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Browse Content Changes for the International Release

For content changes that are ready for publication in the next release please browse here

Concept Inactivation

For concept inactivations that are for publication in the next release please browse here

MRCM Changes

Forthcoming MRCM changes can be viewed here

Quality Initiative

Information about the project can found here

Content Request Service (CRS)

Please see Guidance for Requesting Changes to SNOMED CT

Further information about CRS is available here.

Inactivation of 6920004|Defect (morphologic abnormality)|

6920004|Defect (morphologic abnormality)|is planned for inactivation. 286 concepts currently modelled with 6920004|Defect (morphologic abnormality)| will be reviewed and remodelled; this may include inactivation and replacement.

Please see the briefing note for further details.

Remodeling of 771527003|Structure of synovial sac (body structure)| and Subtypes

The content in this area is being updated to align with this model.

Neoplasm of Connective and Soft Tissue Disorders

Around 30 concepts which include “neoplasm of connective and soft tissue" in their FSN will be inactivated as "Classification derived component." 

Measurement Findings

The next set of changes for measurement findings content will involve the positive and negative results content (~150 concepts). Measurement findings concepts which include 'positive' or 'negative' in the FSN will be updated as follows:

1) The FSN and PT will be updated to include 'detected' or 'not detected.' Existing descriptions with 'positive' or 'negative' will be retained as synonyms.
2) The Has interpretation value of 10828004 |Positive (qualifier value)| or 260385009 |Negative (qualifier value)| will be updated to 260373001 |Detected (qualifier value)| or 260415000 |Not detected (qualifier value)|.

Please see the briefing note (20221116 BN Positive_Negative measurement findings.pdf) for more information.

Update Hierarchy 90708001 |Kidney disease (disorder)|

As part of the Quality Initiative Project, work has commenced on 90708001 |Kidney disease (disorder)|. Work is being undertaken in stages and upcoming sub-hierarchies will be posted here as the work progresses:

• 236423003 |Renal impairment (disorder)| -  In progress

Inactivation of Concepts that state Delivered/Not delivered

Obstetric content that conflates the delivery status with the disorder of the mother that prompted the admission to hospital will be inactivated.

There are 250 concepts that state the delivery status of the mother within the FSN:

• 198905007 |Placenta previa with hemorrhage - delivered (disorder)|
• 198906008 |Placenta previa with hemorrhage - not delivered (disorder)| 

These concepts are classification derived and are used to record whether the baby was, or was not delivered during that inpatient stay for the care of the mother who has placenta previa with a hemorrhage.

Primary and Metastatic Project - New Metastatic Morphologic Abnormality Concepts

Metastatic disorders will be defined by their specific metastatic neoplastic morphologic abnormality concepts, and new metastatic morphologies are being added to the international edition of SNOMED CT as needed. In cooperation with the Netherlands extension of SNOMED CT, SNOMED International will be promoting certain of their existing metastatic morphology concepts to the International release to be used to model new metastatic disorder concepts. 

Inactivation of 118222006 |General finding of observation of patient (finding)|

118222006 |General finding of observation of patient (finding)| is a high level finding with little clinical value.  The concept will be inactivated with an inactivation target of Clinical finding.  Descendants count is 4237 concepts. 

Update for 399248000 |Procedure related to anesthesia and sedation (procedure)|

745638006 |Injection of anesthetic agent (procedure)| and its 283 subtypes will gain a supertype of 399097000 |Administration of anesthesia (procedure)|. 

Inactivation of 415360003 |Severe acute respiratory syndrome-related coronavirus (organism)|

To resolve ambiguity for 415360003 |Severe acute respiratory syndrome-related coronavirus (organism)|, this concept will be inactivated as ambiguous. New concepts will be created to represent the associated strain and species.

840533007 |Severe acute respiratory syndrome coronavirus 2 (organism)| will be a sibling of the “Severe acute respiratory syndrome (SARS) coronavirus” strain and a subtype of the “Severe acute respiratory syndrome-related coronavirus” species.

Children Current children of 415360003 |Severe acute respiratory syndrome-related coronavirus (organism)|, which represent SARS strain subtypes have been  Severe acute respiratory syndrome (SARS) coronavirus strain subtypes will be inactivated using "Outdated component" as the inactivation reason with a "Replaced by" association to the concept representing “Severe acute respiratory syndrome (SARS) coronavirus.".

Details of the change can be found in this Briefing Note.

Change for Clinical Drug Concepts Containing Pancreatic Enzymes

Clinical drug concepts in the International Release containing pancreatic enzymes will be modeled based on the discrete enzymes; because of variability between real clinical drugs, synonyms representing a total amount in a particular product will not be included in the International Release.

The editorial guide and existing content will be reviewed and updated accordingly in a future release.

Update to 307159006|Pregnancy time period (qualifier value)| and Subtypes

Concepts referring to temporal periods for pregnancy and birth (307159006 Pregnancy time period (qualifier value) and subtypes) will be updated with the addition of a small number of concepts to make this area of content more comprehensive.

A new concept which explicitly covers 'maternal antenatal and/or intrapartum and/or postpartum period’ will be added.

Definitions will be added to aid modeling and interpretation.

Planned Inactivation of Concepts in the 260299005 |Number (qualifier value)| Hierarchy

Following the deployment of the concrete domain functionality in SNOMED CT, concepts in the 260299005 |Number (qualifier value)| hierarchy are no longer necessary and plans have been made for their inactivation.

To provide adequate time for any national extension or implementation affected by this change, concepts in the 260299005 |Number (qualifier value)| hierarchy will be inactivated in the January 2023 International Release.

Concepts will be inactivated with reason “Non-conformance to editorial policy” and no historical relationship or replacement concept will be provided.

Exceptions:

118586006 |Ratio (property) (qualifier value)| and descendants have been relocated to 118598001 |Property (qualifier value)| hierarchy.

272070003 |Ordinal number (qualifier value)| and descendants have been relocated to 362981000 |Qualifier value (qualifier value)| hierarchy.

A briefing note will also be distributed to selected Advisory and Project Groups.

Please contact info@snomed.org with any inquiries.

Primary and Metastatic Project
Following the development of proposals by an internal working group and consultation with community stakeholders, the primary and metastatic project is commencing work which will be ongoing for Q1 in 2023, with updates on progress provided in both Early Visibility and Release Notes.

As part of this project, new concepts relating to primary and metastatic disease are being added to SNOMED CT in order to disambiguate those concepts not stated as primary (agnostic) in the subhierary of 372087000 |Primary malignant neoplasm (disorder)| and that may have been used in the past to record both primary and metastatic malignancy. 

Myeloid Neoplasm Pilot Project

The Pathology CRG have identified content that is outdated and modeled inconsistently in the neoplastic morphologies and related disorders. This content does not represent prevailing pathology knowledge as expressed by pathologists and other international subject matter experts, and described in the WHO Blue Books, 5th edition.

A pilot project focussing on <<414792005 |Myeloid neoplasm (morphologic abnormality)| (91 descendants) and related disorder concepts 25333006 |Myeloproliferative disorder (disorder)| and its 117 descendants) is nearing completion. 

The work is planned for promotion in Q1 2023 following successful approval of the Pilot. The project will involve new content, inactivation of outdated concepts, and updating of descriptions where necessary to align with the WHO Blue Books.

Cancer Synoptic Reporting

Concepts representing cancer synoptic reporting content will be added to the International release starting with the July 2021 release. 

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.

This content primarily encompasses observable entity concepts and also includes supporting concepts from other hierarchies, e.g. property values.

For more information about this project, please see the Cancer Synoptic Reporting Clinical Project Group here

Epilepsy Content ILAE Collaboration

Review of << 313287004 |Seizure related finding (finding)| and << 84757009 |Epilepsy (disorder)| (excluding Orphanet related content) for currency and clinical correctness with the addition of missing clinically relevant content. 

Please refer to the project status report for further information.

Nutrition Content

Information about the work of the Nutrition Care Process Clinical Project group is available here.

Project Information

Content Improvements in the Substance and Product Hierarchies

Please see briefing notes here Drugs Project

Implementation of the new anatomy concept model

The completion of the revision of hierarchical relationships provides stable anatomy content and improves the quality of classification results in other hierarchies.

Over forthcoming releases, the plan is to implement the new anatomy concept model. There are almost 35,000 anatomy concepts and they will be modeled by different types of 'part of' relationships. The new model will enable us to automatically generate hierarchies to further improve quality and consistency. 

Information about the work completed in previous release for revision of IS_A relationships can be viewed here

Inactivation of "X by body site" concepts in various hierarchies

Concepts that include "X by body site" in multiple hierarchies are being inactivated, e.g., 371571005 |Imaging by body site (procedure)| and 301810000 |Infection by site (disorder)|, because they are classification groupers with no clinical use.

Content Improvement

Update for Inactive Concepts Without Semantic Tag

Remaining cases of the legacy issue inactive concepts with active FSN without a semantic tag (Content Tracker IHTSDO-645) will be addressed to assign a semantic tag.  The number of inactive concepts requiring this update is 351.

Disorder X without Disorder Y

The vast majority of existing X without Y concepts originated from ICD-9 with the specific meaning of "X disorder without mention of Y disorder".  As the phraseology indicates a lack of data about disorder Y as opposed to a specific exclusion, this type of concept has not been included in ICD-10, nor proposed for ICD-11, except in the case of "Traumatic brain injury without open intracranial wound".  

Addition of new X without Y concepts may only be made under the following conditions:

1. The request for new content must be accompanied by a rationale as to the difference between "X disorder without Y disorder" and "X disorder."
2. Approval for addition is given by the Head of Terminology.

For the most part, existing X without Y concepts will be inactivated as AMBIGUOUS with a historical MAY BE relationship to "X disorder".  Exceptions to inactivation will be made on a case-by-case basis.

WAS_A

Inactivation reason of LIMITED/WAS_A is not allowed for any new content inactivations after the July 2018 release. The WAS_A association refset has not been updated thereafter.

At the Editorial Advisory Group meeting in April 2019, agreement was reached to discontinue the maintenance of WAS_A relationships when inactivating concepts that have a historical association to an inactive concept. When changes are made to a historical relationship for a concept that was previously inactivated using WAS_A, effort will be made to assign a new historical relationship that facilitates traceability of the concept (e.g. DUPLICATE or AMBIGUOUS) as opposed to NON-CONFORMANCE TO EDITORIAL POLICY.

Existing WAS_A relationships will be inactivated in a future release once a plan for batch reassignment of historical relationships has been developed. Until then, SNOMED International will not continue to use or maintain WAS_A relationships.