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that ICPC-3 was in development (and since released in December 2020 (https://www.icpc-3.info/)) meaning that ICPC-2 was no longer being updated, a decision was taken jointly with Wonca to deprecate the map.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.
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 2021 release GP/FP subset
As a result of changes to the July 2021 release of SNOMED CT, 31 concepts were inactivated. The following table lists those concepts that were inactivated in the July 2021 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 34 net new concepts added to the refset as replacements.
|Inactive SCTID||Inactive FSN||Replacement SCT ID||Replacement FSN||Column E|
|102874004||Possible pregnancy (finding)||146799005||Possible pregnancy (situation)||New refset member|
|105618004||Contusion with intact skin (disorder)||125667009||Contusion (disorder)||Existing refset member|
|128545000||Hernia of abdominal wall (disorder)||414396006||Hernia of anterior abdominal wall (disorder)||Existing refset member|
|15394000||Toxemia of pregnancy (disorder)||398254007||Pre-eclampsia (disorder)||Existing refset member|
|162358006||Unilateral earache (situation)||1010234007||Otalgia of right ear (finding)||New refset member|
|162358006||Unilateral earache (situation)||1010233001||Otalgia of left ear (finding)||New refset member|
|1829003||Microcephalus (disorder)||1148758003||Congenital microcephaly (disorder)||New refset member|
|1829003||Microcephalus (disorder)||1148757008||Microcephaly (finding)||New refset member|
|203638000||Kyphoscoliosis and scoliosis (disorder)||405773007||Kyphoscoliosis deformity of spine (disorder)||Existing refset member|
|203638000||Kyphoscoliosis and scoliosis (disorder)||298382003||Scoliosis deformity of spine (disorder)||Existing refset member|
|211500005||Contusion, shoulder or upper arm (disorder)||85636003||Contusion of upper arm (disorder)||New refset member|
|211500005||Contusion, shoulder or upper arm (disorder)||40257000||Contusion of shoulder region (disorder)||New refset member|
|211504001||Contusion, elbow or forearm (disorder)||91613004||Contusion of elbow (disorder)||Existing refset member|
|211504001||Contusion, elbow or forearm (disorder)||39812007||Contusion of forearm (disorder)||New refset member|
|211506004||Contusion wrist or hand (disorder)||5662003||Contusion of hand (disorder)||New refset member|
|211506004||Contusion wrist or hand (disorder)||48123002||Contusion of wrist (disorder)||New refset member|
|22950006||Blindness of one eye (disorder)||274572000||Blind right eye (disorder)||New refset member|
|22950006||Blindness of one eye (disorder)||274571007||Blind left eye (disorder)||New refset member|
|237496006||Thyroid colloid nodule (disorder)||61037007||Colloid goiter (disorder)||New refset member|
|248282002||Undifferentiated illness: Vague ill health (finding)||39104002||Illness (finding)||Existing refset member|
|248282002||Undifferentiated illness: Vague ill health (finding)||213257006||Generally unwell (finding)||Existing refset member|
|25674000||Lichen sclerosus et atrophicus (disorder)||895454001||Lichen sclerosus (disorder)||New refset member|
|268227001||Unilateral undescended testis (situation)||1010569005||Undescended right testicle (disorder)||New refset member|
|268227001||Unilateral undescended testis (situation)||1010568002||Undescended left testicle (disorder)||New refset member|
|269688005||Accidental poisoning caused by drugs, medicines and biologicals (disorder)||7895008||Poisoning caused by drug AND/OR medicinal substance (disorder)||New refset member|
|269688005||Accidental poisoning caused by drugs, medicines and biologicals (disorder)||72431002||Accidental poisoning (disorder)||New refset member|
|269688005||Accidental poisoning caused by drugs, medicines and biologicals (disorder)||275385007||Poisoning caused by biological substance (disorder)||New refset member|
|274096000||Pulmonary heart disease (disorder)||83291003||Cor pulmonale (disorder)||New refset member|
|275330008||Current knee cartilage tear (disorder)||239720000||Tear of meniscus of knee (disorder)||Existing refset member|
|300916003||Allergy to latex (finding)||1003755004||Allergy to Hevea brasiliensis latex protein (finding)||New refset member|
|30989003||Knee pain (finding)||1003722009||Pain of knee region (finding)||New refset member|
|30989003||Knee pain (finding)||1003721002||Pain of joint of knee (finding)||New refset member|
|32273002||Immune thrombocytopenic purpura (disorder)||2897005||Immune thrombocytopenia (disorder)||New refset member|
|373904004||Feels hot/feverish (finding)||373932008||Feels hot (finding)||New refset member|
|373904004||Feels hot/feverish (finding)||103001002||Feeling feverish (finding)||New refset member|
|38342005||Toxic effect of lead compound (disorder)||1145155005||Lead and lead compound poisoning (disorder)||New refset member|
|39020005||Brain injury, without skull fracture (disorder)||127295002||Traumatic brain injury (disorder)||Existing refset member|
|4106009||Rotator cuff syndrome (disorder)||926335004||Rupture of rotator cuff of shoulder (disorder)||New refset member|
|4106009||Rotator cuff syndrome (disorder)||414033006||Disorder of rotator cuff (disorder)||New refset member|
|55680006||Drug overdose (disorder)||1149222004||Overdose (disorder)||New refset member|
|59274003||Intentional drug overdose (disorder)||1149224003||Intentional overdose (disorder)||New refset member|
|65260001||Cervical spondylosis with myelopathy (disorder)||1156963006||Myelopathy due to cervical spondylosis (disorder)||New refset member|
|708038006||Acute exacerbation of asthma (disorder)||281239006||Exacerbation of asthma (disorder)||Existing refset member|
|75705005||Red eye (disorder)||703630003||Red eye (finding)||New refset member|
|95862007||Adverse effect of physical agent (disorder)||400209005||Injury caused by causative force (disorder)||New 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
- Family history
- Adverse drug reactions
- Processes and procedures
- Social history
Details on the development of the subset are available on request from email@example.com
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 firstname.lastname@example.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
- 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 email@example.com.
- Background about the creation and maintenance of subsets can be found by contacting firstname.lastname@example.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 2021 SNOMED CT International Release. The effectiveTime for the content has therefore been set to 20210731 (31st July 2021).
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
7.1 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:
- ...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
- ...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.
7.2 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:
7.3 New files added to the RF2 package format for Derivative products
In order to bring the package format in line with the latest SNOMED International packaging conventions, several new files have been added to the 2021 derivative product release packages:
- > sct2_RelationshipConcreteValues_GPFPDelta_INT_20210731.txt
- > sct2_sRefset_GPFPOWLExpressionDelta_INT_20210731.txt
- > der2_ssccRefset_GPFPMRCMAttributeRangeDelta_INT_20210731.txt
- > der2_sssssssRefset_GPFPMRCMDomainDelta_INT_20210731.txt
- > der2_cRefset_GPFPMRCMModuleScopeDelta_INT_20210731.txt
- > der2_cissccRefset_GPFPMRCMAttributeDomainDelta_INT_20210731.txt
These files will likely remain empty of content in this derivative product package, but are included to ensure consistency across the SNOMED International catalog of products.
Download .pdf here:
Draft Amendment History
|Andrew Atkinson||Initial version|
|Cathy Richardson||Final updates|