TermInfo Discussion at HL7 WGM Atlanta 2013 (SIM&A)

Okay, HL7's RIMBAA Working Group hasn't changed their name to SIM&A yet ("Simba"), but it looks like that is the name that is going to stick to reflect the group's broadened scope.

One issue that this and other working groups are determined to put to bed is that of negation, particularly with TermInfo vocabulary sets like SNOMED CT. The problem is that not all vocabulary sets support negation implicitly, by providing vocabulary terms that are already negated. SNOMED CT does. The big question then is, should you always use the implied negation in the vocabulary set if it is available; or should you sometimes, or never use it.

The alternative, for HL7 v3 at least, is to use a negation indicator, messaged as a negationInd attribute on the element in question... so this is effectively metadata, and the problem with metadata is that there is no guarantee that the receiver interprets it correctly, if at all. For many use cases, this probably doesn't matter much, but for clinical diagnosis and decision making, for allergies, for drug interactions, and even in the context of non-health applications like Corrections and Defense, Person-of-Interest queries need to properly take into account null flavours and negations; so there is a strong Public Health and Public Safety aspect to this discussion as well.

So it is an important concept, and people need to reach agreement on the correct way to do this; however, this issue goes back a number of years, so I'm curious to see where it goes. My own thoughts are that a better way to do this from the start would have been to use a tri-state negation indicator, which indicates "positive", "requires negation", or "implictly negated"... but it's too late for that now, and it always has been.

Here are the details from the RIMBAA forum (via Rob Hausum, MD, Hausum Consulting):

The TermInfo negation discussion at the Atlanta WGM will be held in Q1 Tuesday (tomorrow).  Following a brief introduction, we intend to devote the remainder of the quarter to this topic.  We would like to come away from the quarter with a concrete plan to create and provide guidance on this important topic.  That may involve a focused TermInfo ballot on negation, but the specific form and scope is still open for discussion.

For those who aren't in Atlanta, we expect to have remote participation capability via GoToMeeting (details below).  Please join the discussion, or, if you are unable to attend either in person or remotely, feel free to pass along any comments/questions/concerns.

Rob

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