Introduction

SNOMED CT terminology provides a common language that enables a consistent way of indexing, storing, retrieving, and aggregating clinical data across specialties and sites of care.

The International Health Terminology Standards Development organisation organization (IHTSDO^®), trading as SNOMED International, maintains the SNOMED CT technical design, the content architecture, the SNOMED CT content (includes the concepts table, the descriptions table, the relationships table, a history table, and ICD mappings), and related technical documentation.

Background

This document provides a summarized description of the content changes included in the November 2022 May 2023 Production release of the SNOMED Clinical Terms^® Managed Service Belgium Extension package.

It also includes technical notes detailing the known issues which have been identified (should any of these exist). These are content or technical issues where the root cause is understood, and the fix has been discussed and agreed, but has yet to be implemented.

This Belgium Extension package is dependent upon, and should therefore be consumed in conjunction with the SNOMED CT® September 2022February 2023 International Edition release.

2.1 Scope

This document is written for the purpose described above and is not intended to provide details of the technical specifications for SNOMED CT or encompass every change made during the release.

 Content Development Activity

Summary

Content from the SNOMED CT® September 2022 International CT® February 2023 International Edition release has been translated. 

This extension contains concepts, relationships and reference sets with their Dutch and French translations for healthcare professionals/for use in healthcare profession.

3.2 New and Updated Content

New Belgian content in this release:

New concepts

No new concepts have been created in this release.

New Deleted reference sets

4 new 3 deprecated subsets have been created deleted containing concepts within 4 3 value sets corresponding to the Care Sets of AllergyIntolerance and VaccinationPocFhir:

• PocFhir subsets
  SubsetForAllergyIntoleranceCausativeAgentDrug
  • • SubsetForPocFhirCausativeAgentNoDrug
• SubsetForAllergyIntoleranceCausativeAgentNondrug
• SubsetForAllergyIntoleranceManifestation
VaccinationSubsetForVaccination
• • SubsetForPocFhirManifestation
  • SubsetForPocFhirNoAllergy




New translated content




Regarding the GP language refset:

• 1850 GP subset: 6720 concepts have been added to the GP subset
  The
  • • 558 concepts come from 3BT-SNOMED CT mapping project
    • 6162 concepts come from the International Patient Summary (IPS)
      • These were added for the essential data exchange based on FHIR and are an enrichment of the GP subset
  • GP language refset: the following table contains the total number of translations included in the GP
  subset
  • language refset:
  DUTCH

  Scroll Table Layout
  orientation default sortDirection ASC repeatTableHeaders default style Resolved Issues Table widths 40%,20%,20%,20% sortByColumn 1 tableStyling confluence sortEnabled false cellHighlighting true

  hierarchy

  
  

  Preferred

  Acceptable

  Total

  body structure/morphologic abnormality2

  2

  event211233finding521920637282procedure48957

  situation

  58

  13

  71

  Total534820977445

  FRENCH

  Scroll Table Layout
  orientation default sortDirection ASC repeatTableHeaders default style Resolved Issues Table widths 40%,20%,20%,20% sortByColumn 1 tableStyling confluence sortEnabled false cellHighlighting true

  DUTCH	11.578	6.091	17.669
  FRENCH	10.346	4.994	15.340
  TOTAL	21.924	11.085	33.009

  hierarchy

  Preferred

  Acceptable

  Total

  body structure/morphologic abnormality22

  event

  21

  12

  33

  finding

  5219

  1983

  7202

  procedure

  48

  11

  59

  situation

  58

  6

  64

  Total

  5348

  2012

  7360

  
  Regarding the national language refset:
  

  • New translations have been introduced, both for concepts that didn't have a translation yet as for concepts with existing translations.
  • The following table contains the number the total number of
  concepts with new translations:DUTCH
  • translations included in the actual version of the Belgian language refset:

  Scroll Table Layout
  orientation default sortDirection ASC repeatTableHeaders default style Resolved Issues Table widths 40%,20%,20%,20% sortByColumn 1 tableStyling confluence sortEnabled false cellHighlighting true

  Hierarchy

  
  

  body structure32674

  	Preferred	Acceptable	Total
  DUTCH	29923
  environment / location	846	361
  event	1	1
  finding	3456	2746
  metadata	297	189
  observable entity	2632	1883
  organism	1981	937
  physical force	161	76
  physical object	8278	3434
  procedure	3037	2387
  product	182	144
  qualifier value	1775	1072
  record artifact	22	10
  situation	33	29
  social concept	2875	908
  special concept	2
  specimen	1548	1141
  staging scale	15	8
  substance	54	43
  Total	59869	45292

  FRENCH

  Scroll Table Layout
  orientation default sortDirection ASC repeatTableHeaders default style Resolved Issues Table widths 40%,20%,20%,20% sortByColumn 1 tableStyling confluence sortEnabled false cellHighlighting true

  Hierarchy

  Preferred

  Acceptable

  Total

  finding7956

  6271

  14227

  procedure5474

  4601

  10075

  product51

  9

  60

  Total

  13481

  10881

  24362

  270.107	282.547	552.654
  FRENCH	143.519	58.793	202.312
  TOTAL	413.626	341.340	754.966

  
  

  The other changes are updates of existing content.

  Scroll Table Layout
  orientation default sortDirection ASC repeatTableHeaders default style Resolved Issues Table widths 40%,20%,40% sortByColumn 1 tableStyling confluence sortEnabled false cellHighlighting true

  
  
  5151 for this new refset (50831000172102)64036403 for this new refset (50841000172109)
  11941194 for this new refset (50851000172106)6767 for this new refset (50861000172108)

  Differences found in package Comparison	No RF2 records impacted	Rationale
  Concept files	5 1	5 1 records added/updated
  Association files	20 0	19 0 records added/updated, plus 1 0 inactivated
  AttributeValue files	4389 11436	4381 11433 records added/updated, plus 8 3 inactivated
  Description files (EN)	8 2	8 2 records added/updated
  Description files (FR)	30131 52031	29803 44643 records added/updated, plus 323 7389 inactivated
  Description files (NL)	161,830	682	656 161,738 records added/updated, plus 85 26 inactivated
  Language files (EN)	8 2	8 2 records added/updated
  Language files (FR)	31980 51875	31678 44493 records added/updated, plus 302 7382 inactivated
  Language (FR) context specific GP Refset	2765 7998	2742 7986 records added/updated, plus 23 12 inactivated
  Language files (NL)	159,788	77	66 159,717 records added/updated, plus 71 11 inactivated
  Language (NL) context specific GP Refset	2750 10247	2736 10232 records added/updated, plus 14 15 inactivated
  Inferred Relationship files	25 35	13 3 records added/updated, plus 12 32 inactivated
  OWLExpression files	7 1	7 record 1 records added/updated
  RefsetDescriptor files	10 1	4 1 records added (for 4 1 new refsets added this refset to be  added in Nov 23 cycle) + 6 0 updated
  Translated Plant Materials Simple Refset	0	0 records added/updated, plus 0 inactivated
  Translated Edible Substances Simple Refset	1	0 records added/updated, plus 1 inactivated
  Translated Animal Materials Simple Refset	1	0 records added/updated, plus 1 inactivated
  Belgian GP refset files	1859 6743	1850 6720 records added/updated, plus 9 23 inactivated
  Belgian POC FHIR no allergy Refset files	7 ALL	ALL 7 records inactivated in preparation for deprecation in next cycle files removed as final step in agreed deprecation process for this refset
  Belgian POC FHIR causative agent, no drug Refset files	657 ALL	ALL 657 records inactivated in preparation for deprecation in next cycle files removed as final step in agreed deprecation process for this refset
  Belgian POC FHIR manifestation Refset files	37 ALL	ALL 37 records inactivated in preparation for deprecation in next cycle files removed as final step in agreed deprecation process for this refset
  Extended Map files (containing the new BE ICD-10 map content)	0	0 records added/updated, plus 0 inactivated
  Belgian subset for medical problems in patient health records refset files records refset	22 20	0 records added/updated, plus 22 20 inactivated
  Belgian subset for Vaccination Simple Refset	2	2 records added	/updated, plus 0 inactivated
  Belgian subset for Allergy Intolerance Causative Agent Drug Simple Refset	3	0 records added	/updated, plus 3 inactivated
  Belgian subset for Allergy Intolerance	Causative Agent Non-Drug Simple Refset	2	0 records added	/updated, plus 2 inactivated
  Belgian subset for Allergy Intolerance Manifestation Simple Refset files	0	0 records added
  Metadata .json file	n/a	New field added - "previousPublishedPackage"

  4 Technical notes

  4.1

  /updated, plus 0 inactivated

  Technical notes

  Known Issues

  Known Issues are content or technical issues where the root cause is understood, and the resolution has been discussed and agreed but has yet to be implemented.  This can be due to a number of reasons, from lack of capacity within the current editing cycle, to the risk of impact to the stability of SNOMED CT if the fix were to be deployed at that stage in the Product lifecycle.  

  For the SNOMED CT Managed Service - Belgium Extension Release, the following Known Issues were identified, and agreed to be resolved in the next editing cycle:

  
  

  Scroll Table Layout
  orientation default sortDirection ASC repeatTableHeaders default style Resolved Issues Table widths 10%,30%,50%,10% sortByColumn 1 tableStyling confluence sortEnabled false cellHighlighting true

  Jira
  server IHTSDO JIRA columnIds issuekey,summary,description,priority columns key,summary,description,priority maximumIssues 200 jqlQuery filter = "MS (BE) 20230515 - Known Issues" ORDER BY key ASC serverId b202d822-d767-33be-b234-fec5accd5d8c

  4.2

  Technical notes

  New Refsets

  Please be aware that the following new files have been added to the Belgium Extension Release package, representing the new refsets being introduced in this editing cycle:

  • (no new refsets added this cycle)

   Deprecated Refsets

  Please be aware that the following refset files have been removed from the Belgium Extension Release package, as per the Deprecation process confirmed in previous editing cycles:

  • der2_Refset_SubsetForPocFhirCausativeAgentNoDrugSimpleRefsetFull_BE1000172_20221115.txt
  • der2_Refset_SubsetForPocFhirCausativeAgentNoDrugSimpleRefsetSnapshot_BE1000172_20221115.txt
  • der2_Refset_SubsetForPocFhirManifestationSimpleRefsetFull_BE1000172_20221115.txt
  • der2_Refset_SubsetForPocFhirManifestationSimpleRefsetSnapshot_BE1000172_20221115.txt
  • der2_Refset_SubsetForPocFhirNoAllergySimpleRefsetFull_BE1000172_20221115.txt
  • der2_Refset_SubsetForPocFhirNoAllergySimpleRefsetSnapshot_BE1000172_20221115.txt

  This completes the Deprecation of the following three refsets, which will not be published again as part of the Belgium Extension release:

  1. Belgian POC FHIR no allergy Refset (741000172102)
  2. Belgian POC FHIR causative agent, no drug Refset (751000172100)
  3. Belgian POC FHIR manifestation Refset (731000172109)

  Package Naming Convention

  Please also be aware that as of the November 2022 Release of the BE Extension onwards, the RF2 package naming convention has been changed in order to bring it in line with the naming standards across all Managed Service products.  This is being changed from:

  • • SnomedCT_BelgiumExtensionRF2_PRODUCTION_[date]T[time]Z.zip

  ...to the following:

  • • SnomedCT_ManagedServiceBE_PRODUCTION_BE1000172_[date]T[time]Z.zip

  
  

  So, for the May 2023 BE Extension Release, for example, the RF2 package would have originally been called:

  • • SnomedCT_BelgiumExtensionRF2_PRODUCTION_20230515T120000Z.zip

  ...whereas from now on it will instead be called:

  • • SnomedCT_ManagedServiceBE_PRODUCTION_BE1000172_20230515T120000Z.zip
  4.3  Notice

   Notice of changes to the International Edition Release Schedule

  As you may already know SNOMED International have transitioned to a monthly delivery schedule for the International Edition of SNOMED CT. The move towards more frequent releases of SNOMED CT realizes several benefits, including:

  • The potential to be able to get content changes into the terminology in a shorter time frame.
  • The fostering of better interoperability, as a result of entities being able to consume release content that is more aligned with other organizations.
  • The prevention of circular dependencies that occur in longer projects, due to the move towards smaller, more manageable authoring projects.
  • More automated validation services, as a result of the inherent removal of the Alpha/Beta stages in the Release cycle.

  Whilst most users will continue unaffected (as they can simply continue to download the releases every 6 months as always), this transition will necessarily involve a few changes to process/packages:

  • Delta files have been removed from both International and Managed Service release packages, including the Belgium Extension.  A Delta Generation service will be provided for those who need it. The Delta Generation Tool allows users to create their own Delta between two fixed release dates - you can find it here:
    • https://github.com/IHTSDO/delta-generator-tool/releases
  • The ICD-O/ICD-10 Maps will continue to be published in each Monthly International Edition release package (in line with that month's content) for the foreseeable future, unless we experience issues with the new process in Production, and they need to be removed at a later date.

  The first monthly Release of the SNOMED CT International Edition was published on the 28th February 2022 with the Delta files having been removed, and therefore they have been removed from the Belgium Extension from the March 2022 Release onwards.

  Please note - While the SNOMED CT International Edition is moving to monthly releases, the Belgium Extension of SNOMED CT will remain on the new bi-annual release schedule of May and November.

  
  

  4.4  Notice of changes to the Belgian Extension Release Dates

  As we have already communicated in a separate notification, the release dates of the Belgian extension have changed.

  From now on the new dates of the six-monthly release of the Belgian extension will be:

  • 15 May
  • 15 November

  This change has been made for organisational organizational reasons, taking into account the availability of our human resources.

  Please note that the release cycle of 6 months remains (for now), only the dates have changed.