© 2024 International Health Terminology Standards Development Organisation. All rights reserved. SNOMED CT® was originally created by the College of American Pathologists. This document forms part of the International Edition release of SNOMED CT® distributed by International Health Terminology Standards Development Organisation, trading as SNOMED International, and is subject to the SNOMED CT® Affiliate License, details of which may be found at https://www.snomed.org/snomed-ct/get-snomed. No part of this document may be reproduced or transmitted in any form or by any means, or stored in any kind of retrieval system, except by an Affiliate of SNOMED International in accordance with the SNOMED CT® Affiliate License. Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. Any copy of this document that is not obtained directly from SNOMED International [or a Member of SNOMED International] is not controlled by SNOMED International, and may have been modified and may be out of date. Any recipient of this document who has received it by other means is encouraged to obtain a copy directly from SNOMED International [or a Member of SNOMED International. Details of the Members of SNOMED International may be found at http://www.snomed.org/members/].
Page At A Glance
Table Of Contents
Introduction
Background
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.
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.
Purpose
This document provides a summarized description of the content changes included in the June 2022 release of SNOMED Clinical Terms® (SCT) International Release.
It also includes technical notes detailing the known content or technical issues where the root cause is understood, the fix has been discussed and agreed to, but has yet to be implemented.
The SNOMED International Release Notes are available alongside the June 2022 International 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.
Audience
The audience includes National Release Centers, WHO-FIC release centers, vendors of electronic health records, terminology developers and managers who wish to have an understanding of changes that have been incorporated into the June 2022 International release.
Please note, you may have to register for a Confluence user account in order to access the links included in these release notes.
Changes to the International Edition Release Schedule
NOTICE
SNOMED International have transitioned to a more frequent (monthly) delivery schedule for the International Edition of SNOMED CT. The move towards more frequent releases of SNOMED CT will realise 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 necessarily involved a few changes to process/packages:
- The Member Release period is no longer be required within the new rapid monthly release schedules. If you would like to continue assisting in the validation efforts of SNOMED CT there are other ways in which you can help - please contact support@snomed.org to find out more.
- Delta files have been removed from the release package - 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:
- The ICD-0/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.
NOTE: SNOMED International worked closely with Members over the past couple of years to better understand the impact of the proposed model, and have incorporated feedback into the new processes. This was designed to prevent any adverse impact to users, however if you have any further questions or concerns please see the FAQ's here, or contact us on support@snomed.org.
Content Development Activity
Summary
Continuous quality improvement and enhancement of existing content is an ongoing process undertaken by SNOMED International in preparation for every release. The June 2022 International Release has seen a continuation of the work driven by contributions from: Kaiser Permanente i.e. Convergent Medical Terminology (CMT), Global Medical Device Nomenclature Agency (GMDNA), Orphanet and other domain specific collaborations as well as requests received via the Content Request System (CRS).
Additionally quality improvement activities are advanced via project driven initiatives summarized below. Additional work items impacting every release are updates to the SNOMED CT derived maps such as ICD-10 and ICD-O; details are included in these release notes.
Information about editorial decisions may be found in the SNOMED CT Editorial Guide; mapping guidance for ICD-10 can be found here
COVID-19
Content relating to COVID-19 can be viewed here SNOMED CT COVID-19 Related Content
Any concepts in scope for the SNOMED CT to ICD-10 mapping have been mapped and adhere to the World Health Organization current guidelines.
Inactivation Changes
Please see new editorial guidance for changes to concept inactivation values here.
Quality Initiative
The Quality Initiative (QI) project is the implementation of the Quality Strategy. After a successful pilot project for the July 2018 release the next stage has been implemented for subsequent releases including June 2022.
Quality improvement tasks were deployed to improve internal structural consistency and ensure compliance with editorial policy related to the stated modeling of content. Additionally, correction or addition of defining relationships was carried out to accurately reflect current clinical knowledge and ensure the semantic reliability of descriptions associated with a concept.
Changes made for the Quality Initiative in the procedure hierarchy for the June 2022 release are detailed in section 2.7 below.
Body Structure
Internal Part of Mouth Region
Revision of structures within the internal part of the mouth region to include missing subconcepts such as "floor of mouth", "alveolar process", "palatine arch" has been undertaken for the June 2022 release.
Updates to Tendon/Ligament/Nerve of Wrist and/or Hand
Updates have been made to 46 concepts relating to tendons, ligaments and nerves in the wrist and/or hand region.
New Attribute
A new attribute 1230370004 |Is vasculature of (attribute)| has been added and will be used for the modeling of blood vessels of body organs.New Concept 1220633009 |Structure of left coronary artery bifurcation (body structure)
New concepts and model have been added for the left coronary artery bifurcation.
Updates to 714652009 |Structure of sebaceous gland of eyelid (body structure)|
The hierarchical relationships of concepts in the hierarchy 714652009|Structure of sebaceous gland of eyelid (body structure)| have been updated.
Cross-sectional Pelvis and/or Lower Limb
A new concept 1231522001 |Structure of pelvic cross-sectional segment of trunk and/or lower limb (body structure)| has been added to represent a broader body region to meet an imaging requirement.
Updates for Vertebral Column
A small number of concepts have been added for broader unitary vertebral column regions to support imaging requirements. The concepts are represented by the union of two adjacent vertebral column regions,
For example:
1217256009 |Structure of thoracic and/or lumbar vertebral column region (body structure)|
1222683006 |Entire thoracic and lumbar vertebral column region (body structure)|
Related body regions have also been updated. The concept model of the vertebral column and regions can be found here.
SEP and Laterality Anatomy Reference Sets
Updated and validated release file for the lateralizable body structure reference set.
Updated and validated release files for the SEP refsets.
Clinical Finding
NOTE: '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 to' and update the Editorial Guide for this area. The Editorial Guide and all concepts that are currently modeled as 'Co-occurrent and due to' will be updated over future release cycles. |
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Monkeypox
Human monkeypox (disorder) has been inactivated as duplicate to Monkeypox (disorder) as the causative agent of Monkeypox is the same in all species affected. There is no human specific Monkeypox virus.
New concepts related to Monkeypox, including disorders, exposure, and viral nucleic acid have been added to support reporting.
Pigmented Pupuric Dermatosis
A new concept 1230397006 |Pigmented pupuric dermatosis (disorder)| has been created, and subtypes assigned and remodeling and defining relationships added to the concepts. The incorrect synonyms 'pigmented purpuric dermatosis' and 'pigmented purpuric eruption' have been removed from 20343006 |Pigmented purpuric lichenoid dermatitis of Gougerot and Blum (disorder)| as equivalent semantically to new concept 1230397006 |Pigmented pupuric dermatosis (disorder)|.
NOTE: 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. |
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Procedure
Remodel 1202017008 |Surgical procedure using flap (procedure)| Subhierarchy
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 this QI project and remodeled for the June 2022 release.
For the QI project this has involved defining some existing complex flap procedures and related disorders for congenital conditions.
This was achieved by the creation of new concepts for 1231288003 |Congenital anomaly of left lower limb (disorder)|, 1231289006 |Congenital anomaly of right lower limb (disorder)|, 1230024004 |Congenital deformity of lower limb (disorder)|,1230271002 |Congenital deformity of upper limb (disorder)|, 1230357008 |Congenital anomaly of left upper limb (disorder)|, 1230356004 |Congenital anomaly of right upper limb (disorder)| and new procedure 1230067007 |Correction of congenital anomaly (procedure)|. Congenital anomaly of limb disorder(s) are the supertypes for the congenital deformity of limb disorders, and the subtypes now classify accordingly.
While every effort has been made to align with the Template model and Sufficiently Define relevant flap procedure concepts, it is recognized that the area would benefit from the input of domain experts in the future.
Stent Procedures
As part of Quality Initiative work on stent insertion, structural quality improvements have been made to percutaneous transluminal/endovascular procedures to enable this content to be sufficiently defined. This results in improved subsumption to assist with searching, queries and analysis. The work is ongoing over several releases and impacts around 350 concepts. This is a necessary initial step before further work on stenting procedures can take place.
Nursing Procedures
31 new concepts have been added for Nursing procedures.
Inactivation of Grouper Concepts
Grouper concepts in the Procedure hierarchy have been inactivated with reason 'Non-conformance to editorial policy' and Replaced by:
- 410771003 |Surgical procedure for clinical finding and/or disorder (procedure)|
- 408766003 |Procedure with a procedure focus (procedure)|
- 408767007 |Procedure with a clinical finding focus (procedure)|
Remodel 428297005 |Excision of cyst (procedure)|
428297005 |Excision of cyst (procedure)| and its 105 subtypes have undergone structural quality improvement including addition of intermediate primitives and stated attribute-value pairs, where applicable.
Specimen
As part of the Quality Initiative and to conform with editorial guidance regarding descriptions, concepts in the Specimen hierarchy with Fully specified names and Preferred terms containing the word "sample" have been re-termed using the word "specimen". For concepts that included the word "sample" in a description, these descriptions were retained as synonyms.
Qualifier Value
NOTE: Planned Inactivation of 260299005 |Number (qualifier value)| and Descendants 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. |
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Substance
Pharmaceutical/Biological Product
Dose Form Related Changes
| Description | Type of change |
|---|---|
| Stick | Has administration method has been 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)|. |
| Gingival | Existing intended site concept 738943003 |Gingival (intended site)| has been updated to be a subtype of 738982001 |Oromucosal (intended site)|. |
| 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. |
| 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 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. |
| 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. Associated pharmaceutical dose form (PDF) concepts have also been added. |
| 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. |
| Gas | New basic dose form concept, 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.” have been added. Associated pharmaceutical dose form (PDF) concepts have also been added. |
| Elixir | Existing basic dose form 738997003 |Elixir (basic dose form)| has been made a child of 739006009 |Solution (basic dose form)|. |
| Syrup | Existing basic dose form 739009002 |Syrup (basic dose form)| has been made a child of 739006009 |Solution (basic dose form)|. |
| Emulsion | Text definition for existing concept 738998008 |Emulsion (basic dose form)| has been 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)." |
| Tablet | Existing basic dose form concept 761877007 |Effervescent tablet (basic dose form)| has been updated to be a subtype of 385055001 |Tablet (basic dose form)|. |
| Granules | Has dose form transformation 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)| has been updated to be a subtype of 385043007 |Granules (basic dose form)|. |
| Powder | Existing basic dose form concept 762948008 |Effervescent powder (basic dose form)| has been updated to be a subtype of 739005008 |Powder (basic dose form)|. |
| Collodion | Text definition for existing basic dose form concept 385115001 |Collodion (basic dose form)| has been updated to "A liquid dose form consisting of active substance(s) in a mixture of pyroxylin or similar in ether and ethanol.” |
| 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.” have been added. Associated pharmaceutical dose form (PDF) concepts have also been added. |
| 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.”, has been added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts have also been added or updated accordingly. |
| 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.”, has been added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts have also been added or updated accordingly. |
| 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.”, has been added. Associated pharmaceutical dose form (PDF) concepts have also been added. |
| 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.”, has been added.Associated pharmaceutical dose form (PDF) concepts have also been added. |
Physical Object
Collaboration/Harmonization Agreements
Convergent Medical Terminology (CMT)
174 new concepts have been added for the June 2022 release predominately from the domains of musculoskeletal and ophthalmology.
Orphanet
Working in collaboration with Orphanet (http://www.orpha.net/consor/cgi-bin/index.php), creation of new concepts for the original set of prioritized rare diseases has been completed. All of the concepts added for the Orphanet project have been mapped to ICD-10.
The Production release of the SNOMED CT to Orphanet Simple Map was published in October 2021. Work is now underway to add further content to the SNOMED CT to Orphanet Simple Map for future releases starting with the next Production release in October 2022.
ICD-11 Update
The June 2022 release has seen continued addition of content for this project.
International Classification for Nursing Practice
7 nursing concepts were added to support work on the reference set.
Gravity Project
9 concepts were added to support the Gravity Project work.
Cancer Synoptic Reporting
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.
For more information about this project, please see Cancer Synoptic Reporting Clinical Project Group
Internal Quality Improvement
Machine Readable Concept Model (MRCM) Changes
Details for forthcoming changes can be reviewed here
NOTE: Advance Notice of Cardinality Changes Scheduled 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 notice is intended to provide additional time for content updates in national extensions. Please contact info@snomed.org with any inquiries. |
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SNOMED CT derived products
ICD-10 map
The SNOMED CT to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (© World Health Organization 1994) 2016 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 SNOMED International member countries and WHO Collaborating Centers.
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_20200731.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)|.
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 2016 release.
Mapped content for June 2022
The map provided for the June 2022 release has been updated, and now represents a complete map from SNOMED CT International release to ICD-10 2016 version.
392 newly authored concepts have been added and mapped.
The SNOMED to ICD-O (morphology) map has 2 additional concept added as a result of the ICD-O 3.2 review or added due to CRS requests.
We would welcome feedback on any issues that users of the map may detect when using the map. Issues should be submitted via mapping@snomed.org
Technical Guide Exemplars
The Technical Guide Exemplars document has now been moved from the International Edition release package to a Confluence page. This page can be found as part of the ICD-10 Mapping Technical Guide (see Appendix B), which is hosted here: http://snomed.org/icd10map
SNOMED CT to OWL conversion and classification
The repository containing the toolkit enabling simple SNOMED CT to OWL conversion and classification can be found here, including documentation on its use: https://github.com/IHTSDO/snomed-owl-toolkit
Please contact SNOMED International at support@snomed.org if you would like to provide any feedback on ways to extend and improve the new toolkit.
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 time within the new monthly editing cycles, 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 current SNOMED CT International edition, the following Known Issues were identified, and agreed to be resolved in future editing cycles:
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. They can also be issues found during testing of the current release, which were resolved before the final deployment of the Production 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 current SNOMED CT International edition can be found here:
Technical updates
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
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.
Configuration file in the RF2 package, containing Release Metadata
A new file has been included since the July 2020 International Edition, containing metadata about the Release package itself. This has been created in conjunction with feedback from the community, and as such initially contains the following fields:
effectiveTime
- previouslyPublishedPackage
languageRefset(s)
licenceStatement
The file is in .JSON format, to ensure that it is both machine-readable and human-readable, and is named "release_package_information.json".
The metadata will be extended and refined going forward, in order to ensure that it contains the most useful information possible. If you have any ideas about any other useful information to include, please send them to info@snomed.org, along with a business case explaining how the information would benefit stakeholders. Please be aware that this use case will then be assessed by SNOMED International, and the new metadata will only be included in the configuration file if the business case is strong enough.
New Association References
In order to support the Content changes above in section 2.3. Concept Inactivation Changes, the following Association Reference set members have been added to the International Edition from the April 2022 release onwards:
- 1186921001|POSSIBLY REPLACED BY association reference set
- 1186924009|PARTIALLY EQUIVALENT TO association reference set
Early visibility of impending changes in the upcoming 2022 Monthly International Edition releases
Please see the following page for details of all upcoming changes planned for 2022:
Document links
All links provide information that is correct and current at the time of this Release. Updated versions may be available at a later date, but if so these will need to be requested from the relevant SNOMED International teams.
NOTE: To access any of the links in the pdf document, please visit the Release Notes @
Approvals
Final Version | Date | Approver | Comments |
|---|---|---|---|
| 1.0 | Rory Davidson | Approved | |
| 1.0 | Monica Harry | Approved | |
| 1.0 | Kelly Kuru | Approved |
Draft Amendment History
Version | Date | Editor | Comments |
|---|---|---|---|
0.1 |
| Andrew Atkinson | First draft for review and comment |
| 0.2 | Maria Braithwaite Donna Morgan | Initial content updates | |
| 1.0 | Andrew Atkinson | Final Production changes |