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Page At A Glance
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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.
The SNOMED CT Irish Extension - packages these components for release every April and October, to be used with the latest SNOMED CT International Edition release.
The same content can be viewed online using the SNOMED CT browser, and eHealth Ireland website
2 Background
This document provides a summarized description of the content changes included in the October 2023 Production release of the SNOMED Clinical Terms® Managed Service Ireland Extension package.
It will also include 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 Ireland Extension package is dependent upon, and should therefore be consumed in conjunction with the SNOMED CT® September 2023 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® September 2023 International Edition release has been included, alongside additional components for use in Ireland.
This extension contains concepts, relationships and reference sets for healthcare professionals.
3.2 New and Updated Content
New content in this release:
This is the 7th SNOMED CT Irish Edition Production release.
New and updated content
Concept statistics
The SNOMED Irish National Release Centre published 156 new concepts, and these are available in the Irish Extension October 2023 release.
Table 1. New concepts in the Irish Edition October release
File | Changes |
Concept | 56 records added/updated, plus 0 records inactivated |
Description (EN) | 159 records added/updated, plus 23 records inactivated |
Language (EN) | 64593 records added/updated, plus 2766 records inactivated |
OWLExpression | 62 records added/updated, plus 1 records inactivated |
Inferred Relationship | 393 new records added/updated, plus 125 records inactivated |
Inferred Relationship Concrete Values | 0 records added/inactivated/updated |
RefsetDescriptor | 8 records added/updated |
ModuleDependency | 5 existing records updated for new effectiveTime |
AttributeValue | 23 records added/updated, plus 0 records inactivated |
Association Refset | 0 new records added/updated, |
Adult oncology daycare nursing discharge SimpleRefset | 0 records added/inactivated/updated |
Epilepsy Simple Refset | 4 records added/updated, plus 2 record inactivated |
Breastcheck screening service SimpleRefset | 139 records added/updated, plus 43 record inactivated |
Nursing Midwifery Quality Care Metrics Dataset SimpleRefset | 1 records added/updated, plus 2 record inactivated |
Dentistry SimpleRefset | 171 records added/updated, plus 6 record inactivated |
National Ambulance Service SimpleRefset | 66 records added/updated, plus 0 record inactivated |
Patient Flow SimpleRefset | 6 records added/updated, plus 2 record inactivated |
Antimicrobial SimpleRefset | 0 records added/updated, plus 2 record inactivated |
Chronic Disease Management SimpleRefset | 0 records added/inactivated/updated |
eServices SimpleRefset | 0 records added/inactivated/updated |
Gynaecology SimpleRefset | 0 records added/inactivated/updated |
Lymphodema SimpleRefset | 167 records added/updated, plus 1 record inactivated |
Make every contact count SimpleRefset | 0 records added/inactivated/updated |
Safeguarding SimpleRefset | 1 records added/updated, plus 1 record inactivated |
Public Health SimpleRefset | 1 records added/updated, plus 2 record inactivated |
Irish National Early Warning Score SimpleRefset | 0 records added/inactivated/updated |
Coronavirus Reference set Ireland SimpleRefset | 0 records added/inactivated/updated |
Table 3.3 Content Sent from Irish NRC to SNOMED International for promotion
| Concepts sent from Irish NRC to SNOMED International for promotion |
| 33 |
Table 1.3 Content sent from Irish NRC to SNOMED International for authoring
| Concepts sent from Irish NRC to SNOMED International for authoring |
| 141 |
3.3 Inactivated concepts in Irish Edition and their replacements:
Inactive Concepts with their suggested Replacement Concepts Breastcheck Screening Ireland Refset: | |||
| Inactive ConceptID | Inactive Concept FSN | Replacement ConceptID(s) | Replacement FSN(s) |
| 103708000 | Diagnostic surgical procedure | 387713003 | Surgical procedure |
| 12619005 | GX grade | 1228845001 | GX |
| 14537002 | Hodgkin lymphoma | 1163005009 | Hodgkin lymphoma |
| 1929004 | Malignant lymphoma, non-Hodgkin | 1172592001 | Non-Hodgkin lymphoma |
| 31845005 | Retraction of nipple | 271955004 | Retraction of nipple |
| 32280000 | Lymphoid leukemia | 1172709000 | Lymphoid leukemia |
| 373150000 | pNX: Regional lymph nodes cannot be assessed (e.g., previously removed, or not removed for pathologic study) (breast) | 1229945006 | pNX |
| 373151001 | pN0: No regional lymph node metastasis histologically (i.e., none greater than 0.2 mm), no additional examination for isolated tumor cells (breast) | 1229947003 | pN0 |
| 373156006 | pN1: Metastasis in 1 to 3 axillary lymph nodes, and/or in internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent (breast) | 1229951001 | pN1 |
| 373157002 | pN1mi: Micrometastasis (greater than 0.2 mm, none greater than 2.0 mm) (breast) | 1229952008 | pN1mi |
| 373158007 | pN1mi(i+): Micrometastasis detected only by IHC (breast) | 1229952008 | pN1mi |
| 373159004 | pN1a: Metastasis in 1 to 3 axillary lymph nodes (at least one tumor deposit greater than 2.0 mm) (breast) | 1229954009 | pN1a |
| 373160009 | pN1b: Metastasis in internal mammary lymph nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent (breast) | 1229955005 | pN1b |
| 373161008 | pN1c: Metastasis in 1 to 3 axillary lymph nodes and in internal mammary lymph nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent (breast) | 1229956006 | pN1c |
| 373162001 | pN2: Metastasis in 4 to 9 axillary lymph nodes, or in clinically apparent internal mammary lymph nodes in the absence of axillary lymph node metastasis (breast) | 1229957002 | pN2 |
| 373163006 | pN2a: Metastasis in 4 to 9 axillary lymph nodes (at least one tumor deposit greater than 2.0 mm) (breast) | 1229959004 | pN2a |
| 373164000 | pN2b: Metastasis in clinically apparent internal mammary lymph nodes in the absence of axillary lymph node metastasis (breast) | 1229960009 | pN2b |
| 373165004 | pN3a: Metastasis in 10 or more axillary lymph nodes (at least one tumor deposit greater than 2.0 mm), or metastasis to infraclavicular lymph nodes (breast) | 1229963006 | pN3a |
| 373166003 | pN3c: Metastasis in ipsilateral supraclavicular lymph nodes (breast) | 1229965004 | pN3c |
| 373167007 | pN3b: Tumor of breast with metastasis as per AJCC 6th Edition definition (breast) | 1229964000 | pN3b |
| 373169005 | pM0: No distant metastasis (breast) | 1229901006 | cM0 |
| 373170006 | pMX: Distant metastasis cannot be assessed (breast) | 1229901006 | cM0 |
| 373171005 | pM1: Distant metastasis (breast) | 1229916009 | pM1 |
| 373172003 | pT1: Tumor 2 cm or less in greatest dimension (breast) | 1228957006 | pT1 |
| 373173008 | pTX: Primary tumor cannot be assessed (breast) | 1228950008 | pTX |
| 373175001 | pTis: Carcinoma in situ (breast) | 1228953005 | pTis |
| 373176000 | pTis: Ductal carcinoma in situ (breast) | 1228954004 | pTis(DCIS) |
| 373177009 | pTis: Lobular carcinoma in situ (breast) | 1228953005 | pTis |
| 373178004 | pTis: Paget disease without invasive carcinoma (breast) | 1228956002 | pTis(Paget) |
| 373179007 | pT1mic: Microinvasion 0.1 cm or less in greatest dimension (breast) | 1228958001 | pT1mi |
| 373180005 | pT1a: Tumor more than 0.1 cm but not more than 0.5 cm in greatest dimension (breast) | 1228959009 | pT1a |
| 373182002 | pT2: Tumor more than 2 cm but not more than 5 cm in greatest dimension (breast) | 1229852009 | pT2 |
| 373183007 | pT1c: Tumor more than 1 cm but not more than 2 cm in greatest dimension (breast) | 1229846008 | pT1c |
| 373184001 | pT3: Tumor more than 5 cm in greatest dimension (breast) | 1229859000 | pT3 |
| 373185000 | pT4: Tumor of any size with direct extension to chest wall or skin (breast) | 1229864001 | pT4 |
| 373186004 | pT4a: Tumor of any size with extension to chest wall, not including pectoralis muscle (breast) | 1229865000 | pT4a |
| 373187008 | pT4b: Tumor of any size with edema (including peau d'orange) or ulceration of the skin of the breast or satellite skin nodules confined to the same breast | 1229866004 | pT4b |
| 373189006 | pT4c: Tumor of any size with direct extension to chest wall (not including pectoralis muscle) and edema (including peau d'orange) or ulceration of the skin of the breast or satellite skin nodules confined to the same breast | 1229867008 | pT4c |
| 373204007 | pT1b: Tumor more than 0.5 cm but not more than 1 cm in greatest dimension (breast) | 1228962007 | pT1b |
| 406088001 | pN0(i-): No regional lymph node metastasis histologically, negative morphologic findings for isolated tumor cells (breast) | 1229947003 | pN0 |
| 406089009 | pN0(i+): No regional lymph node metastasis histologically, positive morphologic findings for isolated tumor cells, no cluster greater than 0.2 mm (breast) | 1229949000 | pN0(i+) |
| 406090000 | pN0(mol-): No regional lymph node metastasis histologically, negative nonmorphologic (molecular) findings for isolated tumor cells (breast) | 1229947003 | pN0 |
| 406091001 | pN0(mol+): No regional lymph node metastasis histologically, positive nonmorphologic (molecular) findings for isolated tumor cells (breast) | 1229950000 | pN0(mol+) |
| 86049000 | Neoplasm, malignant (primary) | 1240414004 | Malignant neoplasm |
| 91512002 | Diagnostic procedure on breast | 392089008 | Breast procedure |
| 93194002 | Malignant lymphoma of lymph nodes of axilla AND/OR upper limb | 1255906008 | Malignant lymphoma of lymph nodes of upper limb |
| 93523009 | Hodgkin's disease of lymph nodes of axilla AND/OR upper limb | 1255905007 | Hodgkin disease of lymph nodes of upper limb |
Dentistry Ireland Refset:
| 10775006 | Root canal therapy, retreatment of molar, by report | 1231801002 | History of revision of root canal treatment of molar tooth |
| 10775006 | Root canal therapy, retreatment of molar, by report | 1231800001 | Revision of root canal treatment of molar tooth |
| 56289008 | Root canal therapy, retreatment of bicuspid, by report | 1231805006 | History of revision of root canal treatment of premolar tooth |
| 56289008 | Root canal therapy, retreatment of bicuspid, by report | 1231796007 | Revision of root canal treatment of premolar tooth |
| 58814005 | Root canal therapy, retreatment, anterior, by report | 1231799000 | History of revision of root canal treatment of anterior tooth |
| 58814005 | Root canal therapy, retreatment, anterior, by report | 1231798008 | Revision of root canal treatment of anterior tooth |
Adult Safeguarding Refset:
| 160327004 | FH: Drug dependency | 1254977008 | Family history of substance dependency |
| Inactive ConceptID | Inactive Concept FSN | Reason | Replacement ConceptID(s) | Replacement FSN(s) |
| Nursing and Midwifery QCM Refset: | ||||
| 249016007 | Height of uterine fundus | SAME AS association reference set (foundation metadata concept) | 364253002 | Fundal height of uterus |
| 408780005 | Finding of color of amniotic fluid | REPLACED BY association reference set (foundation metadata concept) | 365662002 | Amniotic fluid appearance - finding |
| Lymphoedema Refset: | ||||
| 420226006 | Pressure ulcer | REPLACED BY association reference set (foundation metadata concept) | 1163214006 | Pressure injury |
| Patient Flow Refset: | ||||
| 402863005 | Venous stasis ulcer of leg | POSSIBLY EQUIVALENT TO association reference set (foundation metadata concept) | 1237117000 | Venous ulcer of lower leg |
| 402863005 | Venous stasis ulcer of leg | POSSIBLY EQUIVALENT TO association reference set (foundation metadata concept) | 1237116009 | Venous ulcer of lower limb |
| 86049000 | Neoplasm, malignant (primary) | REPLACED BY association reference set (foundation metadata concept) | 1240414004 | Malignant neoplasm |
| Epilepsy Refset: | ||||
| 37356005 | Myoclonic seizure | POSSIBLY EQUIVALENT TO association reference set (foundation metadata concept) | 127324008 | Myoclonic disorder |
| 37356005 | Myoclonic seizure | POSSIBLY EQUIVALENT TO association reference set (foundation metadata concept) | 1208991001 | Myoclonic epileptic seizure |
| 51887003 | Tonic seizure | POSSIBLY EQUIVALENT TO association reference set (foundation metadata concept) | 192993002 | Tonic epileptic seizure |
| 51887003 | Tonic seizure | POSSIBLY EQUIVALENT TO association reference set (foundation metadata concept) | 1208969008 | Generalized onset tonic epileptic seizure |
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 - Ireland Extension Release, some Known Issues were identified, and agreed to be resolved in the next editing cycle:
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4.2 Resolved Issues
Resolved Issues are those where the resolution has been discussed and agreed, and has been implemented in time for this release.
For the SNOMED CT Managed Service - Ireland Extension Release, the some Issues were Resolved:
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4.3 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 will realize 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 Ireland 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:
- 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 Ireland Extension from the October 2022 Release onwards.
Please note - While the SNOMED CT International Edition is moving to monthly releases, the Ireland Extension of SNOMED CT will remain on the current bi-annual release schedule of April and October for 2023.
4.4 Changes to the Identifier file format
In line with the proposals documented here: https://confluence.ihtsdotools.org/mag/snomed-international-proposal-to-change-the-rf2-identifier-file-specification - the Ireland Extension Release will from now on include the following changes to the format of the Identifier files:
- < identifierSchemeId alternateIdentifier effectiveTime active moduleId referencedComponentId ...to
- > alternateIdentifier effectiveTime active moduleId identifierSchemeId referencedComponentId
These improvements are introduced in the October 2023 Ireland Extension release, and will be used in all future Ireland Extension releases until further notice.
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Approvals
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Draft Amendment History
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