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 organisation (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 November 2022 release of the SNOMED Clinical Terms^® Managed Service Sweden Extension package.

It will 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 Sweden Extension package is dependent upon, and should therefore be consumed in conjunction with the SNOMED CT® July 2022 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® July 2022 International Edition release has been translated and additional concepts and synonyms for use in Sweden have been added. Some areas for which new concepts and synonyms have been added are:

• Collaborative work with professional societies (Dietisternas Riksförbund, Svensk sjuksköterskeförening) has been done to improve the quality of the Swedish translations.

• Work has been done to reduce duplicate terms and address other quality issues in the Swedish translation.

• Working with the healthcare regions to develop content in the Swedish extension.

3.2. Concept statistics

New and Updated Content

New concepts: 32

Table 1 New concepts by hierarchy

6 concepts from the Swedish extension were inactivated for this release, 7 concepts were changed, and 30 were promoted to the International edition.

3.2.1. Descriptions statistics

New decriptions: 5999
Inactivated descriptions: 316
Re-activated descriptions: 12
New translations: 5291

Some concepts have not been translated into Swedish. The reasons for non-translation can vary and include concepts not relevant in a Swedish context and concepts were the name in Swedish and English is equivalent (e.g. the Latin names of organisms).

3.2.2.
Reference sets

No new reference sets.

Updated simple reference sets:

• 500221000057105 | Care service reference set|
• 64641000052102 |Severe mental disorder simple type reference set|
• 500061000057107 |Microorganism result reference set|
• 500081000057104 |Generic laboratory result reference set|
• 500101000057105 |Bacteria property class result reference set|
• 500121000057102 |Specimen type reference set|
• 60001000052100 |Chief complaints reference set|
• 59771000052109 |Administrative gender reference set|
• 62151000052104 |Route of administration reference set, Swedish national medication list|

Updated language reference sets:

• 500191000057100 |Laboratory medicine context language type reference set|
• 63461000052102 |Context-specific terms language type reference set, Swedish national medication list|
• 63451000052100 |Common-language expression language type reference set, Swedish national medication list|
• 63481000052108 |Dose unit plural language type reference set, Swedish national medication list|
• 64311000052107 |Chief complaints context language type reference set|
• 83461000052100 |ICNP Swedish language type reference set|
• 113491000052101 |Care service context language type reference set|

Reference sets we are planning to inactivate:

• 58181000052100 |Means of contact reference set|
• 93501000052104 |Recommended actions for entering the labour market reference set|
• 63421000052107 |Means of contact between patient and certificate producer reference set|
• 64641000052102 |Severe mental disorder simple type reference set|
• 83551000052104 |Job support program activities reference set|
• 73171000052105 |Edema as sign of heart failure reference set|
• 46051000052106 |Lifestyle reference set|
• 60381000052109 |Systolic blood pressure reference set|
• 60391000052106 |Diastolic blood pressure reference set|
• 60401000052109 |Body height reference set|
• 60411000052106 |Body temperature reference set|
• 60421000052103 |Body weight reference set|
• 59761000052100 |Marital status reference set|

If any of these reference sets are in use please send a message to ehalsa@socialstyrelsen.se Otherwise we will inactivate all records in these refsets at the next release May 2023. At the release November 2023 the reference-id will be inactivated.

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 this cycle of the SNOMED CT Managed Service - Sweden Extension, the following Known Issues were identified, and agreed to be resolved in the next editing cycle:

4.2. Technical notes

4.2.1. Deprecated Refsets

The following refset(s) are being deprecated from the Sweden Extension Release package:

• 113461000052109 |urval förekomst av implantat, uppmärksamhetsinformation| - the use of this refset within Uppmärksamhetsinformation (UMI) has been deprecated and has been replaced with an information model referring to this refset: 59841000052105 |urval implantat, uppmärksamhetsinformation|. Please refer to the specification for details: https://www.socialstyrelsen.se/kunskapsstod-och-regler/omraden/e-halsa/tillampning/uppmarksamhetsinformation/.

For the May 2022 Release, this involved inactivating all records in the refset(s), and retaining the Refset file(s) in the Sweden Extension Release package.

For this November 2022 release, the inactive Refset file(s) have now been completely removed from the Sweden Extension Release package.

Note:  However, the RefsetDescriptor record(s) for these deprecated Refsets remain in the package (and remain active), as the Descriptor patterns themselves are still valid, and therefore standard practice dictates that they remain in place.

Please contact the Sweden National Release Centre for any further details, or if you need assistance with these deprecations.

4.2.2. Notice of changes to the International Edition 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 Sweden 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 first monthly Release of the SNOMED CT International Edition was published on the 28th February 2022 with the Delta files having been removed, and therefore they will be removed from the Sweden Extension from the May 2022 Release onwards.

Please note - While the SNOMED CT International Edition is moving to monthly releases, the Sweden Extension of SNOMED CT will remain on the current bi-annual release schedule of May and November for 2022.