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20230421

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1.0

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titlePRODUCTION


  

  

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SNOMED CT Managed Service - Ireland Extension package license
SNOMED CT Managed Service - Ireland Extension package license
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Table of Contents


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 organisation (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.

The SNOMED CT Irish Extension - packages these components for release every April and October, to be used with the latest SNOMED CT International Edition release.

The same content can be viewed online using the SNOMED CT browser, and eHealth Ireland website


2 Background

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

It will also include 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 Ireland Extension package is dependent upon, and should therefore be consumed in conjunction with the SNOMED CT® February 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® February 2023 International Edition release has been included, alongside additional components for use in Ireland. 

This extension contains concepts, relationships and reference sets for healthcare professionals. 

3.2 New and Updated Content

New content in this release:

This is the 6th 7th SNOMED CT Irish Edition Production release.

New and updated content

Concept statistics

The SNOMED Irish National Release Centre published 156 new concepts, and these are available in the Irish Extension April 2023 release.

Table 1. New concepts in the Irish Edition April release


File

Changes

Concept

56 records added/updated, plus 0 records inactivated

Description (EN)

159 records added/updated, plus 23 records inactivated

Language (EN)

64593 records added/updated, plus 2766 records inactivated

OWLExpression

62 records added/updated, plus 1 records inactivated 

Inferred Relationship

393 new records added/updated, plus 125 records inactivated

Inferred Relationship Concrete Values

0 records added/inactivated/updated 

RefsetDescriptor

8 records added/updated

ModuleDependency

5 existing records updated for new effectiveTime

AttributeValue

23 records added/updated, plus 0 records inactivated 

Association Refset

0 new records added/updated, 

Adult oncology daycare nursing discharge SimpleRefset

0 records added/inactivated/updated

Epilepsy Simple Refset

4 records added/updated, plus 2 record inactivated

Breastcheck screening service SimpleRefset

139 records added/updated, plus 43 record inactivated

Nursing Midwifery Quality Care Metrics Dataset SimpleRefset

1 records added/updated, plus 2 record inactivated

Dentistry SimpleRefset

171 records added/updated, plus 6 record inactivated

National Ambulance Service SimpleRefset

66 records added/updated, plus 0 record inactivated

Patient Flow SimpleRefset

6 records added/updated, plus 2 record inactivated

Antimicrobial SimpleRefset

0 records added/updated, plus 2 record inactivated

Chronic Disease Management  SimpleRefset

0 records added/inactivated/updated

eServices SimpleRefset

0 records added/inactivated/updated

Gynaecology SimpleRefset

0 records added/inactivated/updated

Lymphodema SimpleRefset

167 records added/updated, plus 1 record inactivated

Make every contact count SimpleRefset

0 records added/inactivated/updated   

Safeguarding SimpleRefset

1 records added/updated, plus 1 record inactivated

Public Health SimpleRefset

1 records added/updated, plus 2 record inactivated

Irish National Early Warning Score SimpleRefset

0 records added/inactivated/updated   

Coronavirus Reference set Ireland SimpleRefset

0 records added/inactivated/updated   


Table 13.2 3 Content Sent from Irish NRC to SNOMED International for promotion

Concepts sent from Irish NRC to SNOMED International for promotion
33

Table 1.3 Content sent from Irish NRC to SNOMED International for authoring

Concepts sent from Irish NRC to SNOMED International for authoring
141

3.3 Inactivated concepts in Irish Edition and their replacements:


Inactive Concepts with their suggested Replacement Concepts

Breastcheck Screening Ireland Refset: 




Inactive ConceptIDInactive Concept FSNReplacement ConceptID(s)Replacement FSN(s)
103708000Diagnostic surgical procedure387713003Surgical procedure
12619005GX grade1228845001GX
14537002Hodgkin lymphoma1163005009Hodgkin lymphoma
1929004Malignant lymphoma, non-Hodgkin1172592001Non-Hodgkin lymphoma
31845005Retraction of nipple271955004Retraction of nipple
32280000Lymphoid leukemia1172709000Lymphoid leukemia
373150000pNX: Regional lymph nodes cannot be assessed (e.g., previously removed, or not removed for pathologic study) (breast)1229945006pNX
373151001pN0: No regional lymph node metastasis histologically (i.e., none greater than 0.2 mm), no additional examination for isolated tumor cells (breast)1229947003pN0
373156006pN1: Metastasis in 1 to 3 axillary lymph nodes, and/or in internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent (breast)1229951001pN1
373157002pN1mi: Micrometastasis (greater than 0.2 mm, none greater than 2.0 mm) (breast)1229952008pN1mi
373158007pN1mi(i+): Micrometastasis detected only by IHC (breast)1229952008pN1mi
373159004pN1a: Metastasis in 1 to 3 axillary lymph nodes (at least one tumor deposit greater than 2.0 mm) (breast)1229954009pN1a
373160009pN1b: Metastasis in internal mammary lymph nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent (breast)1229955005pN1b
373161008pN1c: Metastasis in 1 to 3 axillary lymph nodes and in internal mammary lymph nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent (breast)1229956006pN1c
373162001pN2: Metastasis in 4 to 9 axillary lymph nodes, or in clinically apparent internal mammary lymph nodes in the absence of axillary lymph node metastasis (breast)1229957002pN2
373163006pN2a: Metastasis in 4 to 9 axillary lymph nodes (at least one tumor deposit greater than 2.0 mm) (breast)1229959004pN2a
373164000pN2b: Metastasis in clinically apparent internal mammary lymph nodes in the absence of axillary lymph node metastasis (breast)1229960009pN2b
373165004pN3a: Metastasis in 10 or more axillary lymph nodes (at least one tumor deposit greater than 2.0 mm), or metastasis to infraclavicular lymph nodes (breast)1229963006pN3a
373166003pN3c: Metastasis in ipsilateral supraclavicular lymph nodes (breast)1229965004pN3c
373167007pN3b: Tumor of breast with metastasis as per AJCC 6th Edition definition (breast)1229964000pN3b
373169005pM0: No distant metastasis (breast)1229901006cM0
373170006pMX: Distant metastasis cannot be assessed (breast)1229901006cM0
373171005pM1: Distant metastasis (breast)1229916009pM1
373172003pT1: Tumor 2 cm or less in greatest dimension (breast)1228957006pT1
373173008pTX: Primary tumor cannot be assessed (breast)1228950008pTX
373175001pTis: Carcinoma in situ (breast)1228953005pTis
373176000pTis: Ductal carcinoma in situ (breast)1228954004pTis(DCIS)
373177009pTis: Lobular carcinoma in situ (breast)1228953005pTis
373178004pTis: Paget disease without invasive carcinoma (breast)1228956002pTis(Paget)
373179007pT1mic: Microinvasion 0.1 cm or less in greatest dimension (breast)1228958001pT1mi
373180005pT1a: Tumor more than 0.1 cm but not more than 0.5 cm in greatest dimension (breast)1228959009pT1a
373182002pT2: Tumor more than 2 cm but not more than 5 cm in greatest dimension (breast)1229852009pT2
373183007pT1c: Tumor more than 1 cm but not more than 2 cm in greatest dimension (breast)1229846008pT1c
373184001pT3: Tumor more than 5 cm in greatest dimension (breast)1229859000pT3
373185000pT4: Tumor of any size with direct extension to chest wall or skin (breast)1229864001pT4
373186004pT4a: Tumor of any size with extension to chest wall, not including pectoralis muscle (breast)1229865000pT4a
373187008pT4b: Tumor of any size with edema (including peau d'orange) or ulceration of the skin of the breast or satellite skin nodules confined to the same breast1229866004pT4b
373189006pT4c: Tumor of any size with direct extension to chest wall (not including pectoralis muscle) and edema (including peau d'orange) or ulceration of the skin of the breast or satellite skin nodules confined to the same breast1229867008pT4c
373204007pT1b: Tumor more than 0.5 cm but not more than 1 cm in greatest dimension (breast)1228962007pT1b
406088001pN0(i-): No regional lymph node metastasis histologically, negative morphologic findings for isolated tumor cells (breast)1229947003pN0
406089009pN0(i+): No regional lymph node metastasis histologically, positive morphologic findings for isolated tumor cells, no cluster greater than 0.2 mm (breast)1229949000pN0(i+)
406090000pN0(mol-): No regional lymph node metastasis histologically, negative nonmorphologic (molecular) findings for isolated tumor cells (breast)1229947003pN0
406091001pN0(mol+): No regional lymph node metastasis histologically, positive nonmorphologic (molecular) findings for isolated tumor cells (breast)1229950000pN0(mol+)
86049000Neoplasm, malignant (primary)1240414004Malignant neoplasm
91512002Diagnostic procedure on breast392089008Breast procedure
93194002Malignant lymphoma of lymph nodes of axilla AND/OR upper limb1255906008Malignant lymphoma of lymph nodes of upper limb
93523009Hodgkin's disease of lymph nodes of axilla AND/OR upper limb1255905007Hodgkin disease of lymph nodes of upper limb

Dentistry Ireland Refset: 

10775006Root canal therapy, retreatment of molar, by report1231801002History of revision of root canal treatment of molar tooth
10775006Root canal therapy, retreatment of molar, by report1231800001Revision of root canal treatment of molar tooth
56289008Root canal therapy, retreatment of bicuspid, by report1231805006History of revision of root canal treatment of premolar tooth
56289008Root canal therapy, retreatment of bicuspid, by report1231796007Revision of root canal treatment of premolar tooth
58814005Root canal therapy, retreatment, anterior, by report1231799000History of revision of root canal treatment of anterior tooth
58814005Root canal therapy, retreatment, anterior, by report1231798008Revision of root canal treatment of anterior tooth

Adult Safeguarding Refset: 

160327004FH: Drug dependency1254977008Family history of substance dependency


Inactive ConceptIDInactive Concept FSNReasonReplacement ConceptID(s)Replacement FSN(s)
Nursing and Midwifery QCM Refset:



249016007Height of uterine fundusSAME AS association reference set (foundation metadata concept)364253002Fundal height of uterus
408780005Finding of color of amniotic fluidREPLACED BY association reference set (foundation metadata concept)365662002Amniotic fluid appearance - finding
Lymphoedema Refset:



420226006Pressure ulcerREPLACED BY association reference set (foundation metadata concept)1163214006Pressure injury
Patient Flow Refset: 



402863005Venous stasis ulcer of legPOSSIBLY EQUIVALENT TO association reference set (foundation metadata concept)1237117000Venous ulcer of lower leg
402863005Venous stasis ulcer of legPOSSIBLY EQUIVALENT TO association reference set (foundation metadata concept)1237116009Venous ulcer of lower limb
86049000Neoplasm, malignant (primary)REPLACED BY association reference set (foundation metadata concept)1240414004Malignant neoplasm
Epilepsy Refset: 



37356005Myoclonic seizurePOSSIBLY EQUIVALENT TO association reference set (foundation metadata concept)127324008Myoclonic disorder
37356005Myoclonic seizurePOSSIBLY EQUIVALENT TO association reference set (foundation metadata concept)1208991001Myoclonic epileptic seizure
51887003Tonic seizurePOSSIBLY EQUIVALENT TO association reference set (foundation metadata concept)192993002Tonic epileptic seizure
51887003Tonic seizurePOSSIBLY EQUIVALENT TO association reference set (foundation metadata concept)1208969008Generalized onset tonic epileptic seizure


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 - Ireland Extension Release, the following some Known Issues were identified, and agreed to be resolved in the next editing cycle:

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columnIdsissuekey,summary,description,priority
columnskey,summary,description,priority
maximumIssues100
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Jira
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4.2 Resolved Issues

Resolved Issues are those where the resolution has been discussed and agreed, and has been implemented in time for this release. 

For the SNOMED CT Managed Service - Ireland Extension Release, the following some Issues were Resolved: 

Jirascroll-tablelayout
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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 will realize 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 Ireland 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:
  • 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 will be removed from the Ireland Extension from the April 2022 Release onwards.

Please note - While the SNOMED CT International Edition is moving to monthly releases, the Ireland Extension of SNOMED CT will remain on the current bi-annual release schedule of April and October for 2023.



 






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Approvals


Final Version

Date

Approver

Comments

1.0

20/04/2023

Theresa BarryApproved



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Draft Amendment History


Version

Date

Editor

Comments

0.1

 

Andrew AtkinsonInitial draft created
0.9

16/04/2023

Theresa BarryFinal draft
1.0

20/04/2023

Theresa BarryFinal fixes to stats etc