High-level role groupers in the Substance hierarchy have been intended to support the organization of the hierarchy based on roles. An example of such a role grouper is 373265006 |Analgesic (substance)|. Substance role groupers have been an issue in SNOMED CT for many years. Role based groupers are associated with a particular purpose or outcome. A role does not belong to a substance per se but instead is associated with a manufactured product and its usage. Roles are a function of the way a product is formulated or presented.

In 2018 a solution was proposed to move the role groupers from the Substances hierarchy to the Products hierarchy--and specifically the “therapeutic roles” to the Medicinal Product hierarchy. While a small percentage (20%) of the role groupers have been created in the Medicinal product hierarchy, e.g. 53009005 |Medicinal product acting as analgesic agent (product)|, the majority of the role groupers remain in the Substances hierarchy at this time.

Please provide feedback on the proposal.

Send comments to ( ) by December 15th, 2023 with the heading attention of Nicki Ingram and Farzaneh Ashrafi.


The proposed changes are detailed in the attached briefing note, and relate to radiographic imaging

Implementation of the content changes specified in this informational briefing note will commence in Q4 2023.

The changes have been based on feedback recieved.

SNOMED International in collaboration with the The International League Against Epilepsy is working on improving the seizure and epilepsy content within the sub hierarchies of

313287004 |Seizure related finding (finding)| and 84757009 |Epilepsy (disorder)|.

To assist content users briefing notes are being provided as changes to content are released. Briefing notes on previous changes may be viewed here.

The content changes for the September 2023 release were made in the area of focal anatomical seizures.

The focal seizure content changes include:

  • Eight new concepts e.g. 1287672003 |Frontal lobe epileptic seizure (finding)|


  • Inactivation of four outdated concepts - list provided as an appendix

Any questions on this work should be sent to with the subject ‘Epilepsy Consultation’.

Kind regards


To update the SNOMED CT community on the replacement of the use of 363703001 |Has intent (attribute)| and value of Therapeutic intent in procedure concepts with a 260686004 |Method

(attribute)| value of Therapy - action, where appropriate. The potential number of affected concepts is nearly 2000.

This briefing note is a continuation of work communicated by a December 2021 briefing note titled, ‘Inactivation of procedures stating intent as diagnostic or therapeutic’.

The Has intent attribute is used when a procedure may be performed for reasons, described with subtypes of 363675004 |Intents (nature of procedure values) (qualifier value)|, such as diagnostic, palliative, preventive, therapeutic, etc. These intents are not used to define procedures with intents that are inherent to the procedure; such as biopsies that are by definition diagnostic, or fracture fixations which are always therapeutic.

Procedures with the Has intent (attribute) with value of Therapeutic intent are classified under 277132007 |Therapeutic procedure (procedure)|. The challenge with |Therapeutic procedure (procedure)| is that it is used to mean: (1) therapy as a medical treatment procedure, or (2) as an intent to differentiate between the same procedure that could possibly have other intents. 277132007 |Therapeutic procedure (procedure) is no longer necessary

Kind regards


The representation of ethnicity and race varies from country to country. For example:

There is no international categorisation that can be used for international content. Given this, ethnicity and racial group concepts are out of scope for the international edition. Next Steps The subtypes of 372148003 |Ethnic group (ethnic group)| and 415229000 |Racial group (racial group)| will be inactivated using the reason Non-conformance to editorial policy with no replacement value. Concepts relevant for use within a specific country may be reactivated within their extension.

The concepts 372148003 |Ethnic group (ethnic group)| and 415229000 |Racial group (racial group)| will remain active.

Comments should be submitted to Cathy Richardson ( or by 21 September 2023.

The attached briefing note summaries the proposed resolution to the Observable entity and Evaluation procedure hierarchies. They were created in the early 2000s and have been maintained as separate hierarchies even though the content is overlapping in many areas. This has created confusion and inconsistency in how observation information is represented in record systems and in SNOMED CT. While some stakeholders have expressed their requirement for separate codes for ordering (evaluation procedure) and resulting (observable entity) observations, other stakeholders have expressed their requirement to include codes for ordering and resulting observations in the same hierarchy at various levels of granularity.

Previous efforts to resolve the issue and meet stakeholder needs have stalled. Details are provided in the attached briefing note.20230809 BN Evaluation procedure to Observable entity v1.0.pdf

Feedback can be submitted via the Chief Termonologist ( by September 15, 2023.

Kind regards

Ian Green

As part of the QI project, transplantation procedures are being remodeled. To fix incorrect subsumptions changes need to be made. At present surgical transplantation procedures are classifying as subtypes of grafting procedures due to the placement of 410820007 |Surgical transplantation - action (qualifier value)| as a subtype of 129407005 |Grafting - action (qualifier value)|. Example in current SNOMED CT: 32413006 |Transplantation of heart (procedure)| is a 129212008 |Grafting procedure of heart (procedure).

Grafting is generally applied to the application of various types of tissue without their original blood supply, and then that tissue generates its own blood supply from the recipient site.

The attached note provides further detail to the proposed changes.

Comments to be submitted to Nicki Ingram ( or by 15th September 2023.

Kind regards


The attached briefing note summaries the proposed changes to subtypes of 67770001 |Male mammary gland structure (body structure)| and 91532001 |Female mammary gland structure (body structure)| and their associated

disorder and specimen concepts.

Body structure concepts that specify male or female in descriptions and that are not unique to a specific sex (e.g. male/female breast) are to be considered for inactivation. The concepts

modeled by these structures are also to be inactivated. It is proposed that the work for this update begins with the anatomy content for subtypes of 76752008|Breast structure (body


The deadline for feedback is 26 August 2023.  Feedback can be submitted via or Freshdesk (

Kind regards

Ian Green

Abstract submission deadline extended to May 2

What's better than attending an exciting conference? Being part of it! Submit an abstract for an oral presentation or an e-poster to see your name on the program at this year's SNOMED CT Expo. In addition to being an excellent professional development opportunity, you'll be a part of the ever-expanding SNOMED CT global community, which thrives when users share their knowledge and expertise.

Check out for the guidelines and submit yours by May 2

The details 

Submissions must focus on using the clinical terminology in a product, service or research context across one of the four program streams: 

  • Enhancing Clinical Practice and Outcomes
  • Terminology Leading Practices
  • Demonstrating Implementation Excellence
  • Advances in Research and Innovation

Key dates

  • New submission deadline: May 2, 2023
  • Submitters notified: May 29, 2023
  • Conference: October 26-27, 2023 

SNOMED International and the International Diet Dysphagia Standardisation Initiative (IDDSI) have signed an agreement to incorporate IDDSI Framework v2.0 content into SNOMED CT to enable use in electronic health records globally.

Peter Lam, IDDSI Chair, expressed that, “The agreement with SNOMED is another exciting and positive step to meeting IDDSI's goal of improving the safety of people of all ages, all cultures, and in all care settings, who are living with dysphagia.”

In effect since mid-September 2022, the agreement has been driven by community requests as well as by the need identified by the SNOMED International Nutrition Care Process Terminology (NCPT) Clinical Project Group to include IDDSI Framework v2.0 content in order to facilitate the inclusion of NCPT in SNOMED CT.

Content will be created for each framework level consistent with the IDDSI standard terminology and definitions subject to SNOMED CT editorial guidance, while additional content will be added to facilitate recording the use of the framework and diet scale together with related findings and interventions. The content will be included in SNOMED CT International Edition monthly releases as the IDDSI Framework v2.0 related content is incorporated into the clinical terminology.

In the UK, in response to the Mental Health Taskforce, there was a drive to make sure people experiencing first-episode psychosis have timely access to evidence-based care. The NCCMH (National Collaborating Centre for Mental Health) developed the guidance documents to support this, commissioned by NHS England. These include then following:

  • Implementing the EIP access and waiting time standard: guidance (PDF) describes in detail how commissioners and providers can implement the pathway for EIP services.
  • Implementing the early intervention access and waiting time standard: resources (PDF) accompanies the Guidance, providing commissioners and providers with helpful resources to support the implementation.
  • EIP recording and reporting on NICE-recommended interventions (PDF) (updated November 2022) provides guidance for services delivering care to people experiencing a first episode of psychosis. It describes how to record and report on interventions and outcomes using SNOMED codes, and how to submit the data to NHS Digital as part of the Mental Health Services Data Set (MHSDS).

The use of SNOMED CT in clinical pathways is an important step forwards to support delivery of safe, high quality care, and SNOMED CT coding will enable additional analytical functionality to be available to support clinicians in the future.

The weblink is as follows:

As you will be aware, historically we have had a pathology and laboratory medicine group which unfortunately has been inactive for the last few years. We have now identified new clinical leads for the group, and are looking to relaunch the group. The first meeting will be on 24th, March 2022 at 20:00 UTC. Details of the meeting and Zoom details are available on the groups Confluence site - Pathology and Laboratory Medicine Clinical Reference Group. We are looking at creating two additional subgroups to the main group, these will be focused on "surgical pathology workflow" and "laboratory data management and interoperability". Both of these topics are areas of interest for multiple members, and we look forward to your participation. We would encourage Member Forum representatives to share details of these groups to their wider clinical networks to ensure we have the best possible engagement to ensure the success of the groups 

Definitely have a read, this is a very informative article, on a key clinical area . . . 

Background: Kidney biopsy registries all over the world benefit research, teaching and health policy. Comparison, aggregation and exchange of data is however greatly dependent on how registration and coding of kidney biopsy diagnoses are performed. This paper gives an overview over kidney biopsy registries, explores how these registries code kidney disease and identifies needs for improvement of coding practice.

Conclusions: There were large gaps in the global coverage of kidney biopsy registries. Limited use of international coding systems among existing registries hampers interoperability and exchange of data. The study underlines that the use of a common and uniform coding system is necessary to fully realize the potential of kidney biopsy registries.

Dr. Dai Evans presents: "SNOMED CT implementation in UK general practice (England): A user’s perspective"

The implementation of SNOMED CT within GP clinical systems across England has been underway for a couple of years. This involved a migration from the existing legacy coding systems of Read version 2 and Clinical Terms Version 3 (CTV3) to SNOMED CT. The implications of this implementation for both everyday general practice and national organisations reliant upon data from primary care have been varied. During this session, Dai will explore the transition and impact over the last few years including impact of code mapping, what practices need to do to maintain their the integrity and reliability of their data and will detail his work developing comprehensive data specifications in SNOMED CT, along with tips on what to expect if undertaking similar work.

For further details and registration -

There was a very interesting meeting of the Nursing Clinical Reference Group on 18 November with new attendees and a number of topics discussed - the recording is available on the Nursing CRG area.

We agreed that we would have our next call in December. We agreed 16 December but now need to amend the date.

The next meeting of the Nursing CRG will now be on Tuesday 15th December, 2100 - 2200 UTC. (note this slightly later time is only for this meeting). The agenda and dial in details will be available on the Nursing CRG area of confluence