1 Introduccio?n
1.1 Generalidades
La terminologi?a SNOMED CT provee un lenguaje comu?n y un medio consistente para indizar, almacenar, recuperar y agregar datos cli?nicos de diferentes especialidades y a?mbitos de atencio?n de la salud.
La International Health Terminology Standards Development Organisation (IHTSDO®) mantiene el disen?o te?cnico y la arquitectura de la terminologi?a, y el contenido de su nu?cleo (que incluye las tablas de conceptos, de descripciones, de relaciones y de historial, asi? como referencias cruzadas a la CIE) y la documentacio?n te?cnica relacionada.
1.2 Propo?sito
Este documento presenta una breve descripcio?n de los cambios realizados en el contenido de la Edicio?n Internacional de SNOMED Clinical Terms® (SCT) de julio de 2016.
Tambie?n incluye anotaciones te?cnicas que detallan algunos problemas conocidos en el contenido o aspectos te?cnicos con causas identificadas pero cuya solucio?n au?n no se ha implementado.
Este documento forma parte de la Edicio?n en castellano correspondiente a octubre de 2016.
1.3 Alcance
Este documento esta? escrito para los fines mencionados anteriormente y no incluye detalles sobre las especificaciones te?cnicas para SNOMED CT ni abarca cada cambio realizado durante la publicacio?n.
1.4 A quie?n se dirige este documento
Este documento esta? dirigido a los Centros Nacionales, Centros Colaboradores de la OMS-FCI, proveedores de historias cli?nicas electro?nicas, desarrolladores de terminologi?as y administradores que deseen conocer los cambios incorporados a la Edicio?n en Castellano de SNOMED CT de abril de 2016.
2 Actividad de desarrollo de contenido
2.1 Resumen
La mejora continua de la calidad y del contenido existente se basa en las solicitudes recibidas a trave?s del Sistema de Presentacio?n de Solicitudes de SNOMED Internacional (SNOMED International Request Submission System, SIRS). Se editaron satisfactoriamente ma?s de 900 solicitudes de cambios con la nueva herramienta de Edicio?n de Conceptos Individuales (Single Concept Authoring Tool, SCA). Adema?s, la Edicio?n Internacional de julio de 2016 continuo? el trabajo impulsado por las contribuciones del proyecto de Terminologi?a Me?dica Convergente de Kaiser Permanente (CMT), la Agencia GMDN (Global Medical Device Nomenclature) y Orphanet para agregar nuevo contenido a SNOMED CT. Adema?s, proyectos prioritarios identificados por los miembros dieron lugar a mejoras en la jerarqui?a de anatomi?a, mientras que otros cabios igualmente impulsados por proyectos se reflejaron en numerosos cambios que incluyeron nuevos agregados y mejoras al contenido existente. En la Edicio?n en Castellano, hay 913.097 descripciones activas, de las cuales 9.167 son nuevas y se crearon en esta edicio?n.
2.2 Contenido nuevo y actualizado
- En total se crearon 2602 conceptos nuevos y se realizaron 2019 cambios a conceptos existentes en la Edicio?n Internacional.
2.2.1 Anatomi?a
Se agregaron 100 nuevos conceptos anato?micos que representan los diferentes cortes de la pro?stata para apoyar las anotaciones para procedimientos de diagno?stico por ima?genes. Los nuevos co?digos esta?n incluidos en el subconjunto de DICOM para informes estructurados.
2.2.2 Escala de evaluacio?n
Se agregaron 750 conceptos nuevos solicitados para la representacio?n de escalas de evaluacio?n y conceptos asociados, como procedimientos y entidades observables relacionadas con el registro de dichas escalas.
2.2.3 Terminologi?a Me?dica Convergente (CMT)
Continuamente se agregan nuevos conceptos.
2.2.4 Odontologi?a
- 2.2.4.1 Cephalometry
Para continuar con las mejoras en la cobertura del dominio de la periodontologi?a, se agregaron ma?s de 90 conceptos asociados a el subconjunto de Odontologi?a.
Se agregaron 23 nuevos conceptos relacionados con la cefalometri?a, un dominio especializado de la odontologi?a, como subtipos de 698965000 |entidad anato?mica inmaterial (estructura corporal)|
2.2.5 Procedimientos de diagno?stico por ima?genes
- Se agregaron 48 nuevos conceptos para representar procedimientos de diagno?stico por ima?genes mediante tomografi?a computarizada de haz co?nico.
Se agregaron 23 nuevos conceptos para representar subtipos de 430447002 |tomografi?a computarizada para planificacio?n de radioterapia (procedimiento)| en localizaciones especi?ficas
2.2.6 LOINC
- Se agregaron 6 nuevos conceptos como apoyo del proyecto de colaboracio?n LOINC – SNOMED CT: 1 concepto de metadatos, 1 atributo del modelo conceptual, 1 te?cnica, 1 proceso fisiolo?gico, 2 propiedades de medicio?n.
2.2.7 Dispositivos me?dicos
Se actualizo? el contenido correspondiente a dispositivos me?dicos para alinearlo con la publicacio?n mensual de GMDN hasta abril de 2016, inclusive. Esto dio lugar a la incorporacio?n de 208 conceptos nuevos. El vi?nculo con GMDN se representa en un fichero de referencias cruzadas simples y tambie?n es congruente con la actualizacio?n mensual de GMDN hasta abril de 2016. El trabajo futuro incluira? la resolucio?n de conceptos duplicados.
2.2.8 Organismos
Se agregaron 205 conceptos nuevos para facilitar la realizacio?n de informes de resultados microbiolo?gicos (en las jerarqui?as Organismo y Hallazgo). Este cambio se produjo como resultado de las peticiones de cambio del SIRS, el ana?lisis de las deficiencias de la cobertura del contenido identificadas en el NRC Refset (como componente del ana?lisis retrospectivo luego del cierre del proyecto de informes microbiolo?gicos) y recomendaciones realizadas por el proyecto Redisen?o del a?rea sema?ntica de Organismos y de Enfermedades Infecciosas.
2.2.9 Productos farmace?uticos/biolo?gicos
Tareas menores de mantenimiento.
2.2.10 Procedimientos
- Se agregaron nuevos subtipos de 228615008 |provisio?n de transporte (procedimiento)|
2.2.11 Sustancias
Tareas menores de mantenimiento.
2.2.12 Trastornos
Como resultado de la colaboracio?n con Orphanet. (http://www.orpha.net/consor/cgi-bin/index.php), se crearon ma?s de 500 conceptos para representar enfermedades raras.
2.2.13 Varios
De acuerdo con las solicitudes a los SIRS, se agregaron conceptos en diversas jerarqui?as.
2.3 Content Quality Improvement
2.3.1 Anatomy
- Changes made to 50 bone marrow concepts resolve the reported issue of redundant stated relationships for osteomyelitis concepts; i.e. bone marrow should not have a relationship to bone structure since bone marrow disorders are not considered to be musculoskeletal disorders.
- Changes made to over 70 concepts have fixed incorrect inferences, missing relationships and duplications. The concept model for abnormal shortening conditions by 'structure' anatomy concepts has undesirable inference results, e.g.Congenital short growth of innominate artery and Congenital short urethra are subconcepts of Congenital short trunk. The revision of the concept model has applied abnormal shortening only for 'entire' or 'part' body structures.
2.3.2 Disorders
- Modeling was updated for approximately 60 concepts with pattern |Allergy to X (disorder)| to correct an issue related to inference of more general |Causative agent| attributes. This work will continue with more concepts being updated in a similar manner for the January 2017 release.
2.3.3 Findings
- A number of changes were made as quality improvements based on SIRs requests.
2.3.4 Substances
- Minor maintenance only
2.3.5 Various
Where concepts include "Human papilloma virus" in the FSN, these have been inactivated and the FSN replaced with the new spelling of "Human papillomavirus". The current terminology for Papillomavirus as described by the International Committee on Taxonomy of Viruses (ICTV) is a single word string, i.e. Papillomavirus. Additional descriptions with 'papilloma virus' have not been inactivated; new descriptions that use 'papilloma virus' were not added where they did not already exist.
2.4 SNOMED CT derived products
2.4.1 ICD-10 map
The SNOMED CT to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (© World Health organisation 1994) 2010 Version map (SNOMED CT to ICD-10 Map) is included in the SNOMED CT International release as a Baseline. The SNOMED CT to ICD-10 Map was created to support the epidemiological, statistical and administrative reporting needs of IHTSDO member countries and WHO Collaborating Centres.
The SNOMED CT to ICD-10 Map is released in Release Format 2 (RF2) only. It is located in the file der2_iisssccRefset_ExtendedMapFull_INT_20160731.txt, which is in the Map folder under Refset, in each of the three RF2 Release Type folders.
The SNOMED CT to ICD-10 Map is released as Refset 447562003 |ICD-10 complex map reference set (foundation metadata concept)|.
2.4.1.1 Content development activity summary
The map is a directed set of relationships from SNOMED CT source concepts to ICD-10 target classification codes. The SNOMED CT source domains for the MAP are limited to subtypes of 404684003 |clinical finding|, 272379006 |event| and 243796009 |situation with explicit context|. The target classification codes are ICD-10 2010 release.
2.4.1.2 Mapped content for July 2016
The map provided for the July 2016 release has been updated, and now represents a complete map from SNOMED CT International release to ICD-10 2010 version. We would welcome feedback on any issues that users of the map may detect when using the map. Issues should be submitted via mapping@ihtsdo.org
2.4.2 ICD-9-CM map
IHTSDO produced a SNOMED CT to ICD-9-CM Epidemiological and Statistical Map with each SNOMED CT International Release. The artifact provided a map from a clinical statement expressed in SNOMED CT to a target code(s), or in some cases no target, in the ICD-9-CM classification. The SNOMED CT to ICD-9-CM Epidemiological and Statistical Map includes maps from the SNOMED CT Clinical Findings to ICD-9-CM 2012, the last updated version.
The World Health organisation stopped maintenance of ICD-9 in the 1990s when ICD-10 came into use by the WHO Member States. The United States (U.S.) National Center for Health Statistics (NCHS) is responsible for maintenance of the clinical modification (CM) of ICD-9. The last regular, annual update to ICD-9-CM code was on October 1, 2011.
In view of the legacy nature of the classification, a deprecation process has been followed, to remove the SNOMED CT to ICD-9-CM Epidemiological and Statistical Map from the International edition. The deprecation notice and documents can be found here: https://confluence.ihtsdotools.org/display/PL/Deprecation
The SNOMED CT to ICD-9-CM map has therefore been deprecated without support, as of the July 2016 International edition. The Static version of the map (based on the January 2016 content) is available on the IHTSDO MLDS distribution site (https://mlds.ihtsdotools.org/#/ihtsdoReleases), for any users who wish to access it during their transition to SNOMED CT or ICD-10-CM.
3 Technical notes
3.1 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 July 2016 International edition, the following Known Issues were identified, and agreed to be resolved in the next editing cycle (to be published in January 2017):
3.2 Resolved Issues
Resolved issues are Known Issues which were not fixed as part of the previous release lifecycle, but which have now been resolved in the latest release - in this case the July 2016 International Edition. They can also be issues found during the Alpha and Beta testing of the current release, which were resolved before the final deployment of the associated Member release. Finally they can be issues which were reported or found during the testing phase, but which have been closed without any action taken.
The Resolved Issues for the Snomed CT July 2016 International edition can be found here:
3.3 Technical updates
Complex map files
In line with the ICD-9-CM deprecation process described in section 2.4.2 above, the complex map files have been removed from the RF2 release package. This is because the ICD-9-CM map constituted the entirety of the complex map files, and as this map has now been deprecated, there is no longer a use case to include the complex map files. The same applies to the ICD9 CrossMaps files in the RF1 package, which have been removed for the same reason.
RF1 package
In line with the RF1 deprecation plan approved by the General Assembly in October 2015, IHTSDO will take a new approach to generating qualifying relationships in the RF1 distribution of the SNOMED CT International Edition.
The scope of qualifying relationships in the July 2016 International Edition will be limited to Lateralization Qualifying Relationships in the Body Structure hierarchy. The conversion utility will take a RF2 Laterality reference set as its input. The RF2 Laterality reference set will be available from the IHTSDO Licensing and Distribution system (MLDS). The approach also removes qualifiers not related to body structures because these cannot be reproduced algorithmically. This approach is required so that the new algorithmic derivation of RF1 files from the authoritative RF2 distribution can be run independently of IHTSDO from 2017 onwards.
File types now removed from the RF1 package
The following files will be removed from the RF1 package, as they are incompatible with the new algorithmic RF1 conversion process, which (as detailed above) needs to be self-contained going forward:
- res1_DualKeyIndex_Concepts-en-US_INT_[date].txt
- res1_DualKeyIndex_Descriptions-en-US_INT_[date].txt
- res1_WordKeyIndex_Concepts-en-US_INT_[date].txt
- res1_WordKeyIndex_Descriptions-en-US_INT_[date].txt
- res1_Canonical_Core_INT_[date].txt
- der1_CrossMaps_ICDO_INT_[date].txt
- der1_CrossMapSets_ICDO_INT_[date].txt
- der1_CrossMapTargets_ICDO_INT_[date].txt
Resource Filename update
The naming convention for the Stated Relationship to OWL resource file has been updated from “tls2_StatedRelationshipsToOwlKRSS_INT_[date].pl” to “tls2_StatedRelationshipsToOwlKRSS_Script_INT_[date].pl”
RF2 package format
For future reference, the RF2 package convention dictates that it contains all relevant files, regardless of whether or not there is content to be included in each particular release. Therefore, the package contains a mixture of files which contain both header rows and content data, and also files that are intentionally left blank (including only a header record). The reason that these files are not removed from the package is to draw a clear distinction between
- ...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in this or future releases, and
- ...files that just happen to contain no data in this particular release (and are therefore included in the package but left blank, with only a header record), but are still relevant to RF2, and could therefore potentially contain data in future releases.
This allows users to easily distinguish between files that have purposefully been removed or not, as otherwise if files in option 2 above were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.
Approvals
Final Version | Date | Approver | Comments |
---|---|---|---|
1.00 | 20160629 | Lesley MacNeil | Release Notes (including Technical notes) approved |
Download .pdf here: doc_SnomedCTReleaseNotes_Current_en-US_INT_20160731.pdf
Draft Amendment History
Version | Date | Editor | Comments |
---|---|---|---|
0.01 | 20160512 | Monica Harry | First draft for review and comment |
0.02 | 20160513 | Monica Harry | Amended as per Ian's comments |
0.03 | 20160513 | Monica Harry | Content notes approved by Ian |
0.04 | 20160516 | Andrew Atkinson | Technical notes created |
0.05 | 20160518 | Ian Green | Approved Beta Release Notes |