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This page provides information on planned changes to upcoming SNOMED International Release packages in three sections:

  1. EARLY VISIBILITY OF PROPOSED CONTENT CHANGES (with provisional release date)
  2. EARLY VISIBILITY OF PUBLISHED CHANGES (with confirmed release date)
  3. INFORMATION ABOUT PROJECTS AND WORK IN PROGRESS 

Please submit any feedback relating to the items below to info@snomed.org

PLEASE NOTE, YOU MAY HAVE TO REGISTER FOR A CONFLUENCE USER ACCOUNT IN ORDER TO ACCESS THE LINKS TO DOCUMENTS REFERENCED BELOW.

2024 Proposed Content Changes

ItemsHierarchy/TopicEARLY VISIBILITY OF PROPOSED CONTENT CHANGES

Planned Release timing

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

1.Procedure

Update Hierarchy 363680008|Radiographic imaging Procedure (procedure)|and Descendants

A Briefing Note documenting the proposed changes for the hierarchy 363680008|Radiographic imaging procedure (procedure)| and descendants was shared with the Editorial Advisory Group, Clinical Leads Group, Member Forum, Content Managers Advisory Group, and other key stakeholders in July 2023.

Feedback was received from a wide range of stakeholders. In response to this feedback, the proposed changes to the hierarchy have been modified. These modifications will address issues raised in the feedback.

This Informational Briefing Note summarizes the changes that will be implemented.

Implementation of the content changes will commence in Q4 2023. The updates will be implemented in sub-hierarchies and promoted over a number of international monthly releases until complete.

Ongoing in phases across 2024 International Releases


2.Content Improvement

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. 

Q3 2024 International Release
3.Clinical Finding/Procedure

Patient/Subject concepts in the Clinical finding and Procedure Hierarchies

Concepts in the Clinical finding and Procedure hierarchies that contain the explicit context of patient or subject will be inactivated and replaced with concepts without this explicit context. For further information please see briefing note.

On hold - to be determined
4.Clinical Finding

Inactivation of Mechanical Complication of <x> Device

In October 2023 the Editorial Advisory Group made a decision that the concepts that represent a mechanical complication of <x> device are ambiguous. Following this a briefing note was shared with the community of practice to both inform and collect feedback. This feedback has been reviewed and the work will be proceeding. The concepts will be inactivated as ambiguous with a historical association to 473023007 |Complication associated with device (disorder)| or a suitable subtype.

Q3 2024 International Release
5.Dose Forms

Pharmaceutical Dose Forms with Two or More Intended Sites

Pharmaceutical Dose Forms with more than one intended site will use “and” in their descriptions and include all intended sites in the model. By representing combinations of intended sites as a conjunction ('and' in the description) this will facilitate searching by end users. The concepts are logically modeled as conjunction.

Existing dose forms with "or" will be updated to "and" in their descriptions, this will be included in the Editorial Guide.

9 clinical drugs using these dose forms will correspondingly have their descriptions updated to 'and'.

Note - pharmaceutical dose forms with two or more administration methods:
As this is a less common requirement any requests for this type of dose form will be reviewed on a case by case basis.

Q3 2024 International Release
6.Clinical Finding

Substance Abuse/Use

There has been a shift from the term "substance abuse" to a more nuanced understanding of substance use disorders in this domain which is reflected in both ICD-11 and DSM-5 indicating a greater emphasis on the spectrum of substance-related problems.  Several members have expressed the need for content updates to incorporate this change and to simplify the translation process.  Consequently, efforts to revise the content associated with 66214007 |Substance abuse (disorder)| will begin and is expected to be completed by the end of Q2. 

An example of the content structure and terming using opioid use is shown. Specifically, descriptions will be added with “harmful pattern of X substance use” replacing the term “abuse” in the FSN and PT however the “abuse” descriptions are persisted as synonyms to facilitate searching.  In most cases there is no change in meaning, therefore the concepts will not be inactivated.

Approximately 100 existing concepts relating to “abuse” will be affected together with the addition of new concepts to represent “harmful episode” and the higher level “X substance use disorder 


Q3 2024 International Release
7.Clinical Finding

Inactivation of Complication Disorder Concepts (371 concepts)

The inactivation of concepts that reference “complication” without specifying the nature of the complication is planned. 

The primitive “Complication (disorder)” grouper was inactivated in 2022 due to a lack of consistency or definition of what would properly be assigned as a subtype.

The concepts will be inactivated with inactivation reason “Classification derived concept” and replacement by the parent concept. 

For further information please see this briefing note. 

Beginning June 2024 International Release and then subsequent releases until complete
8.Procedure

Angioplasty procedures

In response to several enquiries from members about the apparent duplication of concepts and descriptions for procedures representing 'Percutaneous transluminal angioplasty' an analysis of the content in this area is underway. It is expected to result in inactivation of duplicates, updates to the descriptions of published concepts and remodeling to represent the imaging guidance aspect where appropriate.

After the analysis of the impact has been completed, a Briefing Note will be dispatched to provide details of the changes. Examples of potential duplication:

  • 3261007| Angioplasty of subclavian artery (procedure)
  • 418738003 | Fluoroscopic angioplasty of subclavian artery (procedure)
  • 175454003| Percutaneous angioplasty of subclavian artery (procedure)
  • 431485005 Percutaneous transluminal angioplasty of subclavian artery using fluoroscopic guidance (procedure) - correct term.
Q3 2024 International Release
9.

Procedure

Review 1263452006 |Anesthesia and/or sedation procedure (procedure)|

A review of the 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy is in progress, the focus is on:

  • Inactivation of Classification derived components.
  • Review of the current model and possible addition of 363703001 |Has intent (attribute)| to the model.
  • Review of current classification of groupers.
Q3 2024 International Release
10.

Procedure

Review 48537004 |Bypass graft (procedure)| 

A review of the 48537004 |Bypass graft (procedure)| hierarchy is in progress, the focus is on:

  • Improving consistency of descriptions.
  • Improving definitions for different types of concepts in the hierarchy (bypass vs shunt)
  • Correct use of the term “graft” within the descriptions.
  • Correct modeling of 260686004 |Method (attribute)| in the hierarchy.
  • Review of the need for 360021005 |Bypass - action (qualifier value)| and 424208002 |Shunt - action (qualifier value)|in the model and testing of 245854003 |Proximal anastomosis (qualifier value)| and 245855002 |Distal anastomosis (qualifier value)| as new 260686004 |Method (attribute)| values in the hierarchy.
  • Review for a consistent and appropriate usage of 425362007 |Surgical insertion - action (qualifier value)|and 129407005 |Grafting - action (qualifier value) in the model.
  • Review for re-classification of 129376004 |Construction - action (qualifier value)| as a direct subtype of 129284003 |Surgical action (qualifier value)|.
  • Given the complexity of some concepts in the hierarchy, potential duplicate, erroneous, or outdated concepts will be identified.
Q3 2024 International Release
11.

Procedure

Review Use of 424876005 |Surgical approach (attribute)| 

A review to generalize 424876005 |Surgical approach (attribute)| to allow non-surgical procedures to be modeled with a subtype of <<103379005 |Procedural approach (qualifier value)| is in progress. 

  • This issue is under review by the Editorial Advisory Group.
  • Currently, 424876005 |Surgical approach (attribute)| is restricted to subtypes of 387713003 |Surgical procedure (procedure)|.  However, the values represented by the 103379005 |Procedural approach (qualifier value)| subhierarchy are applicable to concepts that are not subtypes of Surgical procedure and could potentially be used to define "non-surgical" procedure concepts.
  • The impact of MRCM rule for using 116688005 |Procedure approach (attribute)| with domain constraint:  << 71388002 |Procedure (procedure)| and range constraint:  << 103379005 |Procedural approach (qualifier value) is under review. This change would allow Non-surgical procedures to be modeled with a generic Procedure approach attribute.
Q3 2024 International Release
12.

Procedure

Review 1287742003 |Radiotherapy (procedure)| 

A review of 1287742003 |Radiotherapy (procedure)| hierarchy is in progress, the focus is on:

  • Review of the devices and systems used in the hierarchy for update and to correct subsumption.
  • Review of the impact of changing the Method (attribute) value from 129445006 |Administration - action (qualifier value)| to 129382001 |Destruction - action (qualifier value)| within the hierarchy.
  • The correct type of energy used for these procedures should be 125576007 |Ionizing radiation (physical force)|.
  • Addition of 424832003 |Surgical introduction - action (qualifier value)|or subtypes and 410675002 |Route of administration (attribute)| role group as needed for proper classification.
Q3 2024 International Release
13.

Procedure

Review 424226004 |Using device (attribute)| vs. 363699004 |Direct device (attribute)| for Modeling of Repair Procedures

424226004 |Using device (attribute)| and 363699004 |Direct device (attribute)| are used interchangeably for modeling of repair procedures within the Repair group of relationships.

  • 363699004 |Direct device (attribute)| should be used when grouped with 260686004 |Method (attribute)| = << 257903006 |Repair - action (qualifier value)|.
  • Exceptions were found where the device is used to perform the procedures but are not involved directly in the Repair action itself. e.g. 82830000 |Robotic arm, device (physical object)|
  • New model is being tested.
Q3 2024 International Release
14.

Substance

Update << 385420005 |Contrast media (substance)|

The 95 subtypes of 385420005 |Contrast media (substance) will be updated. Concepts will be remodeled based on discussion with stakeholders. New substance concepts including groupers will be required. 

Q3-Q4 2024 International Release
15.

Procedure

Proposed New Model for Solid Organ and Tissue Transplant Procedures

Feedback is requested for a proposed new model for solid organ and tissue transplant procedures.

Please see briefing note here. Deadline to submit feedback is 15 June 2024.

2024 International Release
16.

Medicinal Product 

Grouping Concepts for Therapeutic Roles in the Medicinal Product Hierarchy

Please see this Briefing Note for further information about the inactivation of grouping concepts for therapeutic roles in the Medicinal Product hierarchy. 

As part of the project all previous subtypes 763087004 |Medicinal product categorized by therapeutic role (product)| will have the 'plays role' additional axiom removed but the 766939001 |Plays role (attribute)| and 766941000 |Therapeutic role (role)| will remain in SNOMED CT. Vaccines are excluded from this work.

Older stated product subtypes of 763087004 |Medicinal product categorized by therapeutic role (product)| (for example, 26580005 |Digestant (product)|) are to also be inactivated most often with an inactivation target of the corresponding grouping concept for roles in the substance hierarchy (70 concepts approx.). All grouping concepts for therapeutic roles will remain in the substance hierarchy with a caveat added to Editorial guidance regarding known issues.

August 2024 International Release
17.

Body Structure

Update for Lateralizable Body Structures

Lateralizable body structures will be modeled by laterality with a value of "side". The changes will be made to over 4000 body structures in the July 2024 release. This will improve the classification of existing concepts.

The lateralizable reference set will also be updated.

August 2024 International Release
18.

Clinical Finding

Update for 1295265008 |Diffuse tenosynovial giant cell tumor (disorder)| and Descendants

Many of the subtypes of << 1295265008 |Diffuse tenosynovial giant cell tumor (disorder)| use the terms 'villonodular synovitis' and 'pigmented villonodular synovitis' in descriptions, including the FSN and PT. The concept FSNs will be updated to Diffuse tenosynovial giant cell tumor of <x> (disorder) with a PT Diffuse tenosynovial giant cell tumor of <x> and synonym Pigmented villonodular synovitis of <x>. Descriptions using Villonodular synovitis of <x> will be inactivated as they are outdated. 

The finding site values of these concepts will be reviewed and updated as required. 

August 2024 International Release
19.

Procedure

Update for 278854009 |Insertion of hormone implant (procedure)| and Descendants

As part of a quality review of the 782901001 |Insertion procedure (procedure)| hierarchy, 10 procedure concepts referring to hormone implants were found to be modeled with 257867005 |Insertion - action (qualifier value)|.  The descriptions also incorrectly referred to insertion of X hormone implant rather than implantation. These concepts will be remodeled with 129336009 |Implantation - action (qualifier value)|, with updated descriptions to reflect implantation. The previous insertion descriptions will be inactivated.

Q3 2024 International Release

2024 Published Content Changes With Confirmed Release Date

ItemHierarchyMOVED FROM PROPOSED CHANGES TO PUBLISHED CHANGESConfirmed Release Date
1.Content Improvement

Urinary Bladder

Following feedback from translation, descriptions for concepts that contain the word 'bladder' and the site of 89837001|Urinary bladder structure (body structure)| will be updated to include 'urinary' in the FSN and PT, for example:

126885006|Neoplasm of bladder (disorder)

will be updated to

126885006|Neoplasm of urinary bladder (disorder).

January 2024 International Release
2.Product

International Unit in Descriptions for Clinical Drugs

'International Unit' as a description is arbitrary and to be understood each product requires reference to a particular bioefficacy specification for that entity. Therefore, 'international' is not meaningful or comparable as a description at Clinical Drug level. International unit will be represented as 'unit' in Clinical Drug descriptions and 20 concepts will have their descriptions changed to 'unit'  Note: abbreviations will not be used. Editorial Guidance has been drafted.

January 2024 International Release
3.Procedure

Inactivation of  “RAST” and “RAST test” from subtypes of 104380004 |Allergen specific antibody measurement (procedure)|

Based on a proposal by the Allergies and Hypersensitivities CRG, descriptions containing “RAST” and “RAST test” will be inactivated from the concepts in this sub-hierarchy as they are not considered real synonyms.

Immunoassays for immunoglobulin specific to an allergen of interest are widely used in the diagnosis of allergic disease. These tests are often incorrectly referred to collectively as "radioallergosorbent tests" ("RAST") because they were the earliest immunoassays to be used extensively.

There are a few concepts of type "X mix radioallergosorbent test (procedure)", where RAST is in fact part of FSN. These concepts will be inactivated as they are ambiguous because they do not mention what allergens are being tested for. Replacement concepts, where individual allergens are spelled out, will be created where the information is available.

January 2024 International Release
4.Morphologic Abnormality

Inactivation of Congenital Morphologic Abnormality Concepts

37764001 |Congenital abnormal fusion (morphologic abnormality)| and 67798003 |Congenital premature fusion (morphologic abnormality) will be inactivated and replaced by:

  • Abnormal fusion (morphologic abnormality)
  • Premature fusion (morphologic abnormality)

These two new concepts do not specify occurrence which is to be modeled separately.  As a result of this change the two new concepts can be used to model fetal disorders.

This change aligns with the Editorial Guide.

February 2024 International Release
5.Clinical Finding

Inactivation of 106109006|Number of previous induced termination of pregnancy (finding)| and Subtypes

106109006|Number of previous induced termination of pregnancy (finding)| and subtypes will be inactivated and replaced by a new concept in the situation with explicit context hierarchy:

1300163008 |Past pregnancy history of multiple induced termination of pregnancy (situation)|

This concept is already published.

713649008 |Past pregnancy history of induced termination of pregnancy (situation)|

February 2024 International Release
6.Procedure

Update 77465005 |Transplantation (procedure) and Descendants

Note this project is ongoing. Proposals for the new model will be considered by the Editorial Advisory Group (EAG).

410820007 |Surgical transplantation - action (qualifier value)| and 129407005 |Grafting - action (qualifier value)| will be siblings (not child-parent relationship)  and will be subtypes of 129338005 |Surgical implantation - action (qualifier value)|. 

129347002 |Surgical transfer - action (qualifier value)| will no longer be a subtype of 410820007 |Surgical transplantation - action (qualifier value)|.

115956009 |Release (procedure)| will be inactivated and its subtypes remodeled to proximal primitive parent modeling and attributes added where necessary.

<< 422285003 |Solid organ graft - material (substance)|  and its subtypes will be updated from 'graft' to 'transplant'.  For example, 420291005 |Transplant heart (substance)|

The 77465005 |Transplantation (procedure)subtypes will be remodeled with 410820007 |Surgical transplantation - action (qualifier value) where necessary. Also, certain grafting procedures that were subtypes of transplantation procedure will be remodeled with 129407005 |Grafting - action (qualifier value)|.

February 2024 International Release
7.

Clinical Finding

Morphologic Abnormality

Situation with Explicit Context

Remodel 127575007 |Malignant neuroendocrine neoplasm, epithelial (morphologic abnormality)| and Subtypes

127575007 |Malignant neuroendocrine neoplasm, epithelial (morphologic abnormality)|, its subtypes and related disorder concepts will be revised to align with the 5th edition of the WHO Blue Book chapter on Endocrine and Neuroendocrine Tumours as part of the Histology Quality Improvement Project.

Please see the briefing note for more information about these changes.

February 2024 International Release
8.Procedure

Update for 73632009 |Laparoscopy (procedure)| and Subtypes 

There will be a bulk update to align 73632009 |Laparoscopy (procedure)| and subtypes with the template here: https://confluence.ihtsdotools.org/display/SCTEMPLATES/Laparoscopy+%28procedure%29+-+Draft

These changes include the addition of INCISION ROLE GROUP and INSPECTION ROLE GROUP for all Laparoscopic procedures. 

February 2024 International Release
9.Clinical Finding

Update for Diabetes Insipidus

Based on a report from October 2022 from the Working Group for Renaming Diabetes Insipidus, concepts using the term “Diabetes insipidus” will be renamed and/or replaced with terms that more appropriately represent the pathophysiology of this condition.  The top-level concept replacing "Diabetes insipidus" will be "Arginine vasopressin-related polyuria" and the specific subtypes will be represented by two renamed conditions: 

  • Arginine Vasopressin Deficiency (AVP-D)” for central etiologies

  • Arginine Vasopressin Resistance (AVP-R)” for nephrogenic etiologies

The legacy descriptions of "Diabetes insipidus", "Central diabetes insipidus" and "Nephrogenic diabetes insipidus" will be retained where appropriate to facilitate retrieval of concepts by their newer names. This affects approximately 18 existing concepts in SNOMED CT.

February 2024 International Release
10.Procedure

17423001 |Epiphysiodesis (procedure) - Remodel Subtypes Epiphyseal Stapling

Epiphyseal stapling concepts will be moved from being a subtype of 17423001 |Epiphysiodesis (procedure)|. 

Epiphysiodesis is a fusion of the epiphyseal plate resulting in a permanent arrest of growth, whereas Epiphyseal stapling is a fixation of the epiphyseal plate in order to arrest growth and is often reversible once the staples are removed.  

February 2024 International Release
11.Annotation Reference Set

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".
  • 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.

June 2024 International Release
12.Morphologic Abnormality

Inactivation of Congenital Morphologic Abnormality Concepts

61295008 |Congenital abnormal number (morphologic abnormality)|

125226006|Congenital malposition, left (morphologic abnormality)|

125225005|Congenital malposition, right (morphologic abnormality)|

56457002|Congenital atresia (morphologic abnormality)| 

41086002 |Congenital smallness (morphologic abnormality)|

81850003 |Congenital sequestration (morphologic abnormality)|

These concepts will be inactivated and replaced by a concept that does not specify congenital. Concepts that are modeled with these morphologic abnormality concepts will be remodeled using the replacement concept. This change aligns with the Editorial Guide.

March 2024 International Release
13.Annotation

OWL Axiom Expressions for Annotation Properties

The new annotation properties should be 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)
  • However, all subconcepts of 1295447006 |Annotation attribute (attribute)| should be represented as "SubAnnotationPropertyOf", instead of "subClassOf" as they currently are.
    • 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)

They should therefore be changed to:

  • SubAnnotationPropertyOf(:1295448001 :1295447006)
  • SubAnnotationPropertyOf(:1295449009 :1295447006)

However, the authoring tool will then need to be updated to ensure all new subconcepts of 1295447006 |Annotation attribute (attribute)| will be represented as SubAnnotationPropertyOf() in the future.  Numerous other tools will also need to be updated first in order to correctly consume the new format.

There are numerous systems that require updating, and that this will therefore need to be carefully tested and rolled out over the next few months.  As the potential impact was analysed and deemed to be low, the Annotations deployment will still go ahead as planned in the January 2024 International Edition release, whereas these axiom updates will be published in subsequent releases.  Please, therefore, be aware that this issue will persist for the first few International Edition releases of 2024.

Axiom updates published March 2024 International Release

Remaining updates to be published in 2024.

Please see section above '2024 Proposed Content Changes' for further updates on the remaining content/tooling changes required to complete this item.

14.Body Structure

Inactivation of 9258009|Gravid uterus structure (body structure)|

This concept will be inactivated, content that is modeled with this concept will be remodeled with a site of 35039007|Uterine structure (body structure)| along with occurrence <<307159006|Pregnancy time period (qualifier value)|.  

The domain of 246454002 |Occurrence (attribute)| has been extended in the October 2023 release to include << 71388002 |Procedure (procedure)| to support these content changes. Content areas that will be updated include 386811000|Fetal procedure (procedure)| and 386637004|Obstetric procedure (procedure)|.

April 2024 International Release
15.Body Structure

Inactivation of Concepts Specified Male/Female in Descriptions

67770001 |Male mammary gland structure (body structure)| and 91532001 |Female mammary gland structure (body structure)| and subtypes plus associated disorder and specimen concepts will be inactivated.  Further information is available here (Confluence log in required).

NOTE: this update will include the inactivation of neoplasm concepts that specify male/female, this includes

<<126927001|Neoplasm of female breast (disorder)|

<<126937006|Neoplasm of male breast (disorder)|

These concepts will be replaced with a concept that does not specify male/female, a new concept will be added where one does not already exist.

April 2024 International Release
16.Procedure

Update Hierarchy 363680008|Radiographic imaging Procedure (procedure)|and Descendants

A Briefing Note documenting the proposed changes for the hierarchy 363680008|Radiographic imaging procedure (procedure)| and descendants was shared with the Editorial Advisory Group, Clinical Leads Group, Member Forum, Content Managers Advisory Group, and other key stakeholders in July 2023.

Feedback was received from a wide range of stakeholders. In response to this feedback, the proposed changes to the hierarchy have been modified. These modifications will address issues raised in the feedback.

This Informational Briefing Note summarizes the changes that will be implemented.

Implementation of the content changes will commence in Q4 2023. The updates will be implemented in sub-hierarchies and promoted over a number of international monthly releases until complete.

April 2024 release:

  • 168537006|Plain radiography (procedure)| and subtypes
  • 168500000|Radiology result normal (finding)| and subtypes
  • 168501001|Radiology result abnormal (finding)| and subtypes

Remaining changes across 2024 International Releases

17.Qualifier Value

Change Parent for 410460000|Illumination - action (qualifier value)| and Subtypes

410460000|Illumination - action (qualifier value)| and descendants will be updated to be a subtype of 272394005|Technique (qualifier value)|.  The concepts will not be inactivated.  Descriptions that currently include '- action’ will be inactivated and replaced. 

Concepts that are currently modeled with method 410460000|Illumination - action (qualifier value)| will be remodeled with a method of 360037004|Imaging - action (qualifier value)|.  These changes will complete this Content Tracker.

April 2024 International Release
18.Procedure

Inactivation of 118661008|Physician service (procedure)| and Descendants

118661008|Physician service (procedure)| and subtypes will be inactivated and replaced with concepts that are a subtype of 224891009|Healthcare services (qualifier value)| where appropriate.

These changes will complete this Content Tracker.

April 2024 International Release
19.Qualifier Value

Addition of New Technique Qualifier Value Concepts

Around 80 new laboratory technique concepts will be added in the 272394005 |Technique (qualifier value)| subhierarchy.

March and April 2024 International Releases
20.Procedure

Inactivation of 277132007|Therapeutic procedure (procedure)

The concept 277132007 |Therapeutic procedure (procedure) will be inactivated with the inactivation reason of Outdated and a replacement association target of 71388002 |Procedure (procedure)|. The nearly 2000 descendants will be reviewed as to the appropriateness of either the Has intent (attribute) of Therapeutic intent, or a Method (attribute) of Therapy - action.

For further information please see briefing note.

For 1st May 2024 release:

The immediate subtypes of <277132007 |Therapeutic procedure (procedure)|, excluding <<416608005 |Drug therapy (procedure)|, will be reviewed for appropriate presence or absence of the Has intent (attribute) according to the Editorial Guide for the 1 May release.   

A potential concept model for 416608005 |Drug therapy (procedure)| and for 276239002 |Therapy (regime/therapy)| requires further consultation. 277132007 |Therapeutic procedure (procedure)| will remain active until this work has been undertaken please watch the Content Tracker for future development.

May 2024 International Release
21.MRCM

Changes to MRCM

There are planned changes to MRCM for the attribute in group cardinality to four attributes:

  • "characterizes"
  • "precondition"
  • "technique"
  • "component"

These changes are being made to support the implementation of role group changes to observables and evaluation procedures. 

The domain "administration via specific route (procedure)" will be removed and the attribute "route of administration" will be optional for the domain of procedure.

May 2024 International Release
22.Clinical Finding

Inactivation of 248536006 |Finding of functional performance and activity (finding)

This concept will be inactivated:

248536006 |Finding of functional performance and activity (finding).

The concept is an intermediate primitive grouper for 2000+ concepts and this inactivation will improve subsumption for content in the hierarchy.

May 2024 International Release
23.Procedure

Inactivation of 410770002 |Administration of anesthesia for procedure (procedure)| and Subtypes

A Briefing note was presented to Anesthesia CRG with a proposal for review and remodeling of 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy.

As part of that proposal, inactivation of 410770002 |Administration of anesthesia for procedure (procedure)| hierarchy was agreed.

This inactivation will affect 410770002 |Administration of anesthesia for procedure (procedure)|and subtypes, and 10745231000119102 |Cardiac arrest due to administration of anesthesia for obstetric procedure in pregnancy (disorder)|.

Concepts in 410770002 |Administration of anesthesia for procedure (procedure)|hierarchy will be inactivated with Inactivation reason = Outdated component and Replaced by 399097000 |Administration of anesthesia (procedure)|.

For 10745231000119102 |Cardiac arrest due to administration of anesthesia for obstetric procedure in pregnancy (disorder)|FSN will be changed to 10745231000119102 |Cardiac arrest due to administration of anesthesia in pregnancy (disorder)| and value for 42752001 |Due to (attribute)| will be changed to 399097000 |Administration of anesthesia (procedure)|.

June 2024 International Release
24.

Substance


Antibody to X Organism

The descriptions for the children of 312301006 |Infective organism antibody (substance)| (antibody to X or X antibody) will be updated as per editorial guidelines where applicable.

June 2024 International Release
25.

Procedure

Update 71651007|Mammography (procedure)| and Descendants

As part of the content update being undertaken for: 363680008|Radiographic imaging Procedure (procedure)| and Descendants (please see item 2 above for details).

Content changes will be undertaken for 71651007|Mammography (procedure)| and subtypes.

A new concept will be added as the supertype - Imaging of breast (procedure).

New imaging actions will be added:

  • Mammographic imaging - action (qualifier value)
  • Mammographic digital tomosynthesis - action (qualifier value)

These new actions will distinguish mammography from the less specific action 278110001 |Radiographic imaging - action (qualifier value)|.

71651007|Mammography (procedure)| and subtypes will be modeled with the new imaging action Mammographic imaging - action (qualifier value). 

NOTE: this change will result in some of the current subtypes of 71651007|Mammography (procedure)| moving up the hierarchy to become subtypes of Imaging of breast (procedure). For example, 709657006|Fluoroscopy of breast (procedure)| will become a subtype of Imaging of breast (procedure) and not 71651007|Mammography (procedure)|.

450566007|Digital tomosynthesis of breast (procedure)| will be sufficiently defined by the new imaging action Mammographic digital tomosynthesis - action (qualifier value) and remain a subtype of 71651007|Mammography (procedure)|.

June 2024 International Release
26.

Morphologic Abnormality

Update << 1187137001|Squamous intraepithelial neoplasia (morphologic abnormality)|

The << 1187137001|Squamous intraepithelial neoplasia (morphologic abnormality)| subhierarchy will be updated to properly represent the two common grading systems used globally.

For further information please see this briefing note.

June 2024 International Release
27.

Social Context

Inactivation of 60134006 |Life style (life style)| and subtypes

60134006 |Life style (life style)| and subtypes will be inactivated as these concept refer to findings about behaviors that an individual has engaged in and not lifestyle. 134436002|Lifestyle (finding)| will also be inactivated.

June 2024 International Release
28.Annotation

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(). Other tools will be updated to correctly consume the updated syntax. This will be carefully tested and rolled out over the next few months.

June 2024 International Release
29.Clinical Finding

Update for Concepts Using 'Caused by'

Clinical finding concepts containing "Caused by" in their FSN will be reviewed and will be updated (if applicable) according to the editorial guidelines related to causation here. 

There is one area where work is still in progress:  

  • Clinical finding caused by radiation.
Changes complete July 2024 International Release
30.Social Context

Inactivation of Race and Ethnicity Concepts

Based on discussions with the Member Forum, all subtypes of 372148003 |Ethnic group (ethnic group)| and most subtypes of 415229000 |Racial group (racial group)| will be inactivated as out of scope for the International release.

While all subtypes of 372148003 |Ethnic group (ethnic group)| will be inactivated, the top level concept will be retained for extensions to add their local concepts.

All subtypes of  415229000 |Racial group (racial group)| will be inactivated except for the following:

  • 413464008 |African race (racial group)|
  • 413773004 |Caucasian (racial group)|
  • 413582008 |Asian race (racial group)|
  • 413491005 |American Indian race (racial group)| 
  • 414752008 |Mixed racial group (racial group)|
  • 415794004 |Unknown racial group (racial group)|
  • 1336109002 |Pacific islander (racial group)|

A briefing note is available here.

July 2024 International Release
31.Observable Entity/Procedure

Update Role Grouping for Observable Entity and Evaluation Procedure Concepts

Currently, Observable Entity concepts’ attributes are self-grouped  in the international edition. Based on recommendation by the Modeling Advisory Group (MAG), the policy has changed to group these attributes together in order to support modeling concepts with multiple observations and address inconsistent modeling between evaluation procedures and observable entities.

The same changes will be applied to the concepts in the evaluation procedure hierarchy that are modeled with applicable self-grouped attributes. Please see this briefing note for details. 

Please note that the scope of this change is limited to implementation of the updated role grouping MRCM rules for the observable entity and evaluation procedure hierarchies. There are areas in these subhierarchies that require content improvements , including but not limited to the following areas: complement assays, autoantibody measurements, concepts that refer to more than one Component (examples: ratios and concepts with “And”), Components including “Free” and “Total," concepts with fully defined parents, and procedure concepts modeled with a combination of evaluation procedure attributes and general procedure attributes.

Some of the issues were already known and some were identified during this work. These improvements are not in the scope of this work and will be undertaken in future work including the QI project and improvements in other hierarchies including substance and specimen. Some of the issues require feedback from SMEs and/or communication with the Members. If required, editorial guidelines will be updated accordingly.

July 2024 International Release
32.

Body Structure

Update for Cardiac Wall and Cardiac Segment

A proposed new model for this area of content is available here.

Further information is available in this briefing note.

July 2024 International Release
33.

Clinical Finding

Procedure

Specimen

Update 'Head and Neck' and 'Head and/or Neck'

A small number of concepts have been 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 will be changed to reflect this intended meaning with therefore no change in descendants.

Procedures such as 430215009 |Biopsy of head and neck structure (procedure)| will be 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 will impact descendants who will become children of the distinct concepts.

Examples of concepts to be 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)|
July 2024 International Release
34.

Procedure

Review of <<75506009 |Construction of stoma (procedure)|

A review of the 75506009 |Construction of stoma (procedure)| hierarchy is in progress. The focus is on updating concept modeling, but there will be a small number of inactivations (<20 concepts) and description changes, where appropriate.

July 2024 International Release
35.

Procedure

Update 42687005|Lymphangiogram (procedure)| and Subtypes

42687005|Lymphangiogram (procedure)| and subtypes have been reviewed as part of the content update being undertaken for: 363680008|Radiographic imaging Procedure (procedure)| and Descendants (please see item 2 above for details).

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’ or 'lymphangiogram' with method 278110001|Radiographic imaging - action (qualifier value)| will be 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)| will be inactivated and replaced by a new concept: Fluoroscopic lymphangiography of lower limb with contrast (procedure)|

A new supertype concept will be added: 1336147007 |Imaging of lymphatic system (procedure)|

July 2024 International Release
36.

Procedure

Update to 55670007 |Endodontic procedure (procedure)| and Subtypes

In consultation with the Dentistry Clinical Reference Group, updates will be made to the hierarchy 55670007 |Endodontic procedure (procedure)|. This will result in approximately 25 concepts being inactivated or remodeled. Where appropriate, replacement concepts will be added.

July 2024 International Release


Project Information and Work in Progress

Item

Hierarchy/Topic

INFORMATION ABOUT PROJECTS AND WORK IN PROGRESS

Planned Release timing

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

1.General Information

Browse Content Changes for the International Release

For content changes that are ready for publication in the next release please browse here

Concept Inactivation

For concept inactivations that are for publication in the next release please browse here

MRCM Changes

Forthcoming MRCM changes can be viewed here

Content Request Service (CRS)

For information please see here


2.Project Information

Cancer Synoptic Reporting

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.

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

2024 International Release and future releases
3.Project Information

Epilepsy Content ILAE Collaboration

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. 

Please refer to the project status report for further information.

2024 International Release and future releases


4.Content Improvement

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

2024 International Release and future releases

5.Procedure/Observable Entity

Evaluation Procedure vs Observable Entity

Member feedback and subsequent discussion on the 2023 briefing note containing a proposed solution to resolve the duplication between the evaluation procedure and observable entity hierarchies has resulted in reconsideration of the resolution. Actions as described in the briefing note will not be instituted. Instead, the existing evaluation procedure hierarchy will be retained to support existing use cases. No new content will be added in the international release in the evaluation procedure hierarchy for content that logically belongs in the observable entity hierarchy. If new content is needed in the evaluation procedure hierarchy to satisfy existing use cases, it can be created in national extensions. 

The SNOMED CT Editorial Guide is being updated to reflect this decision.


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3 Comments

  1. 2024 Proposed Content Changes in the number 9. Procedure/Observable Entity, the link for briefing notes is not working!



    1. Hi Maryam, the link is working for me, the issue may relate to your access (also please check you are logged into Confluence), I attach a download of the PDF, Kind regards, Maria Braithwaite 20230809 BN Evaluation procedure to Observable entity v1.0 (1).pdf

      1. I'm logged in, but the page has not been found! Thanks Maria Braithwaite for the pdf. (smile)