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

3

Bypass graft and shunt modeling proposal update

@Victor Medina 

The remodeling work proposed at the face-to-face meeting related to bypass grafts is ready for review in the authoring platform.  It can be found here:

https://authoring.ihtsdotools.org/#/tasks/task/QICONST/QICONST-11/edit

The EAG had been asked to review the proposed changes in context and provide feedback.

Previous decisions by the EAG (2024-10-21):

• The proposed definitions for bypass and shunt be updated based on input from the EAG 

• Proximal and distal anastomosis actions would be used for bypass graft METHODS (under review)

• Moving 129376004 |Construction - action (qualifier value)| from under Repair - action to a subtype of 129284003 |Surgical action (qualifier value)|

• Moving 360021005 |Bypass - action (qualifier value)| and 424208002 |Shunt - action (qualifier value)| from under 257741005 |Anastomosis - action (qualifier value)| to become a subtype of 129376004 |Construction - action (qualifier value)|.

Specific questions:

• Is the direction of flow in bypass and shunt relevant?

  • If not, the proposed model would be Using Bypass/Shunt actions in the first RG, and the generic 257741005 |Anastomosis - action (qualifier value)| to model the proximal and distal anastomosis.

• How do you model shunt to/shunt from?

• What is the alternative to using Procedure site - indirect for the destination site for shunts not using an anastomosis?  Two RGs?

Discussion:

Previous discussions:

https://conf.spaces.snomed.org/wiki/spaces/editorialag/pages/133988678

https://conf.spaces.snomed.org/wiki/spaces/editorialag/pages/133988680

https://conf.spaces.snomed.org/wiki/spaces/editorialag/pages/133988686

https://conf.spaces.snomed.org/wiki/spaces/editorialag/pages/133988718

https://conf.spaces.snomed.org/wiki/spaces/editorialag/pages/133988722

https://conf.spaces.snomed.org/wiki/spaces/editorialag/pages/133988726

https://conf.spaces.snomed.org/wiki/spaces/editorialag/pages/133988728

Summary of previous discussions:

The surgical actions Should bypass - action and shunt - action be a subtype of anastomosis? Previously agreed that these would be moved under construction.  The question is how to model the remaining semantics of the procedure.  The current model for shunt only represents the result of the procedure, not the actions that are being performed. 

While previous discussions approved the proposed use of new subtypes of 257741005 |Anastomosis - action (qualifier value)| to represent the proximal and distal connections, a number of EAG members expressed a revised view of anastomoses as the result of the construction procedure and represented a resulting morphology rather than an action in and of itself. There is still the perceived need that direction of flow is important; however, if a model that implies the direction of flow can be designed, that would simplify the model.

There were also concerns about using Procedure site - indirect as a proxy for the direction of flow in a shunt. However, in scenarios where there is not a device or an anastomosis in a shunt procedure, how would we address the flow direction?  

The language of bypass and shunt are often conflated.  In many cases the flow is implied, especially in shunts.  

In general the use of action seemed to be the root of the problem and using morphologies would address the issue.  A more general action and focus on the morphology and body structure would be more appropriate.  WRT direction of flow, it can mostly be implied, but there are cases where it is needed. However, using morphologies would add the same complexity to the model as using Proximal and Distal anastomosis actions in different RGs.

There was concern that there bypass and shunt models differed.  Concern about the misuse of Procedure site - indirect in the shunt model. 

Additional comments from MVB:

Open

It was suggested that evaluation of the use of more general 129376004 |Construction - action (qualifier value)| with the direct morphology of <<41796003 |Anastomosis (morphologic abnormality)| (with new morphologies of proximal and distal anastomosis) be undertaken.

Update and agreements 10/22/2025:

A revised set of options, including the original proposal was provided.

One area that had not been considered was the impact of this modeling proposal on takedown procedures

Both shunt and bypass represent anastomoses

For both Bypass and Shunt, three RGs are needed. The upstream and downstreams organs involved and the organ or structure being by passed or shunted.

While modeling with anastomosis - action or anastomosis (morphology) result the same amount of work, the upstream impact of changing from action to morphology is not warranted at this time.

SI will look at the impact of the accepted modeling pattern on takedown procedures.

Update 27/01/2026:

Take-down procedures can be remodeled using the same model as per 47585001 |Surgical closure of anastomosis (procedure)| and will be subsumed by this grouper.

Changes and remodeling agreed in the October 2025 in-person call are available for review by the EAG members in the TS browser:

Decision:

4

Endoscopy procedures

@Victor Medina 

Update and agreements 22/10/2026:

• Consistent modeling of 423827005 |Endoscopy (procedure)| with the 260686004 |Method (attribute)| = 129433002 |Inspection - action (qualifier value)| AND 424226004 |Using device (attribute)| = 37270008 |Endoscope, device (physical object)|

• Consistent modeling of 363687006 |Endoscopic procedure (procedure)| using a second RG when a concurrent procedure is performed beyond the Endoscopic Inspection of a Body Structure.

• Consistent use of the 425391005 |Using access device (attribute)| exclusively for
  Endoluminal endoscopies where the endoscope is the device granting access to perform a secondary action.
  a. The 425391005 |Using access device (attribute)| will be retired from Intracavitary
  endoscopies, where the endoscope is not the direct device granting access to
  perform a secondary action.

• Changes to the 387713003 |Surgical procedure (procedure)| GCI axiom aimed to ensure the subsumption of the Intracavitary endoscopies under Surgical procedure

  • The GCI axiom will be modeled with the 424226004 |Using device (attribute)| =
    << 312032003 |Body cavity endoscope (physical object)|.

  • The Incision RG will be retired from the Intracavitary endoscopies model.

• Consistent use of the different types of 37270008 |Endoscope, device (physical object)| through the hierarchy. Specific endoscopes will be used following the FSN terming or when the procedure requires a specialized endoscope.

• The 116688005 |Procedure approach (attribute)| will be used accordingly to the FSN
  terming, following the next general principle:

  • Avoid adding the Procedure approach attribute when the procedure is performed
    through the usual natural orifice, as this information is already implied in the
    description. However, include the attribute when the approach deviates from the
    norm, has specific clinical significance or is stated in the FSN.

• Normalization of Proximal Primitive Parents.

• Removal of the the Incision RG from the model.

• To use device relationships (as intracavitary vs. intraluminal scopes) to classify procedures as surgical or non-surgical, moving away from using actions for classification. Additional review of endoscope subtype will be performed.

Update 27/01/2026:

Agreed changes to the 423827005 |Endoscopy (procedure)| are finished and available for review by the EAG members in the TS Browser:

Discussion:

Decision:

5

Proposal to add gene names to SNOMED CT

@Jim Case

Key changes since initial review (v1.0 → v1.5) Attachment

Open

Following evaluation of the review comments posted on the SNOMED EAG Forum, the document was further revised. Summary of changes include:

• Clarified scope: proposal does not replicate HGNC, provide a comprehensive gene catalogue, or support direct recording of gene names as test results

• Gene additions limited to those required to define existing content (Disorders, Clinical findings, Observable entities)

• Added section documenting the suggested alternative of linking directly to HGNC and explaining why it was not adopted

• Distinguished alignment with HGNC from technical dependency, addressing governance and maintenance concerns

• Clarified gene–disorder modeling:

  • Finding site used when the gene is the locus of abnormality

  • HAS ASSOCIATED GENE used for non-site, etiological or biological associations

• Distinguished foundational chromosomal anatomy content already implemented (chromosomes, arms, centromeres) from proposed additions (bands and genes)

• Confirmed chromosome bands will be added incrementally, driven by clinical and gene-location needs

• Acknowledged existing use of band ranges in disorder concepts; formal representation of ranges noted as out of scope for first phase and under investigation

• Strengthened impact assessment:

  • Includes new gene and band concepts and any remodeled Disorders, Clinical findings, or Observable entities

  • Evaluation of classification, analytics, and data-entry impact positioned as part of standard SNOMED CT QA and release processes

  • Noted that the absence of gene concepts has already constrained modeling quality

• Overall: technical direction unchanged; scope, safeguards, governance rationale, and modeling rules are now explicit.

Discussion:

Decision:

6

Proposal to add attributes to support modeling of deficiency and excess concepts.

@Jim Case

New deficiency BN revision has been added to the agenda for discussion. The scope of the proposal has been increased to include the addition of a symmetric “has excess of” attribute as well as addressing the issues raised during the initial review of the first proposal.

Following evaluation of the review comments posted on the Breifing Note Forum, the document was further revised. Summary of changes include:

• Expanded scope to address modeling issues identified during review, beyond approval of Deficiency of (attribute) alone

• Added a symmetric Has excess of (attribute) to avoid asymmetry in modeling abnormal physiological states

• Renamed Deficiency of (attribute) to Has deficiency of (attribute) to align with editorial guidance (no change in meaning)

• Explicitly separated deficiency and excess disorders from measurement-based clinical findings

• Clarified that INTERPRETS / HAS INTERPRETATION is inappropriate for modeling pathological physiological states

• Added an explicit response to governance concerns regarding attribute proliferation

• Defined criteria under which new attributes are justified and committed to non-expansion

• Clarified scope boundaries (no impact on measurement findings, structural deficiencies, or functional impairments)

Discussion:

Decision:

7

AOB

EAG

8

Next meeting

@Jim Case 

TBD