© 2024 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 International Edition release of SNOMED CT® 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. No part of this document may be reproduced or transmitted in any form or by any means, or stored in any kind of retrieval system, except by an Affiliate of SNOMED International in accordance with the SNOMED CT® Affiliate License. Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. 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[or a Member of SNOMED International] is not controlled by SNOMED International, and may have been modified and may be out of date.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/].
Page At A Glance
Table Of Contents
Introduction
Background
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.
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.
Purpose
This document provides a summarized description of the content changes included in the January 2021 release of SNOMED Clinical Terms® (SCT) International Release.
It also includes technical notes detailing the known content or technical issues where the root cause is understood, the fix has been discussed and agreed to, but has yet to be implemented.
The SNOMED International Release Notes are available alongside the January 2021 International Edition release.
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.
Audience
The audience includes National Release Centers, WHO-FIC release centers, vendors of electronic health records, terminology developers and managers who wish to have an understanding of changes that have been incorporated into the January 2021 International Edition release.
Content Development Activity
Summary
Continuous quality improvement and enhancement of existing content is an ongoing process undertaken by SNOMED International in preparation for every release. The January 2021 International Release has seen a continuation of the work driven by contributions from: Kaiser Permanente i.e. Convergent Medical Terminology (CMT), Global Medical Device Nomenclature Agency (GMDNA), Orphanet and other domain specific collaborations as well as requests received via the Content Request System (CRS).
Additionally quality improvement activities are advanced via project driven initiatives summarized below. Additional, work items impacting every release are updates to the SNOMED CT derived maps such as ICD-10 and ICD-O; details are included in these release notes.
Information about editorial decisions may be found in the SNOMED CT Editorial Guide; mapping guidance for ICD-10 can be found at this link https://confluence.ihtsdotools.org/display/DOCICD10
COVID-19
New content has been added to SNOMED CT as part of the ongoing global effort to tackle the Coronavirus pandemic.
Content relating to COVID-19 can be viewed here SNOMED CT COVID-19 Related Content
| New content for January 2021 International release |
|---|
1119305005 |Vaccine product containing only Severe acute respiratory syndrome coronavirus 2 antigen (medicinal product)| 1119349007 |Vaccine product containing only Severe acute respiratory syndrome coronavirus 2 messenger ribonucleic acid (medicinal product)| 1119350007 |Administration of vaccine product containing only Severe acute respiratory syndrome coronavirus 2 messenger ribonucleic acid (procedure)| |
To address the need for concepts related to persistent symptoms of COVID-19, three new concepts have been added to SNOMED CT for the Jan 2021 release. 1119302008 |Acute disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder)| 1119303003 |Post-acute COVID-19 (disorder)| 1119304009 |Chronic post-COVID-19 syndrome (disorder)| |
897034005 Severe acute respiratory syndrome coronavirus 2 antibody test positive (finding) 897035006 Severe acute respiratory syndrome coronavirus 2 antibody test negative (finding) |
| 897036007 Occupational exposure to Severe acute respiratory syndrome coronavirus 2 (event) |
1017214008 Viral infection of bloodstream caused by Severe acute respiratory syndrome coronavirus 2 (disorder) |
Any concepts in scope for the SNOMED CT to ICD-10 mapping have been mapped and adhere to the World Health Organization current guidelines.
Content Quality Improvement
| SCT Statistics | |
|---|---|
| Domain | #New concepts |
| SNOMED CT Concept (SNOMED RT+CTV3) | 3545 |
| Body structure (body structure) | 383 |
| Clinical finding (finding) | 1702 |
| Event (event) | 29 |
| Environment or geographical location (environment / location) | 0 |
| Observable entity (observable entity) | 180 |
| Organism (organism) | 164 |
| Pharmaceutical / biologic product (product) | 485 |
| Physical force (physical force) | 1 |
| Physical object (physical object) | 47 |
| Procedure (procedure) | 235 |
| Qualifier value (qualifier value) | 41 |
| Record artifact (record artifact) | 5 |
| Situation with explicit context (situation) | 99 |
| Social context (social concept)| | 6 |
| Specimen (specimen) | 16 |
| Staging and scales (staging scale) | 12 |
| Substance (substance) | 103 |
| SNOMED CT Model Component (metadata) | 37 |
| SCT Statistics for January 2021 Release | |
|---|---|
| #total | |
| Newly inactivated concepts | 3512 |
| Newly reactivated concepts | 17 |
| Changed definitional status | 1884 |
| New sufficiently defined | 2194 |
| New primitive | 1351 |
| Total number of active concepts | 354434 |
Body structure
New body structure concepts: 383
Demonstration Release of the Anatomy Model
The plan is to implement the new anatomy concept model over forthcoming releases. There are approximately 35,000 anatomy concepts to be modeled by different types of 'part of' relationships. The new model will enable the automatic generation of hierarchies to further improve content quality and consistency. The integumentary system (about 2000 concepts) have been modeled. The musculoskeletal system (about 10,000 concepts) is the next hierarchy to be modeled. The concept model requires tooling enhancement to support nested expressions and decision about the inferred relationships for transitive and reflexive attributes. We will inform the community of the schedule for the demo release when the tooling and content are ready. The demo release will help us to gather feedback to evaluate potential impact and options for future releases.
Limbs/Girdles
There is mixed-use of the pelvic girdle and pelvic ring, shoulder girdle and shoulder in relation to the free limbs, limbs, and trunk. Existing content has been reviewed with about 200 model changes and impact to over 2000 classification results.
The following is a high-level view of hierarchical relationships for limb structures:
53120007 |Upper limb structure|
896766000 |Structure of free upper limb|
16982005 |Shoulder region structure|
26444007 |Shoulder girdle structure|
61685007 |Lower limb structure|
46862004 |Buttock structure|
29836001 |Hip region structure|
699617006 |Structure of free lower limb|
897012008 |Structure of bone and/or joint of pelvic girdle| - Note, this relationship is missing in the January 2021 release. It will be added in the next release.
The hierarchical relationships for trunk structures:
816092008 |Structure of pelvic cross-sectional segment of trunk|
46862004 |Buttock structure|
29836001 |Hip region structure|
12921003 |Structure of pelvis|
3665003 |Pelvic wall structure|
897011001 |Structure of pelvic ring|
897012008 |Structure of bone and/or joint of pelvic girdle|
Further detail can be found in the document https://docs.google.com/document/d/1zlVNTxuiL7UrvB8mjvDER0qJHzZjqe_ieVVfeqthNvc/edit?usp=sharing
Flexor annular pulley
Over 40 new concepts for flexor annular pulley of digits of hand have been added in this release.
Muscle tendon of toes
Over 20 new concepts have been added for flexor/extensor digitorum brevis/digitorum longus muscle tendons of toes.
Extensor compartment of wrist region
12 new concepts have been added for six extensor compartments of wrist region.
Nasal sinus structure
Updated the subhiearchy to clarify that sinus structure includes bone, cavity, and mucous membrane of sinus (body structure). New concepts are added for bones and cavities of most nasal sinuses.
Lumbar region
The concept |Lumbar region| has been inactivated as ambiguous and replaced by |Lumbar region of abdomen| and |Lumbar region of back|. The exiting concepts, e.g. clinical findings, procedures have been reviewed and remodelled.
Interdigital webs and spaces of hand and foot
The subhiearchy has been reorganised to under the new concepts interdigital web of hand and foot.
Cell hierarchy
The planned revision of Cell hierarchy has been put on hold. Further investigation is needed to determine if the SEP model should be applied for cell structure.Inactivation of Tooth Anatomy Concepts
On the recommendation of the Dentistry Clinical Reference Group, the following concepts have been inactivated due to their potential to pose a clinical risk:
| 39844006 |Structure of mandibular left canine tooth (body structure) | | 40005008 |Structure of mandibular right second molar tooth (body structure) | |
| 113278005 |Structure of mandibular left central incisor tooth (body structure) | | 72876007 |Structure of maxillary left canine tooth (body structure) | |
| 89625000 |Structure of mandibular left first molar tooth (body structure) | | 31982000 |Structure of maxillary left central incisor tooth (body structure) | |
| 77130001 |Structure of mandibular left lateral incisor tooth (body structure) | | 23427002 |Structure of maxillary left first molar tooth (body structure) | |
| 48402004 |Structure of mandibular left second molar tooth (body structure) | | 25748002 |Structure of maxillary left lateral incisor tooth (body structure) | |
| 47055002 |Structure of mandibular right canine tooth (body structure) | | 66303006 |Structure of maxillary left second molar tooth (body structure) | |
| 15422005 |Structure of mandibular right central incisor tooth (body structure) | | 80647007 |Structure of maxillary right canine tooth (body structure) | |
| 28480000 |Structure of mandibular right first molar tooth (body structure) | | 22120004 |Structure of maxillary right central incisor tooth (body structure) | |
| 82628004 |Structure of mandibular right lateral incisor tooth (body structure) | | 5140004 |Structure of maxillary right first molar tooth (body structure) | |
| 11712009 |Structure of maxillary right lateral incisor tooth (body structure) | | 7121006 |Structure of maxillary right second molar tooth (body structure) | |
The concepts have been inactivated with reason 'ambiguous' and a historical association target of the permanent and deciduous tooth. For example: Structure of mandibular left lateral incisor tooth (body structure) has been inactivated as ambiguous and replaced by Structure of deciduous mandibular left lateral incisor tooth (body structure) and Structure of permanent mandibular left lateral incisor tooth (body structure).
Reference set updates
Updated and validated release file for the lateralizable body structure reference set.
Updated and validated release files for the SEP refsets.
Clinical finding
New concepts added for clinical finding hierarchy: 1702
Quality Initiative
The Quality Initiative (QI) project is the implementation of the Quality Strategy. After a successful pilot project for the July 2018 release the next stage has been implemented for subsequent releases including January 2021.
Quality improvement tasks were deployed to improve internal structural consistency and ensure compliance with editorial policy related to the stated modeling of content. Additionally, correction or addition of defining relationships was carried out to accurately reflect current clinical knowledge and ensure the semantic reliability of descriptions associated with a concept.
Total count of changes for the QI project:
- Stated: A total of 9463 concepts had changes made to the Stated relationships in the model.
- Inferred: A total of 15750 concepts affected by inferred changes.
| QI Project focus for January 2021 release (work has begun or been completed) | |
|---|---|
| 419199007|Allergy to substance (finding)| | 56246009|Hypertrophy (morphologic abnormality)| |
| 37782003|Damage (morphologic abnormality)| | 708039003|Inflammatory lesion (morphologic abnormality)| |
| 5294002 |Developmental disorder (disorder)| (excluding congenital disorders) | 4147007|Mass (morphologic abnormality)| |
| 87642003|Dislocation (morphologic abnormality)| | 708041002|Mechanical lesion (morphologic abnormality)| |
| 25723000|Dysplasia (morphologic abnormality)| | 52988006|Lesion (morphologic abnormality)| |
| 1806006|Eruption (morphologic abnormality)| | 36191001|Perforation (morphologic abnormality)| |
| 107682006|Fibrosis AND/OR repair abnormality (morphologic abnormality)| | 30217000|Proliferation (morphologic abnormality)| |
| 31883006|Fused structure (morphologic abnormality)| | 125671007|Rupture (morphologic abnormality)| |
| 76197007|Hyperplasia (morphologic abnormality)| | 19130008|Traumatic abnormality (morphologic abnormality)| |
269061001|Fracture of vertebra without spinal cord lesion (disorder)
Based on input from the Editorial Advisory Group and a member stakeholder:
269061001 |Fracture of vertebra without spinal cord lesion (disorder)| and descendants have been inactivated with a status of 'Ambiguous' and the historical association POSSIBLY EQUIVALENT TO = 50448004|Fracture of vertebral column (disorder)|. These concepts originated from ICD-9 to represent the notion of "Fracture of X without mention of Y".
This type of term is not represented in ICD-10 or ICD-11. As "without mention" is not semantically equivalent to "without" and could mean that the information was not available in the record abstraction, these concepts are considered to be ambiguous in their meaning.
Allergy to X vaccine
Editorial guidelines and content for concept pattern "Allergy to X vaccine" have been updated for the 2021-January Release.
Editorial guidelines and content for concept pattern "Adverse reaction to X vaccine" have been updated for the 2021-January Release.
12456005 |Iatrogenic disorder (disorder)
Subtypes of 12456005 |Iatrogenic disorder (disorder)| that do not have the word iatrogenic in the FSN have been remodeled so that they are no longer a subtype of this concept.
New subtypes have been added to 12456005 |Iatrogenic disorder (disorder)| where the disorder specifies iatrogenic in the FSN.
25674000|Lichen sclerosus et atrophicus (disorder)
25674000 Lichen sclerosus et atrophicus (disorder) has been inactivated with reason outdated and replaced with new concept 895454001 Lichen sclerosus (disorder).
A new morphology concept 895217008 Lichen sclerosus (morphologic abnormality) has been created and used to remodel the new concept and its 20 descendants. This improvement has resulted in 895454001 Lichen sclerosus (disorder) having no stated subtypes (with all Sufficiently Defined where possible).
40275004 |Contact dermatitis (disorder)
Updated the modeling for 40275004 |Contact dermatitis (disorder)| and subtypes to adhere with a newly constructed template.
52515009|Hernia of abdominal cavity (disorder)
The finding site value for hernia disorder concepts (excluding obstructed hernias which are being managed separately) were reviewed and changes made where required to improve classification results.
106112009|Fetal finding (finding)
The value for the 363698007 |Finding site| attribute for fetal concepts has been updated to << 123037004 |Body structure| MINUS << 55460000 |Fetal structure| unless the site is a unique body structure present during the fetal period.
The fetal semantics are captured using the 246454002 |Occurrence|=303112003 |Fetal period| relationship. These modeling changes has been applied to the fetal content within the Clinical finding hierarchy. Fetal procedure concepts will be reviewed as part of the Procedure QI work.
206002004|Fetal or neonatal effect of maternal medical problem (disorder)
206002004|Fetal or neonatal effect of maternal medical problem (disorder)| and descendants has been inactivated. Replacement concepts that do not include 'or' in the descriptions have been added as subtypes of 70591005|Fetal disorder (disorder)| and 22925008|Neonatal disorder (disorder)|.
67531005|Spina bifida (disorder)
67531005|Spina bifida (disorder) and subtypes have been remodeled and marked as sufficiently defined where appropriate.
Content Tracker Project Updates
Work completed for the following Content Project:
- IHTSDO-668 Congenital absence vs. congenital partial absence.
Other Content Improvements in the Clinical Finding Hierarchy
'On Examination' and 'Complaining of' concepts
'On examination' and 'Complaining of' concepts have been inactivated in the International Edition and moved back to the UK extension.
Disorder X without Disorder Y
The vast majority of existing X without Y concepts originated from ICD-9 with the specific meaning of "X disorder without mention of Y disorder". As the phraseology indicates a lack of data about disorder Y as opposed to a specific exclusion, this type of concept has not been included in ICD-10, nor proposed for ICD-11, except in the case of "Traumatic brain injury without open intracranial wound".
Addition of new X without Y concepts may only be made under the following conditions:
- The request for new content must be accompanied by a rationale as to the difference between "X disorder without Y disorder" and "X disorder."
- Approval for addition is given by the Head of Terminology.
For the most part, existing X without Y concepts will be inactivated as AMBIGUOUS with a historical MAY BE relationship to "X disorder". Exceptions to inactivation will be made on a case-by-case basis.
253530007 |Right ventricular outflow tract obstruction (disorder)| and253546004|Left ventricular outflow tract obstruction (disorder)
Occurrence 'congenital' has been removed from these two concepts with remodel of subtypes.
165816005|Human immunodeficiency virus positive (finding)
Human immunodeficiency virus Centers for Disease Control and Prevention and Human immunodeficiency virus World Health Organization class content has been updated to align with the current categories.
268294001 |Chromosome replaced with ring or dicentric (disorder)
268294001 |Chromosome replaced with ring or dicentric (disorder)| has been inactivated and replaced by 1010276004 |Ring chromosome (disorder). All subtypes have been remodeled and marked sufficiently defined where appropriate. 23345003 |Ring chromosome (morphologic abnormality)| has been remodeled to align with expert input to have monosomy, trisomy and ring chromosome concepts as siblings in the morphology hierarchy.
Social Determinants of Health (SDoH) - Clinical Finding
In line with SNOMED CT priorities, and working with the US Extension of SNOMED CT to make Social Determinants of Health (SDoH) content available for international usage on the subject matter of food insecurity. This work was based on submissions from the US CRS for content for SDoH originating from the consensus-driven standards being developed by the Gravity project: https://confluence.hl7.org/display/GRAV/The+Gravity+Project
A new concept was added with a definition: 1078229009 |Food security (finding)|
New definition for 733423003 |Food insecurity (finding)|
Also supporting SDoH work:
1010682008 |Not entitled to social services assistance due to income above limit (finding)|
Notice: '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 to' and update the Editorial Guide for this area. The Editorial Guide and all concepts that are currently modeled as 'Co-occurrent and due to' will be updated over future release cycles. |
|---|
Convergent Medical Terminologies (CMT)
New CMT concepts: 749
Procedure
New concepts for procedure hierarchy: 235
Social Determinants of Health (SDoH) Procedure
New evaluation procedure concepts:
1004109000 |Assessment of goals to achieve food security (procedure)|
1002223009 |Assessment of progress toward goals to achieve food security (procedure)|
1002224003 |Assessment for food insecurity (procedure)|
1002225002 |Assessment of barriers in food insecurity care plan (procedure)|
Also
1004110005 |Coordination of resources to address food insecurity (procedure)|
Implantation and Insertion procedures
Work continues on content tracker IHTSDO-175. There are ongoing structural changes for the Procedure concepts related to the content tracker. Work on this project will continue for future releases after January 2021.
Collaboration/Harmonization Projects
Orphanet
Working in collaboration with Orphanet (http://www.orpha.net/consor/cgi-bin/index.php), creation of new concepts for the original set of prioritized rare diseases has been completed. The alpha release is now available for feedback, for more information please see April 2020 SNOMED CT Orphanet Simple Map package ALPHA release available
All of the concepts added for the Orphanet project have been mapped to ICD-10.
ICD-11 Update
A total of 593 new concepts were added for the July 2020 release.
Global Medical Device Nomenclature Agency (GMDNA)
33 new device concepts were added to the physical object hierarchy for GMDN for the January 2021 release.
For the GMDN mapping equivalence tables:
- 33 new concepts have been added to in scope and mapped.
- 199 concepts have been modified and removed from the mapping tool as out of scope.
- 84 concepts have been deemed obsolete and removed from the mapping tool and flagged as out of scope.
- 16 concepts have been flagged as out of scope for SNOMED CT and removed from this map.
ICD-O-3.2 Update
A full Impact analysis of both updating the existing SNOMED CT content and updating the current ICD-O-3.1 map has been carried out. In particular this relates to changes to the 400177003 |Neoplasm and/or hamartoma (morphologic abnormality)| sub-hierarchy in SNOMED CT. The impact analysis utilized the final IACR ICD-O-3.2 (WHO IARC) morphology code listing and the new pdf changes documents on their website (http://www.iacr.com.fr/index.php?option=com_content&view=category&layout=blog&id=100&Itemid=577).
For the July 2020 release only minor changes have been made, and 14 new morphologies have been added to the 108369006 |Neoplasm (morphologic abnormality)| sub-hierarchy.
Note - The published maps to ICD-O-3.1 are being updated only for maintenance purposes for the July 2020 release. The maps to ICD-O-3.2 are out of scope for the July 2020 release and are planned for a future release.
Event
New concepts added: 4
Qualifier Value
New concepts added: 65
Occupation
Concepts representing "other" occupations e.g. 79445009 |Other clerk (occupation)| have been inactivated as ambiguous as these represent classification constructs.
Situation with explicit context
New concepts added: 129
Physical object
New concepts added: 89
- Approximately 200 device concepts in the physical object hierarchy were modeled with the new device attributes in the areas of breast implants, shunts, stent, and cardiac valve prosthesis. Some of these concepts also had FSN and description changes.
- 25 concepts in the physical object hierarchy were inactivated.
- Approximately 630 attribute-value relationships were added to the physical object hierarchy including device characteristic such as sterility, absorbability, and custom-made.
- Editorial guidelines developed and documented and noted content updated accordingly. The guidelines are found on the project space: Reference Documentation - Devices (Please note, you may have to register for Confluence user account in order to access this project and the relevant link).
Specimen
New concepts added: 8
Concepts inactivated: 2
Observable Entity
New concepts added: 117
- 30 new concepts were added in the areas of novel coronavirus detection, insulin rates and doses, test due dates, minimum alveloar concentration.
- Estimate intake of X = 30 concepts new concepts
- Measured intake of X = 30 concept new concepts
- Proportion of X = 3 new concepts
- Target = 4 new concepts
Organism
New organism concepts added: 135.
Updated descriptions for 60 concepts.
Pharmaceutical / biologic product
| Changes for the July 2020 International Release | |
|---|---|
| Concrete domain | Information about upcoming changes to implement concrete domains in lieu of concepts representing numeric values will be available on the Modeling Advisory Group Confluence space located at: https://confluence.ihtsdotools.org/display/mag/Modeling+Advisory+Group |
| Vaccine products | Editorial guidelines developed and documented and existing content updated accordingly. The guidelines will be found on the project space Reference Documentation - Drug Model (Please note, you may have to register for Confluence user account in order to access this project and the relevant link). The updated Vaccine product concepts have been used to remodel content throughout SNOMED. Vaccine product "containing" concepts have been used in modeling "Allergy to X vaccine" and "Adverse reaction to X vaccine" patterns. Vaccine product "containing only" concepts have been used in modeling "Administration of X vaccine" pattern. Substance concepts referring to vaccines have been inactivated in lieu of the Vaccine product concepts. Product role attributes added to products used for passive immunization. |
Veterinary Extension
23 concepts were moved to the Veterinary Extension.
Metadata concept
In order to support the upcoming RF2 version of the GPS (Global Patient Set) refset, the GPS requires its own moduleID.
A new concept has been added to support this use case 890195008|International Health Terminology Standards Development Organisation Global Patient Set module (core metadata concept)|
Substances
New concepts added: 137
- New disposition concepts: 7
- Inactivated Allergen class groupers from the Substance hierarchy.
- Inactivated Vaccine substance groupers from the Substance hierarchy.
Internal Quality Improvement
Replacement of the Stated Relationship files with the new OWL Axiom refset files
A set of documentation has been developed to support the Logic Profile Enhancements.
- SNOMED DL Profile Enhancements
- SNOMED CT Logic Profile Specification
- SNOMED CT OWL Guide (OWL Refsets specification)
- Snomed OWL Toolkit - https://github.com/IHTSDO/snomed-owl-toolkit
- Classifying SNOMED CT using the Snomed OWL Toolkit - https://youtu.be/-91egY9mJqA
- Creating an OWL file containing SNOMED CT - https://youtu.be/sfFbMMioA_4
For any questions, please contact SNOMED International at support@snomed.org with “OWL Axiom refset files implementation question” in the subject line.
Machine Readable Concept Model (MRCM) Changes
Changes to the MRCM for the July 2020 release include:
- MRCM for new attribute 860779006 |Has ingredient characteristic (attribute)|
- MRCM for new attribute 246196007 |Has surface characteristic (attribute)|
- MRCM for new attribute 827081001 |Has filling (attribute)|
- MRCM for new attribute 836358009 |Has device intended site (attribute)|
- MRCM for new attribute 840560000 |Has compositional material (attribute)|
- MRCM for new attribute 840562008 |Has device characteristic (attribute)|
- MRCM for new attribute 860781008 |Has product characteristic (attribute)|
- Expand the range of 246075003 |Causative agent (attribute)| to include << 373873005 |Pharmaceutical / biologic product (product)|
Further detail can be found at https://confluence.ihtsdotools.org/display/IAP/MRCM+changes+in+the+July+2020+release (Please note, you may have to register for Confluence user account in order to access this project and the relevant links above).
Improvement for the Representation of Role Groups
It is important to clearly indicate if an attribute is grouped or not because role grouping has impact to semantics and classification results. The majority of the Modeling Advisory Group members recommended explicit representation for role groups. Two key changes have been implemented since the July 2019 release.
Firstly, role groups are explicitly stated and represented by the concept 609096000|Role group (attribute)| as an object property in the OWL axiom refset.
Secondly, for the inferred relationship file, role group 0 is only applied to attributes that are not logically grouped. The attribute is not a value of 609096000|Role group (attribute)| in an OWL axiom. Or the attribute has grouped = 0 in the MRCM. This addresses the potential confusion whether an attribute is grouped or not in role group 0.
The improvements provide consistent representation for role groups in the OWL axioms, inferred relationship file and diagramming of the concept model.
Concrete Domains and Numeric Representation
The Modeling Advisory Group is working on concrete domains and how they will be represented in the inferred RF2 relationship file format. The following is a note on the interim solution relating to concrete domain for the medicinal product model:
Numerics are represented by concepts in the Medicinal product concept model in SNOMED CT, which is an interim solution before the implementation of concrete domains to support data types, such as decimal, integer, string and date/time. We are progressing the development of the specification for the inferred relationship file in consultation with the community of practice. When ready, strength in the medicinal product model can be transformed to concrete domains. The transformation will be completed by technical changes without impact to classification results.
Further information about current progress on Concrete Domains can be found at:
https://confluence.ihtsdotools.org/display/mag/Modeling+Advisory+Group (Please note, you may have to register for Confluence user account in order to access this link).
SNOMED CT derived products
ICD-10 map
The SNOMED CT to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (© World Health Organization 1994) 2016 Version map (SNOMED CT to ICD-10 Map) is included in the SNOMED CT International release as a Baseline. The SNOMED CT to ICD-10 Map was created to support the epidemiological, statistical and administrative reporting needs of SNOMED International member countries and WHO Collaborating Centers.
The SNOMED CT to ICD-10 Map is released in Release Format 2 (RF2) only. It is located in the file der2_iisssccRefset_ExtendedMapFull_INT_20200731.txt, which is in the Map folder under Refset, in each of the three RF2 Release Type folders.
The SNOMED CT to ICD-10 Map is released as Refset 447562003 |ICD-10 complex map reference set (foundation metadata concept)|.
Content development activity summary
The map is a directed set of relationships from SNOMED CT source concepts to ICD-10 target classification codes. The SNOMED CT source domains for the MAP are limited to subtypes of 404684003 |clinical finding|, 272379006 |event| and 243796009 |situation with explicit context|. The target classification codes are ICD-10 2016 release.
Mapped content for January 2021
The map provided for the January 2021 release has been updated, and now represents a complete map from SNOMED CT International release to ICD-10 2016 version.
- 1873 newly authored concepts have been added and mapped
- 3 new codes for special purposes have been added to the terminology browser in accordance with WHO guidelines:
· U08 Personal history of COVID-19
· U09 Post COVID-19 condition
· U10 Multisystem inflammatory syndrome associated with COVID-19
We would welcome feedback on any issues that users of the map may detect when using the map. Issues should be submitted via mapping@snomed.org
Technical Guide Exemplars
The Technical Guide Exemplars document has now been moved from the International Edition release package to a Confluence page. This page can be found as part of the ICD-10 Mapping Technical Guide (see Appendix B), which is hosted here: http://snomed.org/icd10map
ICD-O Map
For the July 2020 release only minor changes have been made, and 14 new morphologies have been added to the 108369006 |Neoplasm (morphologic abnormality)| sub-hierarchy.
The published maps to ICD-O-3.1 are being updated only for maintenance purposes for the July 2020 release. The maps to ICD-O-3.2 are out of scope for the July2020 release and are planned for a future release.
SNOMED CT to OWL conversion and classification
The repository containing the toolkit enabling simple SNOMED CT to OWL conversion and classification can be found here, including documentation on its use: https://github.com/IHTSDO/snomed-owl-toolkit
Please contact SNOMED International at support@snomed.org if you would like to provide any feedback on ways to extend and improve the new toolkit.
Technical notes
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 July 2020 International edition, the following Known Issues were identified, and agreed to be resolved in future editing cycles:
Resolved Issues
Resolved issues are Known Issues which were not fixed as part of the previous release lifecycle, but which have now been resolved in the latest release. They can also be issues found during the Alpha and Beta testing of the current release, which were resolved before the final deployment of the associated Member release. Finally they can be issues which were reported or found during the testing phase, but which have been closed without any action taken.
The Resolved Issues for the Snomed CT July 2020 International edition can be found here:
Technical updates
RF2 package format
For future reference, 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 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
- 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.
New Configuration file in the RF2 package, containing Release Metadata
A new file will be included in the July 2020 International Edition (and all subsequent releases), containing metadata about the Release package itself. This has been created in conjunction with feedback from the community, and as such will initially contain the following fields:
- effectiveTime
- deltaFromDate
- deltaToDate
- languageRefset(s)
- humanReadableLanguageRefset(s)
- licenceStatement
The file will be in .JSON format, to ensure that it is both machine-readable and human-readable. It will be named "release_package_information.json".
The metadata will be extended and refined going forward, in order to ensure that it contains the most useful information possible. If anyone has any ideas about any other useful information to include, please send them to info@snomed.org, along with a business case explaining how the information would benefit stakeholders. Please be aware that this use case will then be assessed by SNOMED International, and the new metadata will only be included in the configuration file if the business case is strong enough.
Additional Rollup Delta Release package
For those users who did NOT use the March 2020 Interim International Edition release in their systems, the advise on bringing systems up to date is as follows:
- The best option is to first apply the March 2020 Interim release Delta files (relative to the January 2020 release), and after that apply the official July 2020 Delta files (relative to the March 2020 Interim release).
- If this is not feasible, then please use the July 2020 International Edition additional Rollup Delta package - please see the Release Notes for full details:
Early visibility of impending change in the July 2020 International edition
Please see the following page for details of all upcoming changes planned for July 2020 and beyond: https://confluence.ihtsdotools.org/display/RMT/July+2020+Early+Visibility+Release+Notice+-+Planned+changes+to+upcoming+SNOMED+International+Release+packages.
Release Notes naming convention
The Release notes naming convention has been refined to bring it in line with other documentation standards - from this release onwards the files will have the following naming format:
- doc_SnomedCTReleaseNotes_Current-en-US_INT_[date].pdf
Instead of the previous underscore after "Current":
- doc_SnomedCTReleaseNotes_Current_en-US_INT_[date].pdf
Document links
All links provide information that is correct and current at the time of this Release. Updated versions may be available at a later date, but if so these will need to be requested from the relevant SNOMED International teams.
NOTE: To access any of the links in the pdf document, please visit the Release Notes @ https://confluence.ihtsdotools.org/display/RMT/SNOMED+CT+July+2020+International+Edition+-+SNOMED+International+Release+notes
Approvals
Final Version | Date | Approver | Comments |
|---|---|---|---|
| 1.0 | 20200728 | Rory Davidson | Approved |
| 1.0 | 20200728 | Monica Harry | Approved |
| 1.0 | 20200729 | Kelly Kuru | Approved |
Draft Amendment History
Version | Date | Editor | Comments |
|---|---|---|---|
0.1 | 20200502 | Andrew Atkinson | First draft for review and comment |
| 0.11 | 20200511 | Maria Braithwaite | Addition of detailed notes on content changes |
| 0.12 | 20200513 | Monica Harry | Minor edits and content detail changes |
| 0.2 | 20200610 | Andrew Atkinson + Maria Braithwaite | Updates for Beta changes + additional Rollup Delta package |
| 0.3 | 20200629 | Andrew Atkinson | Final technical and resolution refinements |
| 0.3 | 20200629 | Maria Braithwaite | Final content refinements |
| 1.0 | 20200728 | Andrew Atkinson | All final updates completed |