Classification Derived Concept

Inactivation Reason	Association	Definition

Inactivation Reason

Association

Definition

REPLACED_BY

PARTIALLY_EQUIVALENT_TO

The inactivation reason “Classification Concept” explicitly states that the inactivated concept originates from the “closed world” classification paradigm and as such is inappropriate content for use within the clinical record. The inactivated concept (A) may be linked to one or more active concepts (B and/or C…) using historical associations as determined by the type of classification concept and associated guidance given below.

Please note that this inactivation reason replaces "Limited Component" and historical association "WAS_A".

Guidance

Identification of "Closed World content"
The donor 'terminologies' to SNOMED CT were often themselves an early evolution of classifications of mortality and morbidity used for statistical analysis and reporting. To support the closed world view it was necessary to include options that catered for disorders that were known but not currently included within the classification. These concepts can usually be identified by the inclusion of “other specified”, “not otherwise specified”, or “not elsewhere classified”, etc. While many of these concepts have already been inactivated, a few remain, and others such as "...without.." and concepts that are complex combinations of clinical phenomena still exist and will over time be removed.
Editorial guidance for specific flavors of classification concepts
As each flavor of classification concept is identified, editorial guidance will be provided giving the reasons for inactivation and advice on how to assign an appropriated "REPLACED_BY" historical association.
Each type of classification concept will then be identified within the authoring tool by a drop-down list e.g.:
- The concept contains "Not Otherwise Specified"
- The concept contains "Not Elsewhere Classified"
- The concept contains "Without"
- The concept contains an "and" or "with" representing a clinical statement composition (conjunction)

Annotation
Authors may wish to add additional notes for specific inactivations.

Examples

Concept with "Not otherwise specified"

Classification concept:

{"timestamp":1758156407197,"msg":"A unknown Exception Occurred","errorMsg":"The provided AtlassianHostUser did not specify a user to act as.","code":"500"}

Resolution

Inactivate {"timestamp":1758156407192,"msg":"A unknown Exception Occurred","errorMsg":"The provided AtlassianHostUser did not specify a user to act as.","code":"500"}
choose the drop-down list item 'The concept contains; Not Otherwise Specified'
- REPLACED_BY {"timestamp":1758156407203,"msg":"A unknown Exception Occurred","errorMsg":"The provided AtlassianHostUser did not specify a user to act as.","code":"500"}

The concept contains an "and" or "with" representing a clinical statement composition (true conjunction)

Classification concept:

{"timestamp":1758156407257,"msg":"A unknown Exception Occurred","errorMsg":"The provided AtlassianHostUser did not specify a user to act as.","code":"500"}

Resolution

Inactivate {"timestamp":1758156407255,"msg":"A unknown Exception Occurred","errorMsg":"The provided AtlassianHostUser did not specify a user to act as.","code":"500"}
choose the drop-down list item 'The concept contains "and or With"
- PARTIALLLY_EQUIVALENT_TO {"timestamp":1758156407257,"msg":"A unknown Exception Occurred","errorMsg":"The provided AtlassianHostUser did not specify a user to act as.","code":"500"}
- PARTIALLY_EQUIVALENT_TO{"timestamp":1758156407262,"msg":"A unknown Exception Occurred","errorMsg":"The provided AtlassianHostUser did not specify a user to act as.","code":"500"}
Annotation:
Both concepts MUST be included in the patient's record

Resolving sequences of Historical Associations

The intention is that functionality to resolve sequences of Historical Associations will normally be seamlessly integrated into the tooling so as to present to the user the appropriate updated historically association to be allocated.

Whenever an already stated “REPLACED_BY” target itself also becomes inactive - whether at the same release or later, identifying the replacement for the original concept, should follow the combinatorial logic stated below.

Combinatorial Logic - REPLACED_BY

Combinatorial Logic - REPLACED_BY

(A) REPLACED_BY (B) and (B) SAME_AS (C) implies (A) REPLACED_BY (C)

(A) REPLACED_BY (B) and (B) REPLACED_BY (C) implies (A) REPLACED_BY (C)

(A^IntEd) REPLACED_BY (B^IntEd) and (B^IntEd) MOVED_TO (C^NRC) implies (A^IntEd) MOVED_TO (C^NRC)

(A) REPLACED_BY (B) and (B) POSSIBLY_EQUIVALENT_TO (C, D) implies (A) POSSIBLY_EQUIVALENT_TO (C, D)

(A) REPLACED_BY (B) and (B) WAS_A (C AND D) implies (A) WAS_A (C AND D)

Note: Once MOVED_TO the NRC we (SNOMED International) have no knowledge of what has happened to C^IntEd