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Change to Effective Time for International Edition Starting 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)| has been extended in the October 2023 release 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 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. 

There is one area where work is still in progress:  

• Clinical finding caused by radiation.

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. 

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.

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.

The Senior Management Team (SMT) recently agreed on a proposed solution to resolve the duplication between the evaluation procedure and observable entity hierarchies. The resolution includes moving the majority of the evaluation procedures to the observable entity hierarchy while retaining the original concept id during the move.

The semantic tag will be updated from evaluation procedure to observable entity, and updates in terming and modeling to align with the observable entity model are expected. This move will allow for concepts of multiple granularities to be classified in a single hierarchy.

Non-defining annotations for “order only,” “observation only,” or “both order and observation” may be added to the concepts to assist with certain use cases. Note that some content areas of evaluation procedures such as panels and procedure methods will not be addressed at this time.

A projected timeline of changes will be developed and shared with the community. Editorial and implementation guidance will be provided with this project. Please see the briefing note for further information.

To be determined

Inactivation of 277132007|Therapeutic procedure (procedure)

The concept 277132007 |Therapeutic procedure (procedure) will be inactivated with the inactivation reason of Outdated and a replacement association target of 71388002 |Procedure (procedure)|. The nearly 2000 descendants will be reviewed as to the appropriateness of either the Has intent (attribute) of Therapeutic intent, or a Method (attribute) of Therapy - action.

For further information please see briefing note.

Remodeling of Subtypes of 128422009 |Destruction using electrical energy (procedure)|

Procedures using electrical energy classified as Diathermy (procedure) and Electro X (procedure) will be remodeled and reclassified according to the main action performed and the expected result of such action.

424244007 |Using energy (attribute)|= 18213006 |Electricity (physical force)| will be added with and updates to the descriptions.

Further information about these change is available here.

Inactivation of Procedure Concepts with AND/OR in FSN.

Classification derived concepts under 71388002 |Procedure (procedure)|using AND/OR in FSN will be inactivated in alignment with Editorial Guidance. As needed, new concepts will be created to substitute inactivated concepts without ambiguity.

Subtypes of 1263452006 |Anesthesia and/or sedation procedure (procedure)| and 108290001 |Radiation oncology AND/OR radiotherapy (procedure)| will be inactivated or modified only if needed to align with other inactivations.

Surgical Drainage - Arthrotomy and Arthroscopy Remodeling

Drainage through Arthrotomy and Arthroscopy procedure concepts currently modeled with 2 role groups with 260686004 |Method (attribute)|= 129287005 |Incision - action (qualifier value)| and  260686004 |Method (attribute)|= 129289008 |Drainage - action (qualifier value)| will be remodeled using 1 role group with 260686004 |Method (attribute)|= 1284859006 |Surgical drainage - action (qualifier value)|.

Normalization of attributes used for Procedure site direct/indirect, Indirect/direct morphology and Direct/indirect substance will be performed. This change is the first step to remodel all Surgical drainage concepts to align.

Remodeling of Non-Surgical Drainage Procedures

Normalization of attributes used for Procedure site direct/indirect, Indirect/direct morphology and Direct/indirect substance will be performed for concepts modeled with 260686004 |Method (attribute)|= 129289008 |Drainage - action (qualifier value)|.

Alignment and normalization is needed for subsequent remodeling of Surgical drainage procedures.

Update Model and Descriptions for Fetal, Neonatal and Perinatal Jaundice Disorder Concepts

A review of content in this area has been undertaken.

The semantic tag for concepts representing “Jaundice due to X” and “Jaundice caused by Y” will be updated from (disorder) to (finding); their modeling and descriptions will be updated accordingly.

Concepts of type “Jaundice due to and co-occurrent with Z” will retain “is_a” relationship to “Z (disorder)”; their semantic tag will be retained as “disorder”.

The "Occurrence" attribute value for perinatal jaundice findings will be updated to 1156671008 |Maternal perinatal period (qualifier value)|. This change is required to reflect the fact that these findings are related to the mother, who has the jaundice, rather than the fetus. 

Inactivation of 168123008 |Sample sent for examination (situation)| and Descendants

168123008 |Sample sent for examination (situation)| and its ~90 descendant concepts will be inactivated as out of scope of the international release of SNOMED CT.