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Overview of Current Notices

For additional Relevant links with regards to Content Development Information please click here Content Development Information

Summary of Substances Changes

Top Level

  • Dietary subhierarchy. To remove context of use from the substance concepts and manage the situation where substances can be both a pharmaceutical ingredient and a foodstuff 80 substances that had a tag of “- dietary” in the Fully Specified Name (FSN) and the Preferred Term (PT) were inactivated. Replacement concepts concept without  "-dietary" in the FSN and PT were created. The top level concept "Dietary substance (substance)" has been inactivated and replaced with a new concept "Edible substance (substance)".
  • Radioactive isotope substances. These concepts have been remodelled and the terming normalised to provide consistent representation without the use of carats.
  • Cancer related substance. The subhierarchy has now been removed. Some concept have been inactivated. Some have been moved within the substances hierarchy.

Substance groupers including Disposition, Structure and Combined groupers have been remodelled and additional grouper concepts created as required. The inactivation of role groupers in the substances hierarchy has been initiated.

Disposition groupers

  • Disposition groupers within the substance hierarchy have been modelled as fully defined concepts. The creation of the new top level substance concept of "Substance categorised by disposition" will allow these to be modelled by proximal primitive authoring.
  • Existing disposition grouper concepts in the substances hierarchy have been retained where appropriate and have been remodelled to conform to SNOMED CT Editorial policy. Examples as below.
    •  Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)
    •  Substance with beta-1 adrenergic receptor agonist mechanism of action (substance)
    •  Substance with phosphodiesterase inhibitor mechanism of action (substance)
  • Currently there are in excess of 200 disposition groupers in the substances hierarchy that have been remodelled.
  • Work to remodel existing substance disposition groupers is ongoing.
  • New concepts will be added as identified.

Role groupers

Role groupers within the substances hierarchy are being inactivated where this is possible without creating disruption in other hierarchies. At the start of this work there were approximately 600 role groupers. Currently in the region of 100 role grouper substance concepts have been inactivated or remodelled.This work is ongoing.

Many of these role grouper concepts remain in the substances hierarchy pending a solution for the roles concepts within the terminology as a whole and so will still be present in the July 2018 release.

Structural groupers

Structural groupers within the substance hierarchy have been modelled as primitive concepts.

Existing structural grouper concepts in the substances hierarchy have been retained where appropriate and have been remodelled to conform to SCT Editorial policy.

New structural grouper concepts have been added.

Groupers that identify X or derivatives where X is a specific substance will be inactivated. Some of these concepts have already been inactivated. As the implementation of the IS Modification attibute is carried out the remainder of these concepts will be inactivated.

Structural groupers that reference a chemical group will be retained.

e.g. Amides and derivatives (substance)

Where the structural group name also refers to a specific chemical the grouper has been re-termed “Substance with X structure” 

e.g. Substance with tetracycline structure (substance)

Combined groupers

Combined groupers that include a role will be inactivated where this is possible without causing disruption in other hierarchies. Inactivation of some of these concepts in the substances hierarchy is waiting on a solution for the roles concepts within the terminology as a whole and so will still be present in the July 2018 release.

Groupers of disposition + structure will be retained in the substance hierarchy. Existing concepts have been remodelled to conform to SCT Editorial policy. Examples as below.

Antimony compound with antiprotozoal mechanism of action (substance)

Quaternary ammonium compound with anticholinergic mechanism of action (substance)

Piperidine derivative with histamine receptor antagonist mechanism of action (substance)

New concepts will be added as required.

Use of the Is Modification attribute

To date, we have added n≈1200 new S Modification attribute. This number will most likely increase by the end of the release. This has achieved a flattening of the substance hierarchy. Priority has been given to the remodelling of substances associated with the definition of medicinal products.

The following guidelines have been developed.

1. Substances may have zero to many Is modification attribute(s). e.g  Iodine (131-I) labelled monoclonal antibody (substance) has 2 IS MODIFICATION attribute values.

2. Salts have a IS MODIFICATION relationship to the base e.g. Doxepin hydrochloride (substance) IS MODIFICATION of Doxepin (substance)

3. Hydrates have a IS MODIFICATION relationship to the unspecified salt e.g. Caffeine hydrate (substance) IS MODIFICATION of Caffeine (substance)

4. Anhydrous salts have a IS MODIFICATION relationship to the unspecified salt e.g. Theophylline anhydrous (substance) IS MODIFICATION of Theophylline (substance)

5. Stereoisomers are subtypes of the unspecified substance. e.g.. Dextrothyroxine IS A thyroxine. 

6. There is no IS MODIFICATION relationship between stereoisomers.

Further guidelines will be added to the published documentation as they are developed.

The initial population of the IS MODIFICATION attribute is still subject to manual authoring input to ensure compliance to Editorial guidelines and so some areas of content may appear to be non-conformant in the Alpha release data.

Improvement to the Release file naming convention for the Asssociation Reference file

In order to improve the description of this file, we will be updating the file naming convention from:

'der2_cRefset_AssociationReferenceSnapshot_INT_*.txt'

to:

'der2_cRefset_AssociationSnapshot_INT_*.txt'

....as of the January 2018 International Edition

January 2018 International Edition - COMPLETE
ItemsProposed improvement

Planned Release date

(*this is provisional only and is subject to change)

1LOINC timeline changes - please refer to Roadmap link here LOINCJuly 2018 and potentially other future releases.

Browse Content Changes for the January 2020 Release

The daily build is available to review changes made to content for the January 2020 release https://dailybuild.ihtsdotools.org/

Forthcoming concept inactivations, new concepts and changes to existing concepts can be reviewed using the tab 'Daily build.'

January 2020 International Release
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Revision of IS A relationships for anatomy concepts 

The new anatomy concept model has implemented the new enhanced Description Logic features, e.g. reflective reflexive and transitive propertyproperties, general concept additional axioms, for consistent logical modeling. However, the new model cannot be implemented in production because these DL features currently are not available in production. The implementation of them will depend on the enhanced logic profile for SNOMED CT which is under development by the Modeling AG. Yet, the inferred IS A relationship The inferred IS A relationships from the OWL anatomy ontology can be have been reviewed and the changes have been implemented in the production. This will utilise the outcomes of the new anatomy model as well as evaluate the design of the new model. In particular, it is important to review the changes of IS-A relationships in anatomy for quality assurance and minimise  The potential impact to other hierarchies, such as disorders, procedures, observables, situations etc are also reviewed as part of the project.

The first subject area for revision is the sub-hierarchy of skin structure. The majority changes have been made in the January 2018 release. The rest will be completed in July 2018 release.of cardiovascular, digestive and genitourinary systems have been included in the July 2019 release. The respiratory, nervous, integumentary, endocrine, immune, sensory organs, lymphoreticular, hematological systems will be revised in the January 2020 International release.

Information about revision of IS_A relationships can be viewed here:For July 2018 release, the subject area for revision of IS A relationships will be determined and updated in the following confluence page.

July 2018 International Edition
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Summary of Drugs changes

Drugs Groupers Chemical structure, Groupers Dispositions, Groupers Intended site. Most existing concepts (n≈450) updated for Groupers (e.g. structural, disposition). Role Groupers have been postponed to January 2019 per request from one of the member country

Groupers Chemical structure

  • Most existing concepts remodeled, with modeling and terming updated per editorial guidelines
  • Top level groupers 763760008 | Medicinal product categorized by structure (product) and 767102007 | Medicinal product categorized by chemical element (product) created; this is an incremental improvement and there may still be missing subtypes

Groupers Dispositions

  • Most existing concepts remodeled, with modeling and terming updated per editorial guidelines
  • Top level grouper 766779001| Medicinal product categorized by disposition (product) created; this is an incremental improvement and there may still be missing subtypes

Groupers Intended site

  • All existing concepts remodeled, with modeling and terming updated per editorial guidelines

Medicinal product (MP)

  • Most existing concepts remodeled (>3800), with modeling and terming updated per editorial guidelines
  • Semantic tag updated to (medicinal product)
  • Terming update to include "product" in Preferred Terms in progress 

Medicinal product form (MPF)

  • Most existing concepts remodeled (>1900), with modeling and terming updated per editorial guidelines
  • Semantic tag updated to (medicinal product form)

Clinical drug (CD), which we changed to “Product containing precisely X”

  • CDs  Most existing discrete solid dose forms updated, excluding ingredient count attributes which will be added in a later batch (n≈3300)

Dose forms hierarchy remodel with additional content has started. Pharmaceutical dose form has been created.

Pharmaceutical dose form

  • Most existing concepts remodeled, with modeling and terming updated per editorial guidelines
  • Semantic tag updated to (dose form)

Updated Editorial Guide draft has been made available for the preview and Alpha Release. Updated Product Model Specification is under second review with closing date 16-APR.

Briefing

Briefing note - Use of Additional Axiom Functionality and Remodeling Product Roles.pdf

Briefing note - Implications of describing liquid dose form product concepts using presentation strength.pdf

July 2018 International Edition
4July 2018 International Edition
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Internal QA

Test and procedure status: Inactivated 143 concepts in the Situations and Findings hierarchies with pattern "Test/procedure OFFERED" and "Test/procedure NOT OFFERED" as these represent an administrative status.

In the July 2019 release changes were made to 113345001|Abdominopelvic structure (body structure)| whilst retaining the ‘synonyms’ of Abdomen and Abdominal structure based on the most common usage.  Further work is currently underway to more explicitly describe and define concepts relating to regional anatomy of the abdomen and pelvis with changes to content due to be implemented after a period of consultation. 

January 2020 International Release

July 2020 International Release







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MRCM Changes

Please see:

MRCM changes in the January 2020 release

January 2020 International Release
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Quality Initiative

Information about the project can found here - Quality Initiative - Progress

Note: There are changes to the Service Level Agreement for the CRS as a result of the Quality Initiative:

https://www.snomed.org/SNOMED/media/SNOMED/documents/Early-Visibility-of-Changes-to-Service-Level-Agreement-International-Content-Request-Service-(CRS).pdf

January 2020 International Release
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Changes to Case Sensitivity

Over 31,000 descriptions have been reviewed and approximately 5,402 descriptions across 2806 concepts have had their case significance settings corrected as appropriate.   
The changes are across all SNOMED CT hierarchies but in particular disorder concepts (1774), procedure (978) and qualifier values (736). 

The Editorial Guidance on case significance related to descriptions containing numeric values and special characters has been updated for the January 2020 release.

January 2020 International Release
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Planned changes to 'Co-occurrent and due to' pattern

During the implementation of the new Description Logic features a conflict was uncovered between the modeling of 'Co-occurrent and due to' and General Concept Inclusions (GCIs). This has resulted in the need to reconsider the modeling of "Co-occurrent and due' and update the Editorial Guide for this area.

There are a number of new concepts in the January 2019 release that are based upon the existing guidance for 'Co-occurrent and due to'. The plan is to update the Editorial Guide and all concepts that are currently modeled as 'Co-occurrent and due to' starting from the July 2019 release.

January 2020 International Release and future releases

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WAS_A

Inactivation reason of LIMITED/WAS_A is not allowed for any new content inactivations after the July 2018 release. The WAS_A association refset has not been updated thereafter.

At the Editorial Advisory Group meeting in April 2019, agreement was reached to discontinue the maintenance of WAS_A relationships when inactivating concepts that have a historical association to an inactive concept. When changes are made to a historical relationship for a concept that was previously inactivated using WAS_A, effort will be made to assign a new historical relationship that facilitates traceability of the concept (e.g. DUPLICATE or AMBIGUOUS) as opposed to NON-CONFORMANCE TO EDITORIAL POLICY.

Existing WAS_A relationships will be inactivated in a future release once a plan for batch reassignment of historical relationships has been developed. Until then, SNOMED International will not continue to use or maintain WAS_A relationships.

January 2020 International Release and future releases
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Known Content Issues July 2019 Release

Approximately 149 text definitions are missing either a US or GB spelling variation. These are all legacy issues that will be rectified in the January 2020 release.

A small set of disorder concepts have been identified with descendants that have a semantic tag of clinical finding. A further small set of concepts have been identified that have a semantic tag of disorder but are not descendants of 64572001|Disease (disorder)|. These concepts are all legacy issues that will be rectified in the January 2020 release.

Release validation rules have been enhanced to prevent recurrence of legacy issues for future content additions.

January 2020 International Release
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Changes for 'On examination' (O/E) and 'Complaining of' (C/O) concepts

Jan 2020 release:

  • Addition of approximately new 230 concepts to cover content identified (to date) as having no base concept.
  • Continued analysis of O/E and C/O content to determine replacement content (current suitable concept, new or no value in replacing)

July 2020 release:

  • Addition of any further required content
  • Inactivation of the O/E and C/O content (Batch change) for return to the UK.

Content being inactivated will use the reason - component moved elsewhere. 

Note: some concepts will not have a replacement concept as they are groupers. For example:
On examination - sign irregular (finding)
On examination - neurological reflex (finding)

January 2020 International Release

July 2020 International Release

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Inactivation of 33359002 |Degeneration (morphologic abnormality)|

In order to distinguish the degenerative process from the structure, 33359002 |Degeneration (morphologic abnormality)| has been inactivated as a DUPLICATE, SAME AS 107669003 |Degenerative abnormality (morphologic abnormality)|.

All morphologies in the disorder hierarchy have been replaced accordingly.

107669003 |Degenerative abnormality (morphologic abnormality)|

33359002 |Degeneration (morphologic abnormality)|

January 2020 International Release
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Inactivation of 23583003 |Inflammation (morphologic abnormality)

In order to distinguish inflammatory process from structure, 23583003 |Inflammation (morphologic abnormality)| has been Inactivated as DUPLICATE, SAME AS 409774005 |Inflammatory morphology (morphologic abnormality)|.

All concepts in the Inflammatory disorder hierarchy have been remodeled accordingly. 

January 2020 International Release
12ICD-O project work

IACR have released ICD-O-3.2 as a listing of all new additions, changes and revisions to ICD-O-3.1 in Excel format. The new version, ICD-O-3.2, is recommended for use from 2020.  ICD-O-3.2 is not yet available online or in book format. In preparation for the update, the changes have been divided into types and are being investigated/addressed in the ICD-O-3.2 update project. The priority is being given to those that have an impact on clinical safety, e.g., changes of behaviour (benign, malignant etc.) and adding new content for SNOMED CT morphologies, this refers to the 400177003 |Neoplasm and/or hamartoma (morphologic abnormality)| hierarchy.

The descriptions with [obs] have been inactivated as outdated because they are artefacts of descriptions from the ICD-O-3 print version for their history tracking. 

The maps to ICD-O-3.1 are being updated only for error correction purposes for the January 2020 release. The maps to ICD-O-3.2 are out of scope for the January 2020 release and are planned for a future release.

January 2020 International Release
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Over the Counter

Concepts referring to “over the counter” status have been inactivated. 

Concepts referring to regulatory status or characterization (e.g. over the counter) are out of scope for the International Release since the meaning may vary by jurisdiction and is not consistent internationally.

January 2020 International Release
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Antigens Required for the Vaccine Products

As a Vaccine project work item and based on requests submitted mutually by Argentina and Canada, new antigen concepts (~150) have been added to the Substance hierarchy to be used in the modeling of vaccine products in a future release.

January 2020 International Release
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Vaccine Poisoning

Concepts referring to vaccine poisoning have been inactivated from the International release and moved to the NHS extension per their request.

The notion of vaccine poisoning has persisted in ICD 10 under T50 but it is not included in ICD-11; the poisoning aspect seemingly referred to the adjuvants and carriers that are included in the vaccines as opposed to the biological component itself.

January 2020 International Release
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Traumatic Dislocation

Traumatic dislocation concepts are being remodeled according to the new representation using DUE TO "Traumatic event".

This work has been partially completed for the Jan 2020 release, resulting in the remaining subhierarchies moving from under "Traumatic dislocation of joint" to "Dislocation of joint". These remaining subhierarchies will be remodeled for the July 2020 release.

January 2020 International Release

July 2020 International Release

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Revision of 298180004 |Finding of range of joint movement (finding)

The concepts under the subhierarchy 298180004 |Finding of range of joint movement (finding)| are being remodeled to represent the finding site of <<785818007 |Structure of joint region (body structure)| instead of <<39352004 |Joint structure (body structure)|. 

Range of movement of a joint region can be impacted by both bone and soft tissues, therefore the use of 39352004 |Joint structure (body structure)| was too restrictive and caused issues in other areas of the terminology.  These changes will be made over the course of two releases due to the number of affected concepts.

July 2019 International Release

January 2020 International Release

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Planned changes to Implantation and Insertion procedures

Work commenced on content tracker IHTSDO-175

Jira
serverIHTSDO JIRA
serverIdb202d822-d767-33be-b234-fec5accd5d8c
keyIHTSDO-175

Ongoing structural changes for the Procedure concepts related to the content tracker:

It was agreed that not all Insertion and Implantation procedures are surgical.

As a result, further work in the hierarchy under 129284003 |Surgical action (qualifier value)| has been undertaken for the January 2020 release and this includes:
Reactivation of 129338005 |Surgical implantation - action (qualifier value)|
Addition of a new concept 788288006 |Surgical reimplantation - action (qualifier value)|
Remodel of 'Reimplantation procedures' replaced METHOD = 129337000 |Reimplantation - action (qualifier value)| with new 788288006 |Surgical reimplantation - action (qualifier value)|.

Work on this project will continue for future releases after January 2020.

January 2020 International Release

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Replacement of the Stated Relationship files with the new OWL Axiom refset files

A set of documentations has been developed to support the Logic Profile Enhancements. 

For any questions, please contact SNOMED International at support@snomed.org with “OWL Axiom refset files implementation question” in the subject line. 

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Internal QA

Inactivation of Agencies and organizations (qualifier value) and subtypes: moved to UK extension i.e. 66 concepts inactivated.

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Improvement to the Release package naming convention

In order to ensure that the status of each package is correctly identified, we will be capitalising the third element of the naming convention. For example therefore, instead of the January 2018 International Edition release package being called:

SnomedCT_InternationalRF2_Production_20180131T120000Z.zip

It will instead be called:

SnomedCT_InternationalRF2_PRODUCTION_20180131T120000Z.zip

Alpha/Beta releases will be called:

SnomedCT_InternationalRF2_ALPHA_20180131T120000Z.zip

SnomedCT_InternationalRF2_BETA_20180131T120000Z.zip

This should have no impact on most users, this is provided for visibility of anyone who's upload routine might be case-sensitive.

January 2018 International Edition - COMPLETE
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