1. Introduction

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.

The International Health Terminology Standards Development organization (IHTSDO^®), trading as 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.

2. Background

This document provides a summarized description of the content changes included in the May 2024 Production release of the SNOMED Clinical Terms^® Managed Service Belgium Extension package.

It also includes technical notes detailing the known issues which have been identified (should any of these exist). These are content or technical issues where the root cause is understood, and the fix has been discussed and agreed, but has yet to be implemented.

This Belgium Extension package is dependent upon, and should therefore be consumed in conjunction with the SNOMED CT® Februari 2024 International Edition release.

2.1 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 during the release.

3.  Content Development Activity

3.1. Summary

Content from the SNOMED CT® Februari 2024 International Edition release has been translated.

This extension contains concepts, relationships and reference sets with their Dutch, French and German translations for healthcare professionals/for use in healthcare profession.

3.2 New and Updated Content

New Belgian content in this release:

Inactivated concepts

3 foundation metadata concepts referring to the POC FHIR value sets for the ‘AllergyIntolerance’ use case have been inactivated and there are no replacements for these:

• 741000172102 |Belgian subset for POC FHIR, no allergy (foundation metadata concept)|
• 731000172109 |Belgian subset for POC FHIR, manifestation (foundation metadata concept)|
• 751000172100 |Belgian subset for POC FHIR, causative agent, no drug (foundation metadata concept)|

New concepts

No new concepts have been created in this release.

Removed reference sets

No removed reference sets.

New translated content

Regarding the GP language refset:

• GP language refset: the following table contains the total number of translations included in the GP language refset:

Regarding the national language refset:

• New translations have been introduced, both for concepts that didn't have a translation yet as for concepts with existing translations.
• The following table contains the number the total number of translations included in the actual version of the Belgian language refset:

The other changes are updates of existing content.

4. Technical notes

4.1. 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 capacity within the current editing cycle, 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 SNOMED CT Managed Service - Belgium Extension Release, the following Known Issues were identified, and agreed to be resolved in the next editing cycle:

4.2. Technical notes

4.2.1. New Refsets

Please be aware that the following new files have been added to the Belgium Extension Release package, representing the new refsets being introduced in this editing cycle:

• der2_Refset_SubsetForCardiologyInPatientHealthRecordsSimpleRefsetFull_BE1000172_20241015.txt
• der2_Refset_SubsetForIntensiveCareInPatientHealthRecordsSimpleRefsetFull_BE1000172_20241015.txt
• der2_Refset_SubsetForHematologyInPatientHealthRecordsSimpleRefsetFull_BE1000172_20241015.txt
• der2_Refset_SubsetForInfectiousDiseasesInPatientHealthRecordsSimpleRefsetFull_BE1000172_20241015.txt

4.3.  Notice of changes to the Belgium Extension Release Schedule

As you may already know SNOMED International have transitioned to a monthly delivery schedule for the International Edition of SNOMED CT. The move towards more frequent releases of SNOMED CT realizes several benefits, including:

• The potential to be able to get content changes into the terminology in a shorter time frame.
• The fostering of better interoperability, as a result of entities being able to consume release content that is more aligned with other organizations.
• The prevention of circular dependencies that occur in longer projects, due to the move towards smaller, more manageable authoring projects.
• More automated validation services, as a result of the inherent removal of the Alpha/Beta stages in the Release cycle.

Whilst most users will continue unaffected (as they can simply continue to download the releases every 6 months as always), this transition will necessarily involve a few changes to process/packages:

• Delta files have been removed from both International and Managed Service release packages, including the Belgium Extension.  A Delta Generation service will be provided for those who need it. The Delta Generation Tool allows users to create their own Delta between two fixed release dates - you can find it here:
  • https://github.com/IHTSDO/delta-generator-tool/releases

• The ICD-O/ICD-10 Maps will continue to be published in each Monthly International Edition release package (in line with that month's content) for the foreseeable future, unless we experience issues with the new process in Production, and they need to be removed at a later date.

The Belgium Extension is now following the precedents set down by the International Edition, and transitioning to monthly Releases of the Extension package.  The first monthly BE Extension release is planned for publication in November 2024.

4.4. Notice of changes to the BE Extension Release package

In line with the refined implementation of Annotations, we are updating all Extensions in order to align them with the updated version of the refsets in the International Edition Release package (which were first published in June 2024).

• The languageCode field was specified as the two characters of ISO|-639-1 code for the language of the annotation text. The change includes 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 changes apply to both the Member Annotations String Value Reference Set + Component Annotation String Value reference set:
  • 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