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A relationship group combines an attribute-value pair with none, one, or multiple attribute-value pairs in order to refine the meaning of a concept.

For example,

Image Modified

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CapId	id-29851
CapType	Figure

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Figure 1. Stated view of 18876004 |Pain in finger (finding)|

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with

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the

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Finding

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site

...

(attribute)

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and

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its

...

value

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of

...

Finger

...

structure

...

(body

...

structure)

An attribute must be populated with a target value to model a concept.

Relationship groups are needed when modellingmodeling:

- Clinical finding concepts that require multiple Associated morphology attributes and multiple Finding site attributes
- Procedure concepts that require multiple Method attributes and multiple Procedure site attributes.

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An attribute that is not in a relationship group is considered to be in a group on its own. When attributes are not grouped, their meanings are interpreted separately. For example, in the following diagram, the Associated morphology is Hemorrhage, and the Finding site is Uterine structure. However, it cannot be interpreted that the site of the Hemorrhage is the Uterine structure because the two attributes are not grouped.

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Figure 2. Inferred view of self-grouped

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attributes

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values

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of

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Hemorrhage

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(morphologic

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abnormality)

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and

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Uterine

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structure

...

(body

...

structure)

When the attributes are grouped, the relationships imply meaning towards each other. To continue the example above for

Concept

t	44991000119100 \|Abnormal uterine bleeding (disorder)\|

, the following diagram shows the Associated morphology of Hemorrhage and the Finding site of Uterine structure in a relationship group together. The grouping can be interpreted that the finding site of the hemorrhage is the uterine structure.

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CapId	inferred-view-of-grouped-attribute-values-of-hemorrhage-morphologic-abnormality-and-uterine-structure-body-structure-
CapType	Figure

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Figure 3. Inferred view of grouped attribute values of Hemorrhage (morphologic abnormality) and Uterine structure (body structure)

Note the difference in the inferred parents between the self-grouped versus grouped attributes. This is explained in more detail below.

Impact of relationship grouping on inheritance

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The meaning of the supertype concept,

Concept

t	63296004 \|Excision of aorta (procedure)\|

(where the relationships are grouped) is interpreted as a procedure with an excision on the aortic structure. This is because

Concept

t	405813007 \|Procedure site - Direct (attribute)\|

and

Concept

t	260686004 \|Method (attribute)\|

are grouped.

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Figure 4. Inferred view of Excision of aorta (procedure)

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with

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grouping

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of

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attributes

In the following diagram, the more general supertype concepts,

Concept

t	65801008 \|Excision (procedure)\|

and

Concept

t	118809006 \|Procedure on aorta (procedure)\|

are the proximal supertype concepts.

Concept

t	50434004 \|Excision of lesion of aorta (procedure)\|

is a logical subtype of

Concept

t	63296004 \|Excision of aorta (procedure)\|

. However, the attributes of the concept

Concept

t	50434004 \|Excision of lesion of aorta (procedure)\|

are not grouped. Thus, the classifier interprets the definitions as non-related and

Concept

t	50434004 \|Excision of lesion of aorta (procedure)\|

is not inferred as a subtype of

Concept

t	63296004 \|Excision of aorta (procedure)\|

. This is because the attributes in the subtype concept are not grouped, i.e are not explicitly stated. From a machine-processing perspective, each attribute is considered a group on its own; i.e. there is an excision, but nothing else is known about the excision. This results in the concept,

Concept

t	63296004 \|Excision of aorta (procedure)\|

, being interpreted more broadly.

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CapId	-inferred-view-of-excision-of-lesion-of-aorta-procedure-without-grouping-of-attribute-value-pairs
CapType	Figure

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Figure 5. Inferred view of Excision of lesion of aorta (procedure) without grouping of attributes

In the following diagram the attributes of the concept

Concept

t	50434004 \|Excision of lesion of aorta (procedure)\|

are grouped. An author that explicitly states that the excision is of a lesion found in the aortic structure, by grouping the attribute-value pairs, provides the necessary information for the classifier. This enables

Concept

t	50434004 \|Excision of lesion of aorta (procedure)\|

to be inferred as a subtype of

Concept

t	63296004 \|Excision of aorta (procedure)\|

.

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CapId	inferred-view-of-excision-of-lesion-of-aorta-procedure-with-grouping-of-attribute-value-pairs
CapType	Figure

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Figure 6. Inferred view of Excision of lesion of aorta (procedure) with grouping of attributes

Same attributes in separate relationship groups

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Two Finding site attributes are required to support the location of

Concept

t	53627009 \|Closed fracture of radius AND ulna (disorder)\|

. Each

Concept

t	363698007 \|Finding site (attribute)\|

and its respective target value are placed in a relationship group with the attribute

Concept

t	116676008 \|Associated morphology (attribute)\|

with its target value of

Concept

t	20946005 \|Fracture, closed (morphologic abnormality)\|

.

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CapId	inferred-view-of-associated-morphology-attribute-with-its-value-of-fracture-closed-morphologic-abnormality-in-two-separate-relationship-groups
CapType	Figure

...

Figure 7. Inferred view of Associated morphology (attribute) with its value of Fracture, closed (morphologic abnormality) in two separate relationship groups

Procedure hierarchy

In the

Concept

t	71388002 \|Procedure (procedure)\|

hierarchy, a relationship group is usually a way of combining attributes about a particular method.

In the concept

Concept

t	302619004 \|Cholecystectomy and exploration of bile duct (procedure)\|

within the following diagram, the relationship groups clarify that there is exploration of the bile duct and excision of the gallbladder. Without the relationship groups, the appropriate relationships between the attributes would be unclear; i.e. the exploration of the bile duct versus gallbladder and the excision of the bile duct versus the gallbladder.

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CapId	inferred-view-of-a-procedure-hierarchy-relationship-group-combining-attributes-around-method-attribute-
CapType	Figure

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Figure 8. Inferred view of a Procedure hierarchy relationship group: combining attributes around Method (attribute)

Tip

title	Modeling

When there is no Method stated, the

Concept

t	363704007 \|Procedure site (attribute)\|

(or its subtype either Procedure site-direct or Procedure site-indirect) is always grouped with

Concept

t	405816004 \|Procedure morphology (attribute)\|

(or its subtype either Direct morphology or Indirect morphology) for that site.

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The Finding site (attribute) and Associated morphology (attribute) are always grouped when both are present and related.
- When there is more than one Finding site (attribute) or Associated morphology (attribute), then more than one relationship group is required.
- When the attributes Occurrence and/or Causative agent are stated and related to the Finding site and Associated morphology attributes, include them within that relationship group.
  - As in the following diagram, when the Causative agent (attribute) is an organism, the Pathological process (attribute) is also included in that relationship group, with the target value of either
    Concept
    t 441862004 |Infectious process (qualifier value)|
    or
    Concept
    t 442614005 |Parasitic process (qualifier value)|
    .

If a concept has values for a Causative agent (attribute) and Finding site (attribute), but does not have a value for an Associated morphology (attribute) or Pathological process (attribute), combine the Causative agent (attribute) and Finding site (attribute) as usual. Concepts that only have Causative agent (attribute) and Finding site (attribute) in a role group are higher in the hierarchy and subsume those concepts that have a role group of Causative agent (attribute), Finding site (attribute), Associated morphology (attribute) and Pathological process (attribute).

The Interprets and Has interpretation attributes are always grouped together where both are present and related to each other. These two attributes and their values are often used in defining a Clinical finding concept by delineating the observation results or describing the analysis used to determine the observation. Interprets and Has interpretation attributes are not grouped with any other attributes.

Tip

title	Relationship group clarification

A relationship group that uses the attributes Associated with, Before, During, After, Due to, Clinical course, or Temporally related to are not grouped with another attribute-value pair; these attributes are "self-grouped". This means, authors place these attributes in a relationship group individually with no other attributes.

Caption labelCapIdstated-view-of-a-disorder-hierarchy-concept-with-causative-agent-and-pathological-process-attribute-value-pairs-in-the-same-relationship-group

CapTypeFigureStated view of a disorder hierarchy concept with Causative agent and Pathological process attributes in the same relationship

Figure 9. Stated view of a disorder hierarchy concept with Causative agent and Pathological process attributes in the same relationship group

Situation with Explicit Context hierarchy

For

Concept

t	413350009 \|Finding with explicit context (situation)\|

concepts, the following four attributes are grouped:

Concept
t 408729009 |Finding context (attribute)|
Concept
t 246090004 |Associated finding (attribute)|
Concept
t 408731000 |Temporal context (attribute)|
Concept
t 408732007 |Subject relationship context (attribute)|

For example,

Concept

t	704008007 \|No family history of asthma (situation)\|

IS A

Concept

t	243796009 \|Situation with explicit context (situation)\|

,

- Concept
  t 408729009 |Finding context (attribute)|
  ,
  Concept
  t 410516002 |Known absent (qualifier value)|
- Concept
  t 246090004 |Associated finding (attribute)|
  ,
  Concept
  t 195967001 |Asthma (disorder)|
- Concept
  t 408731000 |Temporal context (attribute)|
  ,
  Concept
  t 410511007 |Current or past (actual) (qualifier value)|
- Concept
  t 408732007 |Subject relationship context (attribute)|
  ,
  Concept
  t 444148008 |Person in family of subject (person)|

For

Concept

t	129125009 \|Procedure with explicit context (situation)\|

concepts the following four attributes are grouped:

Concept
t 408730004 |Procedure context (attribute)|
Concept
t 363589002 |Associated procedure (attribute)|
Concept
t 408731000 |Temporal context (attribute)|
Concept
t 408732007 |Subject relationship context (attribute)|

For example,

Concept

t	704503005 \|Advice given about pelvic floor exercise (situation)\|

IS A

Concept

t	129125009 \|Procedure with explicit context (situation)\|

- Concept
  t 408730004 |Procedure context (attribute)|
  ,
  Concept
  t 385658003 |Done (qualifier value)|
- Concept
  t 363589002 |Associated procedure (attribute)|
  ,
  Concept
  t 420227002 |Recommendation to (procedure)|
- Concept
  t 408731000 |Temporal context (attribute)|
  ,
  Concept
  t 410512000 |Current or specified time (qualifier value)|
- Concept
  t 408732007 |Subject relationship context (attribute)|
  ,
  Concept
  t 125676002 |Person (person)|

...

For example,

Concept

t	400975005 \|Standing diastolic blood pressure (observable entity)\|

is represented using multiple attributes within one relationship group.

Caption label

CapId	stated-view-of-a-concept-from-the-observable-entity-hierarchy-with-self-grouped-attributes
CapType	Figure

Stated view of a concept from the Observable entity hierarchy with grouped

Figure 10. Stated view of a concept from the Observable entity hierarchy with grouped attributes

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Versions Compared

Old Version 5

New Version Current

Key

Impact of relationship grouping on inheritance

Same attributes in separate relationship groups

Procedure hierarchy

Situation with Explicit Context hierarchy