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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 Radiotherapy procedures will be modeled with 260686004 |Method (attribute) value from | = 129445006 |Administration - action (qualifier value)| and 424244007 |Using energy (attribute)| 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)|.
  • =  125576007 |Ionizing radiation (physical force)|.
  • Changes in the model for the associated subhierarchies: 152198000 |Brachytherapy (procedure)|, 33195004 |External beam radiation therapy procedure (procedure)|, 169331000 |Combined radiotherapy (procedure)| and 399315003 |Radionuclide therapy (procedure)| for correct subsumption.
  • Inactivation of 257863009 |Radioactive destruction Addition of 424832003 |Surgical introduction - action (qualifier value)| or subtypes and 410675002 |Route of administration (attribute)| role group as needed for proper classificationand Brachytherapy - action (qualifier value).
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
20.

Clinical Finding

Inactivation of General body state and General clinical state finding

Inactivation is planned for the following two high-level concepts due to vagueness:

  • 82832008 |General body state finding (finding)| - primitive with 937 subtypes
  • 365860008 |General clinical state finding (finding)| - defined with 435 subtypes

These changes are scheduled for the September 2024 release.

September 2024 International Release
21.

Procedure

Remodeling 50465008 |Hernia repair (procedure)| Hierarchy

50465008 |Hernia repair (procedure)| and subtypes will be reviewed and remodeled for alignment of usage of the 363699004 |Direct device (attribute)| and 424226004 |Using device (attribute)| attributes to current Editorial Guidance.

424226004 |Using device (attribute)| will be used with the 260686004 |Method (attribute)| = << 257903006 |Repair - action (qualifier value)|, because it “refers to the instrument or equipment utilized to execute an action,” and “the device is actually used to carry out the action, that is the focus of the procedure.”

New concepts will be created for modeling of repair concepts related to hernia disorders with specific characteristics such as “recurrent hernia”, “congenital hernia”, “strangulated hernia”, for example:

  • Recurrent umbilical hernia (disorder)
  • Recurrent Spigelian Hernia (disorder)

For the modeling of these types of repair of hernia disorders with specific characteristics, the 363702006 |Has focus (attribute)| will be added to sufficiently define the concepts.

September 2024 International Release

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