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Date

20200731

Document Version

1.0

Release Status

PRODUCTION

 © 2020 International Health Terminology Standards Development Organisation. All rights reserved. SNOMED CT® was originally created by the College of American Pathologists.

This document forms part of the GP/FP SNOMED CT® Production package distributed by International Health Terminology Standards Development Organisation, trading as SNOMED International, and is subject to the SNOMED CT® Affiliate License, details of which may be found at https://www.snomed.org/snomed-ct/get-snomed

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Any copy of this document that is not obtained directly from SNOMED International [or a Member of SNOMED International] is not controlled by SNOMED International, and may have been modified and may be out of date. Any recipient of this document who has received it by other means is encouraged to obtain a copy directly from SNOMED International [or a Member of SNOMED International. Details of the Members of SNOMED International may be found at http://www.snomed.org/members/].

Access within SNOMED International member countries is provided by the national release centre in each country, via the relevant Member page(linked).







Page At A Glance

1 Introduction

The SNOMED CT International General/Family Practice Reasons for Encounter and/or Health Issues reference set (hereafter called the GP/FP Subset) was developed between 2010 and 2013 by the GP/FP Subset and ICPC mapping project group. This project ended on December 31, 2013 after field-testing of the products was completed. Previous releases have been accompanied by a map from the subset to ICPC-2, but a review was started in late 2017 about usage of this product and outreach to the user community.  Members, vendors and Wonca have indicated that this product is not used in electronic systems.  Bearing this in mind, and the fact that ICPC-3 is in development meaning that ICPC-2 is no longer being updated, a decision was taken jointly with Wonca to deprecate the map.  As from the July 2019 version, therefore, the GP/FP release no longer includes active map records for ICPC-2.


2. Background

In December 2009 a harmonization agreement was finalized between SNOMED International and the World organisation of Family Doctors (Wonca) to promote co-operation and collaboration between the two organisations. 

This agreement led to the formation of the International Family Physician/General Practitioner Special Interest Group (IFP/GP SIG) under the auspices of SNOMED International. The IFP/GP SIG was established to suggest content for the Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT®) related to general/family practice and to provide quality assurance for SNOMED CT content from the general/family practice perspective. SNOMED International's existing Primary Care Special Interest Group was converted to the IFP/GP SIG after the agreement was signed. 

The subsets were first released as a candidate baseline in April 2014. Changes to the structure of the subsets were made following feedback from this release.   

3 Release content

3.1 Changes to the July 2020 release GP/FP subset

As a result of changes to the July 2020 release of SNOMED CT, 41 concepts were inactivated. The following table lists those concepts that were inactivated in the July 2020 release hence removed from the refset.

Some target replacements were in the Refset and some were net new to the Refset but not necessarily new to SNOMED CT.  See Column E for details. 

When a concept is inactivated as Ambiguous, more than one concept may be selected as replacement therefore not a 1:1 match between inactivated and replaced. There were 26 net new concepts added to the refset as replacements. 


Inactive SCTIDInactive FSNReplacement SCT IDReplacement FSNColumn E
18628002Discharge of eye (disorder)246679005Discharge from eye (finding)Existing refset member
198036002Impotence of organic origin (disorder)473021009Secondary erectile dysfunction (disorder)New refset member
202717005Cervical disc disorder with myelopathy (disorder)75467001Intervertebral disc disorder of cervical region with myelopathy (disorder)New refset member
209799008Sprain of costal cartilage (disorder)209801006Chondrocostal joint sprain (disorder)New refset member
213024000Allergic reaction caused by insect bite (disorder)871920005Allergic reaction caused by insect bite (disorder)New refset member
247454005Sore on skin (disorder)95324001Skin lesion (disorder)Existing refset member
262994004Leg sprain (disorder)281599007Sprain of ligament of lower limb (disorder)Existing refset member
276729007Cystic dermoid choristoma of skin (disorder)201325006Dermoid cyst of skin (disorder)New refset member
294461000Allergy to antibacterial drug (finding)419199007Allergy to substance (finding)New refset member
304930004Varicose veins of lower extremity with ulcer (disorder)304026004Varicose ulcer of lower extremity (disorder)Existing refset member
371438008Urolith (finding)95566004Urolithiasis (disorder)Existing refset member
397803000Impotence (disorder)860914002Erectile dysfunction (disorder)New refset member
419042001Anaphylactic shock, caused by adverse effect of correct medicinal substance properly administered (disorder)241937000Drug-induced anaphylaxis (disorder)New refset member
45203005Actinic dermatitis (disorder)52636001Actinic reticuloid (disorder)New refset member
45376003Adverse effect, caused by correct medicinal substance properly administered (disorder)62014003Adverse reaction caused by drug (disorder)Existing refset member
571611000119101Administration of varicella live vaccine (procedure)871898007871898007 |Administration of vaccine product containing only live attenuated Human alphaherpesvirus 3 antigen (procedure)|New refset member
57302007Allergic reaction, caused by correct medicinal substance properly administered (disorder)62014003Adverse reaction caused by drug (disorder)Existing refset member
62730001Female proctocele without uterine prolapse (disorder)447072005447072005 |Herniation of rectum into vagina (disorder)|Existing refset member
73491007Psychogenic impotence (disorder)860918004Erectile dysfunction due to psychophysiologic disorder (disorder)New refset member
85224001Pilonidal cyst with abscess (disorder)866000008Abscess of skin and/or subcutaneous tissue caused by ingrown hair (disorder)New refset member
85224001Pilonidal cyst with abscess (disorder)47639008Pilonidal cyst (disorder)Existing refset member
86708008Seborrhea (disorder)50563003Seborrheic dermatitis (disorder)Existing refset member
91930004Allergy to edible egg (finding)213020009Allergy to egg protein (finding)New refset member
313279000Subfertility (finding)17276009Decreased fertility (finding)New refset member
271875007Senile debility (finding)18726006Senile asthenia (finding)New refset member
304891004Cognitive - behavior therapy (regime/therapy)228557008Cognitive and behavioral therapy (regime/therapy)New refset member
47004009Difficulty speaking (disorder)

286378009

Difficulty talking (finding)

New refset member
40603000Furunculosis of skin AND/OR subcutaneous tissue (disorder)416675009Furuncle (disorder)Existing refset member
40603000Furunculosis of skin AND/OR subcutaneous tissue (disorder)238389005Boils of multiple sites (disorder)Existing refset member
200603001Boil of face (excluding eye) (disorder)37396007Furuncle of face (disorder)New refset member
397428000Diphtheria (disorder)397430003Diphtheria caused by Corynebacterium diphtheriae (disorder)New refset member
28689008Interstitial nephritis (disorder)428255004Tubulointerstitial nephritis (disorder)New refset member
195453000Internal hemorrhoids, simple (disorder)721703004Internal hemorrhoids grade I (disorder)New refset member
428570002Vaccination for human papillomavirus (procedure)761841000Administration of vaccine product containing only Human papillomavirus antigen (procedure)New refset member
398307005Low cervical cesarean section (procedure)788180009Lower uterine segment cesarean section (procedure)New refset member
4308002Repetitive strain injury (disorder)788465007Repetitive motion disorder (disorder)New refset member
602001Ross river fever (disorder)789400009Disease caused by Ross River virus (disorder)New refset member
285305004Spots on skin (disorder)789493002Pimple of skin (finding)New refset member
160827005Parent relationship problem (finding)160822004Relationship problems (finding)Existing refset member
160830003Child relationship problem (finding)160822004Relationship problems (finding)Existing refset member
267854005Neurodermatitis (disorder)53891004Lichen simplex chronicus (disorder)Existing refset member
396228006Hyperkeratosis (disorder)254666005Keratosis (disorder)Existing refset member
414341000Giant cell arteritis (disorder)400130008Temporal arteritis (disorder)Existing refset member

3.2 Overview of the GP/FP subset


The GP/FP subset contains SNOMED CT concepts relating to two semantic data types commonly used in general/family practice electronic health records:

  • Reasons For Encounter (RFEs)
  • Health Issues

A 'Reason for encounter' was defined as:


"An agreed statement of the reason(s) why a person enters the health care system, representing the demand for care by that person. The terms written down and later classified by the provider clarify the reason for encounter and consequently the patient's demand for care without interpreting it in the form of a diagnosis. The reason for encounter should be recognized by the patient as an acceptable description of the demand for care" (WONCA Dictionary of General/Family Practice, 2003). 


A 'Health issue' was defined as:


"An Issue related to the health of a subject of care, as identified or stated by a specific health care party". This is further defined in the notes as "according to this definition, a health issue can correspond to a health problem, a disease, an illness" (Health Informatics – System of concepts to support continuity of care – Part 1: basic concepts (CEN/ISO FDIS 13940-1)). 

These definitions were used to define the scope of the GP/FP subset. The subset contains SNOMED CT concepts that represent terms commonly used to populate these semantic data types. 
The content of the subset covers the following:

    • Symptoms and signs
    • Disorders and diseases
    • Results
    • Family history
    • Allergies
    • Adverse drug reactions
    • Processes and procedures
    • Social history

Details on the development of the subset are available on request from info@snomed.org


4 General information about the GP/FP subset

Subsets act as the extensibility mechanism in SNOMED CT, allowing developers and users to customize SNOMED CT content to meet specific use cases. 

Content for the general/family practice subset was initially provided by the SNOMED International's General/Family Practice and ICPC-2 mapping project group. It is designed for use in general/family practice clinical settings within electronic health records (EHRs). It is intended for use as the 'core' subset for two commonly used data fields — reasons for encounter and health issues. 

4.1 Purpose of the GP/FP subset

To provide a subset of frequently used SNOMED CT concepts for use in general/family practice EHRs within the following data fields:

  • Reason for encounter
  • Health issue

4.2 Some example use cases of the GP/FP subset

4.2.1 Data entry – direct entry of SNOMED CT concepts from the GP/FP subset

During an encounter in his/her general/family practice, a GP/FP sees a patient who has presented with a newly identified health issue. The GP/FP enters the new health issue into the data field for 'health issue', and into a problem list (if appropriate) in his/her EHR using the GP/FP subset that has been incorporated in his/her EHR by the EHR software vendor. The GP/FP is presented with a validated list of potential terms from the subset, from which he/she selects the SNOMED CT concept that best represents the patient's health issue.

4.2.2 Electronic transfer of care (referrals, admissions, handovers, discharge)

A GP/FP wishes to transfer the care of a patient to a medical specialist for further investigation. The GP/FP's EHR contains the SNOMED CT GP/FP subset, and the GP/FP has entered all the patient's health issues into the EHR using the subset. An HL7 referral message is then constructed; containing SNOMED CT coded concepts from the patient's problem list. The message is sent electronically to the specialist who populates his/her EHR using the data contained in the message. This reduces the time needed to take a patient history and enter this data into the specialist's EHR.

4.2.3 Constraint of terminology use for population and sub-population analysis

A group of GPs are interested in comparing aspects of care across populations of GPs and their patients. The adoption of a subset will, to an extent, constrain the variability of coding of similar issues, conditions and situations that may confound data analysis where very large terminologies such as SNOMED CT are used without constraint.

4.3 Obtaining the GP/FP subset

Access within SNOMED International member countries is provided by the Member National Release Centre in each country, via the relevant Member page. Affiliates of SNOMED International in non-member countries can access the table through their Member Licensing and Distribution Service (MLDS) account. Please contact info@snomed.org for more information if required. 

4.4 Benefits of the subset

SNOMED CT is regarded as the leading global clinical terminology for use in EHRs. The GP/FP subset utilises the power of SNOMED CT by refining the subset to a list of concepts specific to those commonly used in General/Family practice, in this way assuring and enabling a SNOMED CT encoded system for recording aspects of the clinical record. This increases the usefulness of SNOMED CT for GPs/FPs because searches are targeted to the SNOMED CT concepts that GPs/FPs use most often, and, if implemented properly, users should be able to search and select a SNOMED CT concept quickly and easily. 

As stated in Section 4.5, the SNOMED CT GP/FP subset is being maintained and distributed on an annual basis and in line with the July edition of the SNOMED CT International Release. 

4.5 Characteristics of the GP/FP subset

The GP/FP Subset contains the following characteristics:

  • Only concepts with a status of 'current' (status = 0) have been included, ensuring that the only concepts included are active and able to be used for data entry.
  • The Reason for encounter and Health issue subsets have been combined into one subset.
  • A series of principles for the development of the GP/FP subset were created during the development phase of the project. These principles are documented in the SNOMED CT GP/FP subset and ICPC mapping project: Phase 2 project report.

  • The GP/FP subset is released using Release Format 2 (RF2).

4.6 SNOMED CT target content

The GP/FP subset only contains SNOMED CT content from the following hierarchies:

    • Clinical finding
    • Event
    • Procedure
    • Situation with explicit context.

4.7 Known issues in the GP/FP subset

The GP/FP subset was developed using a 'bottom-up' approach, based on the terms frequently used in general/family practice to describe reasons for encounter and health issues. As a result, it does not contain all the SNOMED CT concepts that could be used to populate the reasons for encounter or health issue data fields in electronic health records. The IFP/GP Clinical Reference Group will add to the content of the subset based on usage in Family/General Practice. 

5 Implementation of the GP/FP Subset 

5.1 Implementation overview

  • There are a variety of ways in which the GP/FP subset can be implemented, and it would be impossible to outline each possible scenario in these release notes.
  • Vendors are encouraged to contact the IFP/GP Clinical reference Group to discuss specific implementation scenarios at info@snomed.org.
  • Background about the creation and maintenance of subsets can be found by contacting info@snomed.org
  • The subset should be implemented in SNOMED CT enabled systems in order to access both additional content and also enable the power of SNOMED CT for retrieval and use of the information stored in systems. 

5.2 Use of a secondary search mechanism

The GP/FP Subset contains concepts that are commonly used by GPs/FPs on an international basis, restricting the SNOMED CT concepts available to GPs/FPs to those concepts they are likely to use frequently. However, rare conditions are managed in general/family practice, and GPs/FPs may need to access a wider source of SNOMED CT concepts to populate their reasons for encounter or health issues.
For this reason, when implementing the GP/FP Subset implementers are strongly encouraged to implement a two-stage search mechanism, where users search for concepts in the GP/FP Subset in the first instance. Then, if a suitable concept cannot be found in the GP/FP Subset, a 'secondary search' is activated, allowing the search to be repeated using a broader set of relevant SNOMED CT concepts.

6 Effective Date and Maintenance

6.1 Effective date

The subset is aligned to the July 2020 SNOMED CT International Release.  The effectiveTime for the content has therefore been set to 20200731 (31st July 2020). 


6.2 Maintenance of the subset and ICPC-2 map

The ICPC-2 map files have been deprecated as part of the GP/FP release package from the July 2019 publication onwards, as publicised in the General Practitioner/Family Practitioner (GP/FP) Reasons for Encounter/Health Issues SNOMED CT package Release Notes - July 2019.


7 Technical Notes

RF2 package format

The RF2 package convention dictates that it contains all relevant files, regardless of whether or not there is content to be included in each particular release.  Therefore, the package contains a mixture of files which contain both header rows and content data, and also files that are intentionally left blank (including only a header record).  The reason that these files are not removed from the package is to draw a clear distinction between:

  1. ...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in this or future releases, and 
  2. ...files that just happen to contain no data in this particular release (and are therefore included in the package but left blank, with only a header record), but are still relevant to RF2, and could therefore potentially contain data in future releases.

This allows users to easily distinguish between files that have purposefully been removed or not, as otherwise if files in option 2 above were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.

RF2 package file naming convention

The file package naming convention has been updated to remove the references to the now inactivated ICPC-2 map records.  The GP/FP packages now follows the following naming convention:

  • SnomedCT_GPFP_PRODUCTION_[date/time].zip



Approvals


Final Version

Date

Approver

Comments

1.0


Monica HarryApproved
1.0

 

Jane MillarApproved
1.0

 

Cathy RichardsonApproved





Download .pdf here:





Draft Amendment History


Version

Date

Editor

Comments

0.1

 

Andrew AtkinsonInitial version
1.0

 

Cathy RichardsonFinal updates


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