A value from the choices below must be chosen as a reason for inactivating a concept. Inactivation replacement associations are ultimately at the author's discretion. Especially in the instance of an infinite number of possible replacements, clinical relevance and subset inclusion should be considered. Non-synonymous synonyms should also be inactivated and reassigned.
|Inactivation reason||Association type||Cardinality||Notes|
Possibly equivalent to
|Partially equivalent to||0..*|
|Duplicate component||Same as||1..1|
Meaning of component unknown
|No association type applied||0..0|
|Non-conformance to editorial policy|
No suitable replacement identified
No suitable replacement identified
|Possibly replaced by||0..*|
When changes are made to a historical relationship for a concept that was previously inactivated, such as Limited/WAS_A, assign a new historical relationship that facilitates traceability of the concept (duplicate, ambiguous, classification derived, etc.). The Limited component inactivation reason (WAS_A association type) is no longer in use for new content inactivations as of the July 2018 release.
All possible meanings should be represented in the replacement targets when feasible, creating new concepts as replacements when appropriate.
Ambiguous concepts with a single replacement target may be used if one of the two possible meanings of the ambiguous concept is not clinically useful.
Note: Many, but not all, concepts precoordinated with "with" and "and" are derived from classifications; regardless, this is the acceptable inactivation reason.
For concepts with exclusions, such as NEC, NOS, etc., use the Replaced by association with the immediate parent concept as the value, which is the clinical condition without any context. If a parent concept without the exclusion does not exist, it should be created as a new concept.
For concepts with conjunctions such as 'and' and 'with', use the Partially equivalent to association with the two separate values as targets. For the purposes of patient care, it is recommended that each disorder is recorded individually.
The Partially equivalent to association signifies that all applied targets must be implemented within the clinical notes to ensure the original clinical idea is represented.
The Duplicate component is the inactivation for duplicated concepts:
Any possible duplicates between concepts among other paired hierarchies not listed above should be reconsidered as duplicates and directed to another inactivation reason.
If the change is a request, inform the requestor as to which concept is inactivated.
Where the error gives rise to potential ambiguity, use the inactivation reason of Ambiguous component. Otherwise, the Erroneous component requires a single Replaced by value.
Meaning of the concept is unknown, and an association type is not given. It will normally be necessary to search the clinical literature to establish that this is truly an unknown concept rather than an outdated clinical concept.
This inactivation reason may be used where the meaning of the FSN is considered to be vague.
Concept which do not adhere to editorial guidance can be inactivated without an association type. Else Replaced by and Alternative are Association type options.
Policies will often delineate how these two Association type options will be used. Changes of this type often include bulk updates and may relate to medicinal products, substances, and devices.
When an outdated concept simply falls into disuse without any appropriate replacement, no historical association is applied.
Replaced by is used for a single replacement concept that is semantically similar to or more general than the inactivated concept.
Possibly replaced by is used for multiple replacement concepts.
A substance or organism originally believed to be a single entity has been reclassified as two or more substances or organisms.
For more information, see the SNOMED CT Editorial Advisory Group, Management of Concept Inactivation Confluence page for details on continuing work in this area.