2026-10-19 Full MAG Sydney Hybrid Meeting

Meeting Introduction

Peter Williams

10

Share Screen.  Start recording.

Housekeeping - Mics and Movement, New AI Transcript + Summary policy : AI enabled summaries are have been activated and are required as a course of SI business. All summaries will be de-identified in terms of inclusion in post event reports.

Previous meeting agenda

Review of today’s agenda, tomorrow and JAG on Wednesday

Intention to not discuss a topic beyond two meetings

Actions arising from last meeting

Peter Williams

5

• Removal of MRCM Guide URLs - complete

• Removal of MRCM template field - JAG, needs MF briefing note

• Actions relating to simplification of MRCM (Module Scope Refset) - being discussed in JAG

• Morphology Hierarchy Remodel - see forum post

Fingers vs Digits

Yongsheng Gao

10

https://docs.google.com/document/d/1wIfT2_c60Bb_zU8o8lo_s6Vstyt-M8nNDFoUQwCqnNU/edit?tab=t.0#heading=h.nnghigz17w9u

Update on fingers vs digits of hand discussions (see https://docs.google.com/document/d/1nINRoqp2iowWLYNoNw7SLVJkoOTcvUAiwgAKnqafN40/edit?usp=sharing )

RESOLUTION!

Ontology Localisation

Yongsheng Gao

20

https://docs.google.com/presentation/d/1_ca9lVl-aMfRpFn7gpS7LrWui97CkiWUzIA2qG8-DWY/edit?usp=sharing

ML Proposes resurrection of the ability to ‘Deprecate’ content, such that concepts retain their position in the hierarchy.

JS Notes that deprecation implies a direction of travel (ML disagrees), suggests ‘hidden’.

Yongsheng Gao

Recommendation to Translation

Drug Model Discussion

Yongsheng Gao

Guillermo Reynoso

30

Drug Model Discussions: Rounding Rules

https://docs.google.com/presentation/d/1a8Sbp69Jiy2-c4IrKXZhHExtZe0N4j7VESzuTKbY4ik/edit?usp=sharing

Snowstorm rule: faithful reproduction of whatever was entered - exact text, no rounding, no additions or removals of decimal points or zeros.

Suggestion to annotate CDs with specific manufactured product that lead to inclusion

Yongsheng Gao

Next steps, discussion in DESUG

Quality Measurement

Peter Williams

2

Question on how we measure quality. See forum topic: https://forums.snomed.org/t/how-should-we-measure-quality-in-snomed-ct/1300

• Current KPIs

• Structural

• Clinical

See new AI forum: https://forums.snomed.org/c/technology/ai-snomed-ct/61

Any Other Business

Peter Williams

2

See topics suggested for the next Joint Advisory Group Meeting.

Meeting Introduction

Peter Williams

5

Share Screen.  Restart recording.

Introduction, welcome and review Agenda.

Planned Changes, not necessarily prioritized

Peter Williams 

10

• FHIR Terminology Ecosystem (see Snowstorm Commits)

• Package Manager (Edition Manager) - ready for trial use, dependent on S3

• Publishing of Templates - lacking push from MF

• Use of Additional Relationships for metadata (see Dion’s work in TRAG)

• GR: Members tab in browser only shows 1 column

• GR: Intensional Refset should have ECL published in Refset

“Hey you said you would…”

Quality Measurement

Peter Williams

5

Question on how we measure quality. See forum topic: https://forums.snomed.org/t/how-should-we-measure-quality-in-snomed-ct/1300

• Current KPIs

• Structural

• Clinical

See new AI forum: https://forums.snomed.org/c/technology/ai-snomed-ct/61

Module Dependency Reference Set

Peter Williams

5

https://docs.google.com/presentation/d/1lli1Cfqq6Pvf3oUnIDGACCcJdrk_ptP6sSAIw28HPm0/edit?slide=id.s_mchn#slide=id.s_mchn

International Concept Inactivation vs Exclusion Refset

Peter Williams

10

Inactivation

Requires broad agreement and demanding work to identify concepts to remove - This is true for both approaches.

Exclusion Refset(s) (Declared in International, optionally adopted & extended by countries)

Another approach might be be to inactivate content into an International hosted extension.

ML: Organisations who operate across countries would prefer to have content in one place, rather than having to collect concepts from multiple country extensions.

Morphology Hierarchy

Yongsheng Gao

Stefan Schulz

Daniel Karlsson

30

Finalisation of proposal for Ontological Remodelling of the SNOMED CT Morphology Hierarchy

https://docs.google.com/presentation/d/1rQW9hLSHo9KJizL3Eh-ZwKMAAjt7-OovJNiyeKLZz2I/edit?usp=sharing

https://docs.google.com/document/d/1zFg5AJiNptOrWFz1_4-wQc_UY_S-NXy8tctjsiDeMfA/edit?usp=sharing

Review of SNOMED CT DL capabilities

Rob Hausam

10

See material: Evaluation of SNOMED DL capabilities - Google Drive

Any Other Business

Peter Williams

2

Intro

Peter Williams

5

Start Recording

Introduction & Housekeeping

Known Pending Changes

Peter Williams

Andrew Atkinson

10

Workflow: Agreement by AG → Briefing note review by SMT → Member Forum → Community Consultation (if required)

Distinction between information briefing note ( → Community BN, rather than MF only) and seeking permission.

Deprecation Policy Update

Andrew Atkinson

Suzy Roy

10

Update on Deprecation Policy

Guidance on Attribution methods

Suzy Roy

Rory Davidson

Jim Case

30

https://docs.google.com/document/d/1Q8lnxA40-1dhuJUDAQHPTgN8zLkY7C-J0MPa1CaW4oY/edit?tab=t.0#heading=h.gjdgxs

When to use Attribution Annotation vs Alternation Identifiers and pros/cons of each. Does not have to be either/or - both could be used in combination.

Also “where it should live” for International content.

See also https://projects.jira.snomed.org/browse/BROWSE-872

Attribute Annotations

Alternate Identifiers

ML: Suggestion to use additional relationship as a reliable way to identify provenance.

Look at “alternate code” in FHIR

General agreement that per-concept URIs should not be used in Annotation. We either have a URI formed through the AltId, OR we’re looking at a map. But the content of the annotation is entirely open.

RD: Push back on the use of URLs in attribution due to risk of change.

Suzy Roy would like to see proposal for usage recommendations

Morphology Hierarchy

Yongsheng Gao

Stefan Schulz

Daniel Karlsson

keng.ling.wallin

30

Finalisation of proposal for Ontological Remodelling of the SNOMED CT Morphology Hierarchy

https://docs.google.com/presentation/d/1rQW9hLSHo9KJizL3Eh-ZwKMAAjt7-OovJNiyeKLZz2I/edit?usp=sharing

https://docs.google.com/document/d/1zFg5AJiNptOrWFz1_4-wQc_UY_S-NXy8tctjsiDeMfA/edit?usp=sharing

Inactivating Avoiding non-International Concepts

Peter Williams

15

https://forums.snomed.org/t/non-international-concepts-to-inactivate/1056

Update from CMAG discussion. Participation in next CMAG call and next steps (return to MF?). Cathy Richardson Sarah Lukha

Solicit country (UK, AU) experience of use of Exclusion Refsets - benefits for amalgamation/extension/override and compatibility with ECL defined subsets.

CMAG → MF request Monica Harry (also Feikje Hielkema offer to supply list of concepts that proved impossible to translate)

DMc: inclusion/exclusion of concepts is always contextual. Not exposed to implementers - used in NRC definition of refsets.

MN: Exclusion refsets increases complexity

TUG: Extension overlap with International content where the modelling is different

Fingers vs Digits

Yongsheng Gao

Jim Case

10

Update on fingers vs digits of hand discussions (see

https://docs.google.com/document/d/1wIfT2_c60Bb_zU8o8lo_s6Vstyt-M8nNDFoUQwCqnNU/edit?usp=sharing

https://docs.google.com/document/d/1nINRoqp2iowWLYNoNw7SLVJkoOTcvUAiwgAKnqafN40/edit?usp=sharing )

Cross-over MAG & EAG (also CMAG indicated interest)

Moving from ISO-639-1 to ISO 639:2023

Kai Kewley

20

Proposal to update the RF2 specification to allow 3 letter language codes if no 2 letter code exists.
Requested for the Uzbekistan Karakalpak language.

See proposal doc: https://docs.google.com/document/d/1OYHrYRpflkFdwaGcWpowRRIOPCUIRKVGb1lEC7LkVhE/edit?tab=t.0

Consultation likely, but more about spec change.

Impact:

• No change to existing editions/extensions

• No change to existing implementation tooling unless it needs to use an extension with a three letter language code.

International Tooling will be updated to allow this.

Use of Prime symbol ie not '

Also Super / Subscript

Peter Williams

20

See:

• https://projects.jira.snomed.org/browse/MAINT-3111

• https://github.com/IHTSDO/snomed-ct-acceptable-character-policy/blob/main/acceptable_characters.tsv

• https://docs.snomed.org/snomed-ct-specifications/snomed-ct-editorial-guide/readme/authoring/general-naming-conventions/punctuation-and-symbols

DMc: suggested versioning these rules along with specific Edition. Required for disallowed characters to be override-able in extension eg Greek letters in the Greek Extension!

MN: Users asking for greek and super/subscript, leading to requirement for acceptable legacy descriptions using lowest common denominator rendering

ML: Need to watch out for allowing characters that are disallowed in other specifications. Distinction might be made between descriptions and other string based content. Potential issue with security concerns eg injection attacks

Peter Williams Make Repo Public

Any Other Business

All

10

AOB / Items outstanding

Peter Williams

Concept model for a condition without condition (Jim Case and Yongsheng Gao)

------------------------------------------

Role Grouping (in the context of BFO harmonization), see Reubmitted Manuscript

Post Coordination (impact of DL changes),   further ECL filtering.

Concept model for conditions caused by substances or products - to be circulated before January Yongsheng Gao (incl. other AGs and Member Forum)

Yong's further items to discuss (quick chat if time allow, or create page to continue)

• Qualifying Attributes - we've called them that, but they're being used as defining attributes (this is more about documentation clarity)

Refset Descriptor Refset - Mandatory / Optional / Transitivity

Peter Williams

5.2.4.1 Reference Set Descriptor

(Generate page for discussion)

Draft Design for Template Publication

Peter Williams

Work in progress:  https://docs.google.com/spreadsheets/d/1hOKOu9kxTFvqlgY_Gzc3T-sn8Z-b-d1bH5-Ocn9Sz90/edit?usp=sharing

Production templates here:  https://github.com/IHTSDO/snomed-templates

GR Major Use cases: 

• MRCM refsets causing issues in computed templates.  Is considered redundant and is heavy overhead for extension.

• UUID for each logical template (Done!)

• Description templates also expected to be used and extended (for each language) by Termmed

• Critical to move forward with this work

DK Points out complexity of generating terms in non-English languages.  We agreed to look at additional use cases although existing design allows for use of RegEx and even small chunks of JScript so already quite flexible.

GR Description rules are most useful when used with sufficiently defined content.  Templated descriptions used with existing International Content could pick up elements from other languages eg use template to help parse the English term parts and translate those in context.  

GR Would like to see refset sample based on current production templates as per GitHub repo.   To be discussed internally Rory Davidson Andrew Atkinson

Future enhancements to the logic profile

Negation

Disjunction

Calculation not currently faster under M1 chip architecture.  Note that most of the time taken up by the classification service end-to-end process goes into generating the NNF, which is single threaded.

Refset Metadata

This topic comes from SNOMED on FHIR

Also TRAG item: Reference set metadata See Agenda item 17 and consider in wider context of machine readable metadata item 11

In fact, this metadata may be more widely useful when applied to a module.

Suggestion that we could use the FHIR standard which already defines metadata. DM suggests a JSON format which would be extensible unlike a column based solution.

Where are we at with this? Checking with Andrew Atkinson

Revisit "Negative Delta"

Peter Williams

At request of EAG - need to revoke/delete a published component. Comments added to Negative Delta.

See TRAG agenda item #

Peter Williams Write parent page to capture various options in one place. Add pros/cons.

Notify Andrew Atkinson

Andrew Atkinson to update critical incident policy to list actions based on particular use cases.

Use cases:

Two groups: where audit is desired (eg technical issue) and where it is not (IP, un-processable characters)

1. Removing IP - suggestion to blank out particular field ("~") while leaving row.

2. Conflicting Rows ie no clear state (technical issue, not content) - suggestion to subsequent delta clarifying row.

3. Clinically dangerous historical error in before-previous release.