Inactivation of 6920004|Defect (morphologic abnormality)|

6920004|Defect (morphologic abnormality)|is planned for inactivation. 286 concepts currently modelled with 6920004|Defect (morphologic abnormality)| will be reviewed and remodelled; this may include inactivation and replacement.

Please see the briefing note for further details.

Update Hierarchy 90708001 |Kidney disease (disorder)|

As part of the Quality Initiative Project, work has commenced on 90708001 |Kidney disease (disorder)|. Work is being undertaken in stages and upcoming sub-hierarchies will be posted here as the work progresses:

• 236423003 |Renal impairment (disorder)| -  In progress

Primary and Metastatic Project - New Metastatic Morphologic Abnormality Concepts

Metastatic disorders will be defined by their specific metastatic neoplastic morphologic abnormality concepts, and new metastatic morphologies are being added to the international edition of SNOMED CT as needed. In cooperation with the Netherlands extension of SNOMED CT, SNOMED International will be promoting certain of their existing metastatic morphology concepts to the International release to be used to model new metastatic disorder concepts. 

Change for Clinical Drug Concepts Containing Pancreatic Enzymes

Clinical drug concepts in the International Release containing pancreatic enzymes will be modeled based on the discrete enzymes; because of variability between real clinical drugs, synonyms representing a total amount in a particular product will not be included in the International Release.

The editorial guide and existing content will be reviewed and updated accordingly in a future release.

Drug Content Analysis Project (DCAP) - Addition of Anti-Infective Clinical Drug Concepts 

DCAP was launched in September 2022 to identify clinical drug concepts that are published in participating National Release Center extensions and that are eligible for promotion to the international release (supported by appropriate references to authoritative source material).

Concepts that are already published in the Norwegian drug extension have been reviewed by multiple countries participating in the group and content eligible for promotion to the international release of SNOMED CT has been identified.

Approximately 100 concepts will be promoted to the international release and corresponding concepts for Medicinal Product (MP) 'containing only', and Medicinal Product Form (MPF) 'containing only' (MP 'containing', and MPF 'containing') will be created in the international release as required.

Planned Inactivation of Subtypes of 129284003 |Surgical action (qualifier value)|

As part of the Quality Initiative, a review has been undertaken of the 129284003 |Surgical action (qualifier value)| hierarchy which has identified:

• 36 concepts with no usage or descendants.
• 4 concepts with 3 or less descendants and no usage.
• 5 concepts with low usage and less than 2 descendants with no usage.

As a result of this review, 45 concepts in the qualifier value hierarchy that are descendants of 129284003|Surgical action (qualifier value)| will be inactivated. The complete list of concepts can be accessed here.

Updates to the Inactivation Reason and Historical Association for 'On Examination' and 'Complaining of' Inactive Content

Many of the 'on examination' and 'complaining of' concepts were previously inactivated with the inactivation reason of |Moved elsewhere| with a historical association value |Extension Namespace 1000000|.

This content will be updated with an inactivation reason of |Non-conformance to editorial policy| and a historical association of |Alternative| to a suitable international concept. 

Update to MRCM

Extend the domain of 246454002 |Occurrence (attribute)| by including << 71388002 |Procedure (procedure)|.

The following is the expected MRCM range after the change.

246454002 |Occurrence (attribute)| << 272379006 |Event (event)| OR << 404684003 |Clinical finding (finding)| OR << 71388002 |Procedure (procedure)|

Inactivation of Concepts that state Delivered/Not delivered

Obstetric content that conflates the delivery status with the disorder of the mother that prompted the admission to hospital will be inactivated.

There are 250 concepts that state the delivery status of the mother within the FSN:

• 198905007 |Placenta previa with hemorrhage - delivered (disorder)|
• 198906008 |Placenta previa with hemorrhage - not delivered (disorder)| 

These concepts are classification derived and are used to record whether the baby was, or was not delivered during that inpatient stay for the care of the mother who has placenta previa with a hemorrhage.

2.

Update for 399248000 |Procedure related to anesthesia and sedation (procedure)|

745638006 |Injection of anesthetic agent (procedure)| and its 283 subtypes will gain a supertype of 399097000 |Administration of anesthesia (procedure)|. 

Inactivation of 415360003 |Severe acute respiratory syndrome-related coronavirus (organism)|

To resolve ambiguity for 415360003 |Severe acute respiratory syndrome-related coronavirus (organism)|, this concept will be inactivated as ambiguous. New concepts will be created to represent the associated strain and species.

840533007 |Severe acute respiratory syndrome coronavirus 2 (organism)| will be a sibling of the “Severe acute respiratory syndrome (SARS) coronavirus” strain and a subtype of the “Severe acute respiratory syndrome-related coronavirus” species.

Current children of 415360003 |Severe acute respiratory syndrome-related coronavirus (organism)|, which represent Severe acute respiratory syndrome (SARS) coronavirus strain subtypes will be inactivated using "Outdated component" as the inactivation reason with a "Replaced by" association to the concept representing “Severe acute respiratory syndrome (SARS) coronavirus."

Details of the change can be found in this Briefing Note.

Planned Inactivation of Concepts in the 260299005 |Number (qualifier value)| Hierarchy

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.

Remodeling of 771527003|Structure of synovial sac (body structure)| and Subtypes

The content in this area is being updated to align with this model.

Inactivation of 118222006 |General finding of observation of patient (finding)|

118222006 |General finding of observation of patient (finding)| is a high level finding with little clinical value.  The concept will be inactivated with an inactivation target of Clinical finding.  Descendants count is 4237 concepts. 

Update to 307159006|Pregnancy time period (qualifier value)| and Subtypes

Concepts referring to temporal periods for pregnancy and birth (307159006 Pregnancy time period (qualifier value) and subtypes) will be updated with the addition of a small number of concepts to make this area of content more comprehensive.

A new concept which explicitly covers 'maternal antenatal and/or intrapartum and/or postpartum period’ will be added.

Definitions will be added to aid modeling and interpretation.

Update to MRCM

Extend the range of 719722006 |Has realization (attribute)| by including 71388002 << |Procedure (procedure)|, << 272379006 |Event (event)|, << 404684003 |Clinical finding (finding)|.

Please see here

Inactivation of "X by body site" concepts in various hierarchies

Concepts that include "X by body site" in multiple hierarchies are being inactivated, e.g., 371571005 |Imaging by body site (procedure)| and 301810000 |Infection by site (disorder)|, because they are classification groupers with no clinical use.

Neoplasm of Connective and Soft Tissue Disorders

Around 30 concepts which include “neoplasm of connective and soft tissue" in their FSN will be inactivated as "Classification derived component." 

Measurement Findings

The next set of changes for measurement findings content will involve the positive and negative results content (~150 concepts). Measurement findings concepts which include 'positive' or 'negative' in the FSN will be updated as follows:

1) The FSN and PT will be updated to include 'detected' or 'not detected.' Existing descriptions with 'positive' or 'negative' will be retained as synonyms.
2) The Has interpretation value of 10828004 |Positive (qualifier value)| or 260385009 |Negative (qualifier value)| will be updated to 260373001 |Detected (qualifier value)| or 260415000 |Not detected (qualifier value)|.

Please see the briefing note (20221116 BN Positive_Negative measurement findings.pdf) for more information.

Metastatic Content with 'Involving' and 'Metastasis to X of Unknown Y'

Approximately 75 disorder concepts of the type 'Malignant tumor involving [x structure] by [separate] metastasis from [y structure]' and 30 disorder concepts of the type 'Metastasis to [x structure] of unknown primary' will be inactivated.

Examples:

369554006 Malignant tumor involving right fallopian tube by separate metastasis from left fallopian tube (disorder)
285643007 |Metastasis to adrenal gland of unknown primary (disorder)|

The current Editorial Guidance indicates that the primary malignancy and the metastatic malignant neoplasm should be recorded using two separate SNOMED CT concepts, and these replacements will be provided as inactivation target values, and if not available they will be created.

Remodel 16356006|Multiple pregnancy (disorder) to Become Subtype of 77386006 |Pregnancy (finding)|

16356006|Multiple pregnancy (disorder) will be updated to a clinical finding with a semantic tag of (finding) and a subtype of 77386006 |Pregnancy (finding)|.

Current subtypes of 16356006|Multiple pregnancy (disorder) will be reviewed as some subtypes should retain the semantic tag ‘disorder’ where the concept meets the criteria of being always and necessarily an abnormal clinical state.

A new parent will be assigned designated by whether the semantic tag has been changed.

Primary and Metastatic Project - New Primary Malignancy Disorders

Approximately 150 new primary malignancy disorders will be added to SNOMED CT.

Inferred subtypes of 372087000 |Primary malignant neoplasm (disorder)| that were assigned by the classifier based on the morphology hierarchy (now revised), but which did not state primary in the FSN ('agnostic') have been reviewed.  

These previous subtypes of 372087000 |Primary malignant neoplasm (disorder)| will have a new subtype concept added that states 'primary' to provide an option for selection by clinicians.

Inactivation of 307844003 |Minor surgery status (finding)| and Subtypes

Concepts that have explicit context should be in the situation hierarchy. Therefore 307844003 |Minor surgery status (finding)| and 5 subtypes with context "done" + a procedure will be inactivated.

One concept 314471005 |Minor surgery done (finding)| will be inactivated and replaced by 1268934004 |Minor surgery done (situation)|.

Concepts in various hierarchies (including Procedure, Clinical finding, Observable entity, Event and Specimen), which are defined by the stated attribute value of "105590001 |Substance (substance)|" are being reviewed.

Many of these concepts are being remodeled by removing the attribute/value relationship—provided that this change doesn’t result in a change to the meaning of the associated concepts. Some of these concepts may need to be remodeled with a more specific substance.

Some of the grouper concepts will be inactivated—specifically the groupers that are classification derived and/or have only one subtype. This change is part of the Substance-Drug project and will allow for the correct subsumption of the subtypes, if and once the attribute values are changed to subtypes of 373873005 |Pharmaceutical / biologic product (product)|.