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I am not aware of any substantial implementations using the SNOMED CT observable content. Pathology has been dominated by LOINC. Other areas of healthcare may have adopted SNOMED CT observables, but we have limited transparency of this and usage. I'd expect whatever decision would be handled as general change management.

As for impacts. The "disruptive approach" of creating new concepts is the safest as implementers and message recipients can easily identify a change has occurred. Though I appreciate a pragmatic approach may be desirable, if taken we would most like generate a list of affected concepts and request all implementations check for the usage of these concepts.

As SNOMED CT is not, yet in wide use in Denmark the Observable entities are not either. However, I do know of a project where our municipalities and regions aim to create a common terminology for general documentation within nursing. Most commonly, they choose a Clinical finding to record what they observe about the patient, but for headings/texts on the user interfaces and for free text fields (when they cannot avoid this) we have encouraged them to use Observables to specifiy the topic that the want to document about. These Observables should preferably have attributes in the Clinical finding hierarchy to specify the actual observations of the patient. As we know they do not always.

This ‘nursing’ set of terminology is not yet implemented as a SNOMED CT refset and I believe any cleanup will be a benefit.