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This page provides information on Planned changes to upcoming SNOMED International Release packages.  These changes are provisional only, and subject to change at any time before the final Publication date.

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

ItemsProposed improvement

Planned Release timing

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

Confirmed Release Date
1

COVID-19 Content

Content relating to COVID-19 can be viewed here SNOMED CT COVID-19 Related Content

2022 International Release and future releases


2

Browse Content Changes for the International Release

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

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



3

Changes to Concept Inactivation Values

Please see new editorial guidance for changes to inactivation values here

2022 International ReleaseApril 2022
4

Implementation of the new anatomy concept model

The completion of the revision of hierarchical relationships provides stable anatomy content and improves the quality of classification results in other hierarchies.

Over forthcoming releases, the plan is to implement the new anatomy concept model. There are almost 35,000 anatomy concepts and they will be modeled by different types of 'part of' relationships. The new model will enable us to automatically generate hierarchies to further improve quality and consistency. 

Information about the work completed in previous release for revision of IS_A relationships can be viewed here

2022 International Release and future releases


5

MRCM

Details for forthcoming changes can be seen here

2022 International Releases



6

MRCM Cardinality Changes for July 2022 Release

All historical content issues where two or more finding sites were included in a single role group have been resolved in the International release as part of the QI project.

There are two MRCM rules for finding site to accommodate the historical content. One MRCM is applicable to all content, it allows more than one finding site in a role group. The other MRCM is only applicable for 'All new precoordinated SNOMED CT content'.

The existing MRCM rules will be updated to only allow at most one finding site in a role group from the July 2022 release.

This early visibility notice is intended to provide additional time for content updates in national extensions. 

July 2022 International Release
7

Quality Initiative

Information about the project can found here

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/Changes-to-SLA_202005_MHA.pdf

2022 International Release and future releases
8

Review of Clinical Finding Hierarchy Epilepsy Content

Review of << 313287004 |Seizure related finding (finding)| and << 84757009 |Epilepsy (disorder)| (excluding Orphanet related content) for currency and clinical correctness with the addition of missing clinically relevant content. 

Work is being undertaken in stages. Initial and current focus is on epileptic seizure finding content. 

2022 International Release
9

Legal/Illegal Abortion Concept Inactivation 

As approved by the SNOMED Editorial Advisory Group, concepts referring to "legal" and "illegal" termination of pregnancy (abortion) will be inactivated from the international release with reason non-conformance to editorial policy and replaced by concepts agnostic as to the legality of the procedure. 

May 2022 International ReleaseMay 2022
10

Inactivation of 116223007|Complication (disorder)|

After consultation with the SNOMED Editorial Advisory Group, the ambiguous primitive concept 116223007 |Complication (disorder)| has been inactivated. Subtypes of this concept continue to classify under their other existing inferred parents except for a few high level grouper concepts that now classify directly under 64572001 |Disease (disorder)|.

2022 International ReleaseMarch 2022 
11

Inactivation of 108290001 |Radiation oncology AND/OR radiotherapy (procedure)

108290001 |Radiation oncology AND/OR radiotherapy (procedure)| will be inactivated and replaced via the reactivation of 61757002 |Radiation therapy (procedure)|.  61757002 |Radiation therapy (procedure)| will gain a synonym of radiotherapy.  Related concepts will undergo structural quality improvement.

2022 International Release
12

Primary and Metastatic Project
Following the development of proposals by an internal working group and consultation with  community stakeholders the primary and metastatic project is commencing work, and will be ongoing for the second half of 2022 with updates on progress provided in both Early Visibility and Release Notes.

Q3 and Q4 2022 International Release
13Primary and Metastatic Project - Descriptions update for 128462008 |Secondary malignant neoplastic disease (disorder)| Hierarchy
For consistency of descriptions, 128462008 |Secondary malignant neoplastic disease (disorder)| and its subtypes will have their Fully Specified Name and Preferred Term with 'secondary' changed to  'metastatic' retaining the 'secondary' description as a synonym. The descriptions with 'secondary' will be inactivated and not the concept. Editorial Guidance will be provided.
July 2022 International Release
14

Inactivation of 365753005 |Finding of presence of drug (finding)|

365753005 |Finding of presence of drug (finding)| will be inactivated and replaced with an appropriate concept that includes “substance” in the FSN due to a mismatch between this concept's FSN and logical definition. In addition, “drug” does not have a universal definition or a consistent international representation.

2022 International ReleaseMarch 2022 
15

Drug Measurement Findings

Measurement finding concepts that include the term "drug" in the FSN are being reviewed and considered for inactivation in future releases.

2022 International Release
16

Inactivation of Metadata Concepts

The following metadata concepts will be inactivated for the July 2022 Release:

  • 741068007 |SNOMED CT to European Directorate for the Quality of Medicines & HealthCare simple map reference set (foundation metadata concept)|
  • 735233007 |European Directorate for the Quality of Medicines & HealthCare simple map reference set module (core metadata concept)|
  • 762959004 |European Directorate for the Quality of Medicines & HealthCare to SNOMED CT simple map reference set (foundation metadata concept)|
  • 733900009 |SNOMED CT to Unified Code for Units of Measure simple map reference set (foundation metadata concept)|
  • 741814003 |SNOMED CT to Unified Code for Units of Measure simple map reference set module (core metadata concept)|
July 2022 International Release
17

Inactivation of subtypes of 717234006 |Allergy to animal protein (finding)

Following the Briefing Note submitted to the MF in March 2022, current subtypes of the “717234006 |Allergy to animal protein (finding)|” sub-hierarchy that represent allergy to "animal part" are being considered for inactivation and will be replaced by concepts representing “Allergy to X animal protein”.

2022 International ReleaseApril 2022
18

Inactivation of "X by body site" concepts in various hierarchies

Concepts that include "X by body site" in multiple hierarchies are being inactivated, e.g., 371571005 |Imaging by body site (procedure)| and 301810000 |Infection by site (disorder)|, because they are classification groupers with no clinical use.

2022 International Release and future releases
19

Remodeling of 74799003 |Flap graft (procedure)| hierarchy and 256683004 |Flap (substance)| hierarchy

QI work has commenced on the area of flap procedures, previously placed under 74799003 Flap graft (procedure), which has been inactivated and replaced with 1202017008 |Surgical procedure using flap (procedure)|. The work is still ongoing, and a new model has been developed and remodeling is now in process.

Work has commenced on improvements to the sub-hierarchy of 256683004 |Flap (substance)| (including planned inactivations).  The redesign involves adding new qualifier values as subtypes of 360032005 |Flap reconstruction - action (qualifier value)|. 

For the April 2022 release there are continuing updates to the sub-hierarchy of 256683004 |Flap (substance)| (including planned inactivations to address the conflation of body structure and flap substance). The redesign will involve remodeling qualifier values as subtypes of 360032005 |Flap reconstruction - action (qualifier value)|. Editorial Guidance has been drafted ready for publication. 

2022 International ReleaseApril 2022
20

Remodeling of Descendants of 1202017008 |Surgical procedure using flap (procedure)|

As part of the Quality Initiative project to improve the 1202017008 |Surgical procedure using flap (procedure)| subhierarchy, a new more comprehensive template is under development, and as a result approximately 50 complex flap procedures have subsequently newly been included in the QI project and will be remodeled for the June 2022 release.
This will involve defining some existing complex flap procedures for congenital conditions. Whilst every effort will be made to align with the template and sufficiently define relevant concepts (for example, by creation of new concepts for 1230024004 |Congenital deformity of lower limb (disorder)| and new 1230067007 |Correction of congenital anomaly (procedure)|), it is recognized that the area would benefit from the input of domain experts in the future.

June 2022 International Release
21

Change for Clinical Drug Concepts Containing Pancreatic Enzymes

Clinical drug concepts in the International Release containing pancreatic enzymes will be modeled based on the discrete enzymes; because of variability between real clinical drugs, synonyms representing a total amount in a particular product will not be included in the International Release.

The editorial guide and existing content will be reviewed and updated accordingly in a future release.

2022 International Release and future releases
22

Administrative Concept Inactivations

Seven situation hierarchy concepts are being inactivated due to the lack of unambiguous meaning and reproducible use case among healthcare systems:

  • 394827008 |Personal administration (situation)|
  • 394824001 |Private prescription (situation)|
  • 182819002 |Replacement therapy (situation)|
  • 394822002 |Prescription types (situation)|
  • 394829006 |Past medication (situation)|
  • 182817000 |Drug prescription (situation)|
  • 703955006 |Prescription telephone order (situation)|
2022 International ReleaseApril 2022
23

Planned Inactivation of Concepts in the 260299005 |Number (qualifier value)| Hierarchy

Following the deployment of the concrete domain functionality in SNOMED CT, concepts in the 260299005 |Number (qualifier value)| hierarchy are no longer necessary and plans have been made for their inactivation.

To provide adequate time for any national extension or implementation affected by this change, concepts in the 260299005 |Number (qualifier value)| hierarchy will be inactivated in the January 2023 International Release.

Concepts will be inactivated with reason “Non-conformance to editorial policy” and no historical relationship or replacement concept will be provided.

Exceptions:

118586006 |Ratio (property) (qualifier value)| and descendants have been relocated to 118598001 |Property (qualifier value)| hierarchy.

272070003 |Ordinal number (qualifier value)| and descendants have been relocated to 362981000 |Qualifier value (qualifier value)| hierarchy.

A briefing note will also be distributed to selected Advisory and Project Groups.

Please contact info@snomed.org with any inquiries.

January 2023 International Release
24

Nutrition Content

Information about the work of the Nutrition Care Process Clinical Project group is available here.

2022 International Release
25

Cancer Synoptic Reporting - Project Information

Concepts representing cancer synoptic reporting content will be added to the International release starting with the July 2021 release. 

Cancer synoptic reports are used by many member countries to record pathology examination of cancer specimens including the College of American Pathologists (US and Canada), Royal College of Pathology (UK), Royal College of Pathology Australasia (Australia, New Zealand), PALGA (The Netherlands), Swedish Society of Pathology, and others.

This content primarily encompasses observable entity concepts and also includes supporting concepts from other hierarchies, e.g. property values.

Planned areas of promotion for the July 2022 release include observable entity concepts for genomics, molecular pathology, immunohistochemistry, treatment effect and intactness/quality of specimen.

For more information about this project, please see the Cancer Synoptic Reporting Clinical Project Group here

2022 International Release and future releases
26

Cancer Synoptic Reporting - Protein Substances

Around 40 new protein concepts will be added to the substance hierarchy which are needed to model the immunohistochemistry neoplasm observables. In addition, around 10-15 existing protein substance concepts will be remodeled to align their terming with the authoritative source for protein nomenclature and to assign parents and other relationships based on the current guidelines for the substance hierarchy.

Guidelines for protein substance concepts will be incorporated into the Editorial Guide following completion of this work.

These substance concepts will be added starting with the May 2022 release and may continue for the June and/or July 2022 releases.

Q2 - Q3 2022 International Release
27

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:

  1. The request for new content must be accompanied by a rationale as to the difference between "X disorder without Y disorder" and "X disorder."
  2. 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.

2022 International Release and future releases
28

Content Improvements in the Substance and Product Hierarchies

Please see briefing notes here Drugs Project

2022 International Release and future releases




29

Change for Groupers in Substance Hierarchy - Analyte

Groupers in the Substance hierarchy that refer to analyte (e.g. 259988005 |Transplantation analyte (substance)|, 312273006 |Microbiology analyte (substance)|) will be inactivated with reason Meaning unknown; no potential replacement concept will be provided.

July 2022 International Release
30

Addition of New Grouper Concepts in the Pharmaceutical Dose Form and Medicinal Product hierarchies 

As per the Briefing Note titled Editorial Guideline and Content Changes for Concepts Referring to “Infusion” or “Injection”, new grouper concepts for “infusion and/or injection” will be added to the Pharmaceutical Dose Form and Medicinal Product hierarchies beginning in the 2022-April Release. (The Briefing Note is located on the Drug Project space https://confluence.ihtsdotools.org/display/IAP/Drugs+Project).

May 2022 International ReleaseMay 2022
31

Dose Form-Related Changes - June 2022 Release

  • Dispersion - New basic dose form concept, 1230183009 |Dispersion (basic dose form)| with text definition "A liquid dose form consisting of semi-solid, gaseous, or small (less than 1 micron) liquid particles dispersed in a suitable vehicle.”, has been added. Associated pharmaceutical dose form (PDF) concepts have also been added; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
  • Gingival - Existing intended site concept 738943003 |Gingival (intended site)| has been updated to be a subtype of 738982001 |Oromucosal (intended site)|.
  • Stick - Has administration method will be updated to 738993004 |Insert (administration method)| for existing concepts 385246006 |Conventional release urethral stick (dose form)|, 385148001 |Conventional release otic stick (dose form)|, and 385162008 |Conventional release nasal stick (dose form)|.
  • Mouthwash - Has administration method will be updated to 785900008 |Rinse or wash (administration method)| for mouthwash pharmaceutical dose forms.
  • Periodontal - New basic dose form concept, 1230218002 |Periodontal (intended site)| with text definition "An intended site for administration of a dose form that is the tissue around a tooth.”, has been added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts have also been added; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.

  • Lozenge - New basic dose form concepts, 1230206006 |Compressed lozenge (basic dose form)| (with text definition = A type of solid dose form prepared by compression intended to dissolve or disintegrate slowly in the mouth while being sucked.) and 1230217007 |Molded lozenge (basic dose form)| (with text definition = A type of solid dose form prepared by molding and intended to dissolve or disintegrate slowly in the mouth while being sucked.) have been added for the June 2022 release as descendants of existing basic dose form 385087003 |Lozenge (basic dose form)| (with text definition = A type of solid dose form intended to dissolve or disintegrate slowly in the mouth while being sucked.). Associated pharmaceutical dose form (PDF) concepts have also been added; the PDFs will not be used for modeling concepts in the International Release but will be available for use in national extensions. No related changes to existing clinical drug concepts is planned.
  • Elixir - Existing basic dose form 738997003 |Elixir (basic dose form)| will be made a child of 739006009 |Solution (basic dose form)|; no changes to existing Clinical drug concepts will be made unless specifically requested via CRS.

  • Emulsion - Text definition for existing concept 738998008 |Emulsion (basic dose form)| will be updated to "A liquid dose form consisting of a system of non-miscible liquids where droplets of the discrete phase are distributed in the continuous phase (usually oily in aqueous but can also be aqueous in oily)."; no changes to existing Clinical drug concepts will be made unless specifically requested via CRS.

  • Gas - New basic dose form concepts 1230326008 |Compressed gas (basic dose form)| with text definition "A gas supplied under pressure which is entirely gaseous at - 50 °C.", 1230327004 |Cryogenic gas (basic dose form)| with text definition ", and 1230328009 |Liquified gas (basic dose form)| with text definition "A gas supplied under pressure, which is partially liquid (gas over liquid) at -50 °C.” will be added. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs will not be used for modeling concepts in the International Release but will be available for use in national extensions. No related changes to existing clinical drug concepts is planned.

  • Syrup - Existing basic dose form 739009002 |Syrup (basic dose form)| will be made a child of 739006009 |Solution (basic dose form)|; no changes to existing Clinical drug concepts will be made unless specifically requested via CRS.

  • Granules - Has dose form transformation will be updated to 764779004 |Disperse or dissolve (transformation)| for 385044001 |Conventional release effervescent oral granules (dose form)|. Existing basic dose form concept 761897002 |Effervescent granules (basic dose form)| will be updated to be a subtype of 385043007 |Granules (basic dose form)|.
  • Tablet - Existing basic dose form concept 761877007 |Effervescent tablet (basic dose form)| will be updated to be a subtype of 385055001 |Tablet (basic dose form)|.

  • Powder - Existing basic dose form concept 762948008 |Effervescent powder (basic dose form)| will be updated to be a subtype of 739005008 |Powder (basic dose form)|.
  • Cement - New basic dose form concept, 1231321009 |Cement (basic dose form)| with text definition "A semi-solid dose form that sets and hardens after application and adheres to other materials to bind or seal them together.”, will be added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
  • Collodion - Text definition for existing basic dose form concept 385115001 |Collodion (basic dose form)| will be updated to "A liquid dose form consisting of active substance(s) in a mixture of pyroxylin or similar in ether and ethanol.”
  • System - New basic dose form concept, 1231568003 |System (basic dose form)|| with text definition "A solid dose form consisting of one or more components which together are used to deliver active substance(s) with a prolonged-release mechanism.”, will be added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added or updated accordingly; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
  • Dialysis - New administration method concept, 1231460007 |Dialysis (administration method)| with text definition “A method of administration of a dose form through a dialysis system.” and new intended site concept, 1231459002 |Extracorporeal (intended site)| with text definition “An intended site or administration of a dose form that is initially outside of the body and is subsequently returned to the body.” will be added. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs can be used in creation of concepts in the International Release. 

  • Vaporize - New dose form transformation concept, 1231537002 |Vaporize (transformation)|| with text definition "A dose form transformation that occurs immediately before administration, often when the dose form is subjected to heat either directly or by addition to hot water to create the vapor.”, will be added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added or updated accordingly; the PDFs can be used in creation of clinical drug (CD) concepts in the International Release moving forward but no changes to existing concepts will be made unless specifically requested via CRS.
  • Pure liquid - New basic dose form concept, 1231710002 |Pure liquid (basic dose form)| with text definition "A liquid dose form consisting of a pure substance in its liquid state.”, will be added for June 2022 release. Associated pharmaceutical dose form (PDF) concepts will also be added; the PDFs will not be used for modeling concepts in the International Release but will be available for use in national extensions. No related changes to existing clinical drug concepts is planned.
June 2022 International Release
32

Dose Form-Related Changes - July 2022 Release

  • Intraocular - Existing intended site concept 762070008 |Intraocular (intended site)| will be remodeled as a descendant of 738952007 |Ocular (intended site)|. Associated pharmaceutical dose form (PDF) and clinical drug (CD) concepts will be updated accordingly.
July 2022 International Release
33

Inactivation of Poisoning by medicinal product role groupers

Following the Briefing Note submitted to the MF and the CMAG in August 2021, and based on the members’ feedback, the poisoning concepts that are defined by a causative agent that is of type “medicinal product role” or “Medicinal product role + structure” that are not in use will be inactivated.

2022 International ReleaseMarch 2022 
34

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.

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.

2022 International Release and future releases


35

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.

2022 International Release and future releases
36

Planned changes to Implantation and Insertion procedures

Work commenced on content tracker IHTSDO-175. 

Ongoing structural changes for the Procedure concepts related to the content tracker, more information is available here

2022 International Release and future releases




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