Many thanks to those stakeholders that have provided feedback on this topic which is focussing on implementation challenges.

I have assembled all comments received in a single document and provided our Canadian feedback to SI.

Here is the pfd.

Thank you again for your engagement in this community!

Hi Marie-Alexandra,
Thank you for your feedback.
Yes this is acknowledged in Canada as well, that FSN changes done without the description being inactivated is challenging for translated concepts.

Hi Linda,

I have written about a year ago to SNOMED international about the danger changing FSNs without inactivating them poses to the countries who need to translate SNOMED CT in order to use it. Despite the best efforts, a non-native english speaker may understand an FSN with another meaning than what the creator intended and thus translate it with that (wrong) idea in mind. I have in my short SNOMED carreer already come across quite bunch of concepts that mean culturally something different for us and that, not knowing the cultural english meaning, we understand very differently. If one changes an FSN, it is of paramount importance in the countries translating that we check always that this doesn't affect the meaning we understood when translating. It's also needed to maybe add an additional synonym to match the new FSN even if the country has decided not to create national FSNs.

I would find it more then prudent if the countries who need to translate would stretch to SNOMED int the need to easily identifiy in a release every modified FSN. They othen think only in terms of themselves, using SNOMED as is in English but now there are almost more users who don't speak english then of users who do and this changes the needs.

The Translation group could relay this issue.

Best regards
Marie-Alexandra

Hi Janice,
Thank you for the feeback!

I do agree with you that it may be difficult to easily identify the changes to FSN that are not involving FSN (description) inactivation or concept inactivation if you do not have proper tooling and process to do so. This also highlight the fact that the RF2 format is a machine readable format that is not easy to read for humans, again if no RF2 supporting tool are in place.

Should we ask if and when a description should be inactivated when a change is done?

Hi Linda,
Based experience, the maintenance process for change in FSN only can be onerous without classifier tools.
•Are the changes easier to manage through the inactivation process? - using the RF files to manually address, yes as one can use concept inactivation reference
•What is the biggest challenge, the change of ConceptID vs change of FSN, both? - Both, but changes in FSN with no ConceptID inactivation is harder to manage. IS there a methodology to flag where only a FSN changes has occurred for example using the description file to easily correlate to the concept ID you are using?
Thanks
Janice

Hi Francis,
Thank you so much for providing examples and a starting point for further discussions.
We will discuss internally and we would like to hear about the community.
What is the least disturbing when concepts are in use in system and maintenance is achieved on those?