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Change to Effective Time for International Edition- 1 September 2023

After consultation with the community, SNOMED International has changed the date of the effective time for the International Edition from the last day of each month, to the first of each month.  

The effective time for the “January” edition will be 1st January.

The effective time for the “July” edition will be 1st July. 

The July 2023 International Edition was the last to be published with effective time of the last day of the month.

Further details about this change can be found in the Q&A blog post. 

Inactivation of 9258009|Gravid uterus structure (body structure)|

This concept will be inactivated, content that is modeled with this concept will be remodeled with a site of 35039007|Uterine structure (body structure)| along with occurrence <<307159006|Pregnancy time period (qualifier value)|.  

The domain of 246454002 |Occurrence (attribute)| will be extended to include << 71388002 |Procedure (procedure)| to support these content changes. Content areas that will be updated include 386811000|Fetal procedure (procedure)| and 386637004|Obstetric procedure (procedure)|.

Inactivation of Concepts Specified Male/Female in Descriptions

Subtypes of 67770001 |Male mammary gland structure (body structure)| and 91532001 |Female mammary gland structure (body structure)| and their associated disorder and specimen concepts.  Further information is available here (Confluence log in required).

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

Update for Concepts Using 'Caused by'

Clinical finding concepts containing "Caused by" in their FSN will be reviewed and will be updated (if applicable) according to the editorial guidelines related to causation here. The main focus of the review will be the following category of concepts:

• Concepts containing "Caused by" in their FSN that have a synonym (including PT), which contains “Due to”
• Concepts where FSN contains "Caused by" and "Due to"

Additional content update may become applicable while reviewing these concepts for example: 

• Concepts that do not contain “Caused by” or “Due to” in their FSN, but contain one of these terms as their preferred terms
• Concepts containing “Due “to in their FSN that have a preferred term which contains “Caused by”.

Concepts with "...attend.. X"

Around 40 "attends X" or "attending X" findings concepts, e.g., 160766005 |Midwife attends 14-16 days post-discharge (finding)| will be inactivated from the international release as they are administrative concepts. 

Commencing Q4 2023 International Releases until completion.

Updates to the Inactivation Reason and Historical Association for 'On Examination' and 'Complaining of' Inactive Content

Many of the 'on examination' and 'complaining of' concepts were previously inactivated with the inactivation reason of |Moved elsewhere| with a historical association value |Extension Namespace 1000000|.

This content will be updated with an inactivation reason of |Non-conformance to editorial policy| and a historical association of |Alternative| to a suitable international concept. 

Update to MRCM

Extend the domain of 246454002 |Occurrence (attribute)| by including << 71388002 |Procedure (procedure)|.

The following is the expected MRCM range after the change.

246454002 |Occurrence (attribute)| << 272379006 |Event (event)| OR << 404684003 |Clinical finding (finding)| OR << 71388002 |Procedure (procedure)|

Review of CRS Requests in “Awaiting agreement compliance” Status from SNOMED CT – LOINC Cooperation Project

CRS requests in “Awaiting agreement compliance” status due to the previous cooperative agreement between SNOMED International and Regenstrief Institute, Inc. have been reviewed in light of the new cooperative agreement, the latest SNOMED CT Editorial Guide, and the latest CRS guidance documents. Concepts deemed in scope are being added.

New Subtypes of 1155866009 |Messenger ribonucleic acid of severe acute respiratory syndrome coronavirus 2 encoding spike protein (substance)|

New subtypes will be added to 1155866009 |Messenger ribonucleic acid of severe acute respiratory syndrome coronavirus 2 encoding spike protein (substance)| including:

• "SARS-CoV-2 mRNA encoding B lineage spike protein" (i.e. "SARS-CoV-2 mRNA encoding original strain spike protein")
• Severe acute respiratory syndrome coronavirus 2 mRNA encoding BA.1 lineage spike protein
• Severe acute respiratory syndrome coronavirus 2 mRNA encoding BA.4/BA.5 lineage spike protein

These concepts will be created to meet the requirement for creation of bivalent vaccines (usually containing original strain + an omicron variant). In addition, creation of "SARS-CoV-2 mRNA encoding original strain spike protein" will allow for accurately representing monovalent vaccines containing "SARS-CoV-2 mRNA encoding B lineage spike protein" (original strain)."

latest SNOMED CT Editorial Guide, and the latest CRS guidance documents. Concepts deemed in scope are being added.

Ethnic/Racial Group Social Context Content Inactivation

The subtypes of 372148003 |Ethnic group (ethnic group)| and 415229000 |Racial group (racial group)| will be inactivated as they are out of scope for the International Edition.  A briefing note is available here.

Inactivation of Subtypes of 125676002|Person (person)|

The following concepts will be inactivated:

444145006 |Partner in relationship with subject (person)| - historical association to 262043009 |Partner in relationship (person)|

444210007 |Cohabitee in relationship with subject (person)| - historical association to 394921008 |Cohabitee (person)|

The Editorial Guide states that the Subject relationship context (attribute) is used to specify the subject of the Clinical finding or Procedure being recorded, in relation to the subject of the record; therefore, the above two concepts are unnecessary.

Patient/Subject concepts in the Clinical finding and Procedure Hierarchies

Concepts in the Clinical finding and Procedure hierarchies that contain the explicit context of patient or subject will be inactivated and replaced with concepts without this explicit context. For further information please see briefing note.

"X result not back (situation)" concepts

Four concepts of the type "X result not back (situation)," e.g., 168709001 |Soft tissue X-ray result not back (situation)|, will be inactivated as they are out of scope for the international edition of SNOMED CT.

October 2023 International Release