Introduction

The 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^®) maintains the SNOMED CT technical design, the content architecture, the SNOMED CT content (including the concepts table, the descriptions table, the relationships table, a history table and ICD mappings), and related technical documentation. 

This document is intended to give a brief description, background context, explanatory notes on the SNOMED CT International Medical Devices project and the resulting Release package, which is now published every 6 months. This document covers the background to the collaboration between IHTSDO and Global Medical Devices Nomenclature Agency (GMDNA) and goes on to cover the consequent release artefacts. It is not a detailed technical document of SNOMED CT, GMDN or the SNOMED CT International Medical Devices release. Nor does it seek to provide an editorial policy for medical devices.

Audience for this document

This document should be read by all those (National Release Centers, vendors of electronic health records, terminology developers and regulators) with an interest in the usage of medical device content in SNOMED CT and its linkage with GMDN. 

Background

The decision of the joint IHTSDO Management Board and General Assembly in October 2010 was to work towards a Cooperation agreement with the Global Medical Devices Nomenclature Agency (GMDNA), owners of the Global Medical Devices Nomenclature (GMDN), with the intention that the content of GMDN be integrated with the basic terminological content of the medical devices component of the International Release of SNOMED CT. In April 2012 the culmination of discussions between the IHTSDO and GMDNA was the signing of a cooperation agreement which now permits the IHTSDO to use the content of GMDN as the basis of the medical device component of SNOMED CT and conversely for the GMDN Agency to use SNOMED CT medical device content to inform GMDN development. The collaboration is consistent with the aims of both organisations to minimize duplication of effort and support international harmonization. 

Scope and Purpose of the collaborative work

The scope of the SNOMED CT International Medical Devices project was the delivery of a concept model to support medical devices within SNOMED CT, and the continuous alignment of SNOMED CT with GMDN.  This was managed in phases. We are now in the business as usual (maintenance) phase of the continuous alignment of SNOMED CT with GMDN. We are in the development phase of the delivery of a concept model to support medical devices within SNOMED CT.  

Under the terms of the Cooperation agreement between the IHTSDO and the GMDNA, only active GMDN Preferred Terms were under consideration for inclusion in the SNOMED CT International Release. Of these approximately 11,000 were In Vitro Diagnostic medical device (IVD) terms. These terms are authored to a different level of granularity than the rest of the GMDN content and set them apart in this difference. The level of detail they hold was discussed and the IHTSDO made the decision to not include them in SNOMED CT until a compelling use case for the IVD terms is identified, from the perspective of SNOMED CT users.

Release content

Overview

The medical devices derivative content is released under a project-specific module (466707005|SNOMED CT Medical Devices module) with component identifiers that are within the main IHTSDO (International Release) namespace. The content links into the main International Release Physical Object hierarchy, and therefore all the fully specified names have a ("physical object") semantic tag. All the concepts are primitive i.e. no modeling beyond the subtype relationships, and the hierarchical organisation is based on existing GMDN groupings ('collective terms'). 

Content detail

Each SNOMED CT new concept has at least 2 descriptions (Fully Specified Name and Synonym). Following International Edition editorial policies, GB and US spelling variants were generated as necessary and the preferences reflected in the corresponding language reference sets. A third reference set (608771002|GMDN language reference set) is included to enable the identification of the original GMDN term, as in a small number of cases minor editing has been necessary to align terms to SNOMED CT International Edition naming conventions (i.e. acronyms included in original GMDN terms were expanded in the FSNs derived from them). 

To enable the tracking of the relationship between SNOMED CT concepts and GMDN terms across releases, the preliminary linkage table has been replaced by a simple map reference set between SNOMED CT concepts and GMDN terms (467614008|GMDN simple map reference set). 

From July 2018 onwards, SNOMED International will also process modified and obsolete concepts, rather than just new and inactivated.  Modified GMDN codes which require a new concept to be authored will subsequently be flagged as "no target". Obsolete GMDN codes will have the GMDN target map flagged as "no target".

Language preferences

The original English language used to represent GMDN terms is 'European English' and therefore spellings conform to US derivative in some instances and GB in others. GMDN terms also include spellings with US and GB variants in the same description. New descriptions were created to align content with International Edition practices, including the expansion of acronyms in FSNs. 

Effective date

The content in the July 2024 GMDN Simple Map package has been updated in line with July 2024 updates received from GMDNA in the latest editing cycle.  All component states in the July 2024 SNOMED CT to GMDN Simple Map package have therefore been assigned the value of 20240701 in the effectiveTime field. 

Inactivations

For the July 2024 release of the SNOMED CT to GMDN map there were a number of inactivations from the previous map. This was due to work undertaken by SNOMED International authors to remove content that referred to kits, sets, device size or device frequency as these are generally considered to be out of scope for the international edition.

Technical Notes

RF2 package format

The RF2 package convention dictates that it contains all relevant files, regardless of whether or not there is content to be included in each particular release.  Therefore, the package contains a mixture of files which contain both header rows and content data, and also files that are intentionally left blank (including only a header record).  The reason that these files are not removed from the package is to draw a clear distinction between:

1. ...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in this or future releases, and 
2. ...files that just happen to contain no data in this particular release (and are therefore included in the package but left blank, with only a header record), but are still relevant to RF2, and could therefore potentially contain data in future releases.

This allows users to easily distinguish between files that have purposefully been removed or not, as otherwise if files in option 2 above were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.

Release Dependencies

The July 2024 release of the SNOMED CT to GMDN map is based on the following versions of the Map Sources:

• SNOMED CT  - July 2024
• GMDN            - July 2024

Notice of changes to the GMDN Map Package Release package

Annotations

In line with the refined implementation of Annotations, we are updating all Products 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

Metadata

After consultation in 2023, SNOMED International are in the process of improving our Derivative release packages by including the relevant metadata in the Derivative packages, as well as in the International Edition.

These Derivatives are solely single refsets/maps, and so don’t mean anything to end users without the supporting terms and other components from the International content.  The nature of these products is therefore such that we necessarily create Derivative packages that are inherently dependent on the relevant International Edition content.  Previously, therefore, we have always created the metadata components (refset/module concepts, descriptions, relationships, etc) in the International Edition release packages, with the Derivative products being dependent on the relevant International content.  Whilst this dependency on the International content would continue, the transition would involve the inclusion the metadata components in the Derivative packages themselves, as well as in the International Edition packages. 

The consensus is that including the Metadata components in the Derivative packages will bring benefits to both the Derivative maintainers, and also to the end users who will no longer need to pull this particular data down from the dependent International Edition in order to use the Derivative products.   It enables maintainers to move to a more efficient model of hosting the Derivative content in termServer branches, rather than importing Delta files from external tools.  They are included for additional information, and do not have to be consumed - so please utilise them as required.

This means that from the March 2024 GMDN Map release onwards, it will include additional metadata components that used to reside solely in the International Edition.  These will include the GMDN module concept + description records, etc.

If you have any feedback on the metadata components, please contact us on release@snomed.org