# Concept model change for review

**URL:** <https://forums.snomed.org/t/concept-model-change-for-review/699>\
**Category:** Editorial AG\
**Created:** [November 3, 2025, 6:14pm UTC](https://forums.snomed.org/t/concept-model-change-for-review/699 "2025-11-03T18:14:10Z")\
**Posts on this page:** 3\
**Page:** 1

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**Author:** ![jcase](https://avatars.discourse-cdn.com/v4/letter/j/57b2e6/32.png) [@jcase](https://forums.snomed.org/u/jcase)\
**Post date:** [November 3, 2025, 6:14pm UTC](https://forums.snomed.org/t/concept-model-change-for-review/699/1 "2025-11-03T18:14:10Z")

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Please review the breifing note: [Proposal to move 129453003 |Deficiency of (attribute)| from unapproved to approved](https://forums.snomed.org/t/proposal-to-move-129453003-deficiency-of-attribute-from-unapproved-to-approved/678). Comments are due by November 30. We will also be discussing this on a future EAG call.

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**Author:** ![fhielkema](https://avatars.discourse-cdn.com/v4/letter/f/76d3ee/32.png) [@fhielkema](https://forums.snomed.org/u/fhielkema)\
**Post date:** [November 7, 2025, 4:58pm UTC](https://forums.snomed.org/t/concept-model-change-for-review/699/2 "2025-11-07T16:58:29Z")

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Hi Jim and fellow EAG members,

We recognise this branch as one that requires some quality improvement. When translating, we often struggled with semi-duplicates or triplicates: the deficiency of, which is sometimes defined as a finding and sometimes as a disorder; and the clinical manifestation that in practice often gets called ‘deficiency of’.

I think it would be great to have an attribute that allows us to model the deficient substance. However, the current proposal does not seem to solve the confusion between a clinical manifestation and the unmanifested deficiency.

Have you considered the following alternative?

- Model deficiencies (e.g. lab results) as a finding: deficiency of = substance

- Model deficiencies with a clinical manifestation as a disorder: deficiency = substance

That makes the difference between the deficiency itself and its manifestation clear but also shows there is a link.

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**Author:** ![jcase](https://avatars.discourse-cdn.com/v4/letter/j/57b2e6/32.png) [@jcase](https://forums.snomed.org/u/jcase)\
**Post date:** [November 10, 2025, 4:01pm UTC](https://forums.snomed.org/t/concept-model-change-for-review/699/3 "2025-11-10T16:01:44Z")

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@fhielkema

The proposal would be to model findings using the INTERPRETS/HAS INTERPRETATION relationship group to define the observation as a level of the substance as being below or above the reference range. It would be assumed that these would indicate a single observation, whereas multiple observations of the same type would indicate a disorder. Disorder concepts would use the proposed “deficiency of” attribute to identify the substance associated with the deficiency. On the general Briefing note forum, there has been a more extensive discussion around the impact of this proposal. I would encourage you to add your thoughts to that thread.