1. Introduction

SNOMED CT terminology provides a common language that enables a consistent way of indexing, storing, retrieving, and aggregating clinical data across specialties and sites of care.

The International Health Terminology Standards Development organization (IHTSDO^®), trading as SNOMED International, maintains the SNOMED CT technical design, the content architecture, the SNOMED CT content (includes the concepts table, the descriptions table, the relationships table, a history table, and ICD mappings), and related technical documentation.

2. Background

This document provides a summarized description of the content changes included in the November 2023 Production release of the SNOMED Clinical Terms^® Managed Service Belgium Extension package.

It also includes technical notes detailing the known issues which have been identified (should any of these exist). These are content or technical issues where the root cause is understood, and the fix has been discussed and agreed, but has yet to be implemented.

This Belgium Extension package is dependent upon, and should therefore be consumed in conjunction with the SNOMED CT® September 2023 International Edition release.

2.1 Scope

This document is written for the purpose described above and is not intended to provide details of the technical specifications for SNOMED CT or encompass every change made during the release.

3.  Content Development Activity

3.1. Summary

Content from the SNOMED CT® September 2023 International Edition release has been translated.

This extension contains concepts, relationships and reference sets with their Dutch and French translations for healthcare professionals/for use in healthcare profession.

3.2 New and Updated Content

New Belgian content in this release:

New concepts

No new concepts have been created in this release.

Removed reference sets

No reference sets have been removed from the package in this release.

New translated content

Regarding the GP language refset:

• GP language refset: the following table contains the total number of translations included in the GP language refset:

Regarding the national language refset:

• New translations have been introduced, both for concepts that didn't have a translation yet as for concepts with existing translations.
• The following table contains the number the total number of translations included in the actual version of the Belgian language refset:

The other changes are updates of existing content.

4. Technical notes

4.1. Known Issues

Known Issues are content or technical issues where the root cause is understood, and the resolution has been discussed and agreed but has yet to be implemented.  This can be due to a number of reasons, from lack of capacity within the current editing cycle, to the risk of impact to the stability of SNOMED CT if the fix were to be deployed at that stage in the Product lifecycle.  

For the SNOMED CT Managed Service - Belgium Extension Release, the following Known Issues were identified, and agreed to be resolved in the next editing cycle:

4.2. Technical notes

4.2.1. New Refsets

Please be aware that the following new files have been added to the Belgium Extension Release package, representing the new refsets being introduced in this editing cycle:

• Subset For Neonatology In Patient Health Records Simple Refset (100971000172106)
  • der2_Refset_SubsetForNeonatologyInPatientHealthRecordsSimpleRefsetFull_BE1000172_20231115.txt
  • der2_Refset_SubsetForNeonatologyInPatientHealthRecordsSimpleRefsetSnapshot_BE1000172_20231115.txt
• Subset For Nephrology In Patient Health Records Simple Refset (100951000172104)
  • der2_Refset_SubsetForNephrologyInPatientHealthRecordsSimpleRefsetFull_BE1000172_20231115.txt
  • der2_Refset_SubsetForNephrologyInPatientHealthRecordsSimpleRefsetSnapshot_BE1000172_20231115.txt
• Subset For Nursing In Patient Health Records Simple Refset (100941000172101)
  • der2_Refset_SubsetForNursingInPatientHealthRecordsSimpleRefsetFull_BE1000172_20231115.txt
  • der2_Refset_SubsetForNursingInPatientHealthRecordsSimpleRefsetSnapshot_BE1000172_20231115.txt
• Subset For Pulmonology In Patient Health Records Simple Refset (100961000172102)
  • der2_Refset_SubsetForPulmonologyInPatientHealthRecordsSimpleRefsetFull_BE1000172_20231115.txt
  • der2_Refset_SubsetForPulmonologyInPatientHealthRecordsSimpleRefsetSnapshot_BE1000172_20231115.txt
• Subset For Rheumatology In Patient Health Records Simple Refset (100981000172109)
  • der2_Refset_SubsetForRheumatologyInPatientHealthRecordsSimpleRefsetFull_BE1000172_20231115.txt
  • der2_Refset_SubsetForRheumatologyInPatientHealthRecordsSimpleRefsetSnapshot_BE1000172_20231115.txt

4.3.  Notice of changes to the International Edition Release Schedule

As you may already know SNOMED International have transitioned to a monthly delivery schedule for the International Edition of SNOMED CT. The move towards more frequent releases of SNOMED CT realizes several benefits, including:

• The potential to be able to get content changes into the terminology in a shorter time frame.
• The fostering of better interoperability, as a result of entities being able to consume release content that is more aligned with other organizations.
• The prevention of circular dependencies that occur in longer projects, due to the move towards smaller, more manageable authoring projects.
• More automated validation services, as a result of the inherent removal of the Alpha/Beta stages in the Release cycle.

Whilst most users will continue unaffected (as they can simply continue to download the releases every 6 months as always), this transition will necessarily involve a few changes to process/packages:

• Delta files have been removed from both International and Managed Service release packages, including the Belgium Extension.  A Delta Generation service will be provided for those who need it. The Delta Generation Tool allows users to create their own Delta between two fixed release dates - you can find it here:
  • https://github.com/IHTSDO/delta-generator-tool/releases

• The ICD-O/ICD-10 Maps will continue to be published in each Monthly International Edition release package (in line with that month's content) for the foreseeable future, unless we experience issues with the new process in Production, and they need to be removed at a later date.

The first monthly Release of the SNOMED CT International Edition was published on the 28th February 2022 with the Delta files having been removed, and therefore they have been removed from the Belgium Extension from the March 2022 Release onwards.

Please note - While the SNOMED CT International Edition is moving to monthly releases, the Belgium Extension of SNOMED CT will remain on the new bi-annual release schedule of May and November.

4.4.  Notice of changes to the Belgian Extension Release Dates

As we have already communicated in a separate notification, the release dates of the Belgian extension have changed.

From now on the new dates of the six-monthly release of the Belgian extension will be:

• 15 May
• 15 November

This change has been made for organizational reasons, taking into account the availability of our human resources.

Please note that the release cycle of 6 months remains (for now), only the dates have changed.

4.5. Changes to the Identifier file format

In line with the proposals documented here:  https://confluence.ihtsdotools.org/mag/snomed-international-proposal-to-change-the-rf2-identifier-file-specification - the Belgium Extension Release will from now on include the following changes to the format of the Identifier files:

• < identifierSchemeId    alternateIdentifier    effectiveTime    active    moduleId    referencedComponentId           ...to
• > alternateIdentifier    effectiveTime    active    moduleId    identifierSchemeId    referencedComponentId

These improvements are introduced in the November 2023 Belgium Extension release, and will be used in all future Belgium Extension releases until further notice.