2023-04-05 Full MAG London Hybrid Meeting

Meeting Introduction

@Peter Williams

5

Start recording

Summary of previous meeting : 2022-09-27 Full MAG Meeting (Hybrid Meeting)

Discussion on Membership

Consultation Update

@Peter Williams 

20

Alternate Identifier File Consultation 

Consultation run from 21 Feb to 14 April

GR: Potential issue that the version of the LOINC source data does not yet have a location - another use case for annotations?

DK: Need to be aware of potential for time delay leading to mismatch between representation of term in LOINC becoming misaligned with that in SNOMED CT.   Note that next LOINC Extension release will bring SNOMED into line with LOINC.

JR: Consider risk of availability of version causing interoperability issues.

DK: We should phrase is as there being "two renderings of LOINC"

GR: SNOMED Expression of LOINC content potentially allows for LOINC to be extended and localised.

Annotations

@Yongsheng Gao 

60

SNOMED CT Annotations

ML: Do we have any support for cardinality (for both validation and rendering - field vs list) and can we specify the type that a particular annotation type can take?   Also looking for clarity about when a language tag will be required.

GR: Content model as a superset of the MRCM.  Looking for discussion on having an easily extensible content model.

ML: Makes point that the example of price is specified as #25 when in reality it would be 25 GBP - a compound value

DM: Makes distinction between metadata like attribution and non-defining attributes like price - which could be constrained to MRCM using existing functionality.

YG: Makes distinction between MR Concept Model and MR Content Model.  Further discussion required on non-defining relationships (GR apparently suggested a new table to keep them distinct).

DM: Regardless of where we express these additional attributes, we should revisit the diagramming standard to be able to show them.

GR: Expressed support for moving forward quickly (ie this year) with the annotation refset for metadata, and would prefer the language column solution.   Does not find adding items to the OWL useful because it can't be independently referenced.  And so addressing that using additional relationships is preferable, because they can - preferably in its own file ('clinical assertions/knowledge'?).

BC: Suggests this document draw the distinction between data and metadata.

DM: Would like clarity on what we intend to use annotations for so that we don't end up with extensions using them for - for example - drug data which would be better expressed as additional relationships once they become available.

EC: What is it about a compositional expression that makes it a component?   Does it have an identifier?

GR: Having a partition id for a post coordinated expression is progress.  Keen to see additional relationships in a separate file to protect implementations that cannot handle them.

Break time 10:30 - 11:00 BST

Role Grouping

@Yongsheng Gao 

45

Role group in SNOMED CT.pptx

DK: Could discuss resolving duplication by retaining Observables and removing Evaluation Procedures.  GR supports.

EC: Gives example of 368881000119109 |Rapidly progressive nephritic syndrome co-occurrent and due to membranoproliferative glomerulonephritis type III| - 2 x self grouped clinical course.

Indicate GCI concepts in browsers

@Yongsheng Gao 

15

DK: Will need explanation of what a GCI is, if we raise its profile (presentation @Jeremy Rogers (Unlicensed) ?)

Misc

@Peter Williams 

@Rory Davidson 

10

Other topics :   Release date changes, LOINC

TRAG agenda items of interest to the MAG @Andrew Atkinson 

• Refset containing the semantic tags?  (@Ed Cheetham ) 

• Reference set metadata - expected to be satisfied using annotations.  Will need to have discussion about what all metadata we want to express, but language alias is an early use case.

• Versioning Templates - yes, we have a proposal for this that was developed internally.  

• Modularisation of SNOMED CT 

• "Negative Delta" file approach 

• Potential for adding a "withdrawn" reason for inactivated content 

AOB

@Peter Williams 

10

Next meetings -

• Summer Call - late June

• SNOMED International Business meeting & Expo Atlanta, October 2023

Please submit abstracts by 2 May or get in touch if that sounds tight.

1

Module Dependency Refset

@Peter Williams

@Andrew Atkinson

Metadata working group proposed - volunteers? @michael lawley @Guillermo Reynoso @Peter Williams

2

Refset Descriptor Refset - Mandatory / Optional / Transitvity

@Peter Williams

5.2.4.1 Reference Set Descriptor

(Generate page for discussion)

3

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

AOB / Items outstanding

@Peter Williams

5

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)

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 #

Notify @Andrew Atkinson

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.