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 May 2021 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 2021 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® Jan 2022 International Edition release has been translated and additional concepts and synonyms for use in Sweden have been added. The main areas for which new concepts and synonyms have been added are:

• The ICNP Swedish language type reference set is adopted from and dependent on the International Classification of Nursing Practice (ICNP) Reference Set. It contains 1938 active concepts from SNOMED CT and translations of these concepts have been reviewed in collaboration with Swenurse. For more details about International Classification of Nursing Practice (ICNP) Reference Set see ICNP SNOMED CT Nursing Practice Refset Release Notes - July 2021.

• 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: 91

Table 1 New concepts by hierarchy

14 concepts from the Swedish extension were inactivated for this release, 5 concepts were changed, and 6 were promoted to the International edition.

Descriptions statistics

New decriptions: 6 549
Inactivated descriptions: 378
Re-activated descriptions: 3
New translations: 4 690

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).

Table 2 Non-translated concepts by hierarchy

Reference sets

No new reference sets.

Updated reference sets:

• 64641000052102 |urval allvarlig psykisk störning|
• 500061000057107 |urval fynd mikroorganism laboratoriemedicin|
• 59831000052104 |urval behandlingar, uppmärksamhetsinformation|
• 500121000057102 |urval provtyp laboratoriemedicin|
• 500221000057105 |urval vårdtjänster|
• 59821000052101 |urval medicinska tillstånd, uppmärksamhetsinformation|
• 59871000052102 |urval kemikalieöverkänsligheter, uppmärksamhetsinformation|

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 - Sweden Extension November 2021, the following Known Issues were identified, and agreed to be resolved in the next editing cycle:

4.2 Technical notes

Promoted concepts

Some concepts from the Swedish extension have been promoted to the international release (900000000000207008 | SNOMED CT core module (core metadata concept) |). The concepts have been added to the international release files with an effectiveTime which supersedes the latest effectiveTime in the Swedish extension release files. The concepts will be retained in the Swedish extension snapshot files in perpetuity as per SNOMED International recommendations and anyone using these files will have to manage the possibility of duplicated ids (with different effectiveTime) across release files. The risk of issues can be mitigated by filtering to only use Swedish extension records with effectiveTime:s greater than their International counterparts. Links to relevant documentation will be added to these release notes once that documentation has been updated.

The promoted concepts in the May 2022 release are:

• 58841000052102 |Bathe (administration method)|
• 72531000052105 |Counseling for contraception (procedure)|

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 the next Release in November 2022, the inactive Refset file(s) will then be completely removed from the Sweden Extension Release package.

Note:  However, the RefsetDescriptor record(s) for these deprecated Refsets will remain in the package (and will 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.

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.

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 May 2021 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 2021 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 2021 International Edition release has been translated and additional concepts and synonyms for use in Sweden have been added. The main areas for which new concepts and synonyms have been added are:

• The ICNP Swedish language type reference set is adopted from and dependent on the International Classification of Nursing Practice (ICNP) Reference Set. It contains 1938 active concepts from SNOMED CT and translations of these concepts have been reviewed in collaboration with Swenurse. For more details about International Classification of Nursing Practice (ICNP) Reference Set see ICNP SNOMED CT Nursing Practice Refset Release Notes - July 2021.

• 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: 

Table 1 New concepts by hierarchy

12 concepts from the Swedish extension were inactivated for this release, 16 concepts were changed, and 6 were promoted to the International edition.

Descriptions statistics

New synonyms added: 9 024
Inactivated descriptions: 678
Re-activated descriptions: 69
New translations: 4 338

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).

Table 2 Non-translated concepts by hierarchy

Reference sets

New reference sets:

• 103491000052103 |urval särskilda vårdrutiner utifrån fattade beslut, uppmärksamhetsinformation|
• 113461000052109 |urval förekomst av implantat, uppmärksamhetsinformation|
• 113471000052100 |urval förekomst av transplantat, uppmärksamhetsinformation|
• 500221000057105 |urval vårdtjänster|
• 83461000052100 |språkurval ICNP svenska|
• 113491000052101 |språkurval vårdtjänster|

Updated reference sets:

• 500061000057107 |urval fynd mikroorganism laboratoriemedicin|
• 59821000052101 |urval medicinska tillstånd, uppmärksamhetsinformation|
• 59831000052104 |urval behandlingar, uppmärksamhetsinformation|
• 59841000052105 |urval implantat, uppmärksamhetsinformation|
• 59861000052106 |urval transplantat, uppmärksamhetsinformation|
• 59881000052100 |urval särskilda vårdrutiner, uppmärksamhetsinformation|
• 60001000052100 |urval sökorsak|
• 62201000052106 |urval dosenhet, nationella läkemedelslistan| 
• 63181000052104 |urval analysmetod laboratoriemedicin|
• 64641000052102 |urval allvarlig psykisk störning|

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 - Sweden Extension November 2021, the following Known Issues were identified, and agreed to be resolved in the next editing cycle:

4.2 Technical notes

Promoted concepts

Some concepts from the Swedish extension have been promoted to the international release (900000000000207008 | SNOMED CT core module (core metadata concept) |). The concepts have been added to the international release files with an effectiveTime which supersedes the latest effectiveTime in the Swedish extension release files. The concepts will be retained in the Swedish extension snapshot files in perpetuity as per SNOMED International recommendations and anyone using these files will have to manage the possibility of duplicated ids (with different effectiveTime) across release files. The risk of issues can be mitigated by filtering to only use Swedish extension records with effectiveTime:s greater than their International counterparts. Links to relevant documentation will be added to these release notes once that documentation has been updated.

The promoted concepts in the November 2021 release are:

• 62461000052109 | Second transurethral resection of bladder (procedure) |
• 65971000052100 | Acute psychosis (disorder) |
• 69621000052107 | Flexible bronchoscopy (procedure) |
• 70711000052105 | Assessment of bone age using Tanner-Whitehouse 2 method (procedure) |
• 70721000052102 | Assessment of bone age using Tanner-Whitehouse 2 radius-ulna-short bones method (procedure) |
• 70731000052100 | Assessment of bone age using Tanner-Whitehouse 3 method (procedure) |

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 the next Release in November 2022, the inactive Refset file(s) will then be completely removed from the Sweden Extension Release package.

Note:  However, the RefsetDescriptor record(s) for these deprecated Refsets will remain in the package (and will 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.

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.