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 February 2025 release of SNOMED Clinical Terms^® (SCT) International Edition.

It also includes 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 February 2025 International Edition.

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.

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 February 2025 International Edition.

Please note, you may have to register for a Confluence user account in order to access the links included in these release notes.

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 February 2025 International Edition 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). 

Information about editorial decisions may be found in the SNOMED CT Editorial Guide; mapping guidance for ICD-10 can be found here.

Quality Initiative

The Quality Initiative (QI) project is the implementation of the Quality Strategy. After a successful pilot project for the July 2018 Edition release, the next stage has been implemented for subsequent releases including February 2025. 

Quality improvement tasks are being 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 is being carried out to accurately reflect current clinical knowledge and ensure the semantic reliability of descriptions associated with a concept.

Description Update Neoplasm/Tumor 

Disorder concepts with a current FSN of the pattern:

• Malignant tumor of
• Benign tumor of

Have had the existing FSN inactivated and replaced by:

• Malignant neoplasm of
• Benign neoplasm of

Synonyms including the word 'tumor' remain active.

Hierarchy: disorder

Number of concepts edited (approx): 500

Body Structure 

New Concept Wall of Body of Uterus

An additional concept 1354768008|Structure of wall of body of uterus (body structure) has been added to explicitly group together concepts relating to the body of uterus. The concept 272666005 |Structure of layer of uterine wall (body structure)| has been inactivated with reason erroneous. The hierarchical arrangement of 4 disorder concepts has slightly changed with the use of this improved definition. Endometrium has also had an additional synonym of 'Uterine mucosa' added.

Number of concepts edited (approx): 10

Revision of Forefoot Structure Hierarchy

The revision of forefoot structure hierarchy has addressed the missing subconcepts, e.g. bone structure of forefoot, toe structure, metatarsal region of foot. A new concept 'structure of joint of forefoot' has been added and the existing joints of this region have been rearranged.

Number of concepts edited (approx): 7

Revision Infantile fibrosarcoma (morphologic abnormality)

52040006 |Infantile fibrosarcoma (morphologic abnormality)| has been reactivated as it is included in our authoritative source for neoplasms. The infantile fibrosarcoma disorder concepts have been remodeled to align with the resource. The concepts have also had updates to descriptions to conform with editorial guidance here.

Hierarchy: morphologic abnormality

Changes in additional hierarchies: disorders

Number of concepts edited (approx): 5

SEP and Laterality Anatomy Reference Sets

The release file for the lateralizable body structure reference set has been updated and validated.

The release file for the SEP reference set has been updated and validated.

Clinical Finding

Revision of 402612007|Hypermelanosis due to neoplasia (disorder)| and Descendants

402612007 |Hypermelanosis due to neoplasia (disorder)| and descendants have been remodeled to align with the guidance in the 'Congenital versus acquired' section of the Editorial Guide here.

The relationship with Occurrence (attribute) and value Period of life beginning after birth and ending before death (qualifier value) has been removed.

Number of concepts edited (approx): 7

Revision of Taxonomic Relationship Between 1149322001 |Intoxication (disorder)| and 75478009 |Poisoning (disorder)|

Based a query submitted by the Translation Working Group, the SNOMED CT current taxonomic relationship between 1149322001 |Intoxication (disorder)| and 75478009 |Poisoning (disorder)| (the former being a subtype the latter) has been reviewed.

While they are related, both are defined as interference in normal bodily functions caused by exposure to a substance. Based on the severity of the consequences, the relationship is really the reverse: an intoxication is a milder reaction to a substance, while poisoning is more severe as noted in the definition.

The definition of 1149322001 |Intoxication (disorder)| has been updated to make the distinction between the two concepts more comparable. The current relationship between the two concepts has been reversed.   

Procedure

Radiographic Imaging

Work is progressing for this content tracker for information please see the informational briefing note here.   

Update Procedural Approach

116688005 |Procedure approach (attribute)| has been moved under 762705008 |Concept model object attribute (attribute)|. The new MRCM for procedure approach has also been tested and included in the release.

424876005 |Surgical approach (attribute)| is now placed under 116688005 |Procedure approach (attribute)|. Please note the surgical approach attribute will be inactivated in Q2 2025.

Update 386722005 |Endoscopic retrograde cholangiography (procedure)| and Descendants

The concepts have been remodeled by the proximal primitive parent along with the addition of 424876005 |Surgical approach (attribute)| as needed. Review and update of target values for the 363704007 |Procedure site (attribute)| was also carried out.

The target value for the 405813007 |Procedure site - Direct (attribute)| within the endoscopic inspection role group has been updated to 67109009 |Structure of ampulla of Vater (body structure)|

Number of concepts edited (approx): 28

Review Catheterization Procedures

Catheterization procedures have been reviewed, the concepts have been remodeled by the proximal primitive parent along with the addition of 424876005 |Surgical approach (attribute)| as needed. Review and update of target values for 363704007 |Procedure site (attribute)| has been carried out as needed.

Changes to descriptions to align them to the Editorial Guidance has also been undertaken for this set of concepts.

Number of concepts edited (approx): 59

Review Hierarchy 441985002|Imaging of heart (procedure)|

Remodeling of concepts in the hierarchy 441985002 |Imaging of heart (procedure)| has been undertaken with a review of target values for Body structure attribute and Method attribute. Addition of Using substance, Using device, Surgical approach and/or Access attributes has been undertaken as required.

Concepts that state a specific focus have been inactivated as these do not align with the editorial guidance, for example:

• 49276007 |Echocardiography for determining interventricular septal thickness (procedure)|
• 35757004 |Echocardiography for determining ventricular contraction (procedure)|.

Number of concepts edited (approx): 84

Inactivation of 38829003|Partial excision (procedure)|

38829003 |Partial excision (procedure)| has been inactivated as a classification-derived concept that is only meaningful when specific body parts are specified. The subconcepts have been remodeled by the proximal primitive parent 71388002 |Procedure (procedure)| in conjunction with body parts.

Number of concepts edited (approx): 12

Substance

New Substance Groupers for Anesthetics

Based on feedback from the Anesthesia Clinical Reference Group, the substance hierarchy for anesthetics has been reviewed and the hierarchy revised with additional groupers created and subtypes assigned for inhalation anesthetics (1354647001|Volatile liquid anesthetic (substance)) and local anesthetics (1354706009 |Benzoic acid ester local anesthetic (substance) and 1354705008| Amide local anesthetic (substance)).

Collaboration/Harmonization Agreements

Convergent Medical Terminology (CMT)

Work for this content area is ongoing.

Orphanet

Working in collaboration with Orphanet efforts are ongoing to update rare disease concepts in SNOMED CT to maintain alignment with Orphanet for the annual update of the SNOMED CT to Orphanet Maps. Work has commenced to annotate content added for the Orphanet project with attribution to Inserm Orphanet. As part of this effort, textual definitions for concepts previously added for the Orphanet project will be updated to align with the current published version of the Orphanet definition. This will result in published text definitions being inactivated and replaced in bulk. Timelines for publication of these changes can be found in the Early Visibility Release Notifications

All of the concepts added for the Orphanet project have been mapped to ICD-10.

Gravity

Seven new concepts have been added to support the Gravity Project work with a focus on provision procedures and energy poverty findings.

Nursing

Seven nursing procedure concepts have been added with a focus of assessments.

Cancer Synoptic Reporting

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.

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

International League Against Epilepsy (ILAE)

In line with approved harmonized terminology, this project is working on alignment including restructuring to update the hierarchy  << 313307000 |Epileptic seizure (finding)|.

Further information about the project is available here

Internal Quality Improvement

Machine Readable Concept Model (MRCM) Changes

There has been one change for the MRCM in the February 2025 International Edition:

• Move 116688005 |Procedure approach (attribute)| from the 408739003 |Unapproved attribute (attribute)| hierarchy to the 762705008 |Concept model object attribute (attribute)| hierarchy. Add and test new MRCM rules for procedure approach. Make 424876005 |Surgical approach (attribute)| a subtype of 116688005 |Procedure approach (attribute)|. 

Future changes that are currently in progress can be viewed via the MRCM Daily Build Browser

Please see Early Visibility Release Notifications for future planned changes to MRCM.

Annotation Reference Set

The addition of content for the Annotations refset was commenced in the July 2024 International Edition release and is ongoing for attribution of text definition to organizations with a collaboration agreement, starting with Inserm Orphanet.  

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 Edition 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 |SNOMED CT to ICD-10 extended map (foundation metadata concept).

The ICD-10 Mapping Technical Guide (including exemplars) is hosted here https://confluence.ihtsdotools.org/display/DOCICD10

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 February 2025

The map provided for the February 2025 International Edition has been updated, and now represents a complete map from SNOMED CT International Edition to ICD-10 2016 version.

• 574 newly authored concepts have been added and mapped.

• The SNOMED to ICD-O (morphology) map has 1 additional concept added as a result of the ICD-O 3.2 review or added due to CRS requests. 

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

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 time within the new monthly editing cycles, 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 current SNOMED CT 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 testing of the current release, which were resolved before the final deployment of the Production 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 current SNOMED CT International Edition can be found here:

Technical updates

RF2 package format

The RF2 package convention dictates that all relevant files are included, regardless of whether or not there is content to be included in each release.  Therefore, the package contains a mixture of files which contain both header rows and content data, and files that (intentionally) include only header records.  The reason that these "empty" files are included in the package is to draw a clear distinction between:

1. ...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in future releases 

2. ...files that happen to contain no data in this particular release (and are therefore included in the package with just a header record), but are still relevant to RF2, and could therefore contain content in future releases.

This allows users to easily distinguish between the two scenarios, as otherwise if files in option 2 were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.

 Proposal to increase the maximum length of Description Types

Please find below the link to the recent announcement on the proposal to increase the limit of characters allowed in Descriptions:

• https://confluence.ihtsdotools.org/pages/viewpage.action?pageId=238158325

A community consultation was launched to solicit feedback on a proposal to increase the size limits of SNOMED CT concept descriptions to 4096 from the current limit of 255 characters. While this change does not represent a modification of the existing specification, it could be disruptive to implementers who have coded fixed length limits into their systems.  

Please read the full proposal, along with the latest Q&A blog post which details the proposed change, its potential benefits, the feedback process and timelines, and the issues that may need to be considered in such an update:

• https://confluence.ihtsdotools.org/mag/community-consultations/snomed-international-proposal-to-increase-description-length-limit
• https://www.snomed.org/news/blog%3A-snomed-international-seeks-community-feedback-on-proposed-description-character-limit-increase

As always, SNOMED International greatly appreciated all feedback provided before the deadline (which was Dec 31, 2024).  A summary of the feedback will be collated and disseminated in 2025, alongside a plan for the transition.

Early visibility of impending changes in the upcoming 2025 Monthly International Edition releases

Please see the Early Visibility Release Notifications Confluence page for details of forthcoming changes.