IHTSDO Editorial Advisory Group James T. Case Head of Terminology.

IHTSDO Editorial Advisory Group

James T. CaseHead of Terminology

Agenda

▪ Welcome & Apologies Chair▪ Conflicts of Interest Chair▪ Review of Terms of Reference Chair▪ Pre-coordination of laterality Group▪ Review of prioritization for content tracker items Group▪ Content model needs Group▪ Application of ECE guidance retrospectively. Maintenance of ambiguous descriptions BGO▪ Unilateral – retire or retain? Group▪ Limited status concepts – keep or retire Group▪ SNOMED CT as interface or reference terminology?

Group▪ Conference call schedule Group▪ Any Other Business Group▪ Date of next meeting Group

▪ Purpose of the AG▪ “…provide IHTSDO with advice and guidance on issues related to…

editorial policy…”▪ Scope

▪ Editorial advice not resolved by the SNOMED CT Editorial Panel▪ Providing a “second opinion” on proposed editorial guidance▪ Review and advise on content tracker proposals▪ Review and update SNOMED CT Editorial Guide▪ Perform out-of-cycle editorial investigation and review for complex

issues▪ Out of Scope

▪ Content development prioritization▪ Derivative development prioritization▪ Tooling

Terms of Reference

▪ Membership▪ Four members staggered terms▪ Certified Consultant Terminologists (or similar)▪ Two year terms – two consecutive terms max▪ SNOMED CT Editorial Panel – ex officio

▪ Meetings▪ Two face-to-face meeting per year▪ Fortnightly meetings between (if agenda items available)▪ Minutes stored on AG confluence site

▪ Time commitment▪ Up to three hours per week

Terms of Reference - continued

Pre-coordination of Laterality

▪ Documented as “Temporarily not allowed” since 2011▪ Existing pre-coordination artifact: artf223747“Concepts with pre-coordinated laterality may be regarded as excessive pre-coordination. With rare exceptions, it should be possible to make the recording of laterality part of the electronic health record, with record architecture elements to record, store, transmit, retrieve and analyze.

Post-coordination is further supported with the Revision of the anatomy hierarchy, which has developed (draft) refset indicating those anatomical codes for which lateralization is sensible. This makes pre-coordination even less necessary in the findings/disorders and procedures.”

History of laterality

▪ Many existing EHR systems do not have the ability to store laterality as a model element.

▪ Many large EHR systems do not have the capability of managing post-coordinated expressions

▪ The proposed refset of anatomical structures that can be lateralized is not readily available

▪ There is a substantial amount of lateralized content existing in SNOMED CT, users see precedence for adding it.

▪ A large number of “bilateral” content requests have been received that cannot be adequately modeled.

Laterality challenges

▪ Should the restriction on the addition of lateralized content to the International release be reconsidered?

▪ If so, which option to add laterality-based content should be adopted?

▪ Options - Abstracted from art6188 - Bilateral clinical findings and disorder concepts

▪ Option 1 – Nested role groups▪ Option 2 – Pre-coordinate laterality with anatomic structure▪ Option 3 – Use additional finding site with “left/right side of body”

Laterality discussion

Option 1: Nested role group

10930601000119107Closed fracture of metatarsal bone of right foot

116676008Associated morphology

363698007Finding site

≡ 64572001Disease

20946005Fracture, closed

301000Fifth metatarsal structure

272741003Laterality

24028007Right

▪ Pros▪ Eliminates the need for explosion of lateralized anatomic

structures▪ Introduction of nesting addresses many other modeling issues

▪ Cons▪ Requires nesting – not currently supported by tooling or release

file structure ▪ Requires changes to MRCM to restrict anatomy to only those

structures that are actually “lateralizable”

Pros and cons: Option 1

Option 2: Lateralized anatomic structure




≡ 64572001Disease


New conceptStructure of metatarsal bone of right foot

▪ Pros▪ Simplifies modeling to a single un-nested role group▪ Ensures that ONLY “lateralizable” anatomic structures are

available for use▪ Allows for retirement of multiple abstract anatomical concepts

related to “bi-laterality”

▪ Cons▪ Requires creation of a large number of lateralized anatomic

structures


Option 3: Additional finding site




≡ 64572001Disease



85421007Structure of right half of body

301000Fifth metatarsal structure

▪ Pros▪ Flattens the laterality model (no nesting needed)▪ Close to “user-form”▪ Does not require any changes to the concept model▪ Does not require the creation of new anatomic structure

concepts▪ Is “consistent” with the post-coordination expression syntax▪ Has precedence in current content (i.e. refinement of finding site

on fully defined concepts)

▪ Cons▪ Can only be used when all associated role groups are related to

the same side of the body (99.99%?)


▪ Should the restriction on the addition of lateralized content to the International release be reconsidered?

▪ If so, which option to add laterality-based content should be adopted?

▪ Changes to the editorial guide▪ Scope of revision project

Laterality discussion

Prioritization of tracker items

▪ Open tracker items▪ Content tracker – 748 open items

▪ 302 rated “High” or “Highest”▪ Pre-coordination tracker – 200 open items

▪ Most rated “Low”▪ Review of size – content tracker only

▪ 142 rated “large”▪ 196 rated “medium”▪ 356 rated “small”, “single concept” or “less than 10 concepts”▪ 54 not assigned size▪ Currently under review

▪ Lifecycle phase▪ None – 5 items▪ Inception – 578 items▪ Elaboration – 108 items▪ Construction – 42 items▪ Transition – 15 items

Current status

▪ 82 items opened in the last year▪ 3 items closed in the last year▪ New items being added faster than they can be resolved

▪ High volume of day-to-day work prevents addressing time-consuming editorial issues

▪ Bottlenecks▪ Review of documentation from Consultant Terminologists a

bottleneck▪ What role can the Editorial AG play to remove this bottleneck?▪ Key point is moving from Elaboration to Construction phase

– Then it goes to the content AG for prioritization

▪ Resources not available to do the construction

Content tracker discussion items

Content model changes

▪ Domain and range revisions▪ Clinical course – Add additional disease phases

▪ E.g. “In remission”, “latent”▪ Specimen substance – physical object

▪ Allows for public and environmental health monitoring

▪ Potential new attributes▪ During

▪ E.g. “Disorder X DURING procedure Y▪ Has prodcut role

▪ Needed to support the specific roles that are being removed as IS-A relationships from the product hierarchy

Content model changes recently requested

Implementing the Event-Condition-Episode guidance

Bruce Goldberg

▪ Update on X with Y, X due to Y▪ Clarification on “due to” vs. “co-occurrent” vs. “co-occurrent and due to”▪ Has “Associated with” been “banished” from use?

▪ Retrospective application of the guidance▪ Scope of concepts that can be “remodeled”▪ Is guidance clear enough for editors to apply consistently?

▪ Clarification of potentially ambiguous descriptions

ECE discussion topics

Unilateral concepts

artf6236 : Unilateral

▪ Most “Unilateral” concepts moved from Clinical Findings to the Situation with Explicit Context hierarchy in 2009

▪ Current concept model cannot explicitly state “one side but not the other”.

▪ Unilateral is ambiguous as to which side is affected

▪ Without negation, in the open world Unilateral is silent about the status of “the other side”.

▪ May be present and not affected by the procedure or finding▪ May or may not be present

▪ Content most likely originated from a classification that is agnostic about laterality (e.g. ICD-9-CM)

▪ Question: Are these clinically useful or a patient safety issue?

Unilateral discussion topics

Limited status concepts

▪ Currently modeled with a WAS A relationship

▪ When the WAS A target needs to be retired, how do you fix the relationship to the limited status concept?

Issues with limited status concepts

SNOMED CT – Interface or reference terminology?

Open discussion

Conference call schedulingAny other businessDate of next meeting

IHTSDO Editorial Advisory Group James T. Case Head of Terminology.

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