Hi Marc,
Thank you for opening the floor to the discussion!

We will add the model clarification to the presentation on the Subsets planned for tomorrow. I think a visual with notes will be easier to understand.

Currently although the model allows to define "packaging", this is not in the current requirements for the Canadian Immunization Edition.

For the "high-dose" question, we would be happy to hear what the community has to say on that .

Thanks for your responses.
I still would like to see brief summary class descriptions and approximate tie-in points to other code systems annotated onto the class diagram on slide 16 of the presentation.

>> "Multi-dose vials and prefilled syringes are units of presentation. They do not exist as such in SNOMED CT core, but if they become a new requirement, they could be considered in the future."

Yes, but they border on packaging - I am wondering if there is a GTIN at this level?
Also, does anyone know what code system Panaroma uses for its inventory module?

I just want to make sure that for all of our use cases, a SNOMED concept like "Influenza high-dose vaccine" is sufficient and we don't care if it came from (I'm assuming the same antigen concentrations here):
- one 4 mL pre-filled syringe
- two 2 mL pre-filled syringes (maybe that's two instances of "Influenza (standard-dose) vaccine")?
- drawing up 4 mL from a 10 mL vial into a syringe and injecting that

Regards,
Marc

Hi Marc,
Here are the answers to your questions:
The details on each class can be found in the SNOMED International guidelines. For those that have a SNOMED International Confluence account, it is possible to access the Drug Model editorial guidelines, which includes the Vaccines guidelines, at: https://confluence.ihtsdotools.org/display/IAP/Medicinal+Product+Hierarchy+-+Editorial+Guidelines.
Section #6 is specific to the Vaccine Model.
For those that don’t have access, here is the PDF.

CCDD immunization content follows a model we have not reviewed. We are aware that members of CCDD participated in the SNOMED International Vaccines concept model group, and we assumed they would be naturally aligned. Our comparisons so far have been done against the generic medicinal product CCDD model. Both SNOMED CT and CCDD have a generic/abstract non-proprietary level and a manufactured product. There are differences in the third class (the therapeutic moiety) that probably is due to the evolution of the models, but since our area of interest for vaccines is focused on the antigens we cannot elaborate on that until we get further specifics about the CCDD immunization model details.

The Canadian Edition aims to represent all relevant real/manufactured products in the market since 2013, in alignment with DPD. In some cases, the same product is marketed by two MAHs, with different DIN. Since the Canadian edition does not contain DINs, this will imply the need for a mapping that is not part of the current distribution, but is probably derivable from the CVC subset distribution that includes both the SCTID and the DIN.

GTINs are related to packages, these classes are not currently represented in the SNOMED CT Canadian model. For vaccines, the boundary is less evident between manufactured product and packages as most vaccines are marketed as single dose, so relationship with GTINs should be explored in the future. In the meantime, the publishing cycles for the Canadian edition greatly differ from DPD so it seems that currently users could obtain some of this information from CVC that is updated monthly.

Multi-dose vials and prefilled syringes are units of presentation. They do not exist as such in SNOMED CT core, but if they become a new requirement, they could be considered in the future.

Hi Marc,
Thank you for the feedback. That is much appreciated.
I will draft answers for you and post back on the forum.

Hello,
I am not sure if this is the appropriate place to comment on this project, but my comments relate to the presentation from this meeting, so I'm putting them here. It would be good if there was one "super-topic" to discuss the SNOMED CT Immunization re-design, instead of potentially having discussions scattered across six different topics (one for each meeting). In the interest of having all discussion in one place, I propose that we use this topic, since it was the original one. I will also make this topic "sticky", and I would ask someone with control over the Public Health Surveillance forum to do the same there.

Now my comments:
- It would be good if the model could be annotated with brief descriptions for each class, along with an example or two of the contents of each class.
- It would also be good if the model could be annotated to show the tie-ins to the CCDD concepts, the DIN, and the GTIN (realizing that the concepts may not be "exactly equivalent").
- A "Historical Capture with Good Information" use case should be added
- A "Historical Capture with Incomplete Information" use case should be added.
- Examples should use vaccines, not medications. Since vaccines are often supplied as a powder that must be reconstituted, I would like to see how this is handled. I would also like to see how pre-filled syringes and multi-dose vials are handled.

Finally, I'm a little concerned that I have seen no discussion up to this point...

Regards,
Marc

Thank you all for attending the meeting today.

Please find the presentation for today: https://infocentral.infoway-inforoute.ca/en/resources/docs/health-terminologies/sct-implementation/3369-snomed-ct-immunization-redesign-project-status-update-kick-off-meeting

Note that this was the kick off meeting for a series of weekly meetings to inform you on the work done on the Immunization content in the Canadian Edition. We would like to get your feedback, challenges and concerns if you have any. Please do not hesitate to post on this forum questions you might have.

Here is the schedule for the weekly calls:

• Influenza vaccines – August 6
• Complex combined DPT-Polio-Hib-HB – August 13
• Coverage and naming conventions for vaccines – August 20
• Placeholder for an additional meeting – August 27
• Placeholder for an additional meeting – September 3

Note: All meetings are scheduled on Thursday from 13:00-14:30 ET