2024-04-17 Full MAG London Hybrid Meeting

Meeting Introduction

@Peter Williams

5

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Previous meeting : 2023-10-24/25 Full MAG Atlanta Hybrid Meeting 

Discussion on Membership

Morphology Model

@Yongsheng Gao 

@stefan.schulz (Unlicensed) 

30

Issues with morphology in body structure hierarchy.

Google document: Ontological Remodelling of the Morphology Hierarchy - Google Docs

Next steps: Asking for member review and comments (cf. section 5 of document).  

Community Consultations

@Peter Williams 

10

Alternate Identifier File Consultation   Follow up:  Need for documentation and rules around use

Deprecation of CNC Indicators

Description length changes (GDPR fix needed)

LOINC Extension Update

@Peter Williams 

10

http://loincsnomed.org

New / refreshed working group (Observables WG)

ECL changes to support LOINC identifiers.  eg LOINC#12346-7 (used in place of the loinc extension hosted SNOMED concept)

Where will LOINC identifiers show up in FHIR?

FHIR Implicit concept map $translate

Role Grouping and impact on Observables Model - Update

@Peter Williams @Yongsheng Gao 

@Jim Case 

@Andrew Perry (Unlicensed) 

@Daniel Karlsson (Unlicensed) 

5

Applying script to Managed Service and other users.

Annotations Update

@Yongsheng Gao 

@Peter Williams 

30

Open

Current state :  "Change from "Concept model" to "Content model" by using "Additional relationship" as non-defining characteristic. Related topics: MRCM, Diagram, release file structure (ie separate file - TRAG opted for same file), and documentation changes.   Note that in the conversion to OWL, Additional Relationships would also be expressed as Annotations. "

Decisions & Actions:  DK suggested validation to ensure attribution values come from an enumerated set

GR: Retire refining relationship type.  Less of a breaking change to create a new file.  Handling of relationship ids (eg reconcilliation after classification) is different with additional relationships; it is stated not inferred.  Would appreciate an empty file so that extensions can start using prior to adoption by the International Edition. Suggested "AssociationRelationship" for filename.

DMcM Suggests speaking to Singapore due to existing additional relationship implementation in their Drug Dictionary.

@Andrew Atkinson Please socialise preference for additional relationships in new files with the TRAG.

GR: Thought there might be use cases where a non-defining relationship might need to stay active post concept 

Break Time 10:30 - 11:00 BST

Annotation Discussion Continued

@Yongsheng Gao 

10

See Above

MRCM

@Peter Williams 

@Chris Swires 

5

Potential to simplify the MRCM by dropping the template field.  It is a calculated field.

ML Suggest blank that column rather than remove.

MRCM Inheritance - recommended approach - currently suggesting inactivation of International row in extension with replacement using new UUID, in same refset.

Publishing of Templates

@Peter Williams 

5

YGA : This should be in place prior to removing the template from the MRCM files.

PWI : We need to upgrade to the latest STL version prior to anything

Management of Common Language Extensions

@Peter Williams 

@Terance Shird 

5

Approaches to common languages - German and French.

Although requested for discussion here, this may be more of a Managed Service discussion.  @Terance Shird is currently working on documentation on our recommended approach to this topic.    

AOB

@Peter Williams 

Other topics :  TRAG agenda items of interest to the MAG @Andrew Atkinson 

• Modularisation of SNOMED CT Has a combination of community content, and the ability to form sub-ontologies addressed the use cases here?

• "Negative Delta" file approach  (suggestion for producing an archived package in order to remove content - StatedRelationship File, CNC Indicators, CTV3 Map

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

@stefan.schulz (Unlicensed) Applied Ontology paper on Clinical Findings and BFO finally published. Thanks for all who contributed as well as those who enabled the open access option! 
See: https://bit.ly/499wUpU

Resolution of state collision 

@Peter Williams @Guillermo Reynoso @Andrew Atkinson 

15

@Guillermo Reynoso : "With the introduction of monthly updates, there are more chances of valid state collisions (for example having two states with the same effectiveTime and the same component). One option to alleviate this risk is the introduction of additional conflict resolution strategies. Currently the only conflict resolution strategy is time (oldest effectiveTime wins), but perhaps we can consider introducing something like "if effectiveTime is the same in the focus extension (the lower level extension without dependencies in the package) and in a higher extension row, the higher extension state in dependency wins", and "if effectiveTime is the same in the focus extension and another extension that is not in the dependency tree, the focus extension state wins". Not sure about the last one, it mostly applies to lateral promotions, which are usual but not regulated so far, and a topic themselves."

1

Module Dependency Refset

@Peter Williams

@Andrew Atkinson

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.