Request for Consideration by IHTSDO Content Committee

Request for Consideration by IHTSDO Content Committee

Submitted by: James T. Case US NLM, Cathy Richardson AU NRC, Beverly Knight CA NRC

Date: 2013/08/30

Topic: Policy on acceptance of concepts present in multiple national extensions that do not comply with IHTSDO Inclusion Criteria for addition to the International Release

Background

IHTSDO sanctions the use of extensions to the International release of SNOMED CT according to the guidelines described in the SNOMED CT® Technical Implementation Guide. Section 4.1.3 of this guide describes the rationale, uses and requirements for compliant management of an extension namespace assigned by IHTSDO. Content that is allowed to be included in extensions are provided wide leeway and may include content that would otherwise not be allowed for inclusion in the International release due to lack of compliance with IHTSDO Inclusion Criteria (SNOMED Clinical Terms Editorial Guidelines, Content Inclusion Principles and Process, 20080501, Version1.08).

Principles for accepting content into the International release are summarized as:

-Multi-national – Is it useful in more than one national healthcare system?

-Conformance – Does it need to be understandable in health information systems within more than one national healthcare system?

-Interoperable – Does it need to be shared so that information systems can use it in a reproducible manner beyond a patient’s national healthcare system, if a patient were to travel or relocate to a different country?

Additionally, all content added to either the International release or a National extension must comply with the URU (Useful, Reproducible, Understandable) principles guiding content development.

The editorial policy document specifies types of content that are not acceptable for addition to the International release including that are deemed:

-Excessive pre-coordination

-Contain numeric ranges

-Contain disjunction (AND/OR)

-Contain acronyms or eponyms (with exceptions)

Additionally, there are a number of categories of content that are restricted or not being added to the International release due to a potential resultant “explosion” of terms that can alternatively be expressed as post-coordinated expressions. These include patterns such as:

-Finding by lateralized body structure

-Disorder or finding by body structure

-Disorder due to disorder

-Disorder by severity

-Family history of or History of finding or procedure

Problem statement

National release centers have a responsibility to provide content to their users based on both realm and operational needs. To support these needs, content requests that do not fulfill the requirements for inclusion in the International release are frequently added to national extensions. There is currently no formal mechanism for the various NRCs to compare extension content. However, it is highly likely that extensions from different countries will have overlapping content. This results in the potential for multiple representations of the same concept, using different identifiers, which would ultimately result in confusion if shared content is exchanged by these various extensions.

Initial discussions on sharing of extension content between NRCs have indicated a desire that overlapping content from different national extensions be promoted to the International release. In some cases, the content would not comply with current inclusion criteria, in spite of the fact that it is used in multiple member countries. However, there is currently no policy that states the position of the IHTSDO with regards to this class of content, i.e. the conflict between use in multiple countries and lack of compliance with existing inclusion criteria.

Proposal

The authors would like to propose approval by the IHTSDO of the following policy statement:

“Content that is recognized as being useful in multiple national extensions, but does not fulfill existing IHTSDO inclusion criteria, will be accepted into the International release of SNOMED CT as long as it fulfills the URU principles outlined in the SNOMED Clinical Terms Editorial Guidelines”.

It is requested that if approved, that this policy statement be incorporated into a new version of the Editorial Policy Content Inclusion document.