Additional Attributes for National Drug Extensions

Shane Byrnes, if it would be helpful, I’m happy to share the full set of AMT MRCM extensions here. This includes:

• Changes to the domain and range for existing international attributes

• Additional attributes defined by AMT, along with their intended purpose and usage – for example, Linda discussed 30465011000036106 | Has container type | at the Oslo meeting

It would also be valuable to gather MRCM extensions from other drug extensions wherever they exist.

We could build a shopping list of attributes for other NRCs to consider. If others have similar needs, optional attributes and MRCM extensions could be added to the international edition to make them easy to use - some already exist like "Has supplier".

This would be better than NRCs having to develop their own attributes and MRCM extensions or "side promote" – which can be both time-consuming and complex.

Before I go ahead, could I please get permission to upload files (e.g. images) to this page? I’d like to include visual examples alongside the text, which will make the explanation more concise and accessible.

Here is a summary of the full set of attributes proposed by Canada (including potential opportunities for promotion from the AMT and CMT).
           NOTE: Our priorities are to agree on the Container type, Subpacks (containered packages), and Multicomponent attributes.

• Container and device: Promote the following attributes from the AMT:
  • 30465011000036106 |Has container type| - Grouped
  • 999000081000168101 |Contains device| - Grouped
  • Either reuse the international attribute 1142142004 |Has pack size (attribute)| or add a new attribute |Has device count| for this - Grouped
  • 999000101000168108 |Count of device type|
• Subpacks: Either promote the following AMT attributes
  • 999000011000168107 |Contains packaged clinical drug| – as long as this actually means "Contains containered packaged clinical drug" - Grouped
  • 999000091000168103 |Count of containered package type| - Grouped
  • Either reuse the international attribute 1142142004 |Has pack size (attribute)| or promote the CMT attribute 62601000087108 |Has subpack count|
    OR promote the following CMT attributes (if my assumption about the 'contains packaged clinical drug' attribute above isn't correct):
  • 62511000087106 |Contains subpack| -  This defines the inner containered packs within a multi-container product - Grouped
  • 62601000087108 |Has subpack count| - The number of this particular type of subpack (ie containered pack) in the outer package. - Grouped
  • 62521000087103 |Count of subpack type| - The number of different types of containered packs

• Multi-component MP/MPF/CD: Add the following new attributes (required, but not yet created in the CMT)
• |Has medicinal product component| – The component MPs of a multi-component MP - Grouped
• |Count of medicinal product component type| – The number of types of MP components (to ensure universal restriction logic)
• |Has medicinal product form component| – The component MPFs of a multi-component MPF - Grouped
• |Count of medicinal product form component type| – The number of types of MPF components (to ensure universal restriction logic)
• |Has clinical drug component| – The component CDs of a multi-component CD - Grouped
• |Count of clinical drug component type| – The number of types of CD components (to ensure universal restriction logic)
• Additional defining information – Promote the following CMT additional defining attributes (assuming that they don't exist anywhere else)
• 62591000087100 |Has excipient ingredient| – A non-active (excipient) substance in the drug product
• 62611000087105 |Is free of excipient ingredient| – A non-active (excipient) substance, which is not contained in the drug product.
• 62721000087105 |Has dose form characteristic| – Additional product characteristics that relate to the dose form, e.g. “Light” (of powder)
• 62731000087107 |Has unit of presentation characteristic| – Additional product characteristics that relate to the unit of presentation, e.g. “Single dose”, “Multidose”
• 92611000087107 |Has dose form after transformation| – Required to distinguish between dose forms that have the same transformation method, but transform into different dose forms, e.g. granules for oral solution, granules for oral syrup.
• Non-defining information (additional relationships) – Additional non-defining attributes that others may need as well
• 62191000087109 |Has registered route of administration|
• 62701000087104 |Target population| (as a non-defining characteristic)
• 62181000087107 |Has product registration status|
• 62151000087104 |Has drug schedule|
• 62581000087102 |Has drug class|
• Non-defining information (annotations) – Additional non-defining concrete values that others may need as well
  • 62711000087102 |Has Global Trade Item Number (GTIN)|
  • 62201000087106 |Has unit of use GTIN|
  • 62161000087101 |Has package GTIN|
• 62131000087108 |Has WHO ATC code|
• 62141000087102 |Has last batch on market product expiration date|
• 62171000087105 |Has product monograph URL|

After chatting with Dion and Matt (Australia) to clarify the meaning of some of the AMT attributes, I have a few adjustments to make in the proposed list of attributes below:

           NOTE: Canada's priorities (in blue) are to agree on the Container type, Subpacks (containered packages), and Multicomponent attributes.

• Container and device: Promote the following attributes from the AMT:
  • 30465011000036106 |Has container type| - Grouped
  • 999000081000168101 |Contains device| - Grouped
  • Add a new attribute |Has device count| for this - Grouped (... or reuse the international 1142142004 |Has pack size (attribute)| as the AMT has done)
  • 999000101000168108 |Count of device type|
• Subpacks: Promote the following attributes
  • AMT: 999000011000168107 |Contains packaged clinical drug| - Grouped
    • We've come to the conclusion that the semantics of this are the same as Canada's 62511000087106 |Contains subpack| attribute, so are happy to use the AMT attribute if promoted. However, we would request a clarification of the FSN to distinguish the term 'packaged clinical drug' from the existing class with the same name in SNOMED Int.'s national drug extension model (which defines the quantity of each clinical drug within, without distinguishing how the inner containers are organised). Possible attributes names include "Contains containered package" or "Contains package in container" or "Has subpack".
  • CMT: 62601000087108 |Has subpack count| - Grouped
    • Note: The AMT reuses an attribute like 1142142004 |Has pack size (attribute)| for this, which would be the alternative.
  • AMT: 999000091000168103 |Count of containered package type|

• Multi-component MP/MPF/CD: Add the following 4 new attributes (and reuse the 2 existing international attributes below) with 2 role chains (1) |Contains medicinal product form| o |Has active ingredient| → |Has active ingredient|, (2) |Contains clinical drug| o |Has manufactured dose form| → |Has manufactured dose form|
  • SCTID |Contains medicinal product| – The component MPs of a multi-component MP - Grouped
    • SCTID |Contains medicinal product form| – The component MPFs of a multi-component MPF - Grouped
      • 774160008 |Contains clinical drug| - The existing attribute (to be a subtype of |Contains MPF| and |Contains MP|
  • SCTID |Count of medicinal product type| – The number of types of MP components (to ensure universal restriction logic)
  • SCTID |Count of medicinal product form type| – The number of types of MPF components (to ensure universal restriction logic)
  • 1142143009 |Count of clinical drug type| – The existing international attribute
• Additional defining information – Promote the following CMT additional defining attributes
  • 92611000087107 |Has dose form after transformation| – Required to distinguish between dose forms that have the same transformation method, but transform into different dose forms, e.g. granules for oral solution, granules for oral syrup.
  • 62591000087100 |Has excipient ingredient| – A non-active (excipient) substance in the drug product
  • 62611000087105 |Is free of excipient ingredient| – A non-active (excipient) substance, which is not contained in the drug product.
  • 62721000087105 |Has dose form characteristic| – Additional product characteristics that relate to the dose form, e.g. “Light” (of powder)
  • 62731000087107 |Has unit of presentation characteristic| – Additional product characteristics that relate to the unit of presentation, e.g. “Single dose”, “Multidose”
• Non-defining information (concept values)
  • 62191000087109 |Has registered route of administration|
  • 62701000087104 |Target population| (as a non-defining characteristic)
  • 62181000087107 |Has product registration status|
  • 62151000087104 |Has drug schedule|
  • 62581000087102 |Has drug class|
• Non-defining information (concrete values)
  • 62711000087102 |Has Global Trade Item Number (GTIN)|
  • 62201000087106 |Has unit of use GTIN|
  • 62161000087101 |Has package GTIN|
  • 62131000087108 |Has WHO ATC code|
  • 62141000087102 |Has last batch on market product expiration date|
  • 62171000087105 |Has product monograph URL|

Hello everyone, a CRS request has been received from Australia to promote the attribute Has container type (attribute) for Canada.

This request has been discussed internally with the Chief Terminologist, Dr Jim Case, who has commented: Since this attribute is intended for use in defining medicinal products, should the FSN be specific to that use case? There are other use cases for container types that have been proposed (e.g. specimens, non-medicinal products).

My thoughts are that something like something like Has medicine container type (attribute) or Has drug container type (attribute) may be required.

Yongsheng Gao re MRCM.

Just to join some dots here, we've also got MSSP-4007 on the board, which is a request for a lateral promotion from AU to IE for the following:

• 999000071000168104 | Package (physical object) |
• 999000081000168101 | Contains device (attribute) |
• 999000001000168109 | Has other identifying information (attribute) |

CC Elena Ilyukhina 

Hello Peter G. Williams 

Per email from Canada additional information referring to 6 CRS requests we have received from Australia:

To centralize the set of container types to use under 398124009 |Drug container (physical object)|, we have requested Australia to submit these concepts (as well as the AU attribute) for lateral promotion to core:

#970722 -> 999000071000168104 |Package (physical object)| - no longer needed by CA - request withdrawn

#970723 -> 710001000168107 |Pouch (physical object)| - no longer needed by CA - request withdrawn

#970724 -> 287011000036106 |Blister pack (physical object)|

#970727 -> 277011000036103 |Tube (physical object)|

#971421 -> 117941000036106 |Tub (physical object)|

#971420 -> 30465011000036106 |Has container type (attribute)|

By "lateral" promotion, I mean going directly from one extension to another extension without going up to the core, which is something we do very rarely.   But it sounds like we're getting set up here to move a number of concepts from AU up to the International Edition, which is more usual.

In that case, do you think we should put a halt to MSSP-4007 and instead expect these additional attributes be listed in CRS requests, promote them to the International Edition and the IE could inherit them from there, rather than having them in their own extension directly?   Or (given that CA have withdrawn the request for Package (physical object), are those 3 I listed not under consideration for inclusion in the International Edition and MSSP-4007 should proceed as is?

CC Elena Ilyukhina Shane Byrnes 

Sorry I missed the meeting last night.

Peter G. Williams - I think "lateral promotion" really is the classic(simple) promotion you describe. A proper "lateral promotion" isn't something I want to think about logistically or technically  

As for comment/question
"Since this attribute is intended for use in defining medicinal products, should the FSN be specific to that use case? There are other use cases for container types that have been proposed (e.g. specimens, non-medicinal products). My thoughts are that something like something like Has medicine container type (attribute) or Has drug container type (attribute) may be required."

I'm not sure why the attribute couldn't be used for the other use cases (specimens/non-drugs). It means the same thing in all instances "the type of container the thing is in".

• "Sudocrem 15.25% cream, 250 g, jar" : has container type = Jar
• "Urine specimen in a jar" : has container type = Jar
• "250g jar of peanut butter" : has container type = Jar

Now there's a different question as to if these are different types of jars (containers)... But that's about the range (physical object) concepts, not attribute.
To be honest I'm not totally sure we need 398124009 |Drug container (physical object)|?
Maybe it's necessary to differentiate a regular bottle from a medicine bottle (which is a specific bottle)....
But then we (AU) have a bunch of issues like this with the existing container concepts and subheirarchy content... Look at the subtypes of 37284003|Bag, device (physical object)| as an example.
Parenteral/enteral solution bag (physical object) is not currently a subtype of Drug container (physical object) ...

This points to a clean up of device/object hierarchy is needed

But I can't see value in multiple different attributes, even if the domains are different.

We already have attributes with different domains e.g. ATT 42752001 Due to - HRCM20230531 - SNOMED Confluence

Hello Yongsheng Gao 30465011000036106 |Has container type| is now a request in CRS:
https://request.ihtsdotools.org/#/requests/preview/971420?fromList=true

See Jim Case comment ("Since this attribute is intended for use in defining medicinal products, should the FSN be specific to that use case? There are other use cases for container types that have been proposed (e.g. specimens, non-medicinal products)) and Matt's feedback above.

Note: 398124009 |Drug container (physical object)| exists - with no subtypes.

Re Matt's point: "But I can't see value in multiple different attributes, even if the domains are different. We already have attributes with different domains e.g. ATT 42752001 Due to - HRCM20230531 - SNOMED Confluence"

Does this multi-domain proposal seem acceptable from an ontology and technical aspect?

I created a ticket for MRCM to summarize the request for the attribute 30465011000036106 |Has container type (attribute)| at ATF-1703 - Getting issue details... STATUS

The domain is restricted to << 781405001 |Medicinal product package (product)|. This attribute is only applicable to packaged products. 763158003 |Medicinal product (product)| should not include information about packages. The MRCM would need to be expanded in the Australia extension to support their use cases and model.  Matt Cordell Dion McMurtrie 

The range is restricted to < 49062001 |Device (physical object)|. There are more specific concepts such as 706437002 |Container (physical object)|, 398124009 |Drug container (physical object)|, 434711009 |Specimen container (physical object)|, and 732990009 |Container (unit of presentation)|. If the range were restricted to 398124009 |Drug container (physical object)|, we would need to make this attribute name more specific, as mentioned by Jim Case  to support different use cases that might require different ranges. The current implementation of MRCM limits us from assigning different ranges to ‘has container type’ for different domains. Therefore, the high-level range 49062001 |Device (physical object)| should be used. 

We may argue that concepts 706437002 |Container (physical object)|, 398124009 |Drug container (physical object)|, 434711009 |Specimen container (physical object)| are not needed for this model. The attribute has represented the intended use or function of devices as a container. The value of this attribute can be any device that can be used as a container. These concepts are devices grouped by their function as containers and things could be contained within them, e.g. medicinal products, specimens, food, etc. A device can have different functions or intended uses, e.g. measurement. Groupers can be helpful in certain contexts, but they can also be contradictory in others. We need to review whether we should retain these container concepts and their usage as suggested by Matt Cordell 

The attribute is not grouped and the attribute cardinality is 0..1.  This means that we can only have one container type for a medicinal product package (MPP). A package has different containers that need to be modeled by 'MPP' contains multiple 'MPPs' that each contained MPP has a container type. Because the container types have been covered by the contained MPP, do we still need 'Has container type' be modeled in a multi-container product? What would be the value, 49062001 |Device (physical object)| or 706437002 |Container (physical object)|? We need confirmation about the agreement on the modeling of the subpacks. Linda Bird Dion McMurtrie 

A Briefing Note will be discussed at the next Editorial Advisory Group:
Changes to 706437002 |Container (physical object)| and the physical object MRCM

See attached 2025-07-29 SNOMED Editorial Advisory Group Conference Call

Thanks for the summary Yongsheng Gao! With respect to the |Has container type| attribute:

• The CMT is using a domain of << 781405001 |Medicinal product package| for this ... so as long as these are included in the international domain, we're covered
• The CMT is using a range of << 398124009 |Drug container (physical object)| ... so as long as these are included in the international range, we're good
• The CMT does not group this attribute, so we're okay with this approach.
• The CMT uses a cardinality of [0..1] on MPPs in general - but we have exactly one ([1..1]) container on each of our "Containered clinical drug" concepts (which sits below "Packaged clinical drug" in the model). Note: Allowing a container to be added on a multi-container product enables the ability to define both the outer container type (on the multi-container MPP) and the inner container types (on the contained MPPs), if required.