Introduction

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

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

Background

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

It will also includes include 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 not yet to be been implemented.

This Sweden Extension package is dependent upon, and should therefore be consumed in conjunction with the SNOMED CT® January CT® July 2023 International Edition release.

Scope

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

Content Development Activity 

Summary

Content from the SNOMED CT® January  July 2023 International Edition release has been translated and additional concepts and synonyms have been added for use in Sweden have been added. Some areas for which new concepts and synonyms have been added are:

• Collaboration and Harmonization
  • Work with National Collaboration Groups (NAG för användning av Snomed CT , Strukturerad vårdinformation patologiand Nationella kvalitetsregister) has been ongoing to develop Swedish content and improve the quality of Swedish translations 
    • For more information about "strukturerad vårdinformation patologi", see https://kunskapsstyrningvard.se/kunskapsstyrningvard/programomradenochsamverkansgrupper/nationellasamverkansgrupper/nsgstruktureradvardinformation/struktureradvardinformationpatologi.56159.html
    • Work with the healthcare regions to develop content in the Swedish extension has been ongoing to develop new content and improved translations. For more information about "NAG för användning av Snomed CT", see https://kunskapsstyrningvard.se/kunskapsstyrningvard/programomradenochsamverkansgrupper/nationellasamverkansgrupper/nsgstruktureradvardinformation/snomedct.56158.html
  • Work with pathology content from international working groups.
  • Work with professional societies (Dietisternas Riksförbund, Svensk sjuksköterskeförening) has been done to improve the quality of the Swedish translations .
  • The final concepts from Nutrition Care Process Terminology (NCPT) and Snomed International's collaboration agreement have been translated.  For more information, see https://www.snomed.org/our-partnerships/academy-of-nutrition-and-dietetics 
  • International Diet Dysphagia Standardisation Initiative (IDDSI) has incorporated IDDSI Framework v2.0 content into SNOMED CT. For more information, see https://www.snomed.org/our-partnerships/international-diet-dysphagia-standardisation-initiative.
  The ICNP Swedish language type reference set is updated to reflect the International Classification of Nursing Practice (ICNP) Reference Set. For more information, see ICNP SNOMED CT Nursing Practice Refset Release Notes - July 2022in these areas.
  • Work with national and local stakeholders to update content in various reference sets. 

• Quality Assurance

  • Work has been done to reduce duplicate terms, update modeling of content, and address other quality issues in the Swedish translation.  A few areas work has been done to improve Swedish content are listed below. For more detailed information about these areas below visit https://www.socialstyrelsen.se/kunskapsstod-och-regler/omraden/e-halsa/snomed-ct/ and see our "Principbeslut" attached to "Språkliga riktlinjer för översättningen av SNOMED CT till svenska".

    • Substance "abuse", misuse and dependency has new updates in translations

    • Assistive walking aids "wheeled walker" investigation and updated translations.

    • "At increased risk" content has updated translations.
    • "Osteoarthritis" content has updated translations.
    • "Chemotherapy" content has updated translations. 

Concept statistics

New and Updated Content

New concepts: 5851

Table 1 New concepts by hierarchy

Descriptions statistics

New descriptions: 6017 6190
Inactivated descriptions: 507273
Re-activated descriptions: 51
New translations: 5941 5224

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

Reference sets

No new reference sets.

Updated simple reference sets:

• 500061000057107 |Microorganism result reference set|
• 500121000057102 |Specimen type 60001000052100 |Chief complaints reference set|
• 500221000057105 |Care service reference set|67081000052106
• |Medical specializations simple type 60001000052100 |Chief complaints reference set|
• 68581000052104 |Occupation reference set|
• 67031000052107 |Licensed occupations simple type reference set|62151000052104 |Route
• of administration reference set, Swedish national medication list63181000052104 |Laboratory analysis method reference set |

Updated language reference sets:

• 64311000052107 |Chief complaints context language type reference set|
• 83461000052100 |ICNP Swedish language type reference set|
• 63451000052100 |Common-language expression language type reference set, Swedish national medication list|
• 63461000052102 |Context-specific terms 500191000057100 |Laboratory medicine context language type reference set, Swedish national medication list|
• 63481000052108 |Dose unit plural language type reference set, Swedish national medication list|
• 63491000052105 |Dose unit abbreviation language type reference set, Swedish national medication list|
• 113491000052101 |Care service context language type reference set|

Simple reference sets with all members removed:

• 60421000052103 |Body weight reference set| 
• 59761000052100 |Marital status reference set| 
• 60411000052106 |Body temperature reference set| 
• 60401000052109 |Body height reference set| 
• 60391000052106 |Diastolic blood pressure reference set| 
• 60381000052109 |Systolic blood pressure reference set| 
• 46051000052106 |Lifestyle reference set| 
• 64641000052102 |Severe mental disorder simple type reference set|
• 58181000052100 |Means of contact reference set|
• 63421000052107 |Means of contact between patient and certificate producer reference set|
• 73171000052105 |Edema as sign of heart failure reference set|

Technical notes

Known Issues

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

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

Technical notes

Deprecated Refsets

The following refsets are being deprecated from the Sweden Extension Release package from November 2023 onwards.

• 60421000052103 |Body weight reference set| 
• 59761000052100 |Marital status reference set| 
• 60411000052106 |Body temperature reference set| 
• 60401000052109 |Body height reference set| 
• 60391000052106 |Diastolic blood pressure reference set| 
• 60381000052109 |Systolic blood pressure reference set| 
• 46051000052106 |Lifestyle reference set| 
• 64641000052102 |Severe mental disorder simple type reference set|
• 58181000052100 |Means of contact reference set|
• 63421000052107 |Means of contact between patient and certificate producer reference set|
• 73171000052105 |Edema as sign of heart failure reference set|

• 93501000052104 |Recommended actions for entering the labour market reference set|
• 83551000052104 |Job support program activities reference set|

For this November 2023 release, the inactive Refset files have been completely removed from the Sweden Extension Release package.

Note:  However, the RefsetDescriptor record(s) for these deprecated Refsets remain in the package (and remain active), as the Descriptor patterns themselves are still valid, and therefore standard practice dictates that they remain in place.

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

Notice of changes to the International Edition Release Schedule

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

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

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

• Delta files have been removed from both International and Managed Service release packages, including the Sweden Extension.  A Delta Generation service will be provided for those who need it. The Delta Generation Tool allows users to create their own Delta between two fixed release dates - you can find it here:
  • https://github.com/IHTSDO/delta-generator-tool/releases

• The ICD-O/ICD-10 Maps will continue to be published in each Monthly International Edition release package (in line with that month's content) for the foreseeable future, unless we experience issues with the new process in Production, and they need to be removed at a later date.

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

Please note - While the SNOMED CT International Edition is moving to monthly releases, the Sweden Extension of SNOMED CT will remain on the current bi-annual release schedule of May and November for 2023.

Changes to the Identifier file format

In line with the proposals documented here:  https://confluence.ihtsdotools.org/mag/snomed-international-proposal-to-change-the-rf2-identifier-file-specification - the Sweden Extension Release will from now on include the following changes to the format of the Identifier files:

• < identifierSchemeId    alternateIdentifier    effectiveTime    active    moduleId    referencedComponentId           ...to
• > alternateIdentifier    effectiveTime    active    moduleId    identifierSchemeId    referencedComponentId

These improvements are introduced in the November 2023 Sweden Extension release, and will be used in all future Sweden Extension releases until further notice.