Please see new updates for 2025 here 2025 Early Visibility Release Notifications
This page provides information on planned changes to upcoming SNOMED International Release packages in three sections:
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| Items | Hierarchy/Topic | EARLY VISIBILITY OF PROPOSED CONTENT CHANGES | Planned Release timing (*this is provisional only and is subject to change) | ||||
|---|---|---|---|---|---|---|---|
| 1. | Clinical Finding | 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:
| 2024 International Release | 2. | Procedure | Update Hierarchy 363680008|Radiographic imaging Procedure (procedure)|and Descendants A Briefing Note documenting the proposed changes for the hierarchy 363680008|Radiographic imaging procedure (procedure)| and descendants was shared with the Editorial Advisory Group, Clinical Leads Group, Member Forum, Content Managers Advisory Group, and other key stakeholders in July 2023. Feedback was received from a wide range of stakeholders. In response to this feedback, the proposed changes to the hierarchy have been modified. These modifications will address issues raised in the feedback. This Informational Briefing Note summarizes the changes that will be implemented. Implementation of the content changes will commence in Q4 2023. The updates will be implemented in sub-hierarchies and promoted over a number of international monthly releases until complete. | Ongoing in phases across 2024 International Releases Please see item below - 42687005|Lymphangiogram (procedure)| and subtypes - July 2024 release |
| 2. | Content Improvement | Updates | 3. | Content Improvement | 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. | Q3 2024 Q1 2025 International Release | |
| 43. | Social Context | Inactivation of Race and Ethnicity Concepts Based on discussions with the Member Forum, all subtypes of 372148003 |Ethnic group (ethnic group)| and most subtypes of 415229000 |Racial group (racial group)| will be inactivated as out of scope for the International release. While all subtypes of 372148003 |Ethnic group (ethnic group)| will be inactivated, the top level concept will be retained for extensions to add their local concepts. All subtypes of 415229000 |Racial group (racial group)| will be inactivated except for the following:
A briefing note is available here. | July 2024 International Release | ||||
| 5. | Clinical Finding/Procedure | 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. | On hold - to be determined | ||||
| 6. | Clinical Finding | Inactivation of Mechanical Complication of <x> Device In October 2023 the Editorial Advisory Group made a decision that the concepts that represent a mechanical complication of <x> device are ambiguous. Following this a briefing note was shared with the community of practice to both inform and collect feedback. This feedback has been reviewed and the work will be proceeding. The concepts will be inactivated as ambiguous with a historical association to 473023007 |Complication associated with device (disorder)| or a suitable subtype. | Q3 2024 International Release | ||||
| 7. | Dose Forms | Pharmaceutical Dose Forms with Two or More Intended Sites Pharmaceutical Dose Forms with more than one intended site will use “and” in their descriptions and include all intended sites in the model. By representing combinations of intended sites as a conjunction ('and' in the description) this will facilitate searching by end users. The concepts are logically modeled as conjunction. Existing dose forms with "or" will be updated to "and" in their descriptions, this will be included in the Editorial Guide. 9 clinical drugs using these dose forms will correspondingly have their descriptions updated to 'and'. Note - pharmaceutical dose forms with two or more administration methods: | Q3 2024 International Release | ||||
| 8. | Clinical Finding | Substance Abuse/Use There has been a shift from the term "substance abuse" to a more nuanced understanding of substance use disorders in this domain which is reflected in both ICD-11 and DSM-5 indicating a greater emphasis on the spectrum of substance-related problems. Several members have expressed the need for content updates to incorporate this change and to simplify the translation process. Consequently, efforts to revise the content associated with 66214007 |Substance abuse (disorder)| will begin and is expected to be completed by the end of Q2. An example of the content structure and terming using opioid use is shown. Specifically, descriptions will be added with “harmful pattern of X substance use” replacing the term “abuse” in the FSN and PT however the “abuse” descriptions are persisted as synonyms to facilitate searching. In most cases there is no change in meaning, therefore the concepts will not be inactivated. Approximately 100 existing concepts relating to “abuse” will be affected together with the addition of new concepts to represent “harmful episode” and the higher level “X substance use disorder
| Q3 2024 International Release | ||||
| 9. | Clinical Finding | Inactivation of Complication Disorder Concepts (371 concepts) The inactivation of concepts that reference “complication” without specifying the nature of the complication is planned. The primitive “Complication (disorder)” grouper was inactivated in 2022 due to a lack of consistency or definition of what would properly be assigned as a subtype. The concepts will be inactivated with inactivation reason “Classification derived concept” and replacement by the parent concept. For further information please see this briefing note. | Beginning June 2024 International Release and then subsequent releases until complete | ||||
| 10. | Observable Entity/Procedure | Update Role Grouping for Observable Entity and Evaluation Procedure Concepts Currently, Observable Entity concepts’ attributes are self-grouped in the international edition. Based on recommendation by the Modeling Advisory Group (MAG), the policy has changed to group these attributes together in order to support modeling concepts with multiple observations and address inconsistent modeling between evaluation procedures and observable entities. The same changes will be applied to the concepts in the evaluation procedure hierarchy that are modeled with applicable self-grouped attributes. Please see this briefing note for details. Please note that the scope of this change is limited to implementation of the updated role grouping MRCM rules for the observable entity and evaluation procedure hierarchies. There are areas in these subhierarchies that require content improvements, including but not limited to the following areas: complement assays, autoantibody, concepts that refer to more than one Component (examples: ratios and concepts with “And”), Components including “Free” and “Total," and concepts with fully defined parents. Some of the issues were already known and some were identified during this work. These improvements are not in the scope of this work and will be undertaken in future work including the QI project and improvements in other hierarchies including substance and specimen. Some of the issues require feedback from SMEs and/or communication with the Members. | July 2024 International Release | ||||
| 11. | Procedure | Angioplasty procedures In response to several enquiries from members about the apparent duplication of concepts and descriptions for procedures representing 'Percutaneous transluminal angioplasty' an analysis of the content in this area is underway. It is expected to result in inactivation of duplicates, updates to the descriptions of published concepts and remodeling to represent the imaging guidance aspect where appropriate. After the analysis of the impact has been completed, a Briefing Note will be dispatched to provide details of the changes. Examples of potential duplication:
| Q3 2024 International Release | ||||
| 12. | Procedure | Review 1263452006 |Anesthesia and/or sedation procedure (procedure)| A review of the 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy is in progress, the focus is on:
| Q3 2024 International Release | ||||
| 13. | Procedure | Review 48537004 |Bypass graft (procedure)| A review of the 48537004 |Bypass graft (procedure)| hierarchy is in progress, the focus is on:
| Q3 2024 International Release | ||||
| 14. | Procedure | Review Use of 424876005 |Surgical approach (attribute)| A review to generalize 424876005 |Surgical approach (attribute)| to allow non-surgical procedures to be modeled with a subtype of <<103379005 |Procedural approach (qualifier value)| is in progress.
| Q3 2024 International Release | ||||
| 15. | Procedure | Review 1287742003 |Radiotherapy (procedure)| A review of 1287742003 |Radiotherapy (procedure)| hierarchy is in progress, the focus is on:
| Q3 2024 International Release | ||||
| 16. | Procedure | Review 424226004 |Using device (attribute)| vs. 363699004 |Direct device (attribute)| for Modeling of Repair Procedures 424226004 |Using device (attribute)| and 363699004 |Direct device (attribute)| are used interchangeably for modeling of repair procedures within the Repair group of relationships.
| Q3 2024 International Release | ||||
| 17. | Body Structure | Update for Cardiac Wall and Cardiac Segment A proposed new model for this area of content is available here. Further information is available in this briefing note. | Q3-Q4 2024 International Release | ||||
| 18. | Clinical Finding Procedure Specimen | Update 'Head and Neck' and 'Head and/or Neck' A small number of concepts have been identified with FSN of “head and neck” but modeled with 774007 |Structure of head and/or neck (body structure)|. For some concepts the intention had always been disjunctive “and/or” so to minimise disruption the FSN’s will be changed to reflect this intended meaning with therefore no change in descendants. Procedures such as 430215009 |Biopsy of head and neck structure (procedure)| will be inactivated and replaced with distinct concepts for each body site as a disjunctive in this instance would be a grouper of no clinical significance and non-conformance to editorial policy. This will impact descendants who will become children of the distinct concepts. Examples of concepts to be inactivated and replaced with two distinct concepts:
Examples of concepts with model change to two role groups (finding/disorder can occur in both structures at the same time):
Examples of concepts with FSN change to 'and/or':
| July 2024 International Release | ||||
| 19. | Procedure | Review of <<75506009 |Construction of stoma (procedure)| A review of the 75506009 |Construction of stoma (procedure)| hierarchy is in progress. The focus is on updating concept modeling, but there will be a small number of inactivations (<20 concepts) and description changes, where appropriate. | Q3 2024 International Release | ||||
| 20. | Procedure | Update 42687005|Lymphangiogram (procedure)| and Subtypes 42687005|Lymphangiogram (procedure)| and subtypes have been reviewed as part of the content update being undertaken for: 363680008|Radiographic imaging Procedure (procedure)| and Descendants (please see item 2 above for details). Based on user feedback and review, ‘lymphangiography’ uses fluoroscopy and contrast unless an alternative imaging method such as MRI is specified. The content in this hierarchy that currently states ‘lymphangiography’ or 'lymphangiogram' with method 278110001|Radiographic imaging - action (qualifier value)| will be inactivated and replaced with a new concept which specifies the imaging modality and the use of contrast. For example: 48858003 |Lymphangiography of lower extremity (procedure)| will be inactivated and replaced by a new concept: Fluoroscopic lymphangiography of lower limb with contrast (procedure)| A new supertype concept will be added: 1336147007 |Imaging of lymphatic system (procedure)| | July 2024 International Release | ||||
| 21. | Procedure | Update to 55670007 |Endodontic procedure (procedure)| and Subtypes In consultation with the Dentistry Clinical Reference Group, updates will be made to the hierarchy 55670007 |Endodontic procedure (procedure)|. This will result in approximately 25 concepts being inactivated or remodeled. Where appropriate, replacement concepts will be added. | Q3 2024 International Release | ||||
| 22. | Substance | Update << 385420005 |Contrast media (substance)| The 95 subtypes of 385420005 |Contrast media (substance) will be updated. Concepts will be remodeled based on discussion with stakeholders. New substance concepts including groupers will be required. | Q3-Q4 2024 International Release | ||||
| 23. | Procedure | Proposed New Model for Solid Organ and Tissue Transplant Procedures Feedback is requested for a proposed new model for solid organ and tissue transplant procedures. Please see briefing note here. Deadline to submit feedback is 15 June 2024. | 2024 International Release | ||||
| 24. | Medicinal Product | Therapeutic Role Groupers Please see the follow up briefing note for further information about the inactivation of therapeutic role groupers in the Medicinal Product hierarchy. | 2024 International Release | ||||
| 25. | Body Structure | Update for Lateralizable Body Structures Lateralizable body structures will be modeled by laterality with a value of "side". The changes will be made to over 4000 body structures in the July 2024 release. This will improve the classification of existing concepts. | July 2024 International Release |
2024 Published Content Changes With Confirmed Release Date
| Clinical Finding/Procedure | 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. | On hold - to be determined | |
| 4. | Clinical Finding | Inactivation of Complication Disorder Concepts (371 concepts) The inactivation of concepts that reference “complication” without specifying the nature of the complication is planned. The primitive “Complication (disorder)” grouper was inactivated in 2022 due to a lack of consistency or definition of what would properly be assigned as a subtype. The concepts will be inactivated with inactivation reason “Classification derived concept” and replacement by the parent concept. For further information please see this briefing note. | Beginning June 2024 International Release and then subsequent releases until complete |
| 5. | Procedure | Review 1263452006 |Anesthesia and/or sedation procedure (procedure)| A review of the 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy is in progress, the focus is on:
| Under review - expected completion by Q3 2025 International Release |
| 6. | Procedure | Review 48537004 |Bypass graft (procedure)| A review of the 48537004 |Bypass graft (procedure)| hierarchy is in progress, the focus is on:
| Under review - expected completion by Q2 2025 International Release |
| 7. | Procedure | Review Use of 424876005 |Surgical approach (attribute)| A review to generalize 424876005 |Surgical approach (attribute)| to allow non-surgical procedures to be modeled with a subtype of <<103379005 |Procedural approach (qualifier value)| is in progress.
| Expected completion by Q2 2025 International Release |
| 8. | Procedure | Surgical Transplantation Procedures Procedures in the 77465005 |Transplantation (procedure)| hierarchy remodeled following circulation of the Briefing note are still under review following feedback received and discussion at the Editorial Advisory Group. Note this project excludes procedures on the eye (for Ophthalmology CRG to revise), and hematopoietic cell transplants including bone marrow and stem cell procedures that are not surgical transplantations. The majority of tissue transplant procedure concepts (nerves, muscle, tendon, skin etc), will be inactivated as duplicate to the grafting procedure concept where this exists (and the transplant procedure will be added as a synonym to the grafting procedure), or if an existing concept is not available then a new grafting procedure will be created. Very high level groupers will be inactivated (eg 120158008 |Thorax transplantation (procedure)|). Approximately 100 concepts will be inactivated as part of this update. | Q1 2025 International Release |
| 9. | Descriptions Update | Forward slash in FSN A review has commenced of those concepts with a forward slash in their FSN. Editorial guidance exists disallowing the use of forward slashes in FSNs, and we have commenced a systematic review of those existing terms containing them. Many areas are excluded for example, medicinal products where strength /1 is the denominator, assessment scales, explicit "and/or", gene names, enzyme and other substance naming, organisms, ratios, per in units (or future consideration), intervertebral structures, content added with an Orphanet map and others. The review is ongoing. If the meaning is clear i.e. single meaning there is no change but groupers, disjoint ('or)' terming and ambiguous terms will be reviewed and possibly inactivated or have a new replacement FSN without a forward slash. Subject matter experts are being consulted as part of this work. | Q4 2024 International Release Q1 2025 International Release |
| 10. | Qualifier Value | Update for Existing AJCC (American Joint Committee on Cancer) Allowable Values and New UICC (Union for International Cancer Control) Staging System Content For << 1222584008 |American Joint Committee on Cancer allowable value (qualifier value)| and its 584 subtypes the following changes will be made:
New concepts for the UICC (Union for International Cancer Control) staging system will be added:
| Q1 2025 International Release |
| 11. | Procedure | Review of 129376004 |Construction - action (qualifier value)| 129376004 |Construction - action (qualifier value)| is a subtype of 257903006 |Repair - action (qualifier value) and sibling of 129377008 |Reconstruction - action (qualifier value)|. Because some concepts modeled with 129376004 |Construction - action (qualifier value)| as target value concept for 260686004 |Method (attribute)| may not be considered a reparative procedure, a review of the 129376004 |Construction - action (qualifier value) and 410614008 |Construction (procedure)| hierarchies is being undertaken. Expected outcomes may be the classification of 129376004 |Construction - action (qualifier value)| directly under 129284003 |Surgical action (qualifier value)| and the creation of new actions that better define the differences between reparative and construction procedures. | Content review - publication date to be determined |
| 12. | Disorder | SNOMED CT to Orphanet Map - Attribution of In Scope Content Work has commenced to annotate new concepts added to SNOMED CT with attribution to 'Inserm Orphanet'. As part of this effort, textual definitions for concepts previously added for this project will be updated to align with the current published version of the Orphanet definition. This will result in published text definitions being inactivated and replaced. | Starting Q4 2024 International Releases until complete. |
| 13. | Clinical Finding | Changes to 365921005 | Weight change finding (finding) Hierarchy Following multiple requests from members regarding overlaps and ambiguities in this hierarchy, the Nutrition and Dietetics Clinical Reference Group (CRG) conducted a systematic review. The requests highlighted confusion over similar and overlapping concepts, such as:
The following changes will be implemented:
| January 2025 International Release |
| 14. | Clinical Finding | Genomic Community Content Phenotype concepts that currently exist in the genomics community content area are being gradually promoted to the International edition release. All content is being reviewed and revised based on the current international editorial guidelines and publication will occur incrementally over several releases. | Starting Q4 2024/Q1 2025 International Release |
| 15. | Descriptions Update | Update for Description Concept Non-Current Indicators Concept Non Current (CNC) indicators are a type of inactivation indicator that are applied to active descriptions, when the concept they are attached to is made inactive. They are intended to allow implementers to show some visual cue to alert users that a description they have searched for relates to an inactive concept. A bulk update will be implemented to inactivate CNC indicators where they are no longer required either because:
This will result in a change to approximately 30,000 descriptions for the international edition release for January 2025. | January 2025 International Release |
| 16. | Clinical Finding | Review Model for Descendants of 118240005|Finding by method (finding)| Descendants of 118240005 |Finding by method (finding)| are currently being reviewed to ensure 418775008 |Finding method (attribute)| is appropriately grouped with other attributes. | January 2025 International Release |
2024 Published Content Changes With Confirmed Release Date
| Item | Hierarchy | MOVED FROM PROPOSED CHANGES TO PUBLISHED CHANGES | Confirmed Release Date |
|---|---|---|---|
| 1. | Content Improvement | Urinary Bladder Following feedback from translation, descriptions for concepts that contain the word 'bladder' and the site of 89837001|Urinary bladder structure (body structure)| will be updated to include 'urinary' in the FSN and PT, for example: 126885006|Neoplasm of bladder (disorder) will be updated to 126885006|Neoplasm of urinary bladder (disorder). | January 2024 International Release |
| 2. | Product | International Unit in Descriptions for Clinical Drugs 'International Unit' as a description is arbitrary and to be understood each product requires reference to a particular bioefficacy specification for that entity. Therefore, 'international' is not meaningful or comparable as a description at Clinical Drug level. International unit will be represented as 'unit' in Clinical Drug descriptions and 20 concepts will have their descriptions changed to 'unit' Note: abbreviations will not be used. Editorial Guidance has been drafted. | January 2024 International Release |
| 3. | Procedure | Inactivation of “RAST” and “RAST test” from subtypes of 104380004 |Allergen specific antibody measurement (procedure)| Based on a proposal by the Allergies and Hypersensitivities CRG, descriptions containing “RAST” and “RAST test” will be inactivated from the concepts in this sub-hierarchy as they are not considered real synonyms. Immunoassays for immunoglobulin specific to an allergen of interest are widely used in the diagnosis of allergic disease. These tests are often incorrectly referred to collectively as "radioallergosorbent tests" ("RAST") because they were the earliest immunoassays to be used extensively. There are a few concepts of type "X mix radioallergosorbent test (procedure)", where RAST is in fact part of FSN. These concepts will be inactivated as they are ambiguous because they do not mention what allergens are being tested for. Replacement concepts, where individual allergens are spelled out, will be created where the information is available. | January 2024 International Release |
| 4. | Morphologic Abnormality | Inactivation of Congenital Morphologic Abnormality Concepts 37764001 |Congenital abnormal fusion (morphologic abnormality)| and 67798003 |Congenital premature fusion (morphologic abnormality) will be inactivated and replaced by:
These two new concepts do not specify occurrence which is to be modeled separately. As a result of this change the two new concepts can be used to model fetal disorders. This change aligns with the Editorial Guide. | February 2024 International Release |
| 5. | Clinical Finding | Inactivation of 106109006|Number of previous induced termination of pregnancy (finding)| and Subtypes 106109006|Number of previous induced termination of pregnancy (finding)| and subtypes will be inactivated and replaced by a new concept in the situation with explicit context hierarchy: 1300163008 |Past pregnancy history of multiple induced termination of pregnancy (situation)| This concept is already published. 713649008 |Past pregnancy history of induced termination of pregnancy (situation)| | February 2024 International Release |
| 6. | Procedure | Update 77465005 |Transplantation (procedure) and Descendants Note this project is ongoing. Proposals for the new model will be considered by the Editorial Advisory Group (EAG). 410820007 |Surgical transplantation - action (qualifier value)| and 129407005 |Grafting - action (qualifier value)| will be siblings (not child-parent relationship) and will be subtypes of 129338005 |Surgical implantation - action (qualifier value)|. 129347002 |Surgical transfer - action (qualifier value)| will no longer be a subtype of 410820007 |Surgical transplantation - action (qualifier value)|. 115956009 |Release (procedure)| will be inactivated and its subtypes remodeled to proximal primitive parent modeling and attributes added where necessary. << 422285003 |Solid organ graft - material (substance)| and its subtypes will be updated from 'graft' to 'transplant'. For example, 420291005 |Transplant heart (substance)| The 77465005 |Transplantation (procedure)subtypes will be remodeled with 410820007 |Surgical transplantation - action (qualifier value) where necessary. Also, certain grafting procedures that were subtypes of transplantation procedure will be remodeled with 129407005 |Grafting - action (qualifier value)|. | February 2024 International Release |
| 7. | Clinical Finding Morphologic Abnormality Situation with Explicit Context | Remodel 127575007 |Malignant neuroendocrine neoplasm, epithelial (morphologic abnormality)| and Subtypes 127575007 |Malignant neuroendocrine neoplasm, epithelial (morphologic abnormality)|, its subtypes and related disorder concepts will be revised to align with the 5th edition of the WHO Blue Book chapter on Endocrine and Neuroendocrine Tumours as part of the Histology Quality Improvement Project. Please see the briefing note for more information about these changes. | February 2024 International Release |
| 8. | Procedure | Update for 73632009 |Laparoscopy (procedure)| and Subtypes There will be a bulk update to align 73632009 |Laparoscopy (procedure)| and subtypes with the template here: https://confluence.ihtsdotools.org/display/SCTEMPLATES/Laparoscopy+%28procedure%29+-+Draft These changes include the addition of INCISION ROLE GROUP and INSPECTION ROLE GROUP for all Laparoscopic procedures. | February 2024 International Release |
| 9. | Clinical Finding | Update for Diabetes Insipidus Based on a report from October 2022 from the Working Group for Renaming Diabetes Insipidus, concepts using the term “Diabetes insipidus” will be renamed and/or replaced with terms that more appropriately represent the pathophysiology of this condition. The top-level concept replacing "Diabetes insipidus" will be "Arginine vasopressin-related polyuria" and the specific subtypes will be represented by two renamed conditions:
The legacy descriptions of "Diabetes insipidus", "Central diabetes insipidus" and "Nephrogenic diabetes insipidus" will be retained where appropriate to facilitate retrieval of concepts by their newer names. This affects approximately 18 existing concepts in SNOMED CT. | February 2024 International Release |
| 10. | Procedure | 17423001 |Epiphysiodesis (procedure) - Remodel Subtypes Epiphyseal Stapling Epiphyseal stapling concepts will be moved from being a subtype of 17423001 |Epiphysiodesis (procedure)|. Epiphysiodesis is a fusion of the epiphyseal plate resulting in a permanent arrest of growth, whereas Epiphyseal stapling is a fixation of the epiphyseal plate in order to arrest growth and is often reversible once the staples are removed. | February 2024 International Release |
| 11. | Annotation Reference Set | NOTICE - JUNE 2024 RELEASE - CHANGES TO THE ANNOTATIONS REFSET FORMAT After discussions with the community, SNOMED International has made changes to the coverage of language in the Annotations refsets in the following way:
The addition of content for the Annotations refset will commence in future International Edition releases. | June 2024 International Release |
| 12. | Morphologic Abnormality | Inactivation of Congenital Morphologic Abnormality Concepts 61295008 |Congenital abnormal number (morphologic abnormality)| 125226006|Congenital malposition, left (morphologic abnormality)| 125225005|Congenital malposition, right (morphologic abnormality)| 56457002|Congenital atresia (morphologic abnormality)| 41086002 |Congenital smallness (morphologic abnormality)| 81850003 |Congenital sequestration (morphologic abnormality)| These concepts will be inactivated and replaced by a concept that does not specify congenital. Concepts that are modeled with these morphologic abnormality concepts will be remodeled using the replacement concept. This change aligns with the Editorial Guide. | March 2024 International Release |
| 13. | Annotation | OWL Axiom Expressions for Annotation Properties The new annotation properties should be represented in the OWL expression axiom refset as follows:
They should therefore be changed to:
However, the authoring tool will then need to be updated to ensure all new subconcepts of 1295447006 |Annotation attribute (attribute)| will be represented as SubAnnotationPropertyOf() in the future. Numerous other tools will also need to be updated first in order to correctly consume the new format. There are numerous systems that require updating, and that this will therefore need to be carefully tested and rolled out over the next few months. As the potential impact was analysed and deemed to be low, the Annotations deployment will still go ahead as planned in the January 2024 International Edition release, whereas these axiom updates will be published in subsequent releases. Please, therefore, be aware that this issue will persist for the first few International Edition releases of 2024. | Axiom updates published March 2024 International Release Remaining updates to be published in 2024. Please see section above '2024 Proposed Content Changes' for further updates on the remaining content/tooling changes required to complete this item. |
| 14. | Body Structure | 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)|. | April 2024 International Release |
| 15. | Body Structure | Inactivation of Concepts Specified Male/Female in Descriptions 67770001 |Male mammary gland structure (body structure)| and 91532001 |Female mammary gland structure (body structure)| and subtypes plus associated disorder and specimen concepts will be inactivated. Further information is available here (Confluence log in required). NOTE: this update will include the inactivation of neoplasm concepts that specify male/female, this includes <<126927001|Neoplasm of female breast (disorder)| <<126937006|Neoplasm of male breast (disorder)| These concepts will be replaced with a concept that does not specify male/female, a new concept will be added where one does not already exist. | April 2024 International Release |
| 16. | Procedure | Update Hierarchy 363680008|Radiographic imaging Procedure (procedure)|and Descendants A Briefing Note documenting the proposed changes for the hierarchy 363680008|Radiographic imaging procedure (procedure)| and descendants was shared with the Editorial Advisory Group, Clinical Leads Group, Member Forum, Content Managers Advisory Group, and other key stakeholders in July 2023. Feedback was received from a wide range of stakeholders. In response to this feedback, the proposed changes to the hierarchy have been modified. These modifications will address issues raised in the feedback. This Informational Briefing Note summarizes the changes that will be implemented. Implementation of the content changes will commence in Q4 2023. The updates will be implemented in sub-hierarchies and promoted over a number of international monthly releases until complete. | April 2024 release:
Remaining changes across 2024 International Releases |
| 17. | Qualifier Value | Change Parent for 410460000|Illumination - action (qualifier value)| and Subtypes 410460000|Illumination - action (qualifier value)| and descendants will be updated to be a subtype of 272394005|Technique (qualifier value)|. The concepts will not be inactivated. Descriptions that currently include '- action’ will be inactivated and replaced. Concepts that are currently modeled with method 410460000|Illumination - action (qualifier value)| will be remodeled with a method of 360037004|Imaging - action (qualifier value)|. These changes will complete this Content Tracker. | April 2024 International Release |
| 18. | Procedure | Inactivation of 118661008|Physician service (procedure)| and Descendants 118661008|Physician service (procedure)| and subtypes will be inactivated and replaced with concepts that are a subtype of 224891009|Healthcare services (qualifier value)| where appropriate. These changes will complete this Content Tracker. | April 2024 International Release |
| 19. | Qualifier Value | Addition of New Technique Qualifier Value Concepts Around 80 new laboratory technique concepts will be added in the 272394005 |Technique (qualifier value)| subhierarchy. | March and April 2024 International Releases |
| 20. | Procedure | 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. For 1st May 2024 release: The immediate subtypes of <277132007 |Therapeutic procedure (procedure)|, excluding <<416608005 |Drug therapy (procedure)|, will be reviewed for appropriate presence or absence of the Has intent (attribute) according to the Editorial Guide for the 1 May release. A potential concept model for 416608005 |Drug therapy (procedure)| and for 276239002 |Therapy (regime/therapy)| requires further consultation. 277132007 |Therapeutic procedure (procedure)| will remain active until this work has been undertaken please watch the Content Tracker for future development. | May 2024 International Release |
| 21. | MRCM | Changes to MRCM There are planned changes to MRCM for the attribute in group cardinality to four attributes:
These changes are being made to support the implementation of role group changes to observables and evaluation procedures. The domain "administration via specific route (procedure)" will be removed and the attribute "route of administration" will be optional for the domain of procedure. | May 2024 International Release |
| 22. | Clinical Finding | Inactivation of 248536006 |Finding of functional performance and activity (finding) This concept will be inactivated: 248536006 |Finding of functional performance and activity (finding). The concept is an intermediate primitive grouper for 2000+ concepts and this inactivation will improve subsumption for content in the hierarchy. | May 2024 International Release |
| 23. | Procedure | Inactivation of 410770002 |Administration of anesthesia for procedure (procedure)| and Subtypes A Briefing note was presented to Anesthesia CRG with a proposal for review and remodeling of 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy. As part of that proposal, inactivation of 410770002 |Administration of anesthesia for procedure (procedure)| hierarchy was agreed. This inactivation will affect 410770002 |Administration of anesthesia for procedure (procedure)|and subtypes, and 10745231000119102 |Cardiac arrest due to administration of anesthesia for obstetric procedure in pregnancy (disorder)|. Concepts in 410770002 |Administration of anesthesia for procedure (procedure)|hierarchy will be inactivated with Inactivation reason = Outdated component and Replaced by 399097000 |Administration of anesthesia (procedure)|. For 10745231000119102 |Cardiac arrest due to administration of anesthesia for obstetric procedure in pregnancy (disorder)|FSN will be changed to 10745231000119102 |Cardiac arrest due to administration of anesthesia in pregnancy (disorder)| and value for 42752001 |Due to (attribute)| will be changed to 399097000 |Administration of anesthesia (procedure)|. | June 2024 International Release |
| 24. | Substance | Antibody to X Organism The descriptions for the children of 312301006 |Infective organism antibody (substance)| (antibody to X or X antibody) will be updated as per editorial guidelines where applicable. | June 2024 International Release |
| 25. | Procedure | Update 71651007|Mammography (procedure)| and Descendants As part of the content update being undertaken for: 363680008|Radiographic imaging Procedure (procedure)| and Descendants (please see item 2 above for details). Content changes will be undertaken for 71651007|Mammography (procedure)| and subtypes. A new concept will be added as the supertype - Imaging of breast (procedure). New imaging actions will be added:
These new actions will distinguish mammography from the less specific action 278110001 |Radiographic imaging - action (qualifier value)|. 71651007|Mammography (procedure)| and subtypes will be modeled with the new imaging action Mammographic imaging - action (qualifier value). NOTE: this change will result in some of the current subtypes of 71651007|Mammography (procedure)| moving up the hierarchy to become subtypes of Imaging of breast (procedure). For example, 709657006|Fluoroscopy of breast (procedure)| will become a subtype of Imaging of breast (procedure) and not 71651007|Mammography (procedure)|. 450566007|Digital tomosynthesis of breast (procedure)| will be sufficiently defined by the new imaging action Mammographic digital tomosynthesis - action (qualifier value) and remain a subtype of 71651007|Mammography (procedure)|. | June 2024 International Release |
| 26. | Morphologic Abnormality | Update << 1187137001|Squamous intraepithelial neoplasia (morphologic abnormality)| The << 1187137001|Squamous intraepithelial neoplasia (morphologic abnormality)| subhierarchy will be updated to properly represent the two common grading systems used globally. For further information please see this briefing note. | June 2024 International Release |
| 27. | Social Context | Inactivation of 60134006 |Life style (life style)| and subtypes 60134006 |Life style (life style)| and subtypes will be inactivated as these concept refer to findings about behaviors that an individual has engaged in and not lifestyle. 134436002|Lifestyle (finding)| will also be inactivated. | June 2024 International Release |
| 28. | Annotation | OWL Axiom Expressions for Annotation Properties The new annotation properties are represented in the OWL expression axiom refset as follows:
These axiom updates are published in the March 2024 International Edition release. The authoring tool has been updated to ensure all new subconcepts of 1295447006 |Annotation attribute (attribute)| are represented as SubAnnotationPropertyOf(). Other tools will be updated to correctly consume the updated syntax. This will be carefully tested and rolled out over the next few months. | June 2024 International Release |
| 29. | Clinical Finding | 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:
| Changes complete July 2024 International Release |
| 30. | Social Context | Inactivation of Race and Ethnicity Concepts Based on discussions with the Member Forum, all subtypes of 372148003 |Ethnic group (ethnic group)| and most subtypes of 415229000 |Racial group (racial group)| will be inactivated as out of scope for the International release. While all subtypes of 372148003 |Ethnic group (ethnic group)| will be inactivated, the top level concept will be retained for extensions to add their local concepts. All subtypes of 415229000 |Racial group (racial group)| will be inactivated except for the following:
A briefing note is available here. | July 2024 International Release |
| 31. | Observable Entity/Procedure | Update Role Grouping for Observable Entity and Evaluation Procedure Concepts Currently, Observable Entity concepts’ attributes are self-grouped in the international edition. Based on recommendation by the Modeling Advisory Group (MAG), the policy has changed to group these attributes together in order to support modeling concepts with multiple observations and address inconsistent modeling between evaluation procedures and observable entities. The same changes will be applied to the concepts in the evaluation procedure hierarchy that are modeled with applicable self-grouped attributes. Please see this briefing note for details. Please note that the scope of this change is limited to implementation of the updated role grouping MRCM rules for the observable entity and evaluation procedure hierarchies. There are areas in these subhierarchies that require content improvements , including but not limited to the following areas: complement assays, autoantibody measurements, concepts that refer to more than one Component (examples: ratios and concepts with “And”), Components including “Free” and “Total," concepts with fully defined parents, and procedure concepts modeled with a combination of evaluation procedure attributes and general procedure attributes. Some of the issues were already known and some were identified during this work. These improvements are not in the scope of this work and will be undertaken in future work including the QI project and improvements in other hierarchies including substance and specimen. Some of the issues require feedback from SMEs and/or communication with the Members. If required, editorial guidelines will be updated accordingly. | July 2024 International Release |
| 32. | Body Structure | Update for Cardiac Wall and Cardiac Segment A proposed new model for this area of content is available here. Further information is available in this briefing note. | July 2024 International Release |
| 33. | Clinical Finding Procedure Specimen | Update 'Head and Neck' and 'Head and/or Neck' A small number of concepts have been identified with FSN of “head and neck” but modeled with 774007 |Structure of head and/or neck (body structure)|. For some concepts the intention had always been disjunctive “and/or” so to minimise disruption the FSN’s will be changed to reflect this intended meaning with therefore no change in descendants. Procedures such as 430215009 |Biopsy of head and neck structure (procedure)| will be inactivated and replaced with distinct concepts for each body site as a disjunctive in this instance would be a grouper of no clinical significance and non-conformance to editorial policy. This will impact descendants who will become children of the distinct concepts. Examples of concepts to be inactivated and replaced with two distinct concepts:
Examples of concepts with model change to two role groups (finding/disorder can occur in both structures at the same time):
Examples of concepts with FSN change to 'and/or':
| July 2024 International Release |
| 34. | Procedure | Review of <<75506009 |Construction of stoma (procedure)| A review of the 75506009 |Construction of stoma (procedure)| hierarchy is in progress. The focus is on updating concept modeling, but there will be a small number of inactivations (<20 concepts) and description changes, where appropriate. | July 2024 International Release |
| 35. | Procedure | Update 42687005|Lymphangiogram (procedure)| and Subtypes 42687005|Lymphangiogram (procedure)| and subtypes have been reviewed as part of the content update being undertaken for: 363680008|Radiographic imaging Procedure (procedure)| and Descendants (please see item 2 above for details). Based on user feedback and review, ‘lymphangiography’ uses fluoroscopy and contrast unless an alternative imaging method such as MRI is specified. The content in this hierarchy that currently states ‘lymphangiography’ or 'lymphangiogram' with method 278110001|Radiographic imaging - action (qualifier value)| will be inactivated and replaced with a new concept which specifies the imaging modality and the use of contrast. For example: 48858003 |Lymphangiography of lower extremity (procedure)| will be inactivated and replaced by a new concept: Fluoroscopic lymphangiography of lower limb with contrast (procedure)| A new supertype concept will be added: 1336147007 |Imaging of lymphatic system (procedure)| | July 2024 International Release |
| 36. | Procedure | Update to 55670007 |Endodontic procedure (procedure)| and Subtypes In consultation with the Dentistry Clinical Reference Group, updates will be made to the hierarchy 55670007 |Endodontic procedure (procedure)|. This will result in approximately 25 concepts being inactivated or remodeled. Where appropriate, replacement concepts will be added. | July 2024 International Release |
| 37. | Clinical Finding | Inactivation of Mechanical Complication of <x> Device In October 2023 the Editorial Advisory Group made a decision that the concepts that represent a mechanical complication of <x> device are ambiguous. Following this a briefing note was shared with the community of practice to both inform and collect feedback. This feedback has been reviewed and the work will be proceeding. The concepts will be inactivated as ambiguous with a historical association to 473023007 |Complication associated with device (disorder)| or a suitable subtype. | August 2024 International Release |
| 38. | Dose Forms | Pharmaceutical Dose Forms with Two or More Intended Sites Pharmaceutical Dose Forms with more than one intended site will use “and” in their descriptions and include all intended sites in the model. By representing combinations of intended sites as a conjunction ('and' in the description) this will facilitate searching by end users. The concepts are logically modeled as conjunction. Existing dose forms with "or" will be updated to "and" in their descriptions, this will be included in the Editorial Guide. 9 clinical drugs using these dose forms will correspondingly have their descriptions updated to 'and'. Note - pharmaceutical dose forms with two or more administration methods: | August 2024 International Release |
| 39. | Medicinal Product | Grouping Concepts for Therapeutic Roles in the Medicinal Product Hierarchy Please see this Briefing Note for further information about the inactivation of grouping concepts for therapeutic roles in the Medicinal Product hierarchy. As part of the project all previous subtypes 763087004 |Medicinal product categorized by therapeutic role (product)| will have the 'plays role' additional axiom removed but the 766939001 |Plays role (attribute)| and 766941000 |Therapeutic role (role)| will remain in SNOMED CT. Vaccines are excluded from this work. Older stated product subtypes of 763087004 |Medicinal product categorized by therapeutic role (product)| (for example, 26580005 |Digestant (product)|) are to also be inactivated most often with an inactivation target of the corresponding grouping concept for roles in the substance hierarchy (70 concepts approx.). All grouping concepts for therapeutic roles will remain in the substance hierarchy with a caveat added to Editorial guidance regarding known issues. | August 2024 International Release |
| 40. | Body Structure | Update for Lateralizable Body Structures Lateralizable body structures will be modeled by laterality with a value of "side". The changes will be made to over 4000 body structures in the July 2024 release. This will improve the classification of existing concepts. The lateralizable reference set will also be updated. | August 2024 International Release |
| 41. | Procedure | Update for 278854009 |Insertion of hormone implant (procedure)| and Descendants As part of a quality review of the 782901001 |Insertion procedure (procedure)| hierarchy, 10 procedure concepts referring to hormone implants were found to be modeled with 257867005 |Insertion - action (qualifier value)|. The descriptions also incorrectly referred to insertion of X hormone implant rather than implantation. These concepts will be remodeled with 129336009 |Implantation - action (qualifier value)|, with updated descriptions to reflect implantation. The previous insertion descriptions will be inactivated. | August 2024 International Release |
| 42. | Clinical Finding | Update for 1295265008 |Diffuse tenosynovial giant cell tumor (disorder)| and Descendants Many of the subtypes of << 1295265008 |Diffuse tenosynovial giant cell tumor (disorder)| use the terms 'villonodular synovitis' and 'pigmented villonodular synovitis' in descriptions, including the FSN and PT. The concept FSNs will be updated to Diffuse tenosynovial giant cell tumor of <x> (disorder) with a PT Diffuse tenosynovial giant cell tumor of <x> and synonym Pigmented villonodular synovitis of <x>. Descriptions using Villonodular synovitis of <x> will be inactivated as they are outdated. The finding site values of these concepts will be reviewed and updated as required. | September 2024 International Release |
| 43. | Clinical Finding | Inactivation of General body state and General clinical state finding Inactivation is planned for the following two high-level concepts due to vagueness:
These changes are scheduled for the September 2024 release. | September 2024 International Release |
| 44. | Procedure | Remodeling 50465008 |Hernia repair (procedure)| Hierarchy 50465008 |Hernia repair (procedure)| and subtypes will be reviewed and remodeled for alignment of usage of the 363699004 |Direct device (attribute)| and 424226004 |Using device (attribute)| attributes to current Editorial Guidance. 424226004 |Using device (attribute)| will be used with the 260686004 |Method (attribute)| = << 257903006 |Repair - action (qualifier value)|, because it “refers to the instrument or equipment utilized to execute an action,” and “the device is actually used to carry out the action, that is the focus of the procedure.” New concepts will be created for modeling of repair concepts related to hernia disorders with specific characteristics such as “recurrent hernia”, “congenital hernia”, “strangulated hernia”, for example:
For the modeling of these types of repair of hernia disorders with specific characteristics, the 363702006 |Has focus (attribute)| will be added to sufficiently define the concepts. | September 2024 International Release |
| 45. | Procedure | Gender Confirmation Surgery Concepts The Sex and Gender group advised that the inclusion of the term 'gender confirmation' in descriptions was not required, rather the generic procedure is what should be described. This aligns with editorial policy on not including the reason for the procedure. Concepts including this term, together with the concept 870629001 |Excision of bilateral breasts for female to male transsexual (procedure)| will be inactivated and replaced with generic procedure and history concepts. | September 2024 International Release |
| 46. | Clinical Finding | Update Descriptions for 1231824009|Non-alcoholic fatty liver disease (disorder)| and Subtypes The descriptions for concepts in this hierarchy will be updated to reflect recent changes for the classification of steatotic liver disease. The changes will be made to FSN and preferred term with the existing descriptions retained as a synonym:
| September 2024 International Release |
| 47. | Procedure | Review 424226004 |Using device (attribute)| vs. 363699004 |Direct device (attribute)| for Modeling of Repair Procedures 424226004 |Using device (attribute)| and 363699004 |Direct device (attribute)| are used interchangeably for modeling of repair procedures within the Repair group of relationships.
| September 2024 International Release |
| 48. | Clinical Finding | Substance Abuse/Use There has been a shift from the term "substance abuse" to a more nuanced understanding of substance use disorders in this domain which is reflected in both ICD-11 and DSM-5 indicating a greater emphasis on the spectrum of substance-related problems. Several members have expressed the need for content updates to incorporate this change and to simplify the translation process. Consequently, efforts to revise the content associated with 66214007 |Substance abuse (disorder)| will begin and is expected to be completed by the end of Q2. An example of the content structure and terming using opioid use is shown. Specifically, descriptions will be added with “harmful pattern of X substance use” replacing the term “abuse” in the FSN and PT however the “abuse” descriptions are persisted as synonyms to facilitate searching. In most cases there is no change in meaning, therefore the concepts will not be inactivated. Approximately 100 existing concepts relating to “abuse” will be affected together with the addition of new concepts to represent “harmful episode” and the higher level “X substance use disorder
| October 2024 International Release |
| 49. | Clinical Finding/Observable Entity | Inactivation of 302081005|Finding of sex of baby (finding)| and Subtypes 302081005|Finding of sex of baby (finding)| and subtypes will be inactivated, 'baby' may mean fetus, neonate, infant. | October 2024 International Release |
| 50. | Procedure | Remodel 241686001|Dual energy X-ray absorptiometry (procedure)| and Subtypes As part of the ongoing work to update hierarchy 363680008|Radiographic imaging Procedure (procedure)| and descendants (see item 1 above), 241686001|Dual energy X-ray absorptiometry (procedure)| and descendants will be remodeled along with associated finding and situation concepts. A new imaging action will be added - Dual energy X-ray absorptiometry imaging - action (qualifier value)| The following concepts will be inactivated:
The editorial guide will be updated. | October 2024 International Release |
| 51. | Descriptions Update | Inactivation of Descriptions with Asterisk Eight concepts containing an asterisk instead of a superscript to represent "power of," e.g. 277288007 |10*9/liter (qualifier value)|, will be inactivated with reason ambiguous. New replacement concepts will be created, e.g. 1348323004 |10^9/liter (qualifier value)|. The concepts scheduled for inactivation and replacement are all subtypes of 282409001 |Nominated concentrations (qualifier value)|). Editorial guidance is available here. | October 2024 International Release. |
| 52. | Procedure | Review 1287742003 |Radiotherapy (procedure)| A review of 1287742003 |Radiotherapy (procedure)| hierarchy is in progress, the focus is on:
| October 2024 International Release |
| 53. | Substance | Update << 385420005 |Contrast media (substance)| and Modality Specific Contrast Procedures The 95 subtypes of 385420005 |Contrast media (substance) will be updated. New substance concepts including groupers will be required, with the following groupers being added:
| November 2024 International Release |
| 54. | Person | Concept Inactivation 255409004 |Pregnant woman (person)| will be inactivated with reason Nonconformance to editorial policy and replaced by 77386006 |Pregnancy (finding)|. | November 2024 International Release. |
| 55. | Procedure | Revision of 363243005|Nonsurgical manipulation procedure (procedure) 363243005|Nonsurgical manipulation procedure (procedure)| hierarchy will be revised to add missing subtypes. | November 2024 International Release. |
| 56. | Procedure | Angioplasty procedures In response to several enquiries from members about the apparent duplication of concepts and descriptions for procedures representing 'Percutaneous transluminal angioplasty' an analysis of the content in this area is underway. It is expected to result in inactivation of duplicates, updates to the descriptions of published concepts and remodeling to represent the imaging guidance aspect where appropriate. After the analysis of the impact has been completed, a Briefing Note will be dispatched to provide details of the changes. Examples of potential duplication:
| December 2024 International Release |
| 57. | Disorder | Update for Gout, Hyperuricemia and Crystal-associated Arthropathies A recent consensus document on terminology for gout, hyperuricemia and crystal-associated arthropathies (https://pubmed.ncbi.nlm.nih.gov/31501138/) has been used to inform the remodeling of gout in SNOMED CT. The prime definitional characteristic of gout is the deposition of monosodium urate crystals in tissues, with or without the presence of elevated levels of blood urate. As elevated blood urates are no longer considered definitional, gout and its subtypes will no longer be subtypes of 269859006 |Blood urate above reference range (finding)|. Gouty arthritis concepts have been re-termed in accordance with the consensus document and will be classified as subtypes of Crystal arthropathy. | December 2024 International Release |
| 58. | Clinical Finding | Update of "Sample" to "Specimen" in FSN and PT of Clinical Finding Concepts 64 findings concepts which include "sample" in their FSN and/or PT will be updated to include "specimen" in place of "sample" in the FSN and/or PT. Descriptions will be inactivated and replaced; no concepts will be inactivated. This follows similar work previously performed in the specimen hierarchy and noted in the Editorial Guide | December 2024 International Release |
| 59. | Procedure | Review 28367004|Cholangiography (procedure)| and Descendants As part of the work being undertaken for IHTSDO-161, 28367004|Cholangiography (procedure)| and descendants will be reviewed. Where a procedure concept is modeled with method 278110001|Radiographic imaging - action (qualifier value)| but is performed using a subtype of that modality such as 312275004|Fluoroscopic imaging - action (qualifier value)|, the concept will be inactivated and replaced with a new concept that specifies the imaging modality and the use of contrast. | December 2024 International Release |
| 60. | Organism | Resolving Name Divergence for Subtypes of 398428002 |Salmonella enterica subsp. diarizonae (organism)| One of the synonyms for many descendants of this concept is incorrect, e.g. "398387008 | Salmonella IIIb 61:c:z35 (organism) |" belongs to Salmonella IIIb i.e. "Salmonella enteric subs. diarizonae" but has "Salmonella III arizonae 61:c:z35" as a synonym. A batch update will be performed to:
| December 2024 International Release |
| 61. | Clinical Finding | Update Descriptions 169826009|Single live birth (finding)| After consultation with the Content Managers Advisory Group, the descriptions for 169826009|Single live birth (finding)| will be updated to 169826009 |Single live birth from singleton pregnancy (finding)| A new concept will also be added 1351929005 |Single live birth from multiple pregnancy (finding)| | December 2024 International Release |
| 62. | Disorder, Event, Physical Object | Update Concepts Relating to Missile Missile as a generalized projectile and missile with the narrower meaning of a specific type of weapon have been conflated in the disorders, events and physical object hierarchy.
| December |
| Item | Hierarchy | MOVED FROM PROPOSED CHANGES TO PUBLISHED CHANGES | Confirmed Release Date |
| 1. | Content Improvement | Urinary Bladder Following feedback from translation, descriptions for concepts that contain the word 'bladder' and the site of 89837001|Urinary bladder structure (body structure)| will be updated to include 'urinary' in the FSN and PT, for example: 126885006|Neoplasm of bladder (disorder) will be updated to 126885006|Neoplasm of urinary bladder (disorder). | January 2024 International Release |
| 2. | Product | International Unit in Descriptions for Clinical Drugs 'International Unit' as a description is arbitrary and to be understood each product requires reference to a particular bioefficacy specification for that entity. Therefore, 'international' is not meaningful or comparable as a description at Clinical Drug level. International unit will be represented as 'unit' in Clinical Drug descriptions and 20 concepts will have their descriptions changed to 'unit' Note: abbreviations will not be used. Editorial Guidance has been drafted. | January 2024 International Release |
| 3. | Procedure | Inactivation of “RAST” and “RAST test” from subtypes of 104380004 |Allergen specific antibody measurement (procedure)| Based on a proposal by the Allergies and Hypersensitivities CRG, descriptions containing “RAST” and “RAST test” will be inactivated from the concepts in this sub-hierarchy as they are not considered real synonyms. Immunoassays for immunoglobulin specific to an allergen of interest are widely used in the diagnosis of allergic disease. These tests are often incorrectly referred to collectively as "radioallergosorbent tests" ("RAST") because they were the earliest immunoassays to be used extensively. There are a few concepts of type "X mix radioallergosorbent test (procedure)", where RAST is in fact part of FSN. These concepts will be inactivated as they are ambiguous because they do not mention what allergens are being tested for. Replacement concepts, where individual allergens are spelled out, will be created where the information is available. | January 2024 International Release |
| 4. | Morphologic Abnormality | Inactivation of Congenital Morphologic Abnormality Concepts 37764001 |Congenital abnormal fusion (morphologic abnormality)| and 67798003 |Congenital premature fusion (morphologic abnormality) will be inactivated and replaced by:
These two new concepts do not specify occurrence which is to be modeled separately. As a result of this change the two new concepts can be used to model fetal disorders. This change aligns with the Editorial Guide. | February 2024 International Release |
| 5. | Clinical Finding | Inactivation of 106109006|Number of previous induced termination of pregnancy (finding)| and Subtypes 106109006|Number of previous induced termination of pregnancy (finding)| and subtypes will be inactivated and replaced by a new concept in the situation with explicit context hierarchy: 1300163008 |Past pregnancy history of multiple induced termination of pregnancy (situation)| This concept is already published. 713649008 |Past pregnancy history of induced termination of pregnancy (situation)| | February 2024 International Release |
| 6. | Procedure | Update 77465005 |Transplantation (procedure) and Descendants Note this project is ongoing. Proposals for the new model will be considered by the Editorial Advisory Group (EAG). 410820007 |Surgical transplantation - action (qualifier value)| and 129407005 |Grafting - action (qualifier value)| will be siblings (not child-parent relationship) and will be subtypes of 129338005 |Surgical implantation - action (qualifier value)|. 129347002 |Surgical transfer - action (qualifier value)| will no longer be a subtype of 410820007 |Surgical transplantation - action (qualifier value)|. 115956009 |Release (procedure)| will be inactivated and its subtypes remodeled to proximal primitive parent modeling and attributes added where necessary. << 422285003 |Solid organ graft - material (substance)| and its subtypes will be updated from 'graft' to 'transplant'. For example, 420291005 |Transplant heart (substance)| The 77465005 |Transplantation (procedure)subtypes will be remodeled with 410820007 |Surgical transplantation - action (qualifier value) where necessary. Also, certain grafting procedures that were subtypes of transplantation procedure will be remodeled with 129407005 |Grafting - action (qualifier value)|. | February 2024 International Release |
| 7. | Clinical Finding Morphologic Abnormality Situation with Explicit Context | Remodel 127575007 |Malignant neuroendocrine neoplasm, epithelial (morphologic abnormality)| and Subtypes 127575007 |Malignant neuroendocrine neoplasm, epithelial (morphologic abnormality)|, its subtypes and related disorder concepts will be revised to align with the 5th edition of the WHO Blue Book chapter on Endocrine and Neuroendocrine Tumours as part of the Histology Quality Improvement Project. Please see the briefing note for more information about these changes. | February 2024 International Release |
| 8. | Procedure | Update for 73632009 |Laparoscopy (procedure)| and Subtypes There will be a bulk update to align 73632009 |Laparoscopy (procedure)| and subtypes with the template here: https://confluence.ihtsdotools.org/display/SCTEMPLATES/Laparoscopy+%28procedure%29+-+Draft These changes include the addition of INCISION ROLE GROUP and INSPECTION ROLE GROUP for all Laparoscopic procedures. | February 2024 International Release |
| 9. | Clinical Finding | Update for Diabetes Insipidus Based on a report from October 2022 from the Working Group for Renaming Diabetes Insipidus, concepts using the term “Diabetes insipidus” will be renamed and/or replaced with terms that more appropriately represent the pathophysiology of this condition. The top-level concept replacing "Diabetes insipidus" will be "Arginine vasopressin-related polyuria" and the specific subtypes will be represented by two renamed conditions:
The legacy descriptions of "Diabetes insipidus", "Central diabetes insipidus" and "Nephrogenic diabetes insipidus" will be retained where appropriate to facilitate retrieval of concepts by their newer names. This affects approximately 18 existing concepts in SNOMED CT. | February 2024 International Release |
| 10. | Procedure | 17423001 |Epiphysiodesis (procedure) - Remodel Subtypes Epiphyseal Stapling Epiphyseal stapling concepts will be moved from being a subtype of 17423001 |Epiphysiodesis (procedure)|. Epiphysiodesis is a fusion of the epiphyseal plate resulting in a permanent arrest of growth, whereas Epiphyseal stapling is a fixation of the epiphyseal plate in order to arrest growth and is often reversible once the staples are removed. | February 2024 International Release |
| 11. | Annotation Reference Set | NOTICE PROPOSED CHANGE(s) TO THE COVERAGE OF LANGUAGE IN ANNOTATIONS REFSET After discussions with the community, SNOMED International is proposing to change the coverage of language in the Annotations refsets in the following way: The langueCode field was specified as the two characters of ISO-639-1 code for the language of the annotation text. The change is to include 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 "languageCode" will be changed to "languageDialectCode" in the field column. A new metadata c "Language dialect", a subconcept of "Language Code", will be used for the metadata of this column in the descriptor refset. Please provide any feedback to info@snomed.org by Friday 26th January 2024 at the absolute latest, as lack of response will be taken as acceptance, and the changes will proceed as planned. | March 2024 International Release |
| 12. | Morphologic Abnormality | Inactivation of Congenital Morphologic Abnormality Concepts 61295008 |Congenital abnormal number (morphologic abnormality)| 125226006|Congenital malposition, left (morphologic abnormality)| 125225005|Congenital malposition, right (morphologic abnormality)| 56457002|Congenital atresia (morphologic abnormality)| 41086002 |Congenital smallness (morphologic abnormality)| 81850003 |Congenital sequestration (morphologic abnormality)| These concepts will be inactivated and replaced by a concept that does not specify congenital. Concepts that are modeled with these morphologic abnormality concepts will be remodeled using the replacement concept. This change aligns with the Editorial Guide. | March 2024 International Release |
| 13. | Annotation | OWL Axiom Expressions for Annotation Properties The new annotation properties should be represented in the OWL expression axiom refset as follows:
They should therefore be changed to:
However, the authoring tool will then need to be updated to ensure all new subconcepts of 1295447006 |Annotation attribute (attribute)| will be represented as SubAnnotationPropertyOf() in the future. Numerous other tools will also need to be updated first in order to correctly consume the new format. There are numerous systems that require updating, and that this will therefore need to be carefully tested and rolled out over the next few months. As the potential impact was analysed and deemed to be low, the Annotations deployment will still go ahead as planned in the January 2024 International Edition release, whereas these axiom updates will be published in subsequent releases. Please, therefore, be aware that this issue will persist for the first few International Edition releases of 2024. | Axiom updates published March 2024 International Release Remaining updates to be published in 2024. Please see section above '2024 Proposed Content Changes' for further updates on the remaining content/tooling changes required to complete this item. |
| 14. | Body Structure | 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)|. | April 2024 International Release |
| 15. | Body Structure | Inactivation of Concepts Specified Male/Female in Descriptions 67770001 |Male mammary gland structure (body structure)| and 91532001 |Female mammary gland structure (body structure)| and subtypes plus associated disorder and specimen concepts will be inactivated. Further information is available here (Confluence log in required). NOTE: this update will include the inactivation of neoplasm concepts that specify male/female, this includes <<126927001|Neoplasm of female breast (disorder)| <<126937006|Neoplasm of male breast (disorder)| These concepts will be replaced with a concept that does not specify male/female, a new concept will be added where one does not already exist. | April 2024 International Release |
| 16. | Procedure | Update Hierarchy 363680008|Radiographic imaging Procedure (procedure)|and Descendants A Briefing Note documenting the proposed changes for the hierarchy 363680008|Radiographic imaging procedure (procedure)| and descendants was shared with the Editorial Advisory Group, Clinical Leads Group, Member Forum, Content Managers Advisory Group, and other key stakeholders in July 2023. Feedback was received from a wide range of stakeholders. In response to this feedback, the proposed changes to the hierarchy have been modified. These modifications will address issues raised in the feedback. This Informational Briefing Note summarizes the changes that will be implemented. Implementation of the content changes will commence in Q4 2023. The updates will be implemented in sub-hierarchies and promoted over a number of international monthly releases until complete. | April 2024 release:
Remaining changes across 2024 International Releases |
| 17. | Qualifier Value | Change Parent for 410460000|Illumination - action (qualifier value)| and Subtypes 410460000|Illumination - action (qualifier value)| and descendants will be updated to be a subtype of 272394005|Technique (qualifier value)|. The concepts will not be inactivated. Descriptions that currently include '- action’ will be inactivated and replaced. Concepts that are currently modeled with method 410460000|Illumination - action (qualifier value)| will be remodeled with a method of 360037004|Imaging - action (qualifier value)|. These changes will complete this Content Tracker. | April 2024 International Release |
| 18. | Procedure | Inactivation of 118661008|Physician service (procedure)| and Descendants 118661008|Physician service (procedure)| and subtypes will be inactivated and replaced with concepts that are a subtype of 224891009|Healthcare services (qualifier value)| where appropriate. These changes will complete this Content Tracker. | April 2024 International Release |
| 19. | Qualifier Value | Addition of New Technique Qualifier Value Concepts Around 80 new laboratory technique concepts will be added in the 272394005 |Technique (qualifier value)| subhierarchy. | March and April 2024 International Releases |
| 20. | Procedure | 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. For 1st May 2024 release: The immediate subtypes of <277132007 |Therapeutic procedure (procedure)|, excluding <<416608005 |Drug therapy (procedure)|, will be reviewed for appropriate presence or absence of the Has intent (attribute) according to the Editorial Guide for the 1 May release. A potential concept model for 416608005 |Drug therapy (procedure)| and for 276239002 |Therapy (regime/therapy)| requires further consultation. 277132007 |Therapeutic procedure (procedure)| will remain active until this work has been undertaken please watch the Content Tracker for future development. | May 2024 International Release |
| 21. | MRCM | Changes to MRCM There are planned changes to MRCM for the attribute in group cardinality to four attributes:
These changes are being made to support the implementation of role group changes to observables and evaluation procedures. The domain "administration via specific route (procedure)" will be removed and the attribute "route of administration" will be optional for the domain of procedure. | May 2024 International Release |
| 22. | Clinical Finding | Inactivation of 248536006 |Finding of functional performance and activity (finding) This concept will be inactivated: 248536006 |Finding of functional performance and activity (finding). The concept is an intermediate primitive grouper for 2000+ concepts and this inactivation will improve subsumption for content in the hierarchy. | May 2024 International Release |
| 23. | Procedure | Inactivation of 410770002 |Administration of anesthesia for procedure (procedure)| and Subtypes A Briefing note was presented to Anesthesia CRG with a proposal for review and remodeling of 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy. As part of that proposal, inactivation of 410770002 |Administration of anesthesia for procedure (procedure)| hierarchy was agreed. This inactivation will affect 410770002 |Administration of anesthesia for procedure (procedure)|and subtypes, and 10745231000119102 |Cardiac arrest due to administration of anesthesia for obstetric procedure in pregnancy (disorder)|. Concepts in 410770002 |Administration of anesthesia for procedure (procedure)|hierarchy will be inactivated with Inactivation reason = Outdated component and Replaced by 399097000 |Administration of anesthesia (procedure)|. For 10745231000119102 |Cardiac arrest due to administration of anesthesia for obstetric procedure in pregnancy (disorder)|FSN will be changed to 10745231000119102 |Cardiac arrest due to administration of anesthesia in pregnancy (disorder)| and value for 42752001 |Due to (attribute)| will be changed to 399097000 |Administration of anesthesia (procedure)|. | June 2024 International Release | 24. | Antibody to X Organism The descriptions for the children of 312301006 |Infective organism antibody (substance)| (antibody to X or X antibody) will be updated as per editorial guidelines where applicable. | June 2024 International Release |
| 25. | Procedure | Update 71651007|Mammography (procedure)| and Descendants As part of the content update being undertaken for: 363680008|Radiographic imaging Procedure (procedure)| and Descendants (please see item 2 above for details). Content changes will be undertaken for 71651007|Mammography (procedure)| and subtypes. A new concept will be added as the supertype - Imaging of breast (procedure). New imaging actions will be added:
These new actions will distinguish mammography from the less specific action 278110001 |Radiographic imaging - action (qualifier value)|. 71651007|Mammography (procedure)| and subtypes will be modeled with the new imaging action Mammographic imaging - action (qualifier value). NOTE: this change will result in some of the current subtypes of 71651007|Mammography (procedure)| moving up the hierarchy to become subtypes of Imaging of breast (procedure). For example, 709657006|Fluoroscopy of breast (procedure)| will become a subtype of Imaging of breast (procedure) and not 71651007|Mammography (procedure)|. 450566007|Digital tomosynthesis of breast (procedure)| will be sufficiently defined by the new imaging action Mammographic digital tomosynthesis - action (qualifier value) and remain a subtype of 71651007|Mammography (procedure)|. | June 2024 International Release |
| 26. | Morphologic Abnormality | Update << 1187137001|Squamous intraepithelial neoplasia (morphologic abnormality)| The << 1187137001|Squamous intraepithelial neoplasia (morphologic abnormality)| subhierarchy will be updated to properly represent the two common grading systems used globally. For further information please see this briefing note. | June 2024 International Release |
| 27. | Social Context | Inactivation of 60134006 |Life style (life style)| and subtypes 60134006 |Life style (life style)| and subtypes will be inactivated as these concept refer to findings about behaviors that an individual has engaged in and not lifestyle. 134436002|Lifestyle (finding)| will also be inactivated. | June 2024 International Release |
| 28. | Annotation | OWL Axiom Expressions for Annotation Properties The new annotation properties are represented in the OWL expression axiom refset as follows:
These axiom updates are published in the March 2024 International Edition release. The authoring tool has been updated to ensure all new subconcepts of 1295447006 |Annotation attribute (attribute)| are represented as SubAnnotationPropertyOf(). Other tools will be updated to correctly consume the updated syntax. This will be carefully tested and rolled out over the next few months. | June 2024 International Release |
Project Information and Work in Progress
Item | Hierarchy/Topic | INFORMATION ABOUT PROJECTS AND WORK IN PROGRESS | Planned Release timing (*this is provisional only and is subject to change) |
|---|---|---|---|
| 1. | General Information | 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 Content Request Service (CRS) For information please see here | |
| 2. | Project Information | 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 | 2024 International Release and future releases |
| 3. | Project Information | 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. | 2024 International Release and future releases |
| 4. | Content Improvement | 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 | 2024 International Release and future releases |
| 5. | Procedure/Observable Entity | Evaluation Procedure vs Observable Entity Member feedback and subsequent discussion on the 2023 briefing note containing a proposed solution to resolve the duplication between the evaluation procedure and observable entity hierarchies has resulted in reconsideration of the resolution. Actions as described in the briefing note will not be instituted. Instead, the existing evaluation procedure hierarchy will be retained to support existing use cases. No new content will be added in the international release in the evaluation procedure hierarchy for content that logically belongs in the observable entity hierarchy. If new content is needed in the evaluation procedure hierarchy to satisfy existing use cases, it can be created in national extensions. |