

c)     This editorial policy will be communicated to NRCs through the Drug Model Project. It is also decided that the pharmacy level use case is not supported, so the need for universal restrictions will be resolved by other means.

Question: BGO had some questions about the impact of these decision on reactions to combined products. Currently this proposal does not address the issue that BGO needs to resolve.

6

Extension of Cauastive agent to include Product

JCA/TMO

There are specific use cases that more appropriately require the use of concepts from the Product hierarchy. The current approach has been to create matching Substances to allow for sufficient modeling, but in many cases this does not make sense and creates duplicate meanings.

E.g. Adverse reaction to product; Allergy to food product, etc.

7

Assessment instrument responses

JCA

Policy on addition of assessment tool responses to the International edition.

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. As many of these are extremely context dependent, being tied specifically to the particular instrument, what should be the policy of IHTSDO to requests to add assessment instrument responses to the International release.

Example: Requests to add responses to Tinetti balance assessment tool.

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

8

ECE Update

BGO

Update on ongoing issues with ECE

• Model for complications and sequela incl. postoperative complications

• Final approval on editorial guide updates for combined disorders

  • Result of combine disorder naming exercise

• Updates to allergy models

  • Allergic disorder caused by substance

  • Pseudoallergy to substance

  • Intolerance to substance

  • SNOMED allergy content and ICD-11

9

Clinical genomics

EAG

Editorial principles to support content development of clinical genomics content.

The purpose of this discussion is to develop the high level issues that need to be addressed regarding clinical genomics including scope, alignment with external standards, sources of truth, level of granularity, etc.

10

Aligning SNOMED CT with clinical use cases

KCA/JCA

High level discussion on whether SNOMED CT is appropriately organized to support the highly variable granularity of content the are influenced by current EHR applications (i.e. single code recording of pre-coordinated content) and newer initiatives that are focused on capturing more structured data (e.g. CIMI, FHIR)

11

Unilateral findings and procedures

JCA

Revisit of this issue following decision on laterality. From the discussion held in Uruguay:

• The Unilateral concepts were confusing both from a clinical usage and terminological aspect.

• Having these concepts located in the Situation with explicit context hierarchy while lateralized concepts are was not helpful, he said. User feedback showed confusion.

• In the short term it was suggested that we remove them from the situation hierarchy, providing a clear message to users, and eventually getting rid of them.

In light of the approval of lateralized content into the International release, is there a compelling reason to keep these concepts (approx. 325).

12

 Bilateral morphologies

JCA

Related to the acceptance of lateralized content. There are a few morphologic abnormality concepts that contain the string "bilateral":

Bilateral hypoplasia (morphologic abnormality)
Bilateral hyperplasia (morphologic abnormality)
Bilateral traumatic amputation (morphologic abnormality)
Bilateral congenital dislocation (morphologic abnormality)
Bilateral congenital failure of fusion (morphologic abnormality)
Bilateral partial congenital dislocation (morphologic abnormality)
Complete bilateral congenital failure of fusion (morphologic abnormality)

These have been rarely used, but can be replaced by individual relationship groups representing both sides.

Recommendation: Inactivate these concepts as redundant.

13

Requirement for matching description to FSN

JCA

Continuation of discussion around proposal to eliminate the requirement for a matching description to the FSN:

1. SCA will automatically create a matching description to the FSN.

2. Editors will determine whether the matching FSN provides a useful clinical description

3. Useful descriptions will be maintained in the terminology.

4. Those descriptions determined to be not useful will be removed.

5. SCA will present a warning for those concepts where the matching description has been removed, but will not prevent saving the concept.

14

Organizational groupers

JCA

The IHTSDO Editorial Panel would like guidance on the creation of a policy regarding the addition of fully defined "grouper" concepts that are not clinically useful, but are used primarily for navigation of the hierarchy. For example "Procedure on vena cava" without any specifics as to the nature of the procedure.

15

Action item review

EAG

Space Actions

16

Meeting schedule 2016-2017

EAG

The EAG members have expressed a desire to meet more frequently.