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.

Background

This document provides a summarized description of the content changes included in the November 2024 release of the SNOMED Clinical Terms^® Managed Service Sweden Extension package.

It will also include technical notes detailing 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 not yet been implemented.

This Sweden Extension package is dependent upon, and should therefore be consumed in conjunction with the SNOMED CT® August 2024 International Edition release.

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.

Content Development Activity 

Summary

Content from the SNOMED CT® August 2024 International Edition release has been translated and additional concepts and synonyms have been added for use in Sweden. Some areas for which new concepts and synonyms have been added are:

• Collaboration and Harmonization
  • Work with National Collaboration Groups (NAG för användning av Snomed CT and Nationella kvalitetsregister) has been ongoing to develop Swedish content and improve the quality of Swedish translations 
    • Work with the healthcare regions to develop content in the Swedish extension has been ongoing to develop new content and improved translations. For more information about "NAG för användning av Snomed CT", see:  https://kunskapsstyrningvard.se/kunskapsstyrningvard/programomradenochsamverkansgrupper/nationellasamverkansgrupper/nsgstruktureradvardinformation/snomedct.56158.html
    • Work with content: Body structures hierarchy.
  • Work with pathology content.
  • Work with professional societies (Dietisternas Riksförbund, Svensk sjuksköterskeförening) has been done to improve the quality of the Swedish translations in these areas
    •  30 new translations to complete translation of the 166 new members in 1303957004 |Nutrition Care Process Terminology reference set|,
    • 189 new translations to complete translation of 2120 members in 1157358007 |International Classification for Nursing Practice reference set|.
  • Work with national and local stakeholders to update content in various reference sets. 

• Quality Assurance

  • Work has been done to reduce duplicate terms, update modeling of content, and address other quality issues in the Swedish translation.  For more detailed information visit https://www.socialstyrelsen.se/kunskapsstod-och-regler/omraden/e-halsa/snomed-ct/ and see our "Principbeslut" attached to "Språkliga riktlinjer för översättningen av SNOMED CT till svenska". 
  • Work has been done to improve Swedish content in the areas listed below:
    • International Patient Summary refset has updated translations under disorder hierarchy, for example content involving neoplasm, digital nerve and ocular hypertension.
    • Ultrasound content has updated translations.
    • Physical examination content has updated translations.
    • Due to and following content has updated translations.
    • Metastatic malignant neoplasm content has updated translations.
    • Health literacy content has updated translations.
    • Rheumatoid nodule content has updated translations.
    • Colic flexure content has updated translations.

Concept statistics

New and Updated Content

New concepts: 15

Table 1 New concepts by hierarchy

Descriptions statistics

• New descriptions: 7695 
• Inactivated descriptions: 1896
• Reactivated descriptions: 7
• New translations: 4458

Some concepts have not been translated into Swedish. The reasons for non-translation varies and can include; concepts that are not relevant in a Swedish context or concepts where the name in Swedish and English are equivalent (e.g. the Latin names of organisms).

Reference sets

No new reference sets has been added.

Updated simple reference sets:

• 500221000057105 |Care service reference set|
• 500061000057107 |Microorganism result reference set|
• 62171000052105 |Medical device used for administration reference set, Swedish national medication list|
• 59841000052105 |Implants, alert information reference set|
• 59821000052101 |Medical conditions, alert information reference set|

Updated language reference sets:

• 63461000052102 |Context-specific terms language type reference set, Swedish national medication list|
• 63451000052100 |Common-language expression language type reference set, Swedish national medication list|
• 83461000052100 |ICNP Swedish language type reference set|
• 113491000052101 |Care service context language type reference set|

Simple reference sets with all members removed:

• 68581000052104 |Occupation reference set|    
• 68591000052102 |Non-licensed occupations reference set|
• 68661000052109 |Medical residency simple type reference set|
• 67051000052103 |Nursing specializations simple type reference set|
• 67071000052109 |Dentistry specializations simple type reference set|
• 67081000052106 |Medical specializations simple type reference set|
• 67031000052107 |Licensed occupations simple type reference set|
• 59771000052109 |Administrative gender reference set|

If any reference sets with all members removed are in use please send a message to ehalsa@socialstyrelsen.se. They are marked for deprecation, with plans of inactivation May 2025.

Technical notes

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 this cycle of the SNOMED CT Managed Service - Sweden Extension, the following Known Issues were identified, and agreed to be resolved in the next editing cycle:

Technical notes

Deprecated Refsets

No refset has been depricated from November release 2024. 

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.

Notice of changes to the SE Extension Release package

Annotations format changes

In line with the refined implementation of Annotations, we are updating all Extensions in order to align them with the updated version of the refsets in the International Edition Release package (which were first published in June 2024).

The languageCode field was specified as the two characters of ISO-639-1 code for the language of the annotation text. The change includes support for specifying dialect when it is applicable by adhering to RFC 5646, which allows the combination of two characters of ISO 639-1 code and two uppercase letters of country code (ISO 3166) separated by a hyphen.  The changes apply to both the Member Annotations String Value Reference Set + Component Annotation String Value reference set:

• • The column "languageCode" has therefore been changed to "languageDialectCode".

    • Component Annotations (1292992004)
      • OLD:    id    effectiveTime    active    moduleId    refsetId    referencedComponentId    languageCode    typeId    value
      • NEW:   id    effectiveTime    active    moduleId    refsetId    referencedComponentId    languageDialectCode    typeId    value
    • Member Annotations (1292995002)
      • OLD:   id    effectiveTime    active    moduleId    refsetId    referencedComponentId    referencedMemberId    languageCode    typeId    value
      • NEW:  id    effectiveTime    active    moduleId    refsetId    referencedComponentId    referencedMemberId    languageDialectCode    typeId    value

Refset File Naming conventions

The new naming conventions for additional reference sets files have now been applied to the SE Extension release package, from the November 2024 SE Managed Service Release onwards.  The new convention updates the file names to use RefsetID prefixes instead of the old human readable format, in order to improve maintainability and allow for machine reading of the file names.  However, this convention will ONLY be applied to additional refsets, and not core refsets such as Language refset, Association refset, MRCM refset files, etc. (as these were considered to incur too high an impact on end users if the naming conventions were to be changed)

So, for example, in the November 2024 SE Managed Service Release the additional refset file names have changed from:

• der2_Refset_urvalPreciseringAvAdministreringsställeNationellaLäkemedelslistanSimpleRefsetDelta_SE1000052_20241130.txt   →    der2_Refset_62191000052109SimpleRefsetDelta_SE1000052_20241130.txt
• der2_Refset_urvalFörekomstAvTransplantatUppmärksamhetsinformationSimpleRefsetDelta_SE1000052_20241130.txt                →    der2_Refset_113471000052100SimpleRefsetDelta_SE1000052_20241130.txt
• ...etc.

Please contact the Swedish National Release Center via ehalsa@socialstyrelsen.se for any further details, or if you need assistance with these improvements.