| Please see here for 2024 Early Visibility Release Notifications |
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This page provides information
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on planned changes to upcoming SNOMED International Release packages
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For additional Relevant links with regards to Content Development Information please click here Content Development Information
in three sections:
- EARLY VISIBILITY OF PROPOSED CONTENT CHANGES (with provisional release date)
- EARLY VISIBILITY OF PUBLISHED CHANGES (with confirmed release date)
- INFORMATION ABOUT PROJECTS AND WORK IN PROGRESS
Please submit any feedback relating to the items below to info@snomed.org
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Proposed Content Changes
Planned Release timing
| Items | Hierarchy/Topic | EARLY VISIBILITY OF PROPOSED CONTENT CHANGES | Planned Release timing |
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(*this is provisional only and is subject to change) |
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COVID-19 Content
Content relating to COVID-19 can be viewed here SNOMED CT COVID-19 Related Content
2022 International Release and future releases
Browse Content Changes for the International Release
The daily build is available to review changes made to content for the International release https://dailybuild.ihtsdotools.org/
Forthcoming concept inactivations, new concepts and changes to existing concepts can be reviewed using the tab 'Daily build.'
MRCM changes that have been implemented into the production environment and will be published in the next monthly release cycle (subject to completion of final release validation processes) can be viewed here https://dailybuild.ihtsdotools.org/mrcm/?branch=MAIN
Changes to Concept Inactivation Values
Please see new editorial guidance for changes to inactivation values here
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
2022 International Release and future releases
MRCM Changes for July 2022 Release
Details for forthcoming changes can be seen here
July 2022 International Release
MRCM Cardinality Changes for July 2022 Release
All historical content issues where two or more finding sites were included in a single role group have been resolved in the International release as part of the QI project.
There are two MRCM rules for finding site to accommodate the historical content. One MRCM is applicable to all content, it allows more than one finding site in a role group. The other MRCM is only applicable for 'All new precoordinated SNOMED CT content'.
The existing MRCM rules will be updated to only allow at most one finding site in a role group from the July 2022 release.
This early visibility notice is intended to provide additional time for content updates in national extensions.
MRCM Change for September 2022 Release
Extend the range 370135005 |Pathological process (attribute)| to include < < 1495041000004108 |Proliferation of neoplasm (qualifier value)|
Quality Initiative
Information about the project can found here
Note: There are changes to the Service Level Agreement for the CRS as a result of the Quality Initiative:
https://www.snomed.org/SNOMED/media/SNOMED/documents/Changes-to-SLA_202005_MHA.pdf
Measurement Findings
Numerous changes to the measurement findings content are planned for several releases. The first set of changes will involve the reference range content:
1) Concepts which include 'high,' 'elevated,' 'raised,' 'low,' 'decreased,' normal,' etc. in the FSN will have their FSN updated to 'above reference range,' 'below reference range,' or 'within reference range.'
2) Concepts which include 'abnormal' in the FSN will have their FSN updated to include 'outside reference range.' The modeling of these concepts will include 394844007 |Outside reference range (qualifier value)| as the value for Has interpretation (attribute).
3) Concepts representing a finding about a therapeutic range will be updated to include 'above therapeutic range,' 'below therapeutic range,' or 'within reference range' in the FSN. The Has interpretation (attribute) value of these concepts is 281303003 |Above therapeutic range (qualifier value)|, 281306006 |Below therapeutic range (qualifier value)| or 281304009 |Within therapeutic range (qualifier value)| accordingly.
4) Concepts which include "borderline" in the FSN are being inactivated as ambiguous.
See the briefing note "20221103 BN Reference range measurement findings.pdf" (https://confluence.ihtsdotools.org/x/5OB4C) for more information.
These changes are planned for the December 2022 release.
Additional changes to measurement findings concepts will occur over several releases. Upcoming changes for each future release will be posted here as the work progresses.
Planned Changes to Findings/Disorders of Gravid Uterus
The scope of changes to findings/disorders (over 100 concepts) modelled by the gravid uterus.
These concepts can be identified by the ECL << 404684003 |Clinical finding (finding)| : * = (9258009 |Gravid uterus structure (body structure)| or 362253003 |Entire gravid uterus (body structure)|)
These concepts will be remodeled by using finding site of |Uterine structure| and occurrence in |Maternal pregnancy period (qualifier value)| or more specific |Maternal antepartum period|. The updated model pattern will address the missing subsumptions of conditions modeled by parts of the uterus during pregnancy.
Update Hierarchy 17322007 |Disease caused by parasite (disorder)|
370135005 |Pathological process (attribute)| with value 442614005 |Parasitic process (qualifier value) will be added where it is missing to descendants of 17322007 |Disease caused by parasite (disorder)| and any relevant clinical findings concepts.
Update Hierarchy 90708001 |Kidney disease (disorder)|
As part of the Quality Initiative Project, work has commenced on 90708001 |Kidney disease (disorder)|. Work is being undertaken in stages and upcoming sub-hierarchies will be posted here as the work progresses:
- 236514003 |Toxic nephropathy (disorder)| - Complete for November 2022 release
- 236423003 |Renal impairment (disorder)| - In progress
Update for 363101005 |Drug withdrawal (disorder)|
Review of the modeling and terming of 363101005 |Drug withdrawal (disorder)| and child concepts to reflect the associated meaning.
See the briefing note submitted to the Member Forum for details.
Description Update for 191816009 |Drug dependence (disorder)| and Associated Concepts
The terming for concepts including "drug dependence" will be updated to reflect "substance dependence": the word “drug” in the existing terms is ambiguous and does not have a universal definition or a consistent international representation; it can refer to illicit drugs and/or prescription medications. Additionally, dependence can occur with the use of substances such as ethanol, which are not considered an illicit drug or a prescription medication.
Poisoning Caused by Organism
As part of the Quality Initiative project, the modelling for concepts of type poisoning caused by organism, including the following sub-hierarchies, will be reviewed and updated where applicable:
- 275390005 |Toxic effect of plant (disorder)|
- 44400004 |Toxic effect of venom (disorder)|
- 75258004 |Food poisoning (disorder)|
- 26033009 |Toxic effect of mycotoxin (disorder)|
- 1149327007 |Poisoning caused by Clostridium botulinum toxin (disorder)|
Update for Inactive Concepts Without Semantic Tag
Remaining cases of the legacy issue inactive concepts with active FSN without a semantic tag (Content Tracker IHTSDO-645) will be addressed to assign a semantic tag. The number of inactive concepts requiring this update is 351.
Review of Clinical Finding Hierarchy Epilepsy Content
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.
Work is being undertaken in stages. Initial and current focus is on epileptic seizure finding content.
Inactivation of "X of person (person)" concepts
Based on a consensus decision by the SNOMED International Editorial Advisory Group, concepts of the form "X of subject (person)" will be inactivated and concepts using these as the value for SUBJECT RELATIONSHIP CONTEXT relationships will be replaced by analogous "X (person)" concepts.
Legal/Illegal Abortion Concept Inactivation
As approved by the SNOMED Editorial Advisory Group, concepts referring to "legal" and "illegal" termination of pregnancy (abortion) will be inactivated from the international release with reason non-conformance to editorial policy and replaced by concepts agnostic as to the legality of the procedure.
Inactivation of 116223007|Complication (disorder)|
After consultation with the SNOMED Editorial Advisory Group, the ambiguous primitive concept 116223007 |Complication (disorder)| has been inactivated. Subtypes of this concept continue to classify under their other existing inferred parents except for a few high level grouper concepts that now classify directly under 64572001 |Disease (disorder)|.
Inactivation and Replacement of 76981001|Discogram (procedure)| and Subtypes
76981001|Discogram (procedure)| and subtypes will be inactivated and replaced with concepts that explicitly state the use of contrast and injection into the intervertebral disc.
The replacement concepts will follow the pattern 'Discography with injection of contrast into intervertebral disc'.
Inactivation of Concepts that state Delivered/Not delivered
Obstetric content that conflates the delivery status with the disorder of the mother that prompted the admission to hospital will be inactivated.
There are 250 concepts that state the delivery status of the mother within the FSN:
- 198905007 |Placenta previa with hemorrhage - delivered (disorder)|
- 198906008 |Placenta previa with hemorrhage - not delivered (disorder)|
These concepts are classification derived and are used to record whether the baby was, or was not delivered during that inpatient stay for the care of the mother who has placenta previa with a hemorrhage.
Inactivation of Walker Concepts
Concepts 705404007 |Walker/Walking frame (physical object)| and 705406009 |Walker (physical object)| will be inactivated with reason ambiguous, as the term 'walker' is being used to represent both walking frames and wheeled walkers (rollators).
A new concept Wheeled walker (physical object)| will be created with a text definition added to both that concept and also 266731002 |Walking frame (physical object)|.
Concepts that were previously subtypes of 705406009 |Walker (physical object)| will be inactivated with an inactivation replacement value to a new explicit wheeled version of those concepts and where applicable a pre-existing subtype of 266731002 |Walking frame (physical object)| in addition.
Inactivation of 108290001 |Radiation oncology AND/OR radiotherapy (procedure)
108290001 |Radiation oncology AND/OR radiotherapy (procedure)| will be inactivated and replaced via the reactivation of 61757002 |Radiation therapy (procedure)|. 61757002 |Radiation therapy (procedure)| will gain a synonym of radiotherapy. Related concepts will undergo structural quality improvement.
Primary and Metastatic Project
Following the development of proposals by an internal working group and consultation with community stakeholders the primary and metastatic project is commencing work, and will be ongoing for the second half of 2022 with updates on progress provided in both Early Visibility and Release Notes.
Primary and Metastatic Project - Inactivation of Neoplastic Morphologies Stated as 'Primary' in the FSN
86049000 |Malignant neoplasm, primary (morphologic abnormality)| is to be inactivated and replaced with a new concept 1240414004 |Malignant neoplasm (morphologic abnormality)|. Similarly, neoplastic morphologies with 'primary' in their FSN will be inactivated.
Concepts scheduled for inactivation are:
367651003 |Malignant neoplasm of primary, secondary, or uncertain origin (morphologic abnormality)|
1187469002 |Squamous cell carcinoma of primary, secondary, or uncertain origin (morphologic abnormality)|
86049000 |Malignant neoplasm, primary (morphologic abnormality)|
450594004 |Primary malignant adenomatous neoplasm (morphologic abnormality)|
252988009 |Malignant squamous tumor, primary (morphologic abnormality)|
400156001 |Malignant blood vessel neoplasm, primary (morphologic abnormality)|
719952009 |Primary sarcoma (morphologic abnormality)|
734095001 |Primary solid type intraosseous squamous cell carcinoma (morphologic abnormality)|
733913003 |Primary intraosseous squamous cell carcinoma derived from keratocystic odontogenic neoplasm (morphologic abnormality)|
278411006 |Primary intra-osseous carcinoma (morphologic abnormality)|
733912008 |Primary intraosseous squamous cell carcinoma derived from odontogenic cyst (morphologic abnormality)|
720346009 |Primary seminoma (morphologic abnormality)|
133850008 |Primary synovial chondromatosis (morphologic abnormality)|
These inactivations will impact around 2,400 concepts in the disorder hierarchy, and approximately 1200 observable entity concepts (2,000 disorders will be impacted following inactivation of 86049000 |Malignant neoplasm, primary (morphologic abnormality)|) and all concepts will be restructured as outlined in the circulated Briefing Notes.
The reason for inactivation is Nonconformance to Editorial Policy, and the replacement inactivation target for 86049000 |Malignant neoplasm, primary (morphologic abnormality)| and 367651003 |Malignant neoplasm of primary, secondary, or uncertain origin (morphologic abnormality)| will be new concept 1240414004 |Malignant neoplasm (morphologic abnormality)|.
There may be some inconsistencies as this large project develops, including certain adenocarcinoma disorders that are modeled with 1186968006 |Malignant adenomatous neoplasm (morphologic abnormality)| in order to ensure that there is no change to the hierarchical subsumption and the assignment of subtypes by the classifier. As the project develops, and in particular the pathology group give their expert input to update the neoplastic morphologies in SNOMED CT, these inconsistencies will be addressed.
Descendants of 363346000 |Malignant neoplastic disease (disorder)| that include a disjunctive "and/or" in the FSN will be inactivated.
- 15 concepts containing " extranodal AND/OR solid organ site" e.g., Malignant lymphoma of extranodal AND/OR solid organ site (disorder) will be inactivated with a historical association target to the parent concept (or the relevant concept without 'extranodal AND/OR solid organ site'). The origin of these concepts has been traced to ICD-9 grouper codes.
- 14 malignant neoplastic concepts containing 'head, face AND/OR neck' Example: 93533001 |Hodgkin's granuloma of lymph nodes of head, face AND/OR neck (disorder)| will be inactivated and 3 new replacement concepts created for the 3 sites of head, neck and head and neck. Also, the inactivation of 1 benign concept: 109920008 |Benign neoplasm of peripheral nerve of head, face AND/OR neck (disorder)| and creation of 3 new replacements.
- 15 concepts containing 'lymph nodes of axilla AND/OR upper limb' e.g., 93185008 |Malignant histiocytosis of lymph nodes of axilla AND/OR upper limb (disorder)| will be inactivated and new replacement concepts created for 'lymph nodes of upper limb'. Where these concepts had primitive subtypes for ' lymph nodes of axilla and upper limb' (11 concepts) these concepts will also be inactivated.
- 12 malignant neoplastic concepts containing 'lymph nodes of inguinal region AND/OR lower limb' Example: 93516008 |Hodgkin's disease, nodular sclerosis of lymph nodes of inguinal region AND/OR lower limb (disorder)| will be inactivated and new replacement concepts created for 'lymph nodes of lower limb'. This work includes inactivation of their primitive subtypes for 'lymph nodes of inguinal region and lower limb' (12 concepts). Also, inactivation of 188044004 |Malignant melanoma of scalp and/or neck (disorder)| and 3 new replacements created.
Primary and Metastatic Project - Addition of 415 New Primary Malignancy Disorder Subtypes
"Agnostic” malignancy disorders (i.e. not specified as primary or metastatic) that can not be correctly modeled using the current “agnostic” morphologic abnormalities that are subtypes of 86049000 |Malignant neoplasm, primary (morphologic abnormality)|, precisely because they are subtypes of a primary malignant neoplasm morphology parent will be made subtypes of a non-primary parent following the inactivations flagged above.
The majority of the changes will be by inactivation of 86049000 |Malignant neoplasm, primary (morphologic abnormality)| and replacement with Malignant neoplasm (morphologic abnormality) with 'primary' being defined in disorders and observable entities by 370135005 |Pathological process (attribute)| (704321009|Characterizes (attribute)| for observable entities) and target value 1234914003 |Malignant proliferation of primary neoplasm (qualifier value)|.
Approximately 415 current agnostic malignancy disorders inferring a primary designation through their hierarchy parent, will have a new primary malignancy concept added as a subtype that will be available for use in implementations as a subtype of 372087000 |Primary malignant neoplasm (disorder)|.
Primary and Metastatic Project - New Metastatic Morphologic Abnormality Concepts
Metastatic disorders will be defined by their specific metastatic neoplastic morphologic abnormality concepts, and new metastatic morphologies are being added to the international edition of SNOMED CT as needed. In cooperation with the Netherlands extension of SNOMED CT, SNOMED International will be promoting certain of their existing metastatic morphology concepts to the International release to be used to model new metastatic disorder concepts.
Primary and Metastatic Project - Inactivation of Metastatic Disorder Content
7 concepts termed ‘Malignant tumor involving an organ by separate metastasis from X’ and 20 concepts termed ‘Metastasis from malignant neoplasm of X’ are to be inactivated.
Metastasis ‘involving an organ’ and metastasis concepts that are unspecified as to site of the metastatic neoplasm are not clinically useful as in most cases there will already be a record of the site of the primary malignant tumor and the actual site of the metastasis will also be recorded as a separate concept.
Going forward, metastatic malignant neoplasm ‘to X site’ and ‘from X site’ will not be precoordinated in one concept but recorded separately as 2 concepts.
For consistency of descriptions, 128462008 |Secondary malignant neoplastic disease (disorder)| and its subtypes will have their Fully Specified Name and Preferred Term with 'secondary' changed to 'metastatic' retaining the 'secondary' description as a synonym. The descriptions with 'secondary' will be inactivated and not the concept. Editorial Guidance will be provided.
Inactivation of 365753005 |Finding of presence of drug (finding)|
365753005 |Finding of presence of drug (finding)| will be inactivated and replaced with an appropriate concept that includes “substance” in the FSN due to a mismatch between this concept's FSN and logical definition. In addition, “drug” does not have a universal definition or a consistent international representation.
Description Updates Haemophilus influenzae types “a” to “f"
Terming for descriptions containing Haemophilus influenzae types “a” to “f” are being updated such that concepts in other hierarchies are consistent with the terming of associated concepts in the Organism hierarchy, which is the source of truth as specified in the general naming guidelines.
Drug Measurement Findings
Measurement finding concepts that include the term "drug" in the FSN are being reviewed and considered for inactivation in future releases.
Inactivation of Metadata Concepts
The following metadata concepts will be inactivated for the July 2022 Release:
- 741068007 |SNOMED CT to European Directorate for the Quality of Medicines & HealthCare simple map reference set (foundation metadata concept)|
- 735233007 |European Directorate for the Quality of Medicines & HealthCare simple map reference set module (core metadata concept)|
- 762959004 |European Directorate for the Quality of Medicines & HealthCare to SNOMED CT simple map reference set (foundation metadata concept)|
- 733900009 |SNOMED CT to Unified Code for Units of Measure simple map reference set (foundation metadata concept)|
- 741814003 |SNOMED CT to Unified Code for Units of Measure simple map reference set module (core metadata concept)|
Inactivation of subtypes of 717234006 |Allergy to animal protein (finding)
Following the Briefing Note submitted to the MF in March 2022, current subtypes of the “717234006 |Allergy to animal protein (finding)|” sub-hierarchy that represent allergy to "animal part" are being considered for inactivation and will be replaced by concepts representing “Allergy to X animal protein”.
Inactivation of "X by body site" concepts in various hierarchies
Concepts that include "X by body site" in multiple hierarchies are being inactivated, e.g., 371571005 |Imaging by body site (procedure)| and 301810000 |Infection by site (disorder)|, because they are classification groupers with no clinical use.
Dupuytren Content Changes
The Dupuytren content will be remodeled. The following concepts will be inactivated for the September 2022 Release:
- 410812005 |Dupuytren's disease (disorder)|
- 203052004 |Dupuytren's disease of palm and finger (disorder)|
- 203046000 |Dupuytren's disease of palm, nodules with no contracture (disorder)|
- 203047009 |Dupuytren's disease of palm, with contracture (disorder)|
- 203050007 |Dupuytren's disease of finger(s), nodules with no contracture (disorder)|
- 203053009 |Dupuytren's disease of palm and finger(s), nodules with no contracture (disorder)|
- 203051006 |Dupuytren's disease of finger, with contracture (disorder)|
- 203054003 |Dupuytren's disease of palm and finger, with contracture (disorder)|
- 16216861000119107 |Dupuytren's contracture (morphologic abnormality)|"
Remodeling of 74799003 |Flap graft (procedure)| hierarchy and 256683004 |Flap (substance)| hierarchy
QI work has commenced on the area of flap procedures, previously placed under 74799003 Flap graft (procedure), which has been inactivated and replaced with 1202017008 |Surgical procedure using flap (procedure)|. The work is still ongoing, and a new model has been developed and remodeling is now in process.
Work has commenced on improvements to the sub-hierarchy of 256683004 |Flap (substance)| (including planned inactivations). The redesign involves adding new qualifier values as subtypes of 360032005 |Flap reconstruction - action (qualifier value)|.
For the April 2022 release there are continuing updates to the sub-hierarchy of 256683004 |Flap (substance)| (including planned inactivations to address the conflation of body structure and flap substance). The redesign will involve remodeling qualifier values as subtypes of 360032005 |Flap reconstruction - action (qualifier value)|. Editorial Guidance has been drafted ready for publication.
Remodeling of Descendants of 1202017008 |Surgical procedure using flap (procedure)|
As part of the Quality Initiative project to improve the 1202017008 |Surgical procedure using flap (procedure)| subhierarchy, a new more comprehensive template is under development, and as a result approximately 50 complex flap procedures have subsequently newly been included in the QI project and will be remodeled for the June 2022 release.
This will involve defining some existing complex flap procedures for congenital conditions. Whilst every effort will be made to align with the template and sufficiently define relevant concepts (for example, by creation of new concepts for 1230024004 |Congenital deformity of lower limb (disorder)| and new 1230067007 |Correction of congenital anomaly (procedure)|), it is recognized that the area would benefit from the input of domain experts in the future.
Change for Clinical Drug Concepts Containing Pancreatic Enzymes
Clinical drug concepts in the International Release containing pancreatic enzymes will be modeled based on the discrete enzymes; because of variability between real clinical drugs, synonyms representing a total amount in a particular product will not be included in the International Release.
The editorial guide and existing content will be reviewed and updated accordingly in a future release.
Administrative Concept Inactivations
Seven situation hierarchy concepts are being inactivated due to the lack of unambiguous meaning and reproducible use case among healthcare systems:
- 394827008 |Personal administration (situation)|
- 394824001 |Private prescription (situation)|
- 182819002 |Replacement therapy (situation)|
- 394822002 |Prescription types (situation)|
- 394829006 |Past medication (situation)|
- 182817000 |Drug prescription (situation)|
- 703955006 |Prescription telephone order (situation)|
Planned Inactivation of Concepts in the 260299005 |Number (qualifier value)| Hierarchy
Following the deployment of the concrete domain functionality in SNOMED CT, concepts in the 260299005 |Number (qualifier value)| hierarchy are no longer necessary and plans have been made for their inactivation.
To provide adequate time for any national extension or implementation affected by this change, concepts in the 260299005 |Number (qualifier value)| hierarchy will be inactivated in the January 2023 International Release.
Concepts will be inactivated with reason “Non-conformance to editorial policy” and no historical relationship or replacement concept will be provided.
Exceptions:
118586006 |Ratio (property) (qualifier value)| and descendants have been relocated to 118598001 |Property (qualifier value)| hierarchy.
272070003 |Ordinal number (qualifier value)| and descendants have been relocated to 362981000 |Qualifier value (qualifier value)| hierarchy.
A briefing note will also be distributed to selected Advisory and Project Groups.
Please contact info@snomed.org with any inquiries.
Nutrition Content
Information about the work of the Nutrition Care Process Clinical Project group is available here.
Cancer Synoptic Reporting - Project Information
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.
Planned areas of promotion for the January 2023 release include observable entity concepts for genomics, molecular pathology, immunohistochemistry, treatment effect and intactness/quality of specimen.
For more information about this project, please see the Cancer Synoptic Reporting Clinical Project Group here
Cancer Synoptic Reporting - Protein Substances
Around 40 new protein concepts will be added to the substance hierarchy which are needed to model the immunohistochemistry neoplasm observables. In addition, around 10-15 existing protein substance concepts will be remodeled to align their terming with the authoritative source for protein nomenclature and to assign parents and other relationships based on the current guidelines for the substance hierarchy.
Guidelines for protein substance concepts will be incorporated into the Editorial Guide following completion of this work.
These substance concepts will be added starting with the May 2022 release and may continue for the June and/or July 2022 releases.
Disorder X without Disorder Y
The vast majority of existing X without Y concepts originated from ICD-9 with the specific meaning of "X disorder without mention of Y disorder". As the phraseology indicates a lack of data about disorder Y as opposed to a specific exclusion, this type of concept has not been included in ICD-10, nor proposed for ICD-11, except in the case of "Traumatic brain injury without open intracranial wound".
Addition of new X without Y concepts may only be made under the following conditions:
- The request for new content must be accompanied by a rationale as to the difference between "X disorder without Y disorder" and "X disorder."
- Approval for addition is given by the Head of Terminology.
For the most part, existing X without Y concepts will be inactivated as AMBIGUOUS with a historical MAY BE relationship to "X disorder". Exceptions to inactivation will be made on a case-by-case basis.
Content Improvements in the Substance and Product Hierarchies
Please see briefing notes here Drugs Project
2022 International Release and future releases
Inactivation of 360215002 |Pharmaceutical excipient (substance)| Hierarchy
The 360215002 |Pharmaceutical excipient (substance)| hierarchy will be inactivated with descendant grouper concepts (e.g. 418403001 |Drug preservative (substance)|, 412307009 |Drug vehicle (substance)|) being inactivated as duplicates of existing or new concepts in the 43747001 |Drug excipient (product)| hierarchy.
Concepts representing discrete substances will remain in the Substance hierarchy. One concept, 438784000 |Adverse reaction caused by pharmaceutical excipient (disorder)|, will be remodeled using the corresponding product concept, with classification results consistent with the pattern for vaccine products.
Change for Groupers in Substance Hierarchy - Analyte
Groupers in the Substance hierarchy that refer to analyte (e.g. 259988005 |Transplantation analyte (substance)|, 312273006 |Microbiology analyte (substance)|) will be inactivated with reason Meaning unknown; no potential replacement concept will be provided.
Addition of New Grouper Concepts in the Pharmaceutical Dose Form and Medicinal Product hierarchies
As per the Briefing Note titled Editorial Guideline and Content Changes for Concepts Referring to “Infusion” or “Injection”, new grouper concepts for “infusion and/or injection” will be added to the Pharmaceutical Dose Form and Medicinal Product hierarchies beginning in the 2022-April Release. (The Briefing Note is located on the Drug Project space https://confluence.ihtsdotools.org/display/IAP/Drugs+Project).
Dose Form-Related Changes - June 2022 Release
- Dispersion - New basic dose form concept, 1230183009 |Dispersion (basic dose form)| with text definition "A liquid dose form consisting of semi-solid, gaseous, or small (less than 1 micron) liquid particles dispersed in a suitable vehicle.”, has been added. Associated pharmaceutical dose form (PDF) concepts have also been added; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
- Gingival - Existing intended site concept 738943003 |Gingival (intended site)| has been updated to be a subtype of 738982001 |Oromucosal (intended site)|.
- Stick - Has administration method will be updated to 738993004 |Insert (administration method)| for existing concepts 385246006 |Conventional release urethral stick (dose form)|, 385148001 |Conventional release otic stick (dose form)|, and 385162008 |Conventional release nasal stick (dose form)|.
Periodontal - New basic dose form concept, 1230218002 |Periodontal (intended site)| with text definition "An intended site for administration of a dose form that is the tissue around a tooth.”, has been added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts have also been added; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
- Lozenge - New basic dose form concepts, 1230206006 |Compressed lozenge (basic dose form)| (with text definition = A type of solid dose form prepared by compression intended to dissolve or disintegrate slowly in the mouth while being sucked.) and 1230217007 |Molded lozenge (basic dose form)| (with text definition = A type of solid dose form prepared by molding and intended to dissolve or disintegrate slowly in the mouth while being sucked.) have been added for the June 2022 release as descendants of existing basic dose form 385087003 |Lozenge (basic dose form)| (with text definition = A type of solid dose form intended to dissolve or disintegrate slowly in the mouth while being sucked.). Associated pharmaceutical dose form (PDF) concepts have also been added; the PDFs will not be used for modeling concepts in the International Release but will be available for use in national extensions. No related changes to existing clinical drug concepts is planned.
Elixir - Existing basic dose form 738997003 |Elixir (basic dose form)| will be made a child of 739006009 |Solution (basic dose form)|; no changes to existing Clinical drug concepts will be made unless specifically requested via CRS.
Emulsion - Text definition for existing concept 738998008 |Emulsion (basic dose form)| will be updated to "A liquid dose form consisting of a system of non-miscible liquids where droplets of the discrete phase are distributed in the continuous phase (usually oily in aqueous but can also be aqueous in oily)."; no changes to existing Clinical drug concepts will be made unless specifically requested via CRS.
Gas - New basic dose form concepts 1230326008 |Compressed gas (basic dose form)| with text definition "A gas supplied under pressure which is entirely gaseous at - 50 °C.", 1230327004 |Cryogenic gas (basic dose form)| with text definition ", and 1230328009 |Liquified gas (basic dose form)| with text definition "A gas supplied under pressure, which is partially liquid (gas over liquid) at -50 °C.” will be added. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs will not be used for modeling concepts in the International Release but will be available for use in national extensions. No related changes to existing clinical drug concepts is planned.
Syrup - Existing basic dose form 739009002 |Syrup (basic dose form)| will be made a child of 739006009 |Solution (basic dose form)|; no changes to existing Clinical drug concepts will be made unless specifically requested via CRS.
- Granules - Has dose form transformation will be updated to 764779004 |Disperse or dissolve (transformation)| for 385044001 |Conventional release effervescent oral granules (dose form)|. Existing basic dose form concept 761897002 |Effervescent granules (basic dose form)| will be updated to be a subtype of 385043007 |Granules (basic dose form)|.
Tablet - Existing basic dose form concept 761877007 |Effervescent tablet (basic dose form)| will be updated to be a subtype of 385055001 |Tablet (basic dose form)|.
- Powder - Existing basic dose form concept 762948008 |Effervescent powder (basic dose form)| will be updated to be a subtype of 739005008 |Powder (basic dose form)|.
- Cement - New basic dose form concept, 1231321009 |Cement (basic dose form)| with text definition "A semi-solid dose form that sets and hardens after application and adheres to other materials to bind or seal them together.”, will be added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
- Collodion - Text definition for existing basic dose form concept 385115001 |Collodion (basic dose form)| will be updated to "A liquid dose form consisting of active substance(s) in a mixture of pyroxylin or similar in ether and ethanol.”
- System - New basic dose form concept, 1231568003 |System (basic dose form)|| with text definition "A solid dose form consisting of one or more components which together are used to deliver active substance(s) with a prolonged-release mechanism.”, will be added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added or updated accordingly; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
Dialysis - New administration method concept, 1231460007 |Dialysis (administration method)| with text definition “A method of administration of a dose form through a dialysis system.” and new intended site concept, 1231459002 |Extracorporeal (intended site)| with text definition “An intended site or administration of a dose form that is initially outside of the body and is subsequently returned to the body.” will be added. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs can be used in creation of concepts in the International Release.
- Vaporize - New dose form transformation concept, 1231537002 |Vaporize (transformation)|| with text definition "A dose form transformation that occurs immediately before administration, often when the dose form is subjected to heat either directly or by addition to hot water to create the vapor.”, will be added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added or updated accordingly; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
- Pure liquid - New basic dose form concept, 1231710002 |Pure liquid (basic dose form)| with text definition "A liquid dose form consisting of a pure substance in its liquid state.”, will be added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs will not be used for modeling concepts in the International Release but will be available for use in national extensions. No related changes to existing clinical drug concepts is planned.
- Lacquer - New basic dose form concept, 1230223002 |Lacquer (basic dose form)| with text definition "A liquid dose form where active substance(s) are suspended or dissolved in a volatile liquid which evaporate to leave them in a hard coating.”, has been added. Associated pharmaceutical dose form (PDF) concepts have also been added.
Dose Form-Related Changes - July 2022 Release
- Intraocular - Existing intended site concept 762070008 |Intraocular (intended site)| will be remodeled as a descendant of 738952007 |Ocular (intended site)|. Associated pharmaceutical dose form (PDF) and clinical drug (CD) concepts will be updated accordingly.
- Impregnated material - new basic dose form 1231762000 |Impregnated material (basic dose form)| with text definition "A solid dose form consisting of porous or absorbent material onto or into which active substance(s) are taken up or taken in, for subsequent release after administration.” will be added for the July 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
- Mouthwash - Has administration method will be updated to 785900008 |Rinse or wash (administration method)| for mouthwash pharmaceutical dose forms.
- Mix - New dose form transformation concept, 764462006 |Mix (transformation)| with text definition "Transformation of a dose form into a different dose form by combining it together with a component item." will be added for the 2022-July release. Associated pharmaceutical dose form (PDF) concepts will be added or updated accordingly. No related changes to existing clinical drug (CD) concepts is planned.
- Intestinal - New intended site concept, 1231834000 |Intestinal (intended site)| with text definition "An intended site for a dose form that is for administration directly to the intestine (duodenum through the colon) using an appropriate device.”, has been added for the 2022-July release. Associated pharmaceutical dose form (PDF) concepts have also been added; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
Inactivation of Poisoning by medicinal product role groupers
Following the Briefing Note submitted to the MF and the CMAG in August 2021, and based on the members’ feedback, the poisoning concepts that are defined by a causative agent that is of type “medicinal product role” or “Medicinal product role + structure” that are not in use will be inactivated.
Planned changes to 'Co-occurrent and due to' pattern
During the implementation of the new Description Logic features a conflict was uncovered between the modeling of 'Co-occurrent and due to' and General Concept Inclusions (GCIs). This has resulted in the need to reconsider the modeling of "Co-occurrent and due' and update the Editorial Guide for this area.
The plan is to update the Editorial Guide and all concepts that are currently modeled as 'Co-occurrent and due to' starting from the July 2019 release.
2022 International Release and future releases
WAS_A
Inactivation reason of LIMITED/WAS_A is not allowed for any new content inactivations after the July 2018 release. The WAS_A association refset has not been updated thereafter.
At the Editorial Advisory Group meeting in April 2019, agreement was reached to discontinue the maintenance of WAS_A relationships when inactivating concepts that have a historical association to an inactive concept. When changes are made to a historical relationship for a concept that was previously inactivated using WAS_A, effort will be made to assign a new historical relationship that facilitates traceability of the concept (e.g. DUPLICATE or AMBIGUOUS) as opposed to NON-CONFORMANCE TO EDITORIAL POLICY.
Existing WAS_A relationships will be inactivated in a future release once a plan for batch reassignment of historical relationships has been developed. Until then, SNOMED International will not continue to use or maintain WAS_A relationships.
Planned changes to Implantation and Insertion procedures
Work commenced on content tracker IHTSDO-175.
Ongoing structural changes for the Procedure concepts related to the content tracker, more information is available here
2022 International Release and future releases
Inactivation of 6920004|Defect (morphologic abnormality)|
6920004|Defect (morphologic abnormality)|is planned for inactivation. 286 concepts currently modelled with 6920004|Defect (morphologic abnormality)| will be reviewed and remodelled; this may include inactivation and replacement.
Please see the briefing note submitted to the Member Forum for further details.
Inactivation of 118222006 |General finding of observation of patient (finding)|
118222006 |General finding of observation of patient (finding)| is a high level finding with little clinical value. The concept will be inactivated with an inactivation target of Clinical finding. Descendants count is 4237 concepts.
Update for 399248000 |Procedure related to anesthesia and sedation (procedure)|
26402001 Nerve block anesthesia (procedure) and its 211 descendants along with 745638006 |Injection of anesthetic agent (procedure)| and its 283 descendants will acquire the proximal primitive parent of 399248000 |Procedure related to anesthesia and sedation (procedure)|.
| . | Release Schedule | Change to Effective Time for International Edition Starting 1 September 2023 After consultation with the community, SNOMED International has changed the date of the effective time for the International Edition from the last day of each month, to the first of each month. The effective time for the “January” edition will be 1st January. The effective time for the “July” edition will be 1st July. The July 2023 International Edition was the last to be published with effective time of the last day of the month. Further details about this change can be found in the Q&A blog post. | From: 1st September 2023 |
| 2. | 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)|. | Q4 2023/Q1 2024 International Release |
| 3. | Body Structure | Inactivation of Concepts Specified Male/Female in Descriptions Subtypes of 67770001 |Male mammary gland structure (body structure)| and 91532001 |Female mammary gland structure (body structure)| and their associated disorder and specimen concepts. Further information is available here (Confluence log in required). | Q4 2023/Q1 2024 International Release |
| 4. | 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 |
| 5. | 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. | Editing work commencing Q4 2023 (<<168537006|Plain radiography (procedure)|). First phase of content updates planned for promotion Q1 2024. |
| 6. | 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. | Q4 2023 International Release |
| 7. | Social Context | Ethnic/Racial Group Social Context Content Inactivation The subtypes of 372148003 |Ethnic group (ethnic group)| and 415229000 |Racial group (racial group)| will be inactivated as they are out of scope for the International Edition. A briefing note is available here. | Q4 2023 International Release |
| 8. | 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. | Q1 2024 International Release |
| 9. | Procedure/Observable Entity | Evaluation Procedure vs Observable Entity The Senior Management Team (SMT) recently agreed on a proposed solution to resolve the duplication between the evaluation procedure and observable entity hierarchies. The resolution includes moving the majority of the evaluation procedures to the observable entity hierarchy while retaining the original concept id during the move. The semantic tag will be updated from evaluation procedure to observable entity, and updates in terming and modeling to align with the observable entity model are expected. This move will allow for concepts of multiple granularities to be classified in a single hierarchy. Non-defining annotations for “order only,” “observation only,” or “both order and observation” may be added to the concepts to assist with certain use cases. Note that some content areas of evaluation procedures such as panels and procedure methods will not be addressed at this time. A projected timeline of changes will be developed and shared with the community. Editorial and implementation guidance will be provided with this project. Please see the briefing note for further information. | To be determined |
| 10. | 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. | Q4 2023 International Release |
| 11. | 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 |
| 12. | 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. | Q1 2024 International Release |
| 13. | 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 |
| 14. | 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. | Q1 2024 International Release |
Published Content Changes
| Item | Hierarchy | MOVED FROM PROPOSED CHANGES TO PUBLISHED CHANGES | Confirmed Release Date |
|---|---|---|---|
| 1. | Clinical Finding | Inactivation of Concepts that state Delivered/Not delivered Obstetric content that conflates the delivery status with the disorder of the mother that prompted the admission to hospital will be inactivated. There are 250 concepts that state the delivery status of the mother within the FSN:
These concepts are classification derived and are used to record whether the baby was, or was not delivered during that inpatient stay for the care of the mother who has placenta previa with a hemorrhage. | January 2023 International Release |
2. | Procedure | Update for 399248000 |Procedure related to anesthesia and sedation (procedure)| 745638006 |Injection of anesthetic agent (procedure)| and its 283 subtypes will gain a supertype of 399097000 |Administration of anesthesia (procedure)|. | January 2023 International Release |
| 3. | Organism | Inactivation of 415360003 |Severe acute respiratory syndrome-related coronavirus (organism)| To resolve ambiguity for 415360003 |Severe acute respiratory syndrome-related coronavirus (organism)|, this concept will be inactivated as ambiguous. New concepts will be created to represent the associated strain and species. 840533007 |Severe acute respiratory syndrome coronavirus 2 (organism)| will be a sibling of the “Severe acute respiratory syndrome (SARS) coronavirus” strain and a subtype of the “Severe acute respiratory syndrome-related coronavirus” species. Current children of 415360003 |Severe acute respiratory syndrome-related coronavirus (organism)|, which represent Severe acute respiratory syndrome (SARS) coronavirus strain subtypes will be inactivated using "Outdated component" as the inactivation reason with a "Replaced by" association to the concept representing “Severe acute respiratory syndrome (SARS) coronavirus." Details of the change can be found in this Briefing Note. | January 2023 International Release |
| 4. | Qualifier Value | Planned Inactivation of Concepts in the 260299005 |Number (qualifier value)| Hierarchy Following the deployment of the concrete domain functionality in SNOMED CT, concepts in the 260299005 |Number (qualifier value)| hierarchy are no longer necessary and plans have been made for their inactivation. To provide adequate time for any national extension or implementation affected by this change, concepts in the 260299005 |Number (qualifier value)| hierarchy will be inactivated in the January 2023 International Release. Concepts will be inactivated with reason “Non-conformance to editorial policy” and no historical relationship or replacement concept will be provided. Exceptions: 118586006 |Ratio (property) (qualifier value)| and descendants have been relocated to 118598001 |Property (qualifier value)| hierarchy. 272070003 |Ordinal number (qualifier value)| and descendants have been relocated to 362981000 |Qualifier value (qualifier value)| hierarchy. A briefing note will also be distributed to selected Advisory and Project Groups. Please contact info@snomed.org with any inquiries. | January 2023 International Release |
| 5. | Body Structure | Remodeling of 771527003|Structure of synovial sac (body structure)| and Subtypes The content in this area is being updated to align with this model. | February 2023 International Release |
| 6. | Clinical Finding | Inactivation of 118222006 |General finding of observation of patient (finding)| 118222006 |General finding of observation of patient (finding)| is a high level finding with little clinical value. The concept will be inactivated with an inactivation target of Clinical finding. Descendants count is 4237 concepts. | February 2023 International Release |
| 7. | Qualifier Value | Update to 307159006|Pregnancy time period (qualifier value)| and Subtypes Concepts referring to temporal periods for pregnancy and birth (307159006 Pregnancy time period (qualifier value) and subtypes) will be updated with the addition of a small number of concepts to make this area of content more comprehensive. A new concept which explicitly covers 'maternal antenatal and/or intrapartum and/or postpartum period’ will be added. Definitions will be added to aid modeling and interpretation. | February 2023 International Release |
| 8. | MRCM | Update to MRCM Extend the range of 719722006 |Has realization (attribute)| by including 71388002 << |Procedure (procedure)|, << 272379006 |Event (event)|, << 404684003 |Clinical finding (finding)|. Please see here | February 2023 International Release |
| 9. | Content Improvement | Inactivation of "X by body site" concepts in various hierarchies Concepts that include "X by body site" in multiple hierarchies are being inactivated, e.g., 371571005 |Imaging by body site (procedure)| and 301810000 |Infection by site (disorder)|, because they are classification groupers with no clinical use. | February 2023 International Release |
| 10. | Clinical Finding | Neoplasm of Connective and Soft Tissue Disorders Around 30 concepts which include “neoplasm of connective and soft tissue" in their FSN will be inactivated as "Classification derived component." | March 2023 International Release |
| 11. | Clinical Finding | Measurement Findings The next set of changes for measurement findings content will involve the positive and negative results content (~150 concepts). Measurement findings concepts which include 'positive' or 'negative' in the FSN will be updated as follows: 1) The FSN and PT will be updated to include 'detected' or 'not detected.' Existing descriptions with 'positive' or 'negative' will be retained as synonyms. Please see the briefing note (20221116 BN Positive_Negative measurement findings.pdf) for more information. | March 2023 International Release |
| 12. | Clinical Finding | Metastatic Content with 'Involving' and 'Metastasis to X of Unknown Y' Approximately 75 disorder concepts of the type 'Malignant tumor involving [x structure] by [separate] metastasis from [y structure]' and 30 disorder concepts of the type 'Metastasis to [x structure] of unknown primary' will be inactivated. Examples: 369554006 Malignant tumor involving right fallopian tube by separate metastasis from left fallopian tube (disorder) The current Editorial Guidance indicates that the primary malignancy and the metastatic malignant neoplasm should be recorded using two separate SNOMED CT concepts, and these replacements will be provided as inactivation target values, and if not available they will be created. | March 2023 International Release |
| 13. | Clinical Finding | Remodel 16356006|Multiple pregnancy (disorder) to Become Subtype of 77386006 |Pregnancy (finding)| 16356006|Multiple pregnancy (disorder) will be updated to a clinical finding with a semantic tag of (finding) and a subtype of 77386006 |Pregnancy (finding)|. Current subtypes of 16356006|Multiple pregnancy (disorder) will be reviewed as some subtypes should retain the semantic tag ‘disorder’ where the concept meets the criteria of being always and necessarily an abnormal clinical state. A new parent will be assigned designated by whether the semantic tag has been changed. | March 2023 International Release |
| 14. | Clinical Finding | Primary and Metastatic Project - New Primary Malignancy Disorders Approximately 150 new primary malignancy disorders will be added to SNOMED CT. Inferred subtypes of 372087000 |Primary malignant neoplasm (disorder)| that were assigned by the classifier based on the morphology hierarchy (now revised), but which did not state primary in the FSN ('agnostic') have been reviewed. These previous subtypes of 372087000 |Primary malignant neoplasm (disorder)| will have a new subtype concept added that states 'primary' to provide an option for selection by clinicians. | March 2023 International Release |
| 15. | Clinical Finding | Inactivation of 307844003 |Minor surgery status (finding)| and Subtypes Concepts that have explicit context should be in the situation hierarchy. Therefore 307844003 |Minor surgery status (finding)| and 5 subtypes with context "done" + a procedure will be inactivated. One concept 314471005 |Minor surgery done (finding)| will be inactivated and replaced by 1268934004 |Minor surgery done (situation)|. | March 2023 International Release |
| 16. | Substance | Review of Concepts Defined by Stated = 105590001 |Substance (substance)| Concepts in various hierarchies (including Procedure, Clinical finding, Observable entity, Event and Specimen), which are defined by the stated attribute value of "105590001 |Substance (substance)|" are being reviewed. Many of these concepts are being remodeled by removing the attribute/value relationship—provided that this change doesn’t result in a change to the meaning of the associated concepts. Some of these concepts may need to be remodeled with a more specific substance. Some of the grouper concepts will be inactivated—specifically the groupers that are classification derived and/or have only one subtype. This change is part of the Substance-Drug project and will allow for the correct subsumption of the subtypes, if and once the attribute values are changed to subtypes of 373873005 |Pharmaceutical / biologic product (product)|. | March 2023 International Release |
| 17. | Body Structure | Inactivation of 6920004|Defect (morphologic abnormality)| 6920004|Defect (morphologic abnormality)|is planned for inactivation. 286 concepts currently modelled with 6920004|Defect (morphologic abnormality)| will be reviewed and remodelled; this may include inactivation and replacement. Please see the briefing note for further details. | May 2023 International Release |
| 18. | Clinical Finding | Inactivation of Measurement Finding Concepts The following concepts will be inactivated as they do not comply with editorial guidance:
| May 2023 International Release |
| 19. | Qualifier Value | Planned Inactivation of Subtypes of 129284003 |Surgical action (qualifier value)| As part of the Quality Initiative, a review has been undertaken of the 129284003 |Surgical action (qualifier value)| hierarchy which has identified:
As a result of this review, 45 concepts in the qualifier value hierarchy that are descendants of 129284003|Surgical action (qualifier value)| will be inactivated. The complete list of concepts can be accessed here. | May 2023 International Release |
| 20. | Clinical Finding | Primary and Metastatic Project - New Metastatic Morphologic Abnormality Concepts Metastatic disorders will be defined by their specific metastatic neoplastic morphologic abnormality concepts, and new metastatic morphologies are being added to the international edition of SNOMED CT as needed. In cooperation with the Netherlands extension of SNOMED CT, SNOMED International will be promoting certain of their existing metastatic morphology concepts to the International release to be used to model new metastatic disorder concepts. | Completed May 2023 International Release |
| 21. | Procedure | Inactivation of Concepts of the Type “Administration of substance via X specific route (procedure)” Concepts of the type “Administration of substance via X specific route (procedure)” will be replaced with concepts of type “Administration via X specific route (procedure)”. This change is part of the Substance-Drug project and will allow for the unambiguous subsumption of the subtypes, if and once instances of 363701004 |Direct substance (attribute)|are modeled with subtypes of 373873005 |Pharmaceutical / biologic product (product)|. The only remaining concept of this type will be the parent concept, 433590000 - Administration of substance via specific route (procedure). The change for this concept is is pending required MRCM changes, and will be applied once the required MRCM change is complete. | June 2023 International Release |
| 22. | MRCM | Update to MRCM The domain and proximal primitive refinement will be updated to the MRCM of situations of findings and procedures. The existing exclusion constraints for domains will be removed. The "associated finding" and "associated procedure" will be added as mandate requirements, and the contexts will be removed. Further details are available | June 2023 International Release |
| 23. | Qualifier Value | Addition of AJCC Cancer Staging Content New subtypes of 1222584008 |American Joint Committee on Cancer allowable value (qualifier value)| Based on requests from several member countries through the Content Managers Advisory Group, AJCC have now approved addition to SNOMED CT of new cancer staging content as part of a joint collaborative process agreed between both organizations. | June 2023 International Release |
| 24. | Product | Change for Clinical Drug Concepts Containing Pancreatic Enzymes Clinical drug concepts in the International Release containing pancreatic enzymes will be modeled based on the discrete enzymes; because of variability between real clinical drugs, synonyms representing a total amount in a particular product will not be included in the International Release. The editorial guide and existing content will be reviewed and updated accordingly in a future release. | Completed in Q2 2023 International Release |
| 25. | Procedure | Dental "Fit X" concept updates Dental procedure concepts in the format "Fit X” e.g. 234856007 |Fit removable orthodontic retainer (procedure)| will be inactivated with reason “ambiguous". This change has been agreed by the Dentistry CRG and will affect approximately 50 concepts. This work is part of Content Tracker IHTSDO-122 | July 2023 release |
| 26. | Release Schedule | Plan to Move the International Monthly Release Date to the First of Each Month After consultation with the community, SNOMED International will be changing the dates of the International Edition from the end of each month, to the first of each month. This will mean that in addition to all of the other months, the “January” release will move from 31st January to the 1st January, and the “July” release will move from 31st July to 1st July each year. Further details of this proposal can be found here (https://www.snomed.org/news/blog%3A-the-snomed-ct-international-edition-to-be-published-on-first-day-of-each-month), however if you have any concerns in the meantime please provide feedback to release@snomed.org as soon as possible. | 1st September 2023 |
| 27. | Clinical Finding | "Did not attend X" or "Attended X" Clinical Finding Concepts Around 30 "did not attend X" or "attended X" findings concepts, e.g., 390923003 |Did not attend cardiac clinic (finding)|, will be inactivated from the international release as they are administrative concepts. Around 20 "did not attend X" or "attended X" situation concepts, e.g., 310352003 |Mammography not attended (situation)|, will be inactivated from the international release as they are out of scope of this hierarchy. | September 2023 International Release |
| 28. | Clinical Finding | Measurement Findings The six false positive and false negative measurement findings, e.g., 274684006 |False-positive serological test for syphilis (finding)|, will be inactivated with reason of Nonconformance to editorial policy. | September 2023 International Release |
| 29. | Product | Drug Content Analysis Project (DCAP) - Addition of Anti-Infective Clinical Drug Concepts DCAP was launched in September 2022 to identify clinical drug concepts that are published in participating National Release Center extensions and that are eligible for promotion to the international release (supported by appropriate references to authoritative source material). Concepts that are already published in the Norwegian drug extension have been reviewed by multiple countries participating in the group and content eligible for promotion to the international release of SNOMED CT has been identified. Approximately 100 concepts will be promoted to the international release and corresponding concepts for Medicinal Product (MP) 'containing only', and Medicinal Product Form (MPF) 'containing only' imported from Norway if missing. MP 'containing' concepts will be created in the international release as required. | September 2023 International Release |
| 30. | Product | Clinical drugs modeled with dose form 421366001 |Tablet for conventional release oral suspension (dose form)| The dose form 421366001 |Tablet for conventional release oral suspension (dose form)| will be updated with the new Preferred Term 'Dispersible oral tablet'. This aligns with the EDQM standard. 37 clinical drugs that are defined with a dose form of 421366001 |Tablet for conventional release oral suspension (dose form)| will have a new Preferred Term created for 'dispersible oral tablet' and the existing PT made a synonym. | September 2023 International Release |
| 31. | MRCM | Update to MRCM 1142142004 |Has pack size (attribute)|is an attribute that is used for modeling real clinical drugs in a national extension (not for use in the international edition of SNOMED CT). The current MRCM prevents national extensions from using a decimal to define a pack size (for example, a 3.5 milliliter bottle) as it limits the attribute range to whole integers only. The MRCM will be changed for Has pack size (attribute)|from Integer to Decimal. | September 2023 International Release |
| 32. | Qualifier Value | Resolution of Dose Form Inconsistency for 421366001 | Tablet for conventional release oral suspension (dose form) The Preferred Term (PT) of 421366001 | Tablet for conventional release oral suspension (dose form) | will be updated from “tablet for oral suspension” to “dispersible oral tablet.” This is in line with EDQM (also national data sets) where a dispersible tablet is equivalent to a tablet for oral suspension. The PT of 37 clinical drugs (CDs) that currently have a mixture of names will be updated to all use “dispersible oral tablet”. Therefore, users will be able to search for and translate these CDs more effectively. | September 2023 International Release |
| 33. | Substance | New Subtypes of 1155866009 |Messenger ribonucleic acid of severe acute respiratory syndrome coronavirus 2 encoding spike protein (substance)| New subtypes will be added to 1155866009 |Messenger ribonucleic acid of severe acute respiratory syndrome coronavirus 2 encoding spike protein (substance)| including:
These concepts will be created to meet the requirement for creation of bivalent vaccines (usually containing original strain + an omicron variant). In addition, creation of "SARS-CoV-2 mRNA encoding original strain spike protein" will allow for accurately representing monovalent vaccines containing "SARS-CoV-2 mRNA encoding B lineage spike protein" (original strain)." | September 2023 International Release |
| 34. | Clinical Finding | Update Hierarchy 90708001 |Kidney disease (disorder)| As part of the Quality Initiative Project, work has commenced on 90708001 |Kidney disease (disorder)|. Work is being undertaken in stages and upcoming sub-hierarchies will be posted here as the work progresses:
The remaining content areas in this hierarachy will be reviewed and updated as part of the QI project. | 2023 International Release |
| 35. | Clinical Finding | Concepts with "...attend.. X" Around 40 "attends X" or "attending X" findings concepts, e.g., 160766005 |Midwife attends 14-16 days post-discharge (finding)| will be inactivated from the international release as they are administrative concepts. | October 2023 International Release |
| 36. | MRCM | Update to MRCM Extend the domain of 246454002 |Occurrence (attribute)| by including << 71388002 |Procedure (procedure)|. The following is the expected MRCM range after the change. 246454002 |Occurrence (attribute)| << 272379006 |Event (event)| OR << 404684003 |Clinical finding (finding)| OR << 71388002 |Procedure (procedure)| | October 2023 International Release |
| 37. | Observable Entity | Review of CRS Requests in “Awaiting agreement compliance” Status from SNOMED CT – LOINC Cooperation Project CRS requests in “Awaiting agreement compliance” status due to the previous cooperative agreement between SNOMED International and Regenstrief Institute, Inc. have been reviewed in light of the new cooperative agreement, the latest SNOMED CT Editorial Guide, and the latest CRS guidance documents. Concepts deemed in scope are being added. | Completed October 2023 International Release |
| 38. | Social Context | Inactivation of Subtypes of 125676002|Person (person)| The following concepts will be inactivated: 444145006 |Partner in relationship with subject (person)| - historical association to 262043009 |Partner in relationship (person)| 444210007 |Cohabitee in relationship with subject (person)| - historical association to 394921008 |Cohabitee (person)| The Editorial Guide states that the Subject relationship context (attribute) is used to specify the subject of the Clinical finding or Procedure being recorded, in relation to the subject of the record; therefore, the above two concepts are unnecessary. | October 2023 International Release |
| 39. | Situation With Explicit Context | "X result not back (situation)" concepts Four concepts of the type "X result not back (situation)," e.g., 168709001 |Soft tissue X-ray result not back (situation)|, will be inactivated as they are out of scope for the international edition of SNOMED CT. | October 2023 International Release |
| 40. | Situation With Explicit Context | Update Hierarchy 271903000|History of pregnancy (situation) Content relating to past pregnancy history of the subject of the record will be remodeled to subsume under the parent 271903000|History of pregnancy (situation)|. Fully specified name and preferred term will be updated to explicitly state 'Past pregnancy history of.' 161811009|History of perinatal fetal loss (situation)| and 726626004|History of neonatal death (situation)| will be inactivated and replaced by concepts: Past pregnancy history of neonatal death (situation) | October 2023 International Release |
| 41. | MRCM | Update to MRCM The MRCM for Administration of substance via specific route (procedure) is no longer needed. The domain 433590000 |Administration of substance via specific route (procedure)| is replaced by a new concept 1285465008 |Administration via specific route (procedure)| Instances of “Administration of substance via X specific route (procedure)” have been replaced with concepts of type “Administration via X specific route (procedure)”. This change is part of the Substance-Drug project and allows for the unambiguous subsumption of the subtypes, if and once instances of 363701004 |Direct substance (attribute)|are modeled with subtypes of 373873005 |Pharmaceutical / biologic product (product)|. | October 2023 International Release |
| 42. | 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. The main focus of the review will be the following category of concepts:
Additional content update may become applicable while reviewing these concepts for example:
| November 2023 International Release |
| 43. | Procedure | Remodel for Heart Valve Replacement Procedure Concepts Heart valve replacement concepts will be remodeled as a surgical replacement procedure. Distinction will be made between replacement of native valves and implanted prosthetic valves. Updates for concepts with a prosthetic valve will include both mechanical and biological valves. Surgical REMOVAL and REPLACEMENT may not occur at the same point in time so a surgical replacement procedure may not subsume under surgical REMOVAL. These surgical methods are at the same level within the hierarchy. | November 2023 International Release |
| 44. | Substance | Review of 35331000 |Toxic substance (substance)| 35331000 |Toxic substance is an ambiguous concept and will be inactivated; it can refer to any substance that has been used in amount that is harmful for health (including medication), a toxin, heavy metals, or preservatives--not all of these are currently children of 35331000 |Toxic substance (substance)|. In addition, concepts defined by 35331000 |Toxic substance (substance)| will be reviewed; their terming and modeling will be updated where applicable, specifically where the FSN and attribute/value do not match. | November 2023 International Release |
| 45. | Clinical Finding | Update hierarchy 263026000|Dislocation of perilunate joint (disorder)| A new supertype concept 1290805004 |Dislocation of joint of lunate (disorder)| will be added with subtypes:
Subtype content will be remodeled. A text definition will be added for 263026000 |Dislocation of perilunate joint (disorder)|. The FSN for 264132003|Structure of perilunate joint (body structure)| will be updated to 264132003 |Structure of joint of lunate (body structure)|. | November 2023 International Release |
| 46. | Procedure | Remodeling of Subtypes of 128422009 |Destruction using electrical energy (procedure)| Procedures using electrical energy classified as Diathermy (procedure) and Electro X (procedure) will be remodeled and reclassified according to the main action performed and the expected result of such action. 424244007 |Using energy (attribute)|= 18213006 |Electricity (physical force)| will be added with and updates to the descriptions. Further information about these change is available here. | December 2023 International Release |
| 47. | Procedure | Inactivation of Procedure Concepts with AND/OR in FSN. Classification derived concepts under 71388002 |Procedure (procedure)|using AND/OR in FSN will be inactivated in alignment with Editorial Guidance. As needed, new concepts will be created to substitute inactivated concepts without ambiguity. Subtypes of 1263452006 |Anesthesia and/or sedation procedure (procedure)| and 108290001 |Radiation oncology AND/OR radiotherapy (procedure)| will be inactivated or modified only if needed to align with other inactivations. | December 2023 International Release |
| 48. | Procedure | Remodeling of Non-Surgical Drainage Procedures Normalization of attributes used for Procedure site direct/indirect, Indirect/direct morphology and Direct/indirect substance will be performed for concepts modeled with 260686004 |Method (attribute)|= 129289008 |Drainage - action (qualifier value)|. Alignment and normalization is needed for subsequent remodeling of Surgical drainage procedures. | December 2023 International Release |
| 49. | Clinical Finding | Update Model and Descriptions for Fetal, Neonatal and Perinatal Jaundice Disorder Concepts A review of content in this area has been undertaken. The semantic tag for concepts representing “Jaundice due to X” and “Jaundice caused by Y” will be updated from (disorder) to (finding); their modeling and descriptions will be updated accordingly. Concepts of type “Jaundice due to and co-occurrent with Z” will retain “is_a” relationship to “Z (disorder)”; their semantic tag will be retained as “disorder”. The "Occurrence" attribute value for perinatal jaundice findings will be updated to 1156671008 |Maternal perinatal period (qualifier value)|. This change is required to reflect the fact that these findings are related to the mother, who has the jaundice, rather than the fetus. | December 2023 International Release |
| 50. | Situation With Explicit Context | Inactivation of 168123008 |Sample sent for examination (situation)| and Descendants 168123008 |Sample sent for examination (situation)| and its ~90 descendant concepts will be inactivated as out of scope of the international release of SNOMED CT. | December 2023 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 Quality Initiative Information about the project can found here Content Request Service (CRS) Please see Guidance for Requesting Changes to SNOMED CT Further information about CRS is available here. Content Development Information can be accessed 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 | 2023 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. | 2023 International Release and future releases Expected completion by mid 2024 |
| 4. | Project Information | Nutrition Content Information about the work of the Nutrition Care Process Clinical Project group is available here. | 2023 International Release and future releases |
| 5. | Project Information | Content Improvements in the Substance and Product Hierarchies Please see briefing notes here Drugs Project | 2023 International Release and future releases |
| 6. | 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 | 2023 International Release and future releases |
| 7. | Content Improvement | Update for Inactive Concepts Without Semantic Tag Remaining cases of the legacy issue inactive concepts with active FSN without a semantic tag (Content Tracker IHTSDO-645) will be addressed to assign a semantic tag. The number of inactive concepts requiring this update is 351. | 2023 International Release |
| 8. | Content Improvement | Disorder X without Disorder Y The vast majority of existing X without Y concepts originated from ICD-9 with the specific meaning of "X disorder without mention of Y disorder". As the phraseology indicates a lack of data about disorder Y as opposed to a specific exclusion, this type of concept has not been included in ICD-10, nor proposed for ICD-11, except in the case of "Traumatic brain injury without open intracranial wound". Addition of new X without Y concepts may only be made under the following conditions:
For the most part, existing X without Y concepts will be inactivated as AMBIGUOUS with a historical MAY BE relationship to "X disorder". Exceptions to inactivation will be made on a case-by-case basis. | 2023 International Release and future releases |
| 9. | Content Improvement | Planned changes to Implantation and Insertion procedures Work commenced on content tracker IHTSDO-175. Ongoing structural changes for the Procedure concepts related to the content tracker, more information is available here | 2023 International Release and future releases |
| 10. | Content Improvement | Planned changes to 'Co-occurrent and due to' pattern During the implementation of the new Description Logic features a conflict was uncovered between the modeling of 'Co-occurrent and due to' and General Concept Inclusions (GCIs). This has resulted in the need to reconsider the modeling of "Co-occurrent and due' and update the Editorial Guide for this area. The plan is to update the Editorial Guide and all concepts that are currently modeled as 'Co-occurrent and due to' starting from the July 2019 release. | 2023 International Release and future releases |
| 11. | Content Improvement | WAS_A Inactivation reason of LIMITED/WAS_A is not allowed for any new content inactivations after the July 2018 release. The WAS_A association refset has not been updated thereafter. At the Editorial Advisory Group meeting in April 2019, agreement was reached to discontinue the maintenance of WAS_A relationships when inactivating concepts that have a historical association to an inactive concept. When changes are made to a historical relationship for a concept that was previously inactivated using WAS_A, effort will be made to assign a new historical relationship that facilitates traceability of the concept (e.g. DUPLICATE or AMBIGUOUS) as opposed to NON-CONFORMANCE TO EDITORIAL POLICY. Existing WAS_A relationships will be inactivated in a future release once a plan for batch reassignment of historical relationships has been developed. Until then, SNOMED International will not continue to use or maintain WAS_A relationships. | 2023 International Release and future releases |