Meeting Introduction

@Peter Williams

10

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Previous meeting

Housekeeping - Mics and Movement

Membership Changes

Question to be answered by all, at some point:  What needs to be looked at?  What does the future look like?

Community Consultations

@Peter Williams 

30

Description Length increase - @Linda Bird (Unlicensed) mentioned additional use case for chemo regimes that specify medicinal products used, but in procedure hierarchy

Deprecation of CNC indicators - @Andrew Atkinson discussion on full removal of CNC indicators (ie surgical removal from full and snapshot files for July 2026) and making available through a static resource package that can be loaded separately.  @Guillermo Reynoso requests further guidance for country extensions, particularly with a view to inactivating and removing content.

Super and Subscript (Documentation needed on use cases - coming mostly from Translation User Group). @Guillermo Reynoso would like to see technology independent markup. @Maël Le Gall noted issues with searching in the browser.  @Brian Carlsen Noted use of <sup> <sub> in UMLS.  @stefan.schulz (Unlicensed) noted that languages for which these characters are not considered 'special' do still expect searching to work for the 'base' character ie without the diacritic mark.   Also that keyboards often don't feature these characters.  @Daniel Karlsson (Unlicensed) Notes rules for folding are well published by UTF-8.  @Mikael Nyström (Unlicensed) Database config often allows for known character folding to be done per language.

Morphology Proposal

@Yongsheng Gao 

@stefan.schulz (Unlicensed)

50

Link to the Slides

Ontological Remodelling of the Morphology Hierarchy - Google Docs.pdf

4

Break 10:30-11:00 - 2nd Floor Foyer

Technology roadmap

@Rory Davidson 

30

Five year strategy - Technology roadmap

@Guillermo Reynoso would like to see better interoperability in tooling eg including Snap2SNOMED in workflow.  Considering continuous delivery (immediate update).

Planned Changes, not necessarily prioritized

@Peter Williams 

30

• FHIR Terminology Ecosystem - see 'todo' list item #7 from the SNOMED on FHIR agenda: 2025-04-06 - SNOMED on FHIR Meeting (TS & TB)

• Package Manager (Edition Manager) - specific issue with packaging 3rd party code systems (eg LOINC) with country extensions.  @Guillermo Reynoso "modules are too big" - would like to pick and choose concept inclusion (eg lateral promotion) @michael lawley a good 'picknmix' package manager would help encourage the use of smaller (ie more re-usable) modules.  @Dion McMurtrie brought in URI spec composition feature.  Simple case of derivative content (eg just simple refsets), translations, to most complex case with axiom content.  We're then talking about a new Edition.  Interoperable issue with SNOMED Codes appearing related to different URIs @Daniel Karlsson (Unlicensed) whether or not we use  the MDRS, there is still going to be a dependency between these modules.   @Guillermo Reynoso makes distinction between raw content bundling and actually referencing the content eg child concepts. @Brian Carlsen suggests "Edition Composer". 

• Removal of Template field from MRCM.  @Guillermo Reynoso would like to see this prioritized.   Also @Dion McMurtrie 

• Publishing of Templates.

• Use of Additional Relationships for metadata (already permissible in the specification (in use by AU?), limited business driver eg use case of BCP-47 language/dialect code for language refsets).  @Dion McMurtrie other metadata around meaning of fields in refsets.  Map source and target codesystems. Alternative solution in using annotations.  @Guillermo Reynoso is using additional relationships with Canada.

LOINC Extension Update

@Peter Williams 

20

https://loincsnomed.org/

SNOMED CT Implementation Guide for the LOINC Ontology

Work in progress: Surfacing Alternate Identifier Values in FHIR

Map Target Mutability

@Peter Williams 

10

Discussion: Map Targets should be mutable.

Generally agreed.

index synonyms modules

@Brian Carlsen 

Index synonyms modules in RF2. 

Spqrql

@Brian Carlsen 

Discuss having more of a Spqrql presence at least in the docs

Meeting Introduction

@Peter Williams

5

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Previous meeting : 2024-04-17 Full MAG London Hybrid Meeting

Housekeeping - Mics and Movement

Membership Changes

Community Consultations

@Peter Williams 

10

Alternate Identifier File Consultation   Follow up:  Need for documentation and rules around use.  Update: will be discussed in LOINC Implementation Guide

Deprecation of CNC Indicators will skip consultation and go direct to deprecation via Deprecation Pro Forma Template 

Description length changes (GDPR fix applied)

LOINC Extension Update

@Peter Williams 

10

http://loincsnomed.org  Release 1.0.0 targeting LOINC 2.79

Work In Progress Browser for Expo

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)

TODO Where will LOINC identifiers show up in FHIR?  See 'synonym' suggestion in R6

FHIR Implicit concept map $translate

Morphology Model

@Yongsheng Gao 

@stefan.schulz (Unlicensed) 

10

Issues with morphology in body structure hierarchy.

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

Review of comments received (if any?)

BREAK 10:30-11:00 KST in Studio Foyer

Annotations Update

@Yongsheng Gao 

@Peter Williams 

15

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 

2024-10-22 ML Would like to see example of each file to better understand what is being said.   Also notes that "File naming convention" is a suggestion and that if this were a "must" we'd call it a pattern.

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.

2024-10-22 GL We should remove the Refset of MRCMs from the Specification which was problematic from the outset.  MC B2i are using this Scope Refset so do not want to see this removed.  GN Notes that MRCM Refset is named as International MRCM

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

2024-10-22 KL Suggested we make a step forward with just publishing the logical templates and continue to work on the lexical templates.

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.    

2024-10-22 GR 

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?  2024-10-22 The "copy into your own module" approach is well understood and while there is a risk of drift in meaning or difference of interpretation, there are also benefits of the copied content becoming the responsibility of the new module, and that it is then isolated from changes in the original 

• "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

GL Potential changes to NNF - use of modifier column.   Ability to link set of relationships groups back to the axiom that they came from.

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."

@Peter Williams 

Meeting Parameters and Start Recording

Rapid Fire Updates

@Peter Williams 

• Role Grouping in Observables and Evaluation Procedures rolled out to Extensions (any feedback @Stuart Abbott (Unlicensed) / @Guillermo Reynoso? ) 

• Annotations / Additional non-defining Relationships.  Decision made that International will continue to use the NNF Relationship file for these additional rows (or the RelationshipConcreteValue file).  ML: Request for examples prior to first publication.  GR Concerns about impact of MRCM changes regardless of use of additional relationship - clear guidance needed around how detection of Additional Relationship Attribute Types will be done via hierarchy (do we need test file with MRCM changes first?  MC Singapore going live in February so existing MRCM Specification in production use.   PW Agreed to back fill the MRCM Scope Refset at the same time that the template field is blanked.  Need to change specification to allow for same refset updates to International MRCM.

• Increasing Description Text Limit - alarmed feedback received from UK; can we propose 512 characters as compromise?  AA Thought the feedback objected to any change, so a compromise would be ineffective. DMc AU go over 512 chars. GR Less safe to have abbreviated terms, ES will use maybe 300 characters

• Deprecation Pro Forma Template 

• LOINC Progress (also NUVA and NPU)  See Work In Progress Browser for Expo GL Suggested potential for multiple axiom representation.

• MRCM Template field deprecation

• Publishing templates (see draft design).  GR Is blocked from making progress until these are available.  PW/KK Need to upgrade to latest specification, including ECL.

RF2 Specification Update

@Kai Kewley 

Updated Release File Specification for use of Partition 16 identifiers for Post Coordinated Expressions.

See https://confluence.ihtsdotools.org/display/DOCEXPPG

Calculating the ECL HISTORY supplement.

@Kai Kewley 

Inactivations lacking historical associations prevent ECL +HISTORY supplement from functioning. 

Fall back to last known IS A ?

Explicit publication to reduce burden of computation on downstream implementations.  ML Would like to see a separate artefact that can be curated, rather than increase the complexity of the ECL Engine with no scope for resolving edge cases like moving hierarchy.

BREAK 15:00 - 15:30 KST

Special Characters / UTF-8

This item comes in part via the Translation User Group

@Peter Williams @Anne Randorff Højen

@Ole Kristian Våge 

30

Characters already in use (is extended ASCII less of a problem in legacy implementations?)

Superscript² / Subscript₂ 

Greek letters (@Jim Case Think this concept should be µm - 369720008 |G1: Nuclei round, uniform, approximately 10 µ; nucleoli inconspicuous or absent (finding)|)

Standard mappings (eg hyphen, NBSP...).   Suggest tooling support for folding such that entering H₂O would automatically cause H2O to be added, to aid searching.

Editorial policy on use of emoji's in SNOMED CT See Punctuation and Symbols

GL A new description type of Symbol was discussed in the past.  Would be in favour of more explicit markup rather than work-around.  MN Would not want to see pre-processing of preferred terms before they can be displayed

SL Spotted 437962006 |Lipoprotein associated phospholipase A₂ measurement (procedure)|

Confluence page for discussion and information.

AOB

Any other topics of general interest?

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