2025-04-15 Full MAG Vienna Hybrid Meeting

Meeting Introduction

@Peter Williams

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Previous meeting

Housekeeping - Mics and Movement

Membership Changes

@Peter Williams

Question on how we measure quality

• Current KPIs

• Structural

• Clinical

@Peter Williams

Discussion on how extensions extending the Machine Readable Concept Model

@Peter Williams

Discussion on using the Module Dependent Reference Set

Planned Changes, not necessarily prioritized

@Peter Williams 

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• 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 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.

AOB / Items outstanding

@Peter Williams

5

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

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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 #

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.