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Please see here for 2023 Early Visibility Notification

This page provides information on Planned changes to upcoming SNOMED International Release packages.  These changes are provisional only, and subject to change at any time before the final Publication date.

For additional Relevant links with regards to Content Development Information please click here Content Development Information

ItemsProposed improvement

Planned Release timing

(*this is provisional only and is subject to change)

Confirmed Release Date
1

COVID-19 Content

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

2022 International Release and future releases


2

Browse Content Changes for the International Release

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

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

MRCM changes that have been implemented into the production environment and will be published in the next monthly release cycle (subject to completion of final release validation processes) can be viewed here https://dailybuild.ihtsdotools.org/mrcm/?branch=MAIN



3

Changes to Concept Inactivation Values

Please see new editorial guidance for changes to inactivation values here

2022 International ReleaseApril 2022
4

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

2022 International Release and future releases


5

MRCM Changes for July 2022 Release

Details for forthcoming changes can be seen here

July 2022 International Release


July 2022
6

MRCM Cardinality Changes 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All historical content issues where two or more finding sites were included in a single role group have been resolved in the International release as part of the QI project.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 visibility notice is intended to provide additional time for content updates in national extensions. 

July 2022 International ReleaseJuly 2022
7

MRCM Change for September 2022 Release

Extend the range 370135005 |Pathological process (attribute)| to include < < 1495041000004108 |Proliferation of neoplasm (qualifier value)|

September 2022 International ReleaseSeptember 2022
8

Quality Initiative

Information about the project can found here

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

2022 International Release and future releases
9

Inactivation of 272426002|Specific site descriptor (qualifier value)| and Subtypes

Approximately 101 concepts.

272426002|Specific site descriptor (qualifier value)| and subtypes contain a set of concepts that are mainly represented in the body structure hierarchy.  Concepts such as 264010009|Gastric (qualifier value)| represent the adjectival form of the body structure. Some of these concepts duplicate descriptions for new concepts that are required for the drug maintenance project.

272426002|Specific site descriptor (qualifier value)| and subtypes will be inactivated with inactivation reason ‘non conformance to editorial policy’ and association target ‘alternative’ with a target concept that is a subtype of 123037004|Body structure (body structure)| where appropriate.

For further information please see briefing note here.

December 2022 International ReleaseDecember 2022
10

Measurement Findings - December 2022 Release
Numerous changes to the measurement findings content are planned for several releases. The first set of changes will involve the reference range content:

1) Concepts which include 'high,' 'elevated,' 'raised,' 'low,' 'decreased,' normal,' etc. in the FSN will have their FSN updated to 'above reference range,' 'below reference range,' or 'within reference range.' 
2) Concepts which include 'abnormal' in the FSN will have their FSN updated to include 'outside reference range.' The modeling of these concepts will include 394844007 |Outside reference range (qualifier value)| as the value for Has interpretation (attribute).
3) Concepts representing a finding about a therapeutic range will be updated to include 'above therapeutic range,' 'below therapeutic range,' or 'within reference range' in the FSN. The Has interpretation (attribute) value of these concepts is  281303003 |Above therapeutic range (qualifier value)|, 281306006 |Below therapeutic range (qualifier value)| or 281304009 |Within therapeutic range (qualifier value)| accordingly. 
4) Concepts which include "borderline" in the FSN are being inactivated as ambiguous.

See the briefing note "20221103 BN Reference range measurement findings.pdf" (https://confluence.ihtsdotools.org/x/5OB4C) for more information.

These changes are planned for the December 2022 release. 

Additional changes to measurement findings concepts will occur over several releases. Upcoming changes for each future release will be posted here as the work progresses.

December 2022 International ReleaseDecember 2022
11

Measurement Findings - First Quarter 2023

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)|.

See the briefing note "20221116 BN Positive_Negative measurement findings.pdf" (https://confluence.ihtsdotools.org/x/AJcxCQ) for more information.

These changes are planned for the first quarter of 2023.

Q1 2023 International Release
12

Planned Changes to Findings/Disorders of Gravid Uterus

The scope of changes to findings/disorders (over 100 concepts) modelled by the gravid uterus.

These concepts can be identified by the ECL << 404684003 |Clinical finding (finding)| : * = (9258009 |Gravid uterus structure (body structure)| or 362253003 |Entire gravid uterus (body structure)|)

These concepts will be remodeled by using finding site of |Uterine structure| and occurrence in |Maternal pregnancy period (qualifier value)| or more specific |Maternal antepartum period|. The updated model pattern will address the missing subsumptions of conditions modeled by parts of the uterus during pregnancy.  

Q4 2022 International ReleaseDecember 2022
13

Update Hierarchy 17322007 |Disease caused by parasite (disorder)|

370135005 |Pathological process (attribute)| with value 442614005 |Parasitic process (qualifier value) will be added where it is missing to descendants of 17322007 |Disease caused by parasite (disorder)| and any relevant clinical findings concepts.

November 2022 International Release November 2022
14

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:

  • 236514003 |Toxic nephropathy (disorder)| - Complete for November 2022 release
  • 236423003 |Renal impairment (disorder)| -  In progress
Q4 2022 International Release and future releases
15

Update for 363101005 |Drug withdrawal (disorder)| 

Review of the modeling and terming of 363101005 |Drug withdrawal (disorder)| and child concepts to reflect the associated meaning.

See the briefing note submitted to the Member Forum for details. 

October 2022 International ReleaseOctober 2022
16

Description Update for 191816009 |Drug dependence (disorder)| and Associated Concepts

The terming for concepts including "drug dependence" will be updated to reflect "substance dependence": the word “drug” in the existing terms is ambiguous and does not have a universal definition or a consistent international representation; it can refer to illicit drugs and/or prescription medications. Additionally, dependence can occur with the use of substances such as ethanol, which are not considered an illicit drug or a prescription medication.

October 2022 International ReleaseOctober 2022
17

Poisoning Caused by Organism

As part of the Quality Initiative project, the modelling for concepts of type poisoning caused by organism, including the following sub-hierarchies, will be reviewed and updated where applicable:

  • 275390005 |Toxic effect of plant (disorder)|
  • 44400004 |Toxic effect of venom (disorder)|
  • 75258004 |Food poisoning (disorder)|
  • 26033009 |Toxic effect of mycotoxin (disorder)|
  • 1149327007 |Poisoning caused by Clostridium botulinum toxin (disorder)|
October 2022 International ReleaseOctober 2022
18

Update for Inactive Concepts Without Semantic Tag

Remaining cases of the legacy issue inactive concepts with active FSN without a semantic tag (Content Tracker IHTSDO-645) will be addressed to assign a semantic tag.  The number of inactive concepts requiring this update is 351.

Q1 2023 International Release
19

Review of Clinical Finding Hierarchy Epilepsy Content

Review of << 313287004 |Seizure related finding (finding)| and << 84757009 |Epilepsy (disorder)| (excluding Orphanet related content) for currency and clinical correctness with the addition of missing clinically relevant content. 

Work is being undertaken in stages. Initial and current focus is on epileptic seizure finding content. 

2022 International Release and future releases expected completion by mid 2024
20

Inactivation of "X of person (person)" concepts

Based on a consensus decision by the SNOMED International Editorial Advisory Group, concepts of the form "X of subject (person)" will be inactivated and concepts using these as the value for SUBJECT RELATIONSHIP CONTEXT relationships will be replaced by analogous "X (person)" concepts.  

August 2022 International ReleaseAugust 2022
21

Legal/Illegal Abortion Concept Inactivation 

As approved by the SNOMED Editorial Advisory Group, concepts referring to "legal" and "illegal" termination of pregnancy (abortion) will be inactivated from the international release with reason non-conformance to editorial policy and replaced by concepts agnostic as to the legality of the procedure. 

May 2022 International ReleaseMay 2022
22

Inactivation of 116223007|Complication (disorder)|

After consultation with the SNOMED Editorial Advisory Group, the ambiguous primitive concept 116223007 |Complication (disorder)| has been inactivated. Subtypes of this concept continue to classify under their other existing inferred parents except for a few high level grouper concepts that now classify directly under 64572001 |Disease (disorder)|.

2022 International ReleaseMarch 2022 
23

Inactivation and Replacement of 76981001|Discogram (procedure)| and Subtypes

76981001|Discogram (procedure)| and subtypes will be inactivated and replaced with concepts that explicitly state the use of contrast and injection into the intervertebral disc.  

The replacement concepts will follow the pattern 'Discography with injection of contrast into intervertebral disc'.

Q3 2022 International ReleaseSeptember 2022
24

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.

Q4 2022 International Release / Q1 2023 International Release
25

Inactivation of Walker Concepts

Concepts 705404007 |Walker/Walking frame (physical object)| and 705406009 |Walker (physical object)| will be inactivated with reason ambiguous, as the term 'walker' is being used to represent both walking frames and wheeled walkers (rollators).

A new concept Wheeled walker (physical object)| will be created with a text definition added to both that concept and also 266731002 |Walking frame (physical object)|.

Concepts that were previously subtypes of 705406009 |Walker (physical object)| will be inactivated with an inactivation replacement value to a new explicit wheeled version of those concepts and where applicable a pre-existing subtype of 266731002 |Walking frame (physical object)| in addition.

November 2022 International ReleaseNovember 2022
26

Inactivation of 108290001 |Radiation oncology AND/OR radiotherapy (procedure)

108290001 |Radiation oncology AND/OR radiotherapy (procedure)| will be inactivated and replaced via the reactivation of 61757002 |Radiation therapy (procedure)|.  61757002 |Radiation therapy (procedure)| will gain a synonym of radiotherapy.  Related concepts will undergo structural quality improvement.

2022 International Release
27

Primary and Metastatic Project
Following the development of proposals by an internal working group and consultation with community stakeholders, the primary and metastatic project is commencing work which will be ongoing for Q1 in 2023, with updates on progress provided in both Early Visibility and Release Notes.

As part of this project, new concepts relating to primary and metastatic disease are being added to SNOMED CT in order to disambiguate those concepts not stated as primary (agnostic) in the subhierary of 372087000 |Primary malignant neoplasm (disorder)| and that may have been used in the past to record both primary and metastatic malignancy. 

Q1 2023 International Release
28

Primary and Metastatic Project - QI Description Updates

Work is ongoing as part of this project to address the incorporation into SNOMED CT neoplastic morphologies and disorders of the ICD classification rule that if a malignancy does not specify primary then this can be assumed.

A result of this assumption, primary malignancy disorders have had non-primary descriptions added as synonyms and also vice versa  (primary malignancy synonyms have been added to malignant neoplasm disorders). For the December 2022 release, these descriptions will be inactivated and new disorder concepts created where necessary.

December 2022 International ReleaseDecember 2022
29

Primary and Metastatic Project - Inactivation of Neoplastic Morphologies Stated as 'Primary' in the FSN

86049000 |Malignant neoplasm, primary (morphologic abnormality)| is to be inactivated and replaced with a new concept 1240414004 |Malignant neoplasm (morphologic abnormality)|. Similarly, neoplastic morphologies with 'primary' in their FSN will be inactivated.
Concepts scheduled for inactivation are:

367651003 |Malignant neoplasm of primary, secondary, or uncertain origin (morphologic abnormality)|

1187469002 |Squamous cell carcinoma of primary, secondary, or uncertain origin (morphologic abnormality)|

86049000 |Malignant neoplasm, primary (morphologic abnormality)| 

450594004 |Primary malignant adenomatous neoplasm (morphologic abnormality)|

252988009 |Malignant squamous tumor, primary (morphologic abnormality)|

400156001 |Malignant blood vessel neoplasm, primary (morphologic abnormality)|

719952009 |Primary sarcoma (morphologic abnormality)|

734095001 |Primary solid type intraosseous squamous cell carcinoma (morphologic abnormality)|

733913003 |Primary intraosseous squamous cell carcinoma derived from keratocystic odontogenic neoplasm (morphologic abnormality)|

278411006 |Primary intra-osseous carcinoma (morphologic abnormality)|

733912008 |Primary intraosseous squamous cell carcinoma derived from odontogenic cyst (morphologic abnormality)|

720346009 |Primary seminoma (morphologic abnormality)|

133850008 |Primary synovial chondromatosis (morphologic abnormality)|

These inactivations will impact around 2,400 concepts in the disorder hierarchy, and approximately 1200 observable entity concepts (2,000 disorders will be impacted following inactivation of 86049000 |Malignant neoplasm, primary (morphologic abnormality)|) and all concepts will be restructured as outlined in the circulated Briefing Notes.

The reason for inactivation is Nonconformance to Editorial Policy, and the replacement inactivation target for 86049000 |Malignant neoplasm, primary (morphologic abnormality)| and 367651003 |Malignant neoplasm of primary, secondary, or uncertain origin (morphologic abnormality)| will be new concept 1240414004 |Malignant neoplasm (morphologic abnormality)|.

There may be some inconsistencies as this large project develops, including certain adenocarcinoma disorders that are modeled with 1186968006 |Malignant adenomatous neoplasm (morphologic abnormality)| in order to ensure that there is no change to the hierarchical subsumption and the assignment of subtypes by the classifier. As the project develops, and in particular the pathology group give their expert input to update the neoplastic morphologies in SNOMED CT, these inconsistencies will be addressed.

November 2022 International ReleaseNovember 2022
30

Quality Initiative: Inactivation of Disjunctive Concepts in 363346000 |Malignant neoplastic disease (disorder)| Hierarchy

Descendants of 363346000 |Malignant neoplastic disease (disorder)| that include a disjunctive "and/or" in the FSN will be inactivated.

  • 15 concepts containing " extranodal AND/OR solid organ site" e.g., Malignant lymphoma of extranodal AND/OR solid organ site (disorder) will be inactivated with a historical association target to the parent concept (or the relevant concept without 'extranodal AND/OR solid organ site'). The origin of these concepts has been traced to ICD-9 grouper codes.
  • 14 malignant neoplastic concepts containing 'head, face AND/OR neck' Example: 93533001 |Hodgkin's granuloma of lymph nodes of head, face AND/OR neck (disorder)|  will be inactivated and 3 new replacement concepts created for the 3 sites of head, neck and head and neck. Also, the inactivation of 1 benign concept: 109920008 |Benign neoplasm of peripheral nerve of head, face AND/OR neck (disorder)| and creation of 3 new replacements.
  • 15 concepts containing 'lymph nodes of axilla AND/OR upper limb' e.g., 93185008 |Malignant histiocytosis of lymph nodes of axilla AND/OR upper limb (disorder)| will be inactivated and new replacement concepts created for 'lymph nodes of upper limb'. Where these concepts had primitive subtypes for ' lymph nodes of axilla and upper limb' (11 concepts) these concepts will also be inactivated.
  • 12 malignant neoplastic concepts containing 'lymph nodes of inguinal region AND/OR lower limb' Example: 93516008 |Hodgkin's disease, nodular sclerosis of lymph nodes of inguinal region AND/OR lower limb (disorder)| will be inactivated and new replacement concepts created for 'lymph nodes of lower limb'. This work includes inactivation of their primitive subtypes for 'lymph nodes of inguinal region and lower limb' (12 concepts). Also, inactivation of 188044004 |Malignant melanoma of scalp and/or neck (disorder)| and 3 new replacements created.
November 2022 International ReleaseNovember 2022
31

Primary and Metastatic Project - Addition of 415 New Primary Malignancy Disorder Subtypes

"Agnostic” malignancy disorders (i.e. not specified as primary or metastatic) that can not be correctly modeled using the current “agnostic” morphologic abnormalities that are subtypes of 86049000 |Malignant neoplasm, primary (morphologic abnormality)|, precisely because they are subtypes of a primary malignant neoplasm morphology parent will be made subtypes of a non-primary parent following the inactivations flagged above.

The majority of the changes will be by inactivation of 86049000 |Malignant neoplasm, primary (morphologic abnormality)| and replacement with Malignant neoplasm (morphologic abnormality) with 'primary' being defined in disorders and observable entities by 370135005 |Pathological process (attribute)| (704321009|Characterizes (attribute)| for observable entities) and target value 1234914003 |Malignant proliferation of primary neoplasm (qualifier value)|. 

Approximately 415 current agnostic malignancy disorders inferring a primary designation through their hierarchy parent, will have a new primary malignancy concept added as a subtype that will be available for use in implementations as a subtype of 372087000 |Primary malignant neoplasm (disorder)|.

December 2022 International ReleaseDecember 2022
32

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. 

Ongoing monthly commencing January 2023 International Release
33

Primary and Metastatic Project - Inactivation of Metastatic Disorder Content

7 concepts termed ‘Malignant tumor involving an organ by separate metastasis from X’ and 20 concepts termed  ‘Metastasis from malignant neoplasm of X’ are to be inactivated.

Metastasis  ‘involving an organ’ and metastasis concepts that are unspecified as to site of the metastatic neoplasm are not clinically useful as in most cases there will already be a record of the site of the primary malignant tumor and the actual site of the metastasis will also be recorded as a separate concept. 

Going forward, metastatic malignant neoplasm ‘to X site’ and ‘from X site’ will not be precoordinated in one concept but recorded separately as 2 concepts. 

September 2022  International ReleaseSeptember 2022
34Primary and Metastatic Project - Descriptions update for 128462008 |Secondary malignant neoplastic disease (disorder)| Hierarchy
For consistency of descriptions, 128462008 |Secondary malignant neoplastic disease (disorder)| and its subtypes will have their Fully Specified Name and Preferred Term with 'secondary' changed to  'metastatic' retaining the 'secondary' description as a synonym. The descriptions with 'secondary' will be inactivated and not the concept. Editorial Guidance will be provided.
July 2022 International ReleaseJuly 2022
35

Inactivation of 365753005 |Finding of presence of drug (finding)|

365753005 |Finding of presence of drug (finding)| will be inactivated and replaced with an appropriate concept that includes “substance” in the FSN due to a mismatch between this concept's FSN and logical definition. In addition, “drug” does not have a universal definition or a consistent international representation.

2022 International ReleaseMarch 2022 
36

Description Updates Haemophilus influenzae types “a” to “f"

Terming for descriptions containing Haemophilus influenzae types “a” to “f” are being updated such that concepts in other hierarchies are consistent with the terming of associated concepts in the Organism hierarchy, which is the source of truth as specified in the general naming guidelines.

July 2022 International ReleaseJuly 2022
37

Drug Measurement Findings

Measurement finding concepts that include the term "drug" in the FSN are being reviewed and considered for inactivation in future releases.

2022 International Release2022 release
38

Inactivation of Metadata Concepts

The following metadata concepts will be inactivated for the July 2022 Release:

  • 741068007 |SNOMED CT to European Directorate for the Quality of Medicines & HealthCare simple map reference set (foundation metadata concept)|
  • 735233007 |European Directorate for the Quality of Medicines & HealthCare simple map reference set module (core metadata concept)|
  • 762959004 |European Directorate for the Quality of Medicines & HealthCare to SNOMED CT simple map reference set (foundation metadata concept)|
  • 733900009 |SNOMED CT to Unified Code for Units of Measure simple map reference set (foundation metadata concept)|
  • 741814003 |SNOMED CT to Unified Code for Units of Measure simple map reference set module (core metadata concept)|
July 2022 International ReleaseJuly 2022
39

Inactivation of subtypes of 717234006 |Allergy to animal protein (finding)

Following the Briefing Note submitted to the MF in March 2022, current subtypes of the “717234006 |Allergy to animal protein (finding)|” sub-hierarchy that represent allergy to "animal part" are being considered for inactivation and will be replaced by concepts representing “Allergy to X animal protein”.

2022 International ReleaseApril 2022
40

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.

2022 International Release and future releases
41

Dupuytren Content Changes

The Dupuytren content will be remodeled. The following concepts will be inactivated for the September 2022 Release:

  • 410812005 |Dupuytren's disease (disorder)| 
  • 203052004 |Dupuytren's disease of palm and finger (disorder)| 
  • 203046000 |Dupuytren's disease of palm, nodules with no contracture (disorder)|
  • 203047009 |Dupuytren's disease of palm, with contracture (disorder)|
  • 203050007 |Dupuytren's disease of finger(s), nodules with no contracture (disorder)|
  • 203053009 |Dupuytren's disease of palm and finger(s), nodules with no contracture (disorder)|
  • 203051006 |Dupuytren's disease of finger, with contracture (disorder)|
  • 203054003 |Dupuytren's disease of palm and finger, with contracture (disorder)|
  • 16216861000119107 |Dupuytren's contracture (morphologic abnormality)|"
September 2022 International ReleaseSeptember 2022
42

Remodeling of 74799003 |Flap graft (procedure)| hierarchy and 256683004 |Flap (substance)| hierarchy

QI work has commenced on the area of flap procedures, previously placed under 74799003 Flap graft (procedure), which has been inactivated and replaced with 1202017008 |Surgical procedure using flap (procedure)|. The work is still ongoing, and a new model has been developed and remodeling is now in process.

Work has commenced on improvements to the sub-hierarchy of 256683004 |Flap (substance)| (including planned inactivations).  The redesign involves adding new qualifier values as subtypes of 360032005 |Flap reconstruction - action (qualifier value)|. 

For the April 2022 release there are continuing updates to the sub-hierarchy of 256683004 |Flap (substance)| (including planned inactivations to address the conflation of body structure and flap substance). The redesign will involve remodeling qualifier values as subtypes of 360032005 |Flap reconstruction - action (qualifier value)|. Editorial Guidance has been drafted ready for publication. 

2022 International ReleaseApril 2022
43

Remodeling of Descendants of 1202017008 |Surgical procedure using flap (procedure)|

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 the QI project and will be remodeled for the June 2022 release.
This will involve defining some existing complex flap procedures for congenital conditions. Whilst every effort will be made to align with the template and sufficiently define relevant concepts (for example, by creation of new concepts for 1230024004 |Congenital deformity of lower limb (disorder)| and new 1230067007 |Correction of congenital anomaly (procedure)|), it is recognized that the area would benefit from the input of domain experts in the future.

June 2022 International ReleaseJune 2022
44

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.

2022 International Release and future releases
45

Administrative Concept Inactivations

Seven situation hierarchy concepts are being inactivated due to the lack of unambiguous meaning and reproducible use case among healthcare systems:

  • 394827008 |Personal administration (situation)|
  • 394824001 |Private prescription (situation)|
  • 182819002 |Replacement therapy (situation)|
  • 394822002 |Prescription types (situation)|
  • 394829006 |Past medication (situation)|
  • 182817000 |Drug prescription (situation)|
  • 703955006 |Prescription telephone order (situation)|
2022 International ReleaseApril 2022
46

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.

January 2023 International Release
47

Nutrition Content

Information about the work of the Nutrition Care Process Clinical Project group is available here.

2022 International Release
48

Cancer Synoptic Reporting - Project Information

Concepts representing cancer synoptic reporting content will be added to the International release starting with the July 2021 release. 

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.

This content primarily encompasses observable entity concepts and also includes supporting concepts from other hierarchies, e.g. property values.

Planned areas of promotion for the January 2023 release include observable entity concepts for genomics, molecular pathology, immunohistochemistry, treatment effect and intactness/quality of specimen.

For more information about this project, please see the Cancer Synoptic Reporting Clinical Project Group here

2022 International Release and future releases
49

Cancer Synoptic Reporting - Protein Substances

Around 40 new protein concepts will be added to the substance hierarchy which are needed to model the immunohistochemistry neoplasm observables. In addition, around 10-15 existing protein substance concepts will be remodeled to align their terming with the authoritative source for protein nomenclature and to assign parents and other relationships based on the current guidelines for the substance hierarchy.

Guidelines for protein substance concepts will be incorporated into the Editorial Guide following completion of this work.

These substance concepts will be added starting with the May 2022 release and may continue for the June and/or July 2022 releases.

Q2 - Q3 2022 International ReleaseJuly 2022
50

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.

2022 International Release and future releases
51

Content Improvements in the Substance and Product Hierarchies

Please see briefing notes here Drugs Project

2022 International Release and future releases


52

Inactivation of 360215002 |Pharmaceutical excipient (substance)| Hierarchy

The 360215002 |Pharmaceutical excipient (substance)| hierarchy will be inactivated with descendant grouper concepts (e.g. 418403001 |Drug preservative (substance)|, 412307009 |Drug vehicle (substance)|) being inactivated as duplicates of existing or new concepts in the 43747001 |Drug excipient (product)| hierarchy.

Concepts representing discrete substances will remain in the Substance hierarchy. One concept, 438784000 |Adverse reaction caused by pharmaceutical excipient (disorder)|, will be remodeled using the corresponding product concept, with classification results consistent with the pattern for vaccine products.

September 2022 International ReleaseSeptember 2022
53

Change for Groupers in Substance Hierarchy - Analyte

Groupers in the Substance hierarchy that refer to analyte (e.g. 259988005 |Transplantation analyte (substance)|, 312273006 |Microbiology analyte (substance)|) will be inactivated with reason Meaning unknown; no potential replacement concept will be provided.

July 2022 International ReleaseJuly 2022
54

Addition of New Grouper Concepts in the Pharmaceutical Dose Form and Medicinal Product hierarchies 

As per the Briefing Note titled Editorial Guideline and Content Changes for Concepts Referring to “Infusion” or “Injection”, new grouper concepts for “infusion and/or injection” will be added to the Pharmaceutical Dose Form and Medicinal Product hierarchies beginning in the 2022-April Release. (The Briefing Note is located on the Drug Project space https://confluence.ihtsdotools.org/display/IAP/Drugs+Project).

May 2022 International ReleaseMay 2022
55

Dose Form-Related Changes - June 2022 Release

  • 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; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
  • Gingival - Existing intended site concept 738943003 |Gingival (intended site)| has been updated to be a subtype of 738982001 |Oromucosal (intended site)|.
  • Stick - Has administration method will be 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)|.
  • 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 for June 2022 release. Associated pharmaceutical dose form (PDF) concepts have also been added; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.

  • 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 for the June 2022 release 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; the PDFs will not be used for modeling concepts in the International Release but will be available for use in national extensions. No related changes to existing clinical drug concepts is planned.
  • Elixir - Existing basic dose form 738997003 |Elixir (basic dose form)| will be made a child of 739006009 |Solution (basic dose form)|; no changes to existing Clinical drug concepts will be made unless specifically requested via CRS.

  • Emulsion - Text definition for existing concept 738998008 |Emulsion (basic dose form)| will be 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)."; no changes to existing Clinical drug concepts will be made unless specifically requested via CRS.

  • Gas - New basic dose form concepts 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.” will be added. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs will not be used for modeling concepts in the International Release but will be available for use in national extensions. No related changes to existing clinical drug concepts is planned.

  • Syrup - Existing basic dose form 739009002 |Syrup (basic dose form)| will be made a child of 739006009 |Solution (basic dose form)|; no changes to existing Clinical drug concepts will be made unless specifically requested via CRS.

  • Granules - Has dose form transformation will be 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)| will be updated to be a subtype of 385043007 |Granules (basic dose form)|.
  • Tablet - Existing basic dose form concept 761877007 |Effervescent tablet (basic dose form)| will be updated to be a subtype of 385055001 |Tablet (basic dose form)|.

  • PowderExisting basic dose form concept 762948008 |Effervescent powder (basic dose form)| will be updated to be a subtype of 739005008 |Powder (basic dose form)|.
  • 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.”, will be added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
  • Collodion - Text definition for existing basic dose form concept 385115001 |Collodion (basic dose form)| will be updated to "A liquid dose form consisting of active substance(s) in a mixture of pyroxylin or similar in ether and ethanol.”
  • 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.”, will be added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added or updated accordingly; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
  • 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.” will be added. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs can be used in creation of concepts in the International Release. 

  • 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.”, will be added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added or updated accordingly; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
  • 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.”, will be added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs will not be used for modeling concepts in the International Release but will be available for use in national extensions. No related changes to existing clinical drug concepts is planned.
  • 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.
June 2022 International ReleaseJune 2022
56

Dose Form-Related Changes - July 2022 Release

  • Intraocular - Existing intended site concept 762070008 |Intraocular (intended site)| will be remodeled as a descendant of 738952007 |Ocular (intended site)|. Associated pharmaceutical dose form (PDF) and clinical drug (CD) concepts will be updated accordingly.
  • Impregnated material - new basic dose form 1231762000 |Impregnated material (basic dose form)| with text definition "A solid dose form consisting of porous or absorbent material onto or into which active substance(s) are taken up or taken in, for subsequent release after administration.” will be added for the July 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
  • Mouthwash - Has administration method will be updated to 785900008 |Rinse or wash (administration method)| for mouthwash pharmaceutical dose forms.
  • Mix - New dose form transformation concept, 764462006 |Mix (transformation)| with text definition "Transformation of a dose form into a different dose form by combining it together with a component item." will be added for the 2022-July release. Associated pharmaceutical dose form (PDF) concepts will be added or updated accordingly. No related changes to existing clinical drug (CD) concepts is planned.
  • Intestinal - New intended site concept, 1231834000 |Intestinal (intended site)| with text definition "An intended site for a dose form that is for administration directly to the intestine (duodenum through the colon) using an appropriate device.”, has been added for the 2022-July release. Associated pharmaceutical dose form (PDF) concepts have also been added; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
July 2022 International ReleaseJuly 2022
57

Inactivation of Poisoning by medicinal product role groupers

Following the Briefing Note submitted to the MF and the CMAG in August 2021, and based on the members’ feedback, the poisoning concepts that are defined by a causative agent that is of type “medicinal product role” or “Medicinal product role + structure” that are not in use will be inactivated.

2022 International ReleaseMarch 2022 
58

Planned changes to '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' and update the Editorial Guide for this area.

The plan is to update the Editorial Guide and all concepts that are currently modeled as 'Co-occurrent and due to' starting from the July 2019 release.

2022 International Release and future releases


59

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.

2022 International Release and future releases
60

Planned changes to Implantation and Insertion procedures

Work commenced on content tracker IHTSDO-175. 

Ongoing structural changes for the Procedure concepts related to the content tracker, more information is available here

2022 International Release and future releases


61

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 submitted to the Member Forum for further details.

Q1 2023 International Release
62

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. 

February 2023 International Release
63

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

26402001 Nerve block anesthesia (procedure) and its 211 descendants along with 745638006 |Injection of anesthetic agent (procedure)| and its 283 descendants will acquire the proximal primitive parent of 399248000 |Procedure related to anesthesia and sedation (procedure)|.  

January 2023 International Release
64

Myeloid Neoplasm Pilot Project

The Pathology CRG have identified content that is outdated and modeled inconsistently in the neoplastic morphologies and related disorders. This content does not represent prevailing pathology knowledge as expressed by pathologists and other international subject matter experts, and described in the WHO Blue Books, 5th edition.

A pilot project focussing on <<414792005 |Myeloid neoplasm (morphologic abnormality)| (91 descendants) and related disorder concepts 25333006 |Myeloproliferative disorder (disorder)| and its 117 descendants) is nearing completion. 

The work is planned for promotion in Q1 2023 following successful approval of the Pilot. The project will involve new content, inactivation of outdated concepts, and updating of descriptions where necessary to align with the WHO Blue Books. Guidance is being offered to assist production of the upcoming ICD-O-3.2 map. 

Q1 2023 International Release



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