This page provides information on planned changes to upcoming SNOMED International Release packages in three sections:
- EARLY VISIBILITY OF PROPOSED CONTENT CHANGES (with provisional release date)
- EARLY VISIBILITY OF PUBLISHED CHANGES (with confirmed release date)
- INFORMATION ABOUT PROJECTS AND WORK IN PROGRESS
Please submit any feedback relating to the items below to info@snomed.org
PLEASE NOTE, YOU MAY HAVE TO REGISTER FOR A CONFLUENCE USER ACCOUNT IN ORDER TO ACCESS THE LINKS TO DOCUMENTS REFERENCED BELOW. |
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2025 Proposed Content Changes
| Items | Hierarchy/Topic | EARLY VISIBILITY OF PROPOSED CONTENT CHANGES | Planned Release timing (*this is provisional only and is subject to change) |
|---|---|---|---|
| 1. | Procedure | Update Hierarchy 363680008|Radiographic imaging Procedure (procedure)|and Descendants A Briefing Note documenting the proposed changes for the hierarchy 363680008|Radiographic imaging procedure (procedure)| and descendants was shared with the Editorial Advisory Group, Clinical Leads Group, Member Forum, Content Managers Advisory Group, and other key stakeholders in July 2023. Feedback was received from a wide range of stakeholders. In response to this feedback, the proposed changes to the hierarchy have been modified. These modifications will address issues raised in the feedback. This Informational Briefing Note summarizes the changes that will be implemented. Implementation of the content changes will commence in Q4 2023. The updates will be implemented in sub-hierarchies and promoted over a number of international monthly releases until complete. | Expected completion Q1-Q2 2025 International Releases |
| 2. | Content Improvement | Updates to the Inactivation Reason and Historical Association for 'On Examination' and 'Complaining of' Inactive Content Many of the 'on examination' and 'complaining of' concepts were previously inactivated with the inactivation reason of |Moved elsewhere| with a historical association value |Extension Namespace 1000000|. This content will be updated with an inactivation reason of |Non-conformance to editorial policy| and a historical association of |Alternative| to a suitable international concept. | Q1 2025 International Release |
| 3. | Clinical Finding/Procedure | Patient/Subject concepts in the Clinical finding and Procedure Hierarchies Concepts in the Clinical finding and Procedure hierarchies that contain the explicit context of patient or subject will be inactivated and replaced with concepts without this explicit context. For further information please see briefing note. | On hold - to be determined |
| 4. | Clinical Finding | Inactivation of Complication Disorder Concepts (371 concepts) The inactivation of concepts that reference “complication” without specifying the nature of the complication is planned. The primitive “Complication (disorder)” grouper was inactivated in 2022 due to a lack of consistency or definition of what would properly be assigned as a subtype. The concepts will be inactivated with inactivation reason “Classification derived concept” and replacement by the parent concept. For further information please see this briefing note. | Beginning June 2024 International Release and then subsequent releases until complete |
| 5. | Procedure | Review 1263452006 |Anesthesia and/or sedation procedure (procedure)| A review of the 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy is in progress, the focus is on:
| Under review - expected completion by Q3 2025 International Release |
| 6. | Procedure | Review 48537004 |Bypass graft (procedure)| A review of the 48537004 |Bypass graft (procedure)| hierarchy is in progress, the focus is on:
| Under review - expected completion by Q2 2025 International Release |
| 7. | MRCM Change Update to Procedure Content | MRCM change to Surgical approach (attribute) - PLEASE SEE UPDATED TIMESCALES BELOW This change will be implemented in 4 phases:
| Phase 1 - February 2025 International Release Phase 2 - April 2025 International Release Phase 3 - Q2 2025 International Release Phase 4 - Q3 2025 International Release |
| 8. | Descriptions Update | Forward slash in FSN A review has commenced of those concepts with a forward slash in their FSN. Editorial guidance exists disallowing the use of forward slashes in FSNs, and we have commenced a systematic review of those existing terms containing them. Many areas are excluded for example, medicinal products where strength /1 is the denominator, assessment scales, explicit "and/or", gene names, enzyme and other substance naming, organisms, ratios, per in units (or future consideration), intervertebral structures, content added with an Orphanet map and others. The review is ongoing. If the meaning is clear i.e. single meaning there is no change but groupers, disjoint ('or)' terming and ambiguous terms will be reviewed and possibly inactivated or have a new replacement FSN without a forward slash. Subject matter experts are being consulted as part of this work. | Q1 2025 International Release |
| 9. | Procedure | Review of 129376004 |Construction - action (qualifier value)| 129376004 |Construction - action (qualifier value)| is a subtype of 257903006 |Repair - action (qualifier value) and sibling of 129377008 |Reconstruction - action (qualifier value)|. Because some concepts modeled with 129376004 |Construction - action (qualifier value)| as target value concept for 260686004 |Method (attribute)| may not be considered a reparative procedure, a review of the 129376004 |Construction - action (qualifier value) and 410614008 |Construction (procedure)| hierarchies is being undertaken. Expected outcomes may be the classification of 129376004 |Construction - action (qualifier value)| directly under 129284003 |Surgical action (qualifier value)| and the creation of new actions that better define the differences between reparative and construction procedures. | Content review - publication date to be determined |
| 10. | Disorder | SNOMED CT to Orphanet Map - Attribution of In Scope Content Work has commenced to annotate new concepts added to SNOMED CT with attribution to 'Inserm Orphanet'. As part of this effort, textual definitions for concepts previously added for this project will be updated to align with the current published version of the Orphanet definition. This will result in published text definitions being inactivated and replaced. | Starting Q4 2024 International Releases until complete. |
| 11. | Clinical Finding | Genomic Community Content Phenotype concepts that currently exist in the genomics community content area are being gradually promoted to the International edition release. All content is being reviewed and revised based on the current international editorial guidelines and publication will occur incrementally over several releases. | Q4 2024/Q1 2025 International Release |
| 12. | Association Relationships File | Additional Relationships The new "additional relationships" take the same form as the inferred relationships and can be stored in the same format in the RF2 package. Modeling Advisory Group (MAG) recommends that extensions can use the existing relationship files or create new relationship files for them. By default, there is a single file for each component (1 concept file, 1 relationships file, 1 simple refset file, etc.). Edition and extension publishers can decide to split the content of any of those files for business reasons while following the naming convention. The new attributes should be placed under 1295449009 |Additional relationship attribute (attribute)|. The concept 900000000000227009 |Additional relationship (core metadata concept)| should be assigned to characteristicTypeId in the relationship files. | To be determined - 2025 International Release |
| 13. | MRCM | MRCM Update <<540091010000105 |Calculation (calculation)| The range for Component Attribute will be extended to Include <<540091010000105 |Calculation (calculation)| | April 2025 International Release |
| 14. | New Semantic Tag | New Semantic Tag - Calculation A new semantic tag of (calculation) will be added as a descendant of (qualifier value). This will enable representation of concepts that are derived from calculations on other observations (e.g., “Anion gap in blood,” “Anion gap in urine”) with a relationship of Component (attribute) and value from the (calculation) sub-hierarchy. | March 2025 International Release |
| 15. | Disorder | Malignant tumor of X - Update Descriptions Disorder concepts with a current FSN of the pattern:
Will have the existing FSN inactivated and replaced by:
A synonym including the word 'tumor' will remain active. This update will be made to approximately 500 concepts. | February 2025 International Release |
| 16. | Disorder | Taxonomic relationship between 1149322001 |Intoxication (disorder)| and 75478009 |Poisoning (disorder)| Based a query submitted by the Translation Working Group, the SNOMED CT current taxonomic relationship between 1149322001 |Intoxication (disorder)| and 75478009 |Poisoning (disorder)| (the former being a subtype the latter) requires further review. While they are related, both are defined as interference in normal bodily functions caused by exposure to a substance. Based on the severity of the consequences, the relationship is really the reverse: an intoxication is a milder reaction to a substance, while poisoning is more severe as noted in the definition. The definition of 1149322001 |Intoxication (disorder)| will be updated to make the distinction between the two concepts more comparable. The current relationship between the two concepts will be reversed. | February 2025 International Release |
| 17. | Description Update | Inactivation and Replacement of Concepts Using "Arm" and "Leg" in the FSN Concepts that use "arm" or "leg" without qualification are ambiguous, as the anatomical site may be misinterpreted. Information on this topic can be found in the Arm, leg, upper, lower, extremity, limb section in the editorial guide here. Work has commenced on updating Disorder content. Following this, Finding and Procedure content will be managed as resourcing permits. | 2025 International Releases |
| 18. | Observable Entity | Update for Assessment Scale Score Concepts Concepts that are subtypes of 363788007 |Clinical history/examination observable (observable entity)| that are assessment scores but are not also subtypes of 782487009 |Assessment score (observable entity)|, will gain a parent of 782487009 |Assessment score (observable entity)|. Estimated 1300 concepts. | Q2 2025 International Releases |
| 19. | Substance | New Substance Groupers for Anesthetics Based on feedback from the Anesthesia Clinical Reference Group, the substance hierarchy for anesthetics will be reviewed and the hierarchy revised with additional groupers created and subtypes assigned for inhalation anesthetics (1354647001|Volatile liquid anesthetic (substance)) and local anesthetics (1354706009 |Benzoic acid ester local anesthetic (substance) and 1354705008| Amide local anesthetic (substance)). | February 2025 International Release |
| 20. | Deprecation | Notice of Deprecation - Concept Non Current Indicators For further information please see here. | 2025 International Releases |
2025 Published Content Changes With Confirmed Release Date
| Item | Hierarchy | MOVED FROM PROPOSED CHANGES TO PUBLISHED CHANGES | Confirmed Release Date |
|---|---|---|---|
| 1. | Procedure | Surgical Transplantation Procedures Procedures in the 77465005 |Transplantation (procedure)| hierarchy remodeled following circulation of the Briefing note are still under review following feedback received and discussion at the Editorial Advisory Group. Note this project excludes procedures on the eye (for Ophthalmology CRG to revise), and hematopoietic cell transplants including bone marrow and stem cell procedures that are not surgical transplantations. The majority of tissue transplant procedure concepts (nerves, muscle, tendon, skin etc), will be inactivated as duplicate to the grafting procedure concept where this exists (and the transplant procedure will be added as a synonym to the grafting procedure), or if an existing concept is not available then a new grafting procedure will be created. Very high level groupers will be inactivated (eg 120158008 |Thorax transplantation (procedure)|). Approximately 100 concepts will be inactivated as part of this update. | January 2025 International Release |
| 2. | Qualifier Value | Update for Existing AJCC (American Joint Committee on Cancer) Allowable Values and New UICC (Union for International Cancer Control) Staging System Content For << 1222584008 |American Joint Committee on Cancer allowable value (qualifier value)| and its 584 subtypes the following changes will be made:
New concepts for the UICC (Union for International Cancer Control) staging system will be added:
| January 2025 International Release |
| 3. | Clinical Finding | Changes to 365921005 | Weight change finding (finding) Hierarchy Following multiple requests from members regarding overlaps and ambiguities in this hierarchy, the Nutrition and Dietetics Clinical Reference Group (CRG) conducted a systematic review. The requests highlighted confusion over similar and overlapping concepts, such as:
The following changes will be implemented:
| January 2025 International Release |
| 4. | Clinical Finding | Review Model for Descendants of 118240005|Finding by method (finding)| Descendants of 118240005 |Finding by method (finding)| are currently being reviewed to ensure 418775008 |Finding method (attribute)| is appropriately grouped with other attributes. | January 2025 International Release |
| 5. | Descriptions Update | Update for Description Concept Non-Current Indicators Concept Non Current (CNC) indicators are a type of inactivation indicator that are applied to active descriptions, when the concept they are attached to is made inactive. They are intended to allow implementers to show some visual cue to alert users that a description they have searched for relates to an inactive concept. A bulk update will be implemented to inactivate CNC indicators where they are no longer required either because:
This will result in a change to approximately 30,000 descriptions for the international edition release for January 2025. | January 2025 International Release |
| 6. | Regime/therapy | Restructure of 384760004 |Feeding and dietary regime (regime/therapy)| Following a review by the Nutrition and Dietetics Clinical Reference Group (CRG), in consultation with the Nursing CRG, a restructuring of this hierarchy is underway. The content will be reorganized more logically, identifying and addressing duplicate concepts (e.g. 414096000 |Enteral hyperalimentation (regime/therapy)| and 229912004 |Enteral feeding (regime/therapy)|) and removing outdated content (e.g. 37041007 |Forced feeding of patient (regime/therapy)|). Where possible, content will be sufficiently defined. Additionally, the top-level grouper concept 384760004 |Feeding and dietary regime (regime/therapy)| will be inactivated due to its ambiguity as it is unclear what a combined regime would represent or what the logical subtypes would be.
| January 2025 International Release |
| 7. | Physical Object | Hierarchy Improvement 272185007 |Meters (physical object)| and Descendants To support the addition of Gravity provision of device finding content, an improvement will be made to << 272185007 |Meters (physical object)|. | January 2025 International Release |
Project Information and Work in Progress
Item | Hierarchy/Topic | INFORMATION ABOUT PROJECTS AND WORK IN PROGRESS |
|---|---|---|
| 1. | General Information | Browse Content Changes for the International Release For content changes that are ready for publication in the next release please browse here Concept Inactivation For concept inactivations that are for publication in the next release please browse here MRCM Changes Forthcoming MRCM changes can be viewed here Content Request Service (CRS) For information please see here |
| 2. | Project Information | Cancer Synoptic Reporting Concepts representing cancer synoptic reporting content will be added to the International release starting with the July 2021 release. Cancer synoptic reports are used by many member countries to record pathology examination of cancer specimens including the College of American Pathologists (US and Canada), Royal College of Pathology (UK), Royal College of Pathology Australasia (Australia, New Zealand), PALGA (The Netherlands), Swedish Society of Pathology, and others. This content primarily encompasses observable entity concepts and also includes supporting concepts from other hierarchies, e.g. property values. For more information about this project, please see the Cancer Synoptic Reporting Clinical Project Group here |
| 3. | Project Information | Epilepsy Content ILAE Collaboration Review of << 313287004 |Seizure related finding (finding)| and << 84757009 |Epilepsy (disorder)| (excluding Orphanet related content) for currency and clinical correctness with the addition of missing clinically relevant content. Please refer to the project status report for further information. |
| 4. | Content Improvement | Implementation of the new anatomy concept model The completion of the revision of hierarchical relationships provides stable anatomy content and improves the quality of classification results in other hierarchies. Over forthcoming releases, the plan is to implement the new anatomy concept model. There are almost 35,000 anatomy concepts and they will be modeled by different types of 'part of' relationships. The new model will enable us to automatically generate hierarchies to further improve quality and consistency. Information about the work completed in previous release for revision of IS_A relationships can be viewed here |
| 5. | Procedure/Observable Entity | Evaluation Procedure vs Observable Entity Member feedback and subsequent discussion on the 2023 briefing note containing a proposed solution to resolve the duplication between the evaluation procedure and observable entity hierarchies has resulted in reconsideration of the resolution. Actions as described in the briefing note will not be instituted. Instead, the existing evaluation procedure hierarchy will be retained to support existing use cases. No new content will be added in the international release in the evaluation procedure hierarchy for content that logically belongs in the observable entity hierarchy. If new content is needed in the evaluation procedure hierarchy to satisfy existing use cases, it can be created in national extensions. |