© 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[or a Member of SNOMED International] is not controlled by SNOMED International, and may have been modified and may be out of date.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 July 2024 release of SNOMED Clinical Terms® (SCT) International Edition.
It also includes 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 July 2024 International Edition.
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.
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 July 2024 International Edition.
Please note, you may have to register for a Confluence user account in order to access the links included in these release notes.
Important Information
NOTICE
IMPLEMENTED JUNE 2024 RELEASE - CHANGES TO THE ANNOTATIONS REFSET FORMAT
After discussions with the community, SNOMED International has made changes to the coverage of language in the Annotations refsets in the following way:
- The languageCode field was specified as the two characters of ISO-639-1 code for the language of the annotation text. The change is to include support for specifying dialect when it is applicable by adhering to RFC 5646, which allows the combination of two characters of ISO 639-1 code and two uppercase letters of country code (ISO 3166) separated by a hyphen.
- The column "languageCode" has therefore been changed to "languageDialectCode".
- The concept 1296895003|Language code (foundation metadata concept)| has been inactivated and replaced by 1304275002 |Language or dialect code (foundation metadata concept)|
- The changes apply to both the Member Annotations String Value Reference Set + Component Annotation String Value reference set
The addition of content for the Annotations refset has commenced for the July 2024 International Edition release.
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 July 2024 International Edition 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.
Quality Initiative
The Quality Initiative (QI) project is the implementation of the Quality Strategy. After a successful pilot project for the July 2018 Edition release, the next stage has been implemented for subsequent releases including July 2024.
Quality improvement tasks are being 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 is being carried out to accurately reflect current clinical knowledge and ensure the semantic reliability of descriptions associated with a concept.
Update Head and Neck
18 concepts were identified with FSN of “head and neck” but modeled with 774007 |Structure of head and/or neck (body structure)|. For some concepts the intention had always been disjunctive “and/or” so to minimise disruption the FSN’s have been changed to reflect this intended meaning with therefore no change in descendants.
Procedures such as 430215009 |Biopsy of head and neck structure (procedure)| have been inactivated and replaced with distinct concepts for each body site as a disjunctive in this instance would be a grouper of no clinical significance and non-conformance to editorial policy. This impacted the descendants who have become children of the distinct concepts.
Examples of concepts inactivated and replaced with two distinct concepts:
- 430215009 |Biopsy of head and neck structure (procedure)|
- 431056007 |Fine needle aspiration biopsy of head and neck structure (procedure)|
- 430220009 |Specimen from head and neck structure (specimen)|
Examples of concepts with model change to two role groups (finding/disorder can occur in both structures at the same time):
- 255057000 |Benign tumor of head and neck (disorder)|
- 716659002 |Squamous cell carcinoma of head and neck (disorder)|
- 274755005 |Head and neck swelling (finding)|
Examples of concepts with FSN change to 'and/or':
- 301871007|Lipoma of head and neck (disorder)|
- 441535001|Adenocarcinoma of head and neck (disorder)|
- 1197313009|Metastatic adenocarcinoma to lymph node of head and neck (disorder)|
Number of concepts edited (approx): 18
Update Effect of Radiation
1335858009 |Effect of radiation (finding)| and subtypes have been reviewed to apply consistency to descriptions and model. Radiation is a physical force and thus uses the 'caused by' for descriptions.
The causative agent for this set of concepts has been checked for appropriateness as only ionizing radiation can cause damage to internal structures, i.e. beyond skin and/or eyes. Conditions caused by radiotherapy were also included in this review, and standardized descriptions have been applied.
Number of concepts edited (approx): 350
Update Construction of Stoma
75506009|Construction of stoma (procedure)| and subtypes have been reviewed and a consistent approach to modeling has been implemented.
A small number of concept inactivations and description changes have been implemented as part of this review.
Number of concepts edited (approx): 100
Update Glomus Tumor
403969002|Glomus tumor (disorder)| has been inactivated and replaced with new concept 1340052006 |Benign glomus tumor (disorder).
10438002 |Glomus tumor (morphologic abnormality)| has been inactivated with reason ambiguous and replaced with 1340048006 |Benign glomus tumor (morphologic abnormality)|.
Similar 6 disorder concepts referring to 'glomus tumor' have been inactivated and replaced with 'benign glomus tumor'.
4 procedure concepts have been inactivated and replaced with procedure concepts that specify 'benign'.
Concepts in the morphology hierarchy have been aligned with ICD-O-3.2 and are informed by the WHO Blue Books.
Update Intracranial Aneurysm and Repair of Aneurysm
Intracranial aneurysms and related concepts have been remodeled with 281138005 |Intracranial vascular structure (body structure)| to include conditions or procedures that involve either arteries or veins.
75087007 |Repair of aneurysm (procedure)| has been remodeled with GCI axioms to address missing subconcepts that are achieved by specified methods, such as embolization, ligation, excision, and coagulation.
Number of concepts edited (approx): 36
Body Structure
Update Posterior Abdominal Wall
22577007 |Posterior abdominal wall structure (body structure)| has been remodelled as a subtype of 822992007 |Structure of wall of abdominal proper segment of trunk (body structure)| to improve accuracy for this area of content.
Number of concepts edited (approx): 10
SEP and Laterality Anatomy Reference Sets
The release file for the lateralizable body structure reference set has been updated and validated.
The release file for the SEP reference set has been updated and validated.
Clinical Finding
Update Eosinophilic Gastritis
66329006 |Eosinophilic gastritis (disorder)| and subtypes have been remodeled as allergic conditions based on recent findings that these conditions are generally accepted as a Th2-mediated allergic reactions.
Procedure
Radiographic Imaging
Work is progressing for this content tracker. 42687005|Lymphangiogram (procedure)| and subtypes have been reviewed as part of the tracker.
Based on user feedback and review, ‘lymphangiography’ uses fluoroscopy and contrast unless an alternative imaging method such as MRI is specified. The content in this hierarchy that currently states ‘lymphangiography’ with method 278110001|Radiographic imaging - action (qualifier value)| has been inactivated and replaced with a new concept which specifies the imaging modality and the use of contrast.
For example: 48858003 |Lymphangiography of lower extremity (procedure)| has been inactivated and replaced by a new concept: Fluoroscopic lymphangiography of lower limb with contrast (procedure)|
A new supertype concept has been added: 1336147007 |Imaging of lymphatic system (procedure)|
Work for this content tracker continues, for information please see the informational briefing note here.
Inactivation Anesthesia Related Concepts
A further set of 11 anesthesia related procedure concepts have been inactivated. This update is part of the work being undertaken to inactivate 'Administration of anesthesia for X' concepts, this set of inactivations includes:
- 15624001 |Anesthesia for spinal fluid shunting procedure (procedure)|
- 85948003 |Manual reduction of dislocation of sacroiliac joint under anesthesia (procedure)|
- 5065000 |Reduction of closed traumatic hip dislocation with anesthesia (procedure)|
- 69534008 |Tympanostomy with general anesthesia (procedure)|
Pharmaceutical/Biological Product
Addition of Count of active ingredient (attribute) to Valproic Acid Subtype Clinical Drugs
As per the drugs model, once any concept in a hierarchy requires more than the usual Count of base of active ingredient all the siblings of that concept should also have the additional count added. In order for clinical drugs concepts to classify correctly as descendants of the single “valproic acid” parent Medicinal Product Form concept and for consistency, they required both a Count of base of active ingredient (signifying one base moiety substance (valproic acid)) plus a Count of active ingredient so that any new concepts added classify correctly.
Reviewed and count added if missing:
- Subtypes of 780748001 | Product containing only valproic acid in parenteral dose form (medicinal product form) | = 5 Clinical drugs (CD) had Count of active ingredient added (4 sodium valproate concepts,1 valproic acid concept)
- Subtypes of 780747006 | Product containing only valproic acid in oral dose form (medicinal product form) | = 25 CD had Count of active ingredient added (13 sodium valproate concepts, 9 valproic acid concepts, 3 valproic acid (as valproate semi-sodium) concepts).
Number of concepts edited (approx): 25
Substance
Social Context
Model Component Metadata
Collaboration/Harmonization Agreements
Convergent Medical Terminology (CMT)
185 new concepts have been added. The focus area was musculoskeletal with smaller additions to other domains such as neoplasms and injuries.
Orphanet
Working in collaboration with Orphanet (http://www.orpha.net/consor/cgi-bin/index.php), efforts are ongoing to update rare disease concepts in SNOMED CT to maintain alignment with Orphanet for the annual update of the SNOMED CT to Orphanet Maps.
All of the concepts added for the Orphanet project have been mapped to ICD-10.
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
International League Against Epilepsy (ILAE)
In line with approved harmonized terminology, this project is working on alignment including restructuring to update the hierarchy << 313307000 |Epileptic seizure (finding)|.
Further information about the project is available here
Gravity Project
Work for this project is ongoing.
Internal Quality Improvement
Machine Readable Concept Model (MRCM) Changes
There are no changes for the MRCM in the June 2024 International Edition.
Future changes that are currently in progress can be viewed via the MRCM Daily Build Browser
Please see early visibility for future planned changes to MRCM.
OWL Axiom Expressions for Annotation Properties
The new annotation properties are represented in the OWL expression axiom refset as follows:
The 1295447006 |Annotation attribute (attribute)| is correctly represented as subClassOf
01300ccd-d1d7-417d-a70a-f688e72c4d8c 20231201 1 900000000000012004 733073007 1295447006 SubClassOf(:1295447006 :246061005)
All subconcepts of 1295447006 |Annotation attribute (attribute)| are represented as "SubAnnotationPropertyOf", instead of "subClassOf" as they previously were
e6cd65fe-cb81-4db4-9ac4-040dc74fce28 20231201 1 900000000000012004 733073007 1295448001 SubClassOf(:1295448001 :1295447006)
3729ce47-a96e-4dc7-9eff-83c34740c414 20231201 1 900000000000012004 733073007 1295449009 SubClassOf(:1295449009 :1295447006)
These axiom updates are published in the March 2024 International Edition release. The authoring tool has been updated to ensure all new subconcepts of 1295447006 |Annotation attribute (attribute)| are represented as SubAnnotationPropertyOf(). The remaining changes required for other tools to correctly consume the updated syntax have been completed for the June 2024 International Edition release.
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 Edition 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 |SNOMED CT to ICD-10 extended map (foundation metadata concept).
The ICD-10 Mapping Technical Guide (including exemplars) is hosted here https://confluence.ihtsdotools.org/display/DOCICD10
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 July 2024
The map provided for the July 2024 International Edition has been updated, and now represents a complete map from SNOMED CT International Edition to ICD-10 2016 version.
376 newly authored concepts have been added and mapped.
The SNOMED to ICD-O (morphology) map has 4 additional concepts 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
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
The RF2 package convention dictates that all relevant files are included, regardless of whether or not there is content to be included in each release. Therefore, the package contains a mixture of files which contain both header rows and content data, and files that (intentionally) include only header records. The reason that these "empty" files are included in 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 future releases
...files that happen to contain no data in this particular release (and are therefore included in the package with just a header record), but are still relevant to RF2, and could therefore contain content in future releases.
This allows users to easily distinguish between the two scenarios, as otherwise if files in option 2 were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.
Changes to the International Edition package format
In line with the new implementation of Annotations, two new refsets have been added to the International Edition Release package, from December 2023 onwards:
- der2_scsRefset_ComponentAnnotationStringValueSnapshot_INT_20240101.txt
- der2_sscsRefset_MemberAnnotationStringValueSnapshot_INT_20240101.txt
These refset files are empty for the June 2024 release, whilst content is authored in future editing cycles. However, they will then be populated with Annotations data from one of the future 2024 International Edition releases onwards (date to be confirmed). These improvements were introduced in the December 2023 International Edition release, and will be used in all future International Edition releases until further notice.
Changes to the Annotations Refset format
NOTICE
JUNE 2024 RELEASE - CHANGES TO THE ANNOTATIONS REFSET FORMAT
After discussions with the community, SNOMED International has made changes to the coverage of language in the Annotations refsets in the following way:
- The languageCode field was specified as the two characters of ISO-639-1 code for the language of the annotation text. The change is to include support for specifying dialect when it is applicable by adhering to RFC 5646, which allows the combination of two characters of ISO 639-1 code and two uppercase letters of country code (ISO 3166) separated by a hyphen.
- The column "languageCode" has therefore been changed to "languageDialectCode".
- Component Annotations (1292992004)
- OLD: id effectiveTime active moduleId refsetId referencedComponentId languageCode typeId value
- NEW: id effectiveTime active moduleId refsetId referencedComponentId languageDialectCode typeId value
- Member Annotations (1292995002)
- OLD: id effectiveTime active moduleId refsetId referencedComponentId referencedMemberId languageCode typeId value
- NEW: id effectiveTime active moduleId refsetId referencedComponentId referencedMemberId languageDialectCode typeId value
- The concept 1296895003|Language code (foundation metadata concept)| has been inactivated and replaced by 1304275002 |Language or dialect code (foundation metadata concept)|
- The changes apply to both the Member Annotations String Value Reference Set + Component Annotation String Value reference set
The addition of content for the Annotations refset will commence in future International Edition releases.
Changes to the RefsetDescriptor records
NOTICE
JUNE 2024 RELEASE - Changes to the RefsetDescriptor records
In line with the changes to the Annotations refsets (see above for details), the following refinements have also been made to the RefsetDescriptor records:
- 1. The AttributeType for the (attributeOrder=0) refsetDescriptor record for both Member + Component Annotations has been changed from:
- 900000000000461009 |Concept type component| to
- 900000000000460005 |Component type (foundation metadata concept)|
- (eg)
- OLD: 6cc1d4ca-32fd-44cb-8ad3-e49f23ec7760 20231201 1 900000000000012004 900000000000456007 1292992004 900000000000518009 900000000000461009 0
- NEW: 6cc1d4ca-32fd-44cb-8ad3-e49f23ec7760 20240601 1 900000000000012004 900000000000456007 1292992004 900000000000518009 900000000000460005 0
- OLD: f6d9647b-6ee6-400d-9c7f-77818fa1f986 20231201 1 900000000000012004 900000000000456007 1292995002 900000000000518009 900000000000461009 0
- NEW: f6d9647b-6ee6-400d-9c7f-77818fa1f986 20240601 1 900000000000012004 900000000000456007 1292995002 900000000000518009 900000000000460005 0
- OLD: 6cc1d4ca-32fd-44cb-8ad3-e49f23ec7760 20231201 1 900000000000012004 900000000000456007 1292992004 900000000000518009 900000000000461009 0
- 2. The languageDialect column for a) the (attributeOrder=2) refsetDescriptor record for Member Annotations + b) the (attributeOrder=1) refsetDescriptor record for Component Annotations has been changed from:
- 1296895003 |Language code (foundation metadata concept)| to the new concept
- 1304275002 |Language or dialect code (foundation metadata concept)|
- (eg)
OLD: 2c0d0378-c28c-4705-b8af-f5f0f8276dfd 20231201 1 900000000000012004 900000000000456007 1292992004 1296895003 900000000000465000 1
NEW: 2c0d0378-c28c-4705-b8af-f5f0f8276dfd 20240601 1 900000000000012004 900000000000456007 1292992004 1304275002 900000000000465000 1
OLD: afe9824b-1323-4407-a0b7-a028ae2b780a 20231201 1 900000000000012004 900000000000456007 1292995002 1296895003 900000000000465000 2
NEW: afe9824b-1323-4407-a0b7-a028ae2b780a 20240601 1 900000000000012004 900000000000456007 1292995002 1304275002 900000000000465000 2
- 3. The AttributeType for a) the (attributeOrder=4) refsetDescriptor record for Member Annotations (1292995002) + b) the (attributeOrder=3) refsetDescriptor record for Component Annotations (1292992004), needs to be changed from:
- 900000000000459000 (AttributeType) to
- 900000000000465000 (String)
- (eg)
- OLD: 54af9962-2a35-4538-86f3-a8c38de9200b 20231201 1 900000000000012004 900000000000456007 1292995002 900000000000519001 900000000000459000 4
- NEW: 54af9962-2a35-4538-86f3-a8c38de9200b 20240601 1 900000000000012004 900000000000456007 1292995002 900000000000519001 900000000000465000 4
- OLD: b46405ec-5ff1-46a3-a9cc-b2ef2bba23cc 20231201 1 900000000000012004 900000000000456007 1292992004 900000000000519001 900000000000459000 3
- NEW: b46405ec-5ff1-46a3-a9cc-b2ef2bba23cc 20240601 1 900000000000012004 900000000000456007 1292992004 900000000000519001 900000000000465000 3
Early visibility of impending changes in the upcoming 2024 Monthly International Edition releases
Please see the early visibility Confluence page for details of forthcoming changes.
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 @ https://confluence.ihtsdotools.org/display/RMT/SNOMED+CT+June+2024+International+Edition+-+SNOMED+International+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 |
0.1 | Maria Braithwaite Donna Morgan | Content Update Mapping Update | |
| 1.0 | Andrew Atkinson | Final Production changes |