January 2021 Early Visibility Release Notice - Planned changes to upcoming SNOMED International Release packages

COVID-19 Content

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

July 2020 International Edition Release

January 2021 International Release and future releases

COVID-19 Vaccine

The following new concepts have been added:

• 1119305005 |Vaccine product containing only Severe acute respiratory syndrome coronavirus 2 antigen (medicinal product)|
• 1119349007 |Vaccine product containing only Severe acute respiratory syndrome coronavirus 2 messenger ribonucleic acid (medicinal product)|
• 1119350007 |Administration of vaccine product containing only Severe acute respiratory syndrome coronavirus 2 messenger ribonucleic acid (procedure)|

The following concept has updated modeling and terming to conform with the Editorial Guide:

• 840534001 |Administration of vaccine product containing only Severe acute respiratory syndrome coronavirus 2 antigen (procedure)|

The following concept has been inactivated:

• 90640007 |Coronavirus vaccination (procedure)|

Persistent Symptoms of COVID-19

To address the need for concepts related to persistent symptoms of COVID-19, three new concepts have been added to SNOMED CT for the Jan 2021 release.

1119302008 |Acute disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder)|
PT: Acute COVID-19

1119303003 |Post-acute COVID-19 (disorder)|
PT: Post-acute COVID-19
SYN: Long COVID-19
SYN: Long-haul COVID-19
DEF: Symptoms attributed to SARS-CoV-2 infection that persist for more than three weeks following onset.

1119304009 |Chronic post-COVID-19 syndrome (disorder)|
PT: Chronic post-COVID-19 syndrome
DEF: Symptoms related to COVID-19 that persist more than 12 weeks following onset.

Browse Content Changes for the January 2021 Release

The daily build is available to review changes made to content for the January 20201 release https://dailybuild.ihtsdotools.org/

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

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: https://confluence.ihtsdotools.org/display/IAP/Revision+of+IS-A+relationships+for+anatomy

January 2021 International Release and future releases

MRCM Changes

MRCM changes in the January 2021 release

Quality Initiative

Information about the project can found here - Quality Initiative - Progress

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/Early-Visibility-of-Changes-to-Service-Level-Agreement-International-Content-Request-Service-(CRS).pdf

Revision of 420040002|Fluoroscopic angiography (procedure)| and all descendants

After consultation with clinical stakeholders and the Editorial Advisory Group, the following changes have been implemented:

• 420040002|Fluoroscopic angiography (procedure)| and all subtypes have been remodelled to include attribute 424361007 |Using substance (attribute)| and value 385420005 |Contrast media (substance)| in the role group.
• The descriptions for 420040002|Fluoroscopic angiography (procedure)| and subtypes have been updated to explicitly state ‘with contrast.’
• Where logical equivalence has been identified once the above changes have been implemented one of the concepts has been inactivated, in these cases the existing concept that stipulates 'with contrast' in the FSN has been retained.

Revision of 418272005|Computed tomography angiography (procedure)| and all descendants

After consultation with clinical stakeholders and the Editorial Advisory Group, the following changes have been implemented:

• 418272005|Computed tomography angiography (procedure)| and all subtypes have been remodelled to include attribute 424361007 |Using substance (attribute)| and value 385420005 |Contrast media (substance)| in the role group.
• The descriptions for 418272005|Computed tomography angiography (procedure) and subtypes have been updated to explicitly state ‘with contrast.’
• Where logical equivalence has been identified once the above changes have been implemented one of the concepts has been inactivated, in these cases the existing concept that stipulates 'with contrast' in the FSN has been retained.

Inactivation of 206002004|Fetal or neonatal effect of maternal medical problem (disorder)

206002004|Fetal or neonatal effect of maternal medical problem (disorder)| and descendants has been inactivated.

Replacement concepts that do not include 'or' in the descriptions have been added as subtypes of 70591005|Fetal disorder (disorder)| and 22925008|Neonatal disorder (disorder)|.

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.

Contact Dermatitis

We are reviewing and updating the modeling for concepts in this sub-hierarchy to adhere with a newly constructed template. As part of this review, and in consultation with clinical stakeholders, we are identifying and inactivating concepts that are ambiguous or are not clinically useful.

The list of inactivated concepts can be tracked via https://dailybuild.ihtsdotools.org/

12456005 |Iatrogenic disorder (disorder)

Subtypes of 12456005 |Iatrogenic disorder (disorder)| that do not have the word iatrogenic in the FSN have been remodeled so that they are no longer a subtype of this concept.

New subtypes have been added to 12456005 |Iatrogenic disorder (disorder)| where the disorder specifies iatrogenic in the FSN.

Inactivation of ‘unilateral’ content

Unilateral concepts where there is ambiguity in meaning are to be inactivated with a status of ambiguous, this includes for example:

• Unilateral situation concepts
• Unilateral procedure concepts
• 'Remaining' <x> site procedure concepts
• 'One' eye disorder and procedure concepts
• Better/lesser eye disorder concepts 

Replacement left and right concepts are being created where suitable. Please note, vision impairment concepts e.g. |Better eye: severe visual impairment, Lesser eye: profound visual impairment (disorder)|, |Profound impairment, one eye (disorder)| will not be replaced.

Allergy to X vaccine/Adverse reaction to X vaccine

Editorial guidelines and content for the concept pattern "Allergy to X vaccine" and also “Adverse reaction to X vaccine" have been updated for the 2021-January Release.

Editorial Guidelines will be added to the corresponding version of the main SNOMED Editorial Guide; in the meantime, they can be accessed under the announcements section at: Drugs Project.

Content Improvements in the Substance and Product Hierarchies

Please see briefing notes here Drugs Project

Please contact info@snomed.org with any inquiries.

Inactivation of 349362006 |Medical gases (product)

The concept 349362006 |Medical gases (product)| has been inactivated with reason of outdated.

Descendants have been remodeled per existing Medicinal Product editorial guidelines please see Reference Documentation - Medicinal Product Model

Changes will be visible via the DailyBuild Browser after 1-September 2020.

Changes for 318331000221102 |Active immunity stimulant therapeutic role (role)

318331000221102 |Active immunity stimulant therapeutic role (role)| updated based on feedback received and with agreement from Drugs WG:

• New FSN = Active immunity stimulant role (role)
• New PT = Active immunity stimulant role
• Stated parent changed from 766941000 |Therapeutic role (role)| to 766940004 |Role (role)|

Changes can be viewed via DailyBuild Browser

Inactivation of 346348003 |Blood derivative product (product)|

High-level grouper 346348003 |Blood derivative product (product)| has been inactivated based on agreement from Drug WG; the descendants have been reviewed and remodeled using the existing medicinal product concept model.

Inactivation of Vaccine product "containing" groupers

Vaccine product "containing" groupers that are modeled with more than one active ingredient or with an active ingredient that is a substance modification have been inactivated as out of scope per the editorial guidelines.

Inactivation of 81118006 |Gonadal hormone (substance)| and remodeling of sub-hierarchy

As part of the Substance hierarchy maintenance, 81118006 |Gonadal hormone (substance)| has been inactivated and replaced with 312263009 |Sex hormone (substance)|.

The concepts previously subsumed by Gonadal hormone are under review and remodeling. As part of this review, and in consultation with subject matter experts, we are identifying and inactivating concepts that are ambiguous or that are not clinically useful.

Content Improvements in the Physical object Hierarchy

Please see project roadmap and briefing notes here: https://confluence.ihtsdotools.org/display/IAP/Devices+Project

Please contact info@snomed.org with any inquiries.

Inactivation of Fracture of vertebra without spinal cord lesion (disorder) and descendants

Based on input from the Editorial Advisory Group and a member stakeholder:

269061001 |Fracture of vertebra without spinal cord lesion (disorder)| and descendants have been inactivated with a status of 'Ambiguous' and the historical association POSSIBLY EQUIVALENT TO = 50448004|Fracture of vertebral column (disorder)|.

These concepts originated from ICD-9 to represent the notion of "Fracture of X without mention of Y". 

This type of term is not represented in ICD-10 or ICD-11. As "without mention" is not semantically equivalent to "without" and could mean that the information was not available in the record abstraction, these concepts are considered to be ambiguous in their meaning.

Revision of 253546004|Left ventricular outflow tract obstruction (disorder)| and 253530007 |Right ventricular outflow tract obstruction (disorder)|

Occurrence 'congenital' has been removed from these two concepts with remodel of subtypes.

Inactivation of 25674000 Lichen sclerosus et atrophicus (disorder) and remodeling of sub-hierarchy

As part of the QI project, 25674000 Lichen sclerosus et atrophicus (disorder) has been inactivated as outdated and replaced with new concept 895454001 Lichen sclerosus (disorder).

A new morphology concept 895217008 Lichen sclerosus (morphologic abnormality) has been created and used to remodel the new concept and 20 descendants. This improvement has resulted in 895454001 Lichen sclerosus (disorder) having no stated subtypes (with all Sufficiently Defined where possible).

Inactivation of Subtypes of 372148003|Ethnic group (ethnic group)|

Concepts which include "other" or relate to UK census have been inactivated from the International release and moved back to the UK extension.

Inactivation of 362955004|Inactive concept (inactive concept)|

362955004|Inactive concept (inactive concept)| and its seven descendants will be inactivated with a historical relationship to its replacement.

362955004|Inactive concept (inactive concept)| and descendants were used in the first release format (RF1) however these concepts are no longer used in the current release format (RF2).  

Inactivation of Tooth Anatomy Concepts

The Dentistry Clinical Reference Group has recommended inactivation of the following concepts due to the potential to pose a clinical risk: 

• 39844006 |Structure of mandibular left canine tooth (body structure) |
• 113278005 |Structure of mandibular left central incisor tooth (body structure) |
• 89625000 |Structure of mandibular left first molar tooth (body structure) |
• 77130001 |Structure of mandibular left lateral incisor tooth (body structure) |
• 48402004 |Structure of mandibular left second molar tooth (body structure) |
• 47055002 |Structure of mandibular right canine tooth (body structure) |
• 15422005 |Structure of mandibular right central incisor tooth (body structure) |
• 28480000 |Structure of mandibular right first molar tooth (body structure) |
• 82628004 |Structure of mandibular right lateral incisor tooth (body structure) |
• 40005008 |Structure of mandibular right second molar tooth (body structure) |
• 72876007 |Structure of maxillary left canine tooth (body structure) |
• 31982000 |Structure of maxillary left central incisor tooth (body structure) |
• 23427002 |Structure of maxillary left first molar tooth (body structure) |
• 25748002 |Structure of maxillary left lateral incisor tooth (body structure) |
• 66303006 |Structure of maxillary left second molar tooth (body structure) |
• 80647007 |Structure of maxillary right canine tooth (body structure) |
• 22120004 |Structure of maxillary right central incisor tooth (body structure) |
• 5140004 |Structure of maxillary right first molar tooth (body structure) |
• 11712009 |Structure of maxillary right lateral incisor tooth (body structure) |
• 7121006 |Structure of maxillary right second molar tooth (body structure) |

The concepts have been inactivated with reason 'ambiguous' and a historical association target of the permanent and deciduous tooth. For example: Structure of mandibular left lateral incisor tooth (body structure) has been inactivated as ambiguous and replaced by Structure of deciduous mandibular left lateral incisor tooth (body structure) and Structure of permanent mandibular left lateral incisor tooth (body structure).

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.

Changes for 'On examination' (O/E) and 'Complaining of' (C/O) concepts

• Addition of any further required content
• Inactivation of the O/E and C/O content (Batch change) for return to the UK.

Content being inactivated will use the reason - component moved elsewhere. 

Note: some concepts will not have a replacement concept as they are groupers. For example:
On examination - sign irregular (finding)
On examination - neurological reflex (finding)

Planned changes for 'Has ingredient characteristic’ and 'Has product characteristic’ attributes

Based on guidance provided by the Editorial Advisory Group, the Has ingredient characteristic and Has product characteristic attributes will be refined to more specific attributes in a future release.

Concrete Domains and Numeric Representation

The Modeling Advisory Group is working on concrete domains and how they will be represented in the inferred RF2 relationship file format. The following is a note on the interim solution relating to concrete domain for the medicinal product model:

Numerics are represented by concepts in the Medicinal product concept model in SNOMED CT, which is an interim solution before the implementation of concrete domains to support data types, such as decimal, integer, string and date/time. We are in progress for the development of the specification for the inferred relationship file and consult with the community of practice. When they are ready, strength in medicinal product model can be transformed to concrete domains. The transformation will be completed by technical changes without impact to classification results.

The further information about current progress on Concrete Domains can be found at:

https://confluence.ihtsdotools.org/display/mag/Modeling+Advisory+Group 

Replacement of the Stated Relationship files with the new OWL Axiom refset files

A set of documentations has been developed to support the Logic Profile Enhancements. 

• SNOMED DL Profile Enhancements
• SNOMED CT Logic Profile Specification
• SNOMED CT OWL Guide (OWL Refsets specification)
• Snomed OWL Toolkit - https://github.com/IHTSDO/snomed-owl-toolkit
• Classifying SNOMED CT using the Snomed OWL Toolkit - https://youtu.be/-91egY9mJqA
• Creating an OWL file containing SNOMED CT - https://youtu.be/sfFbMMioA_4

For any questions, please contact SNOMED International at support@snomed.org with “OWL Axiom refset files implementation question” in the subject line.