July 2021 Early Visibility Release Notice - Planned changes to upcoming SNOMED International Release packages

COVID-19 Content

Content relating to COVID-19 can be viewed here SNOMED CT COVID-19 Related Content

July 2021 International Release and future releases

Browse Content Changes for the July 2021 Release

The daily build is available to review changes made to content for the July 20201 release https://dailybuild.ihtsdotools.org/

Forthcoming concept inactivations, new concepts and changes to existing concepts can be reviewed using the tab 'Daily build.'

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: https://confluence.ihtsdotools.org/display/IAP/Revision+of+IS-A+relationships+for+anatomy

July 2021 International Release and future releases

MRCM Changes

MRCM changes will be posted here when available.

Quality Initiative

Information about the project can found here - Quality Initiative - Progress

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

Breeds

There are >3000 concepts in the organism hierarchy related to various breeds.

These concepts will be inactivated from the International release and moved to the veterinary extension. Based on the editorial guidelines, breeds are restricted to the veterinary domain. 

Nutrition Content

• Addition of ~165 nutrition observable entity concepts.
• Review and remodeling of ~140 diet (regime/therapy) concepts
• Further information about the work of the Nutrition Care Process Clinical Project group is available here.

Updates for Teletherapy and Teleradiotherapy Concepts

• ~60 concepts which include "teletherapy" or "teleradiotherapy" in the FSN will be updated to include "external beam radiation therapy." Descriptions with "teletherapy" and "teleradiotherapy" will be retained.
• ~7 concepts which include "external beam" in the FSN will be modified to include "external beam radiation therapy" in the FSN.
• 49569001 |Consultation in teletherapy (procedure)| will be inactivated and replaced with a new concept: "Consultation in external beam radiation therapy (procedure).

Update to 271422003 |Fit denture (procedure)|subhierarchy

• Following discussions with the Dentistry CRG the concepts in this subhierarchy will be remodeled with the finding site of 28035005 |Structure of teeth, gums, and supporting structures (body structure)|or a subtype.
• Ambiguous concepts will be inactivated and replaced e.g. 6502003 |Complete lower denture (procedure)| will be replaced by 1144276002 |Fitting of complete lower denture (procedure)|.
• This will require changes to ~25 concepts, which will include ~15 inactivations.

41969006 |Idiopathic disease (disorder)

The almost 350 disorder concepts that specify ‘idiopathic’ in the FSN will be remodeled to have 41969006 |Idiopathic disease (disorder)| as a supertype. 

Inactivation of 3 ambiguous concepts in the body structure hierarchy: 

303295006 |Choroidal and/or retinal structures (body structure)| 

721949003 |Structure of choroid and/or retina of left eye (body structure)| 

721948006 |Structure of choroid and/or retina of right eye (body structure)|

• Disorder/procedure concepts which use these anatomic structures were remodeled with 2 role groups, one representing the finding site of 68703001 |Choroidal structure (body structure)| and the other for the 5665001 |Retinal structure (body structure)|.

• Majority of modeling changes were for ‘chorioretinal’ disorder concepts, findings and procedures.

• 3 procedures were remodeled plus one inactivation of 75278007 |Destruction of chorioretinopathy (procedure)|.

• Approximately 54 disorder concepts were remodeled, including 53854005 |Chorioretinal scar (disorder)| and its 18 subtypes. Two concept inactivations 69811008 |Peripheral disseminated choroiditis AND chorioretinitis (disorder)| and 56787009 |Peripheral focal choroiditis AND chorioretinitis (disorder)|.

• New anatomy concepts created 1137449006 |Structure of posterior pole of left eye (body structure)| and 1137450006 |Structure of posterior pole of right eye (body structure)|.

• Approximately 30 clinical finding concepts were remodeled including 9 subretinal findings and 7 subretinal disorders all remodeled with a finding site of 41275009|Structure of retinal pigment epithelium (body structure)|.

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:

1. The request for new content must be accompanied by a rationale as to the difference between "X disorder without Y disorder" and "X disorder."
2. 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

Please contact info@snomed.org with any inquiries.

Content Improvements in the Physical object Hierarchy

Please see project roadmap and briefing notes here: https://confluence.ihtsdotools.org/display/IAP/Devices+Project

Content inactivations are planned for July 2021 International release:

• Inactivation of ~1200 physical object concepts that include use frequency (e.g., "single use catheter")
• Inactivation of ~600 physical object concepts that include a size or dimension (e.g., "30 cm catheter")

Please contact info@snomed.org with any inquiries.

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 for 'Has ingredient characteristic’ and 'Has product characteristic’ and 'Has device characteristic' attributes

Based on guidance provided by the Editorial Advisory Group, the 'Has ingredient characteristic', 'Has product characteristic' and 'Has device characteristic' attributes will be refined to more specific attributes in a future release.

Concrete Domains and Numeric Representation

The Modeling Advisory Group is working on concrete domains and how they will be represented in the inferred RF2 relationship file format. The following is a note on the interim solution relating to concrete domain for the medicinal product model:

Numerics are represented by concepts in the Medicinal product concept model in SNOMED CT, which is an interim solution before the implementation of concrete domains to support data types, such as decimal, integer, string and date/time. We are in progress for the development of the specification for the inferred relationship file and consult with the community of practice. When they are ready, strength in medicinal product model can be transformed to concrete domains. The transformation will be completed by technical changes without impact to classification results.

The further information about current progress on Concrete Domains can be found at:

https://confluence.ihtsdotools.org/display/mag/Modeling+Advisory+Group 

Replacement of the Stated Relationship files with the new OWL Axiom refset files

A set of documentations has been developed to support the Logic Profile Enhancements. 

• SNOMED DL Profile Enhancements
• SNOMED CT Logic Profile Specification
• SNOMED CT OWL Guide (OWL Refsets specification)
• Snomed OWL Toolkit - https://github.com/IHTSDO/snomed-owl-toolkit
• Classifying SNOMED CT using the Snomed OWL Toolkit - https://youtu.be/-91egY9mJqA
• Creating an OWL file containing SNOMED CT - https://youtu.be/sfFbMMioA_4

For any questions, please contact SNOMED International at support@snomed.org with “OWL Axiom refset files implementation question” in the subject line.