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Page At A Glance
Table Of Contents
1. Introduction
1.1. Background
SNOMED CT terminology provides a common language that enables a consistent way of indexing, storing, retrieving, and aggregating clinical data across specialties and sites of care.
SNOMED International maintains the SNOMED CT technical design, the content architecture, the SNOMED CT content (includes the concepts table, the descriptions table, the relationships table, a history table, and ICD mappings), and related technical documentation.
1.2. Purpose
This document provides a summarized description of the content changes included in the August 2024 release of SNOMED Clinical Terms® (SCT) International Edition.
It also includes notes detailing the known content or technical issues where the root cause is understood, the fix has been discussed and agreed to, but has yet to be implemented.
The SNOMED International release notes are available alongside the August 2024 International Edition.
1.3. Scope
This document is written for the purpose described above and is not intended to provide details of the technical specifications for SNOMED CT or encompass every change made.
1.4. Audience
The audience includes National Release Centers, WHO-FIC release centers, vendors of electronic health records, terminology developers and managers who wish to have an understanding of changes that have been incorporated into the August 2024 International Edition.
Please note, you may have to register for a Confluence user account in order to access the links included in these release notes.
1.5. Important Information
NOTICE
PUBLISHED JUNE 2024 RELEASE - CHANGES TO THE ANNOTATIONS REFSET FORMAT
After discussions with the community, SNOMED International has made changes to the coverage of language in the Annotations refsets in the following way:
- The languageCode field was specified as the two characters of ISO-639-1 code for the language of the annotation text. The change is to include support for specifying dialect when it is applicable by adhering to RFC 5646, which allows the combination of two characters of ISO 639-1 code and two uppercase letters of country code (ISO 3166) separated by a hyphen.
- The column "languageCode" has therefore been changed to "languageDialectCode".
- The concept 1296895003|Language code (foundation metadata concept)| has been inactivated and replaced by 1304275002 |Language or dialect code (foundation metadata concept)|
- The changes apply to both the Member Annotation String Value Reference Set + Component Annotation String Value Reference Set
The addition of content for the Annotations refset was commenced in the July 2024 International Edition release.
2. Content Development Activity
2.1. Summary
Continuous quality improvement and enhancement of existing content is an ongoing process undertaken by SNOMED International in preparation for every release. The August 2024 International Edition has seen a continuation of the work driven by contributions from: Kaiser Permanente i.e. Convergent Medical Terminology (CMT), Global Medical Device Nomenclature Agency (GMDNA), Orphanet and other domain specific collaborations as well as requests received via the Content Request System (CRS).
Additionally quality improvement activities are advanced via project driven initiatives summarized below. Additional work items impacting every release are updates to the SNOMED CT derived maps such as ICD-10 and ICD-O; details are included in these release notes.Information about editorial decisions may be found in the SNOMED CT Editorial Guide; mapping guidance for ICD-10 can be found here.
2.2. Quality Initiative
The Quality Initiative (QI) project is the implementation of the Quality Strategy. After a successful pilot project for the July 2018 Edition release, the next stage has been implemented for subsequent releases including August 2024.
Quality improvement tasks are being deployed to improve internal structural consistency and ensure compliance with editorial policy related to the stated modeling of content. Additionally, correction or addition of defining relationships is being carried out to accurately reflect current clinical knowledge and ensure the semantic reliability of descriptions associated with a concept.
2.2.1. Update for Pathological Process and Infectious Process
In the disorder hierarchy, a review has been undertaken for concepts where the pair 370135005 |Pathological process (attribute)| = 441862004 |Infectious process (qualifier value)| are included in the model but infectious process is not stated in the descriptions. Remodeling of this content has been carried out.
Number of concepts edited (approx): 20
2.2.2. Update Hierarchy 90128006|Photosensitivity (finding)|
Conditions that may be caused by light, but are not abnormal reactions to light, have been removed from descendants of 90128006 |Photosensitivity (finding)|.
Number of concepts edited (approx): 55
2.2.3. Update 230131008|Graft complications (disorder)|
230131008 |Graft complications (disorder)| has been inactivated with reason 'nonconformance to editorial policy' and replaced with 2 new concepts:
- 1344633008 |Disorder following grafting procedure (disorder)|
- 1344632003 |Disorder due to grafting procedure (disorder)|
Subtypes have been remodeled based on whether there is a causative link to the grafting procedure ('Due to' the procedure) or only a temporal link can be established ('After').
239180007 |Skin graft disorder (disorder)| has been inactivated and replaced with 1344638004 |Disorder following skin grafting procedure (disorder)|. All subtypes have been remodeled with the 'After' relationship to the skin grafting procedure.
Number of concepts edited (approx): 50
2.2.4. Update Hierarchy 278854009|Insertion of hormone implant (procedure)|
As part of a quality review of the 782901001 |Insertion procedure (procedure)| hierarchy, 10 procedure concepts referring to hormone implants were found to be modeled with 257867005 |Insertion - action (qualifier value)|. The descriptions also incorrectly referred to insertion of X hormone implant rather than implantation. These concepts have been remodeled with 129336009 |Implantation - action (qualifier value)|, with updated descriptions to reflect implantation. The previous insertion descriptions have been inactivated.
2.3. Body Structure
2.3.1. Update Lateralizable Body Structures
Over 4000 body structure concepts have been modeled with laterality and a value of "side" by batch changes to improve the assignment of laterality and classifications. In scope concepts with an incorrect model have been addressed during the review. Additional quality assurance will be undertaken in future as part of the updates for the new anatomy model.
The lateralizable reference set has also been updated to include these changes.
The following concepts failed validation as a result of these changes, these are not valid failures. An update to the validation rule is in development to exclude 'cells' from reporting, the following failures are validated as exceptions:
- 77810002Clara cell of bronchiole (cell)cellConcept Id= 77810002 should be added to Lateralizable reference set
- 85615000Kultschitzky cell of bronchiole (cell)cellConcept Id= 85615000 should be added to Lateralizable reference set
- 33956004Alveolar macrophage (cell)cellConcept Id= 33956004 should be added to Lateralizable reference set
- 34826000Pneumocyte, type 1 (cell)cellConcept Id= 34826000 should be added to Lateralizable reference set
- 52782001Pneumocyte, type 2 (cell)cellConcept Id= 52782001 should be added to Lateralizable reference set
- 47438009Pneumocyte (cell)cellConcept Id= 47438009 should be added to Lateralizable reference set
Number of concepts edited (approx): 4000
2.3.2. SEP and Laterality Anatomy Reference Sets
The release file for the lateralizable body structure reference set has been updated and validated.
The release file for the SEP reference set has been updated and validated.
2.4. Clinical Finding
2.4.1. Inactivation of Mechanical Complication of <x> Disorder Concepts
Concepts representing mechanical complication of <x> device (disorder), mechanical complication of <x> graft (disorder) and mechanical complication of <x> ostomy (disorder) were identified as classification constructs. These concepts have been inactivated using the inactivation reason of Classification-derived component. A briefing note and advice was previously provided for Mechanical complication of <x> device (disorder) concepts. For further information please see here.
Further work will be undertaking in coming releases to improve the modeling for specific complications associated with devices.
2.5. Procedure
2.5.1. Radiographic Imaging
Work is progressing for this content tracker for information please see the informational briefing note here.
2.5.2. Remodel Hierarchy 51302004 |Turbinectomy (procedure)|
Remodeling of 51302004 |Turbinectomy (procedure)| hierarchy has been undertaken with creation of new concepts:
- 1340150000 |Coblation-assisted inferior turbinoplasty (procedure)
- 1340152008 |Microdebrider-assisted inferior turbinoplasty (procedure)|
Associated body structures have been added as required.
Number of concepts edited (approx): 7
2.5.3. Remodel Hierarchy 359890009|Fundoplication (procedure)|
Subtypes of 359890009|Fundoplication (procedure)| has been reviewed and remodeled. 235187003 |Partial fundoplication (procedure)| and 359893006 |Total fundoplication (procedure)| are now siblings.
Number of concepts edited (approx): 15
2.6. Pharmaceutical/Biological Product
2.6.1. Grouping Concepts for Therapeutic Roles in the Medicinal Product Hierarchy
Please see this Briefing Note for further information about the inactivation of 178 grouping concepts for therapeutic roles in the Medicinal Product hierarchy.
As part of the project all previous subtypes 763087004 |Medicinal product categorized by therapeutic role (product)| have had the 'plays role' additional axiom removed but the 766939001 |Plays role (attribute)| and 766941000 |Therapeutic role (role)| remain in SNOMED CT. Vaccines have been excluded from this work.
Older stated product subtypes of 763087004 |Medicinal product categorized by therapeutic role (product)| (for example, 26580005 |Digestant (product)|) have also been inactivated usually with an inactivation target of the corresponding grouping concept for roles in the substance hierarchy (70 concepts approx.). All grouping concepts for therapeutic roles remain in the substance hierarchy with a caveat added to Editorial guidance regarding known issues.
2.6.2. Update Pharmaceutical Dose Forms with Two or More Intended Sites
Pharmaceutical Dose Forms with more than one intended site will use “and” in their terming and include all intended sites in the model. By representing combinations of intended sites as a conjunction ('and' in the description) this will facilitate searching by end users. The concepts are logically modeled as conjunction. Updated Editorial Guidance has been drafted.
9 clinical drugs using these dose forms have correspondingly had their descriptions updated to 'and'.
Parenteral dose forms for "infusion and/or injection" are modeled with a GCI. As this is a less common requirement any requests for this type of dose form will be reviewed on a case by case basis
2.7. Collaboration/Harmonization Agreements
2.7.1. Convergent Medical Terminology (CMT)
154 new concepts have been added. The main focus areas were ophthalmology and injury.
2.7.2. Orphanet
Working in collaboration with Orphanet efforts are ongoing to update rare disease concepts in SNOMED CT to maintain alignment with Orphanet for the annual update of the SNOMED CT to Orphanet Maps. Work has commenced to annotate content added for the Orphanet project with attribution.
All of the concepts added for the Orphanet project have been mapped to ICD-10.
2.7.3. Cancer Synoptic Reporting
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.
For more information about this project, please see Cancer Synoptic Reporting Clinical Project Group
2.7.4. International League Against Epilepsy (ILAE)
In line with approved harmonized terminology, this project is working on alignment including restructuring to update the hierarchy << 313307000 |Epileptic seizure (finding)|.
Changes have been made in the area of focal epilepsy. This includes the addition of a small number of new concepts, updating of descriptions on current concepts, addition of definitions and inactivation of outdated concepts. Work in the area is continuing.
Further information about the project is available here
2.7.5. Gravity Project
22 new concepts were added to support the Gravity Project work with a focus on digital access findings and providing assistance procedures.
2.8. Internal Quality Improvement
2.8.1. Machine Readable Concept Model (MRCM) Changes
There are no changes for the MRCM in the August 2024 International Edition.
Future changes that are currently in progress can be viewed via the MRCM Daily Build Browser
Please see early visibility for future planned changes to MRCM.
2.8.2. OWL Axiom Expressions for Annotation Properties
The new annotation properties are represented in the OWL expression axiom refset as follows:
-
The 1295447006 |Annotation attribute (attribute)| is correctly represented as subClassOf
-
01300ccd-d1d7-417d-a70a-f688e72c4d8c 20231201 1 900000000000012004 733073007 1295447006 SubClassOf(:1295447006 :246061005)
-
-
All subconcepts of 1295447006 |Annotation attribute (attribute)| are represented as "SubAnnotationPropertyOf", instead of "subClassOf" as they previously were
-
e6cd65fe-cb81-4db4-9ac4-040dc74fce28 20231201 1 900000000000012004 733073007 1295448001 SubClassOf(:1295448001 :1295447006)
-
3729ce47-a96e-4dc7-9eff-83c34740c414 20231201 1 900000000000012004 733073007 1295449009 SubClassOf(:1295449009 :1295447006)
-
These axiom updates are published in the March 2024 International Edition release. The authoring tool has been updated to ensure all new subconcepts of 1295447006 |Annotation attribute (attribute)| are represented as SubAnnotationPropertyOf(). The remaining changes required for other tools to correctly consume the updated syntax were completed for the June 2024 International Edition release. The addition of content for the Annotations refset was commenced in the July 2024 International Edition release.
2.9. SNOMED CT derived products
2.9.1. ICD-10 map
The SNOMED CT to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (© World Health Organization 1994) 2016 Version map (SNOMED CT to ICD-10 Map) is included in the SNOMED CT International Edition as a Baseline. The SNOMED CT to ICD-10 Map was created to support the epidemiological, statistical and administrative reporting needs of SNOMED International member countries and WHO Collaborating Centers.
The SNOMED CT to ICD-10 Map is released in Release Format 2 (RF2) only. It is located in the file der2_iisssccRefset_ExtendedMapFull_INT_20200731.txt, which is in the Map folder under Refset, in each of the three RF2 Release Type folders.
The SNOMED CT to ICD-10 Map is released as Refset 447562003 |SNOMED CT to ICD-10 extended map (foundation metadata concept).
The ICD-10 Mapping Technical Guide (including exemplars) is hosted here https://confluence.ihtsdotools.org/display/DOCICD10
2.9.2. Content Development Activity Summary
The map is a directed set of relationships from SNOMED CT source concepts to ICD-10 target classification codes. The SNOMED CT source domains for the MAP are limited to subtypes of 404684003 |clinical finding|, 272379006 |event| and 243796009 |situation with explicit context|. The target classification codes are ICD-10 2016 release.
Mapped content for August 2024
The map provided for the August 2024 International Edition has been updated, and now represents a complete map from SNOMED CT International Edition to ICD-10 2016 version.
-
316 newly authored concepts have been added and mapped.
-
The SNOMED to ICD-O (morphology) map has null additional concepts added as a result of the ICD-O 3.2 review or added due to CRS requests.
We would welcome feedback on any issues that users of the map may detect when using the map. Issues should be submitted via mapping@snomed.org
2.9.3. SNOMED CT to OWL conversion and classification
The repository containing the toolkit enabling simple SNOMED CT to OWL conversion and classification can be found here, including documentation on its use: https://github.com/IHTSDO/snomed-owl-toolkit
Please contact SNOMED International at support@snomed.org if you would like to provide any feedback on ways to extend and improve the new toolkit.
3. Technical notes
3.1. Known Issues
Known Issues are content or technical issues where the root cause is understood, and the resolution has been discussed and agreed but has yet to be implemented. This can be due to a number of reasons, from lack of time within the new monthly editing cycles, to the risk of impact to the stability of SNOMED CT if the fix were to be deployed at that stage in the Product lifecycle.
For the current SNOMED CT International Edition, the following Known Issues were identified, and agreed to be resolved in future editing cycles:
3.2. Resolved Issues
Resolved issues are Known Issues which were not fixed as part of the previous release lifecycle, but which have now been resolved in the latest release. They can also be issues found during testing of the current release, which were resolved before the final deployment of the Production release. Finally they can be issues which were reported or found during the testing phase, but which have been closed without any action taken.
The Resolved Issues for the current SNOMED CT International Edition can be found here:
3.3. Technical updates
3.3.1. RF2 package format
The RF2 package convention dictates that all relevant files are included, regardless of whether or not there is content to be included in each release. Therefore, the package contains a mixture of files which contain both header rows and content data, and files that (intentionally) include only header records. The reason that these "empty" files are included in the package is to draw a clear distinction between:
-
...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in future releases
-
...files that happen to contain no data in this particular release (and are therefore included in the package with just a header record), but are still relevant to RF2, and could therefore contain content in future releases.
This allows users to easily distinguish between the two scenarios, as otherwise if files in option 2 were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.
3.3.2. Changes to the International Edition package format
In line with the new implementation of Annotations, two new refsets have been added to the International Edition Release package, from December 2023 onwards:
- der2_scsRefset_ComponentAnnotationStringValueSnapshot_INT_20240101.txt
- der2_sscsRefset_MemberAnnotationStringValueSnapshot_INT_20240101.txt
The addition of content for the Annotations refset was commenced in the July 2024 International Edition release.
3.3.3. Changes to the Annotations Refset format
NOTICE
PUBLISHED JUNE 2024 RELEASE - CHANGES TO THE ANNOTATIONS REFSET FORMAT
After discussions with the community, SNOMED International has made changes to the coverage of language in the Annotations refsets in the following way:
- The languageCode field was specified as the two characters of ISO-639-1 code for the language of the annotation text. The change is to include support for specifying dialect when it is applicable by adhering to RFC 5646, which allows the combination of two characters of ISO 639-1 code and two uppercase letters of country code (ISO 3166) separated by a hyphen.
- The column "languageCode" has therefore been changed to "languageDialectCode".
- Component Annotations (1292992004)
- OLD: id effectiveTime active moduleId refsetId referencedComponentId languageCode typeId value
- NEW: id effectiveTime active moduleId refsetId referencedComponentId languageDialectCode typeId value
- Member Annotations (1292995002)
- OLD: id effectiveTime active moduleId refsetId referencedComponentId referencedMemberId languageCode typeId value
- NEW: id effectiveTime active moduleId refsetId referencedComponentId referencedMemberId languageDialectCode typeId value
- The concept 1296895003|Language code (foundation metadata concept)| has been inactivated and replaced by 1304275002 |Language or dialect code (foundation metadata concept)|
- The changes apply to both the Member Annotations String Value Reference Set + Component Annotation String Value reference set
The addition of content for the Annotations refset was commenced in the July 2024 International Edition release.
3.3.4. Changes to the RefsetDescriptor records
NOTICE
PUBLISHED JUNE 2024 RELEASE - Changes to the RefsetDescriptor records
In line with the changes to the Annotations refsets (see above for details), the following refinements have also been made to the RefsetDescriptor records:
- 1. The AttributeType for the (attributeOrder=0) refsetDescriptor record for both Member + Component Annotations has been changed from:
- 900000000000461009 |Concept type component| to
- 900000000000460005 |Component type (foundation metadata concept)|
- (eg)
- OLD: 6cc1d4ca-32fd-44cb-8ad3-e49f23ec7760 20231201 1 900000000000012004 900000000000456007 1292992004 900000000000518009 900000000000461009 0
- NEW: 6cc1d4ca-32fd-44cb-8ad3-e49f23ec7760 20240601 1 900000000000012004 900000000000456007 1292992004 900000000000518009 900000000000460005 0
- OLD: f6d9647b-6ee6-400d-9c7f-77818fa1f986 20231201 1 900000000000012004 900000000000456007 1292995002 900000000000518009 900000000000461009 0
- NEW: f6d9647b-6ee6-400d-9c7f-77818fa1f986 20240601 1 900000000000012004 900000000000456007 1292995002 900000000000518009 900000000000460005 0
- OLD: 6cc1d4ca-32fd-44cb-8ad3-e49f23ec7760 20231201 1 900000000000012004 900000000000456007 1292992004 900000000000518009 900000000000461009 0
- 2. The languageDialect column for a) the (attributeOrder=2) refsetDescriptor record for Member Annotations + b) the (attributeOrder=1) refsetDescriptor record for Component Annotations has been changed from:
- 1296895003 |Language code (foundation metadata concept)| to the new concept
- 1304275002 |Language or dialect code (foundation metadata concept)|
- (eg)
-
OLD: 2c0d0378-c28c-4705-b8af-f5f0f8276dfd 20231201 1 900000000000012004 900000000000456007 1292992004 1296895003 900000000000465000 1
-
NEW: 2c0d0378-c28c-4705-b8af-f5f0f8276dfd 20240601 1 900000000000012004 900000000000456007 1292992004 1304275002 900000000000465000 1
-
OLD: afe9824b-1323-4407-a0b7-a028ae2b780a 20231201 1 900000000000012004 900000000000456007 1292995002 1296895003 900000000000465000 2
-
NEW: afe9824b-1323-4407-a0b7-a028ae2b780a 20240601 1 900000000000012004 900000000000456007 1292995002 1304275002 900000000000465000 2
-
- 3. The AttributeType for a) the (attributeOrder=4) refsetDescriptor record for Member Annotations (1292995002) + b) the (attributeOrder=3) refsetDescriptor record for Component Annotations (1292992004), needs to be changed from:
- 900000000000459000 (AttributeType) to
- 900000000000465000 (String)
- (eg)
- OLD: 54af9962-2a35-4538-86f3-a8c38de9200b 20231201 1 900000000000012004 900000000000456007 1292995002 900000000000519001 900000000000459000 4
- NEW: 54af9962-2a35-4538-86f3-a8c38de9200b 20240601 1 900000000000012004 900000000000456007 1292995002 900000000000519001 900000000000465000 4
- OLD: b46405ec-5ff1-46a3-a9cc-b2ef2bba23cc 20231201 1 900000000000012004 900000000000456007 1292992004 900000000000519001 900000000000459000 3
- NEW: b46405ec-5ff1-46a3-a9cc-b2ef2bba23cc 20240601 1 900000000000012004 900000000000456007 1292992004 900000000000519001 900000000000465000 3
3.3.5. Early visibility of impending changes in the upcoming 2024 Monthly International Edition releases
Please see the early visibility Confluence page for details of forthcoming changes.
3.3.6. Document links
All links provide information that is correct and current at the time of this Release. Updated versions may be available at a later date, but if so these will need to be requested from the relevant SNOMED International teams.
NOTE: To access any of the links in the pdf document, please visit the Release Notes https://confluence.ihtsdotools.org/display/RMT/SNOMED+CT+august+2024+International+Edition+-+SNOMED+International+Release+notes
Approvals
|
Final Version |
Date |
Approver |
Comments |
|---|---|---|---|
| 1.0 |
|
Rory Davidson | Approved |
| 1.0 |
|
Monica Harry | Approved |
| 1.0 |
|
Kelly Kuru | Approved |
Draft Amendment History
|
Version |
Date |
Editor |
Comments |
|---|---|---|---|
|
0.1 |
|
Andrew Atkinson |
First draft for review and comment |
|
0.1 |
|
Maria Braithwaite Donna Morgan |
Content Update Mapping Update |
| 1.0 |
|
Andrew Atkinson |
Final Production changes |