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.
This document provides a summarized description of the content changes included in the July 2019 release of SNOMED Clinical Terms® (SCT) International Release.
It also includes technical notes detailing the known issues which have been identified and agreed to be released. These are content or technical issues where the root cause is understood, and the fix has been discussed and agreed, but has yet to be implemented.
The SNOMED International Release Notes are available alongside the July 2019 International Edition release.
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.
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 July 2019 International Edition release.
Continuous quality improvement and enhancement of existing content is an ongoing process by SNOMED International for every release. The July 2019 International Release has seen a continuation of the work driven by contributions from: Kaiser Permanente 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 in progress for new and enhanced content through project driven initiatives which are also summarized below. Also included as work items for every release are various updates to SNOMED CT derived maps such as ICD-10 and ICD-O and details are also 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.
Inactivation reason of LIMITED/WAS A is not allowed for any content after the July 2018 release. The WAS A association refset has not been updated thereafter.
In 2015, a proposal was made to inactivate 159083000 |WAS A (attribute)| relationship and stop updating the 900000000000528000|WAS A association reference set (foundation metadata concept)| at the Editorial Advisory Group.
Since these recommendations were approved, a formal proposal for the technical approach to batch updating the terminology was created and a notice of the proposed inactivation sent to the Community of Practice.
The implementation of changes was postponed following feedback on utility for implementation and the potential impact to customers who were still using RF1.
The matter was discussed again at the meeting of the Editorial Advisory Group in Bratislava in October 2017. Since the requirements and potential issues can be addressed by deriving such information from the RF2 release format, the recommendation is to proceed with the decision for implemenation after the July 2018 release.
|SCT Statistics||New concept additions|
|SNOMED CT Concept (SNOMED RT+CTV3)||4411|
|Body structure (body structure)||451|
|Clinical finding (finding)||1206|
|Observable entity (observable entity)||32|
|Pharmaceutical / biologic product (product)||1929|
|Physical object (physical object)||44|
|Qualifier value (qualifier value)||149|
|Record artifact (record artifact)||7|
|SNOMED CT Model Component (metadata)||13|
|Situation with explicit context (situation)||86|
|Social context (social concept)||1|
|Staging and scales (staging scale)||2|
|SCT Improvement Statistics to Existing Concepts||Number|
|Total number of changes||44638|
|Change to stated concept definition||30254|
|Change to inferred concept definition||25842|
|Change in concept definition status from Primitive to Sufficiently Defined||2400|
New anatomy concepts: 451
The initial review was completed for over 12,000 hierarchical relationships that are different between the production release and new anatomy model for body structures. For this release, the focus for the Anatomy project is quality improvement for the cardiovascular, digestive and genitourinary systems. Review of the remaining systems is planned for the 2020 January release.
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.
There are a number of new concepts in the July 2019 release that are based upon the existing guidance for 'Co-occurrent and due to'. 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.
New concepts for clinical findings and disorders: 2114
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 the July 2019 release.
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.
The following subhierarchies of the Clinical Finding hierarchy were remodelled to the proximal primitive parent resulting in changes to inferred relationships.
Total count of changes for the QI project:
Changes to Allergy Content
Approximately 2,000 concepts relating to hypersensitivity conditions have been remodeled to conform with new editorial guidance (excluding hypersensitivity reaction):
As the result of Allergy project requirements, the following top level groupers/Allergen classes in substance hierarchy were inactivated and their children assigned to appropriate structural and/or functional parents :
Note: Other top level groupers (as specified in project Allergies-19) will be inactivated in the future releases.
Any maps from SNOMED CT to ICD-10 impacted by this Quality Initiative have been reviewed and updated.
Work commenced on the following Content Projects:
Other content quality improvements:
New CMT concepts: 702
The majority of these newly authored concepts are in scope for mapping to ICD-10 and from the following domains:
New concepts for procedure hierarchy: 215
As a result of collaboration with Orphanet (http://www.orpha.net/consor/cgi-bin/index.php) 306 new SNOMED CT concepts have been created to represent rare diseases in the disorder hierarchy. All of these concepts have been mapped to ICD-10.
55 new SNOMED CT concepts created and mapped in the Physical object hierarchy to support the GMDN collaboration agreement.
New concepts added: 27
Work continued on the following Content Projects:
New concepts added: 61
54 new concepts added for care plan.
New organism concepts added: 326
Content quality improvements:
For further details on the planned changes in this area, please refer to the Drug Model Working Group Directory section.
Please note, you may have to register for Confluence user account in order to access this project and the relevant links below.
The following changes will be included in the 2019-July International Release.
|Clinical drug (CD) concepts|
|Groupers based on disposition and/or structure|
|Medicinal product "containing" (MP-containing) concepts|
|Medicinal product "only" (MP-only) concepts|
|Medicinal product form "containing" (MPF-containing) concepts|
|Medicinal product form "only" (MPF-only) concepts|
|National Extension model|
10 concepts were moved to the Veterinary Extension.
New concepts added : 50
32 new concepts were added for 'X disease suspected.'
Additions and improvements in areas of suspected/risk of bullying, abuse, and abandonment in situation hierarchy.
22 situation concept FSNs updated in areas of organism examination and samples sent.
56 new concepts were added.
5 laboratory observable entity concepts added based on request by two member countries; 2 observable entity concepts added in a non-laboratory area.
1 observable entity laboratory concept inactivated.
Addition of 11 new assessment scale concepts.
223 new concepts were added.
Case Sensitivity changes:
Improvement of substance concepts by updating case sensitivity based on editorial guidelines in the following areas - 5000 concepts.
Changes in the substance hierarchy as the result of Allergy project requirements:
Changes to language acceptability
Other content quality improvements:
For further details on the planned changes in this area, please refer to the Substances project.
Please note, you may have to register for Confluence user account in order to access this project and the relevant links above.
Release of partial OWL expression refset
Content updates in the OWL axiom refset:
A set of documentation has been developed to support the Logic Profile Enhancements:
6 new MRCM rules and 3 updates to the existing MRCM in the MRCM refsets and authoring platform were made for the July 2019 release:
The further details can be found here https://confluence.ihtsdotools.org/display/IAP/MRCM+changes+in+the+January+2019+release
Improvements have been made to fully specified names and synonyms to clarify the intended meaning of the existing concepts for definition status. The decision to retain the existing concepts with improved descriptions was made to reduce disruption to users, though the definition status has limited logical value in SNOMED CT since the addition of the OWL Axiom Refset. The revised descriptions are consistent with the advice provided by the majority of SNOMED Modeling Advisory Group members.
The descriptions for the definition status with concept id 900000000000073002 are now:
The new fully specified name reflects that concepts with this definition status must have a set of necessary relationships that are sufficient to define the concept.
The descriptions for the definition status with concept id 900000000000074008 are now:
The new fully specified name reflects that concepts with this definition status do not have a set of necessary relationships that are sufficient to define the concept.
The SNOMED CT to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (© World Health organisation 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 Centres.
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_20180731.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)|.
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. As part of the ongoing quality improvement of the published maps SNOMED CT concepts mapped to code range Q90 - Q99 Chromosomal abnormalities, not elsewhere classified have been reviewed and the previously assigned map advice POSSIBLE REQUIREMENT FOR AN EXTERNAL CAUSE CODE has been removed for consistency purposes.
The map provided for the July 2019 release has been updated, and now represents a complete map from SNOMED CT International release to ICD-10 2016 version.
We would welcome feedback on any issues that users of the map may detect when using the map. Issues should be submitted via firstname.lastname@example.org
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
There are 5 updates for the ICD-O Morphological abnormality map in July 2019 release.
The repository containing the toolkit enabling simple SNOMED CT to OWL conversion and classification can be found here, including documentation on its use:
Please contact SNOMED International at email@example.com if you would like to provide any feedback on ways to extend and improve the new toolkit.
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 2018 International edition, the following Known Issues were identified, and agreed to be resolved in the next editing cycle (to be published in July 2018):
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 - in this case the July 2018 International Edition. 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 2018 International edition can be found here:
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
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.
Please see section "2.3.1 Logic Profile Enhancements" above for full details of the reason behind the introduction of these new refsets. After the September 2018 Demonstration release, it was agreed to combine these two files into one "OWL Expression" file, which now contains both OWL Axiom + OWL Ontology refsets in the same file, in each section of the International Release package (Full, Snapshot and Delta):
The decision was taken to place the files in the "Terminology" folder in the release package (as opposed to the "Refset" folder), because these files are designed to eventually replace the Stated relationship files (in July 2019), and therefore contain core content which needs to be included in the Terminology folder.
In January 2017 the original OWL conversion script (a.k.a. the "Spackman OWL script") was removed from the International Edition package, and has since been published as a separate artefact alongside each Release.
Because this script does not recognize the two new OWL refsets (see section 3.3.2 of these Release Notes), the Terminology Release Advisory Group has determined that the script should no longer be distributed.
Going forward, Release Notes will now include a link to the new open source OWL conversion toolkit that can be found in the following repository (including documentation on its use):
Please contact SNOMED International at firstname.lastname@example.org if you would like to provide any feedback on ways to extend and improve the new toolkit.
The Terminology Release Advisory Group has confirmed that there should be no impact from removing this almost entirely static document from the International Edition release package, and hosting it instead in a Confluence Page. From the July 2018 International release then, we will deprecate this file (doc_Icd10MapTechnicalGuideExemplars_[date].xlsx) from the Release package, and instead provide a link in the Release Notes to the new Confluence Page. Please see section 22.214.171.124 above for the relevant link.
Please see the following page for details of all upcoming changes planned for July 2019 and beyond: Early Visibility - Planned changes to upcoming SNOMED International Release packages
Replacement of the Stated Relationship files with the new OWL Axiom refset files
In the July 2019 release, the stated relationship file will be replaced by the OWL Axiom refset files, that will include all logical definitions and other features specified in the SNOMED CT logic profile specification. The stated relationship file will NOT be included in the international release; however, it may still be available on request to support migration to the OWL Axiom refset.
|Users should carefully analyse any potential impact to their systems (upload routines, etc) and make provisions for these changes urgently (if not already done), in order to prevent any issues when these changes come into effect in July 2019. Please contact SNOMED International at email@example.com with “OWL Axiom refset files implementation question” in the subject line.|
The inferred relationship file will maintain the same format and structure, though it will no longer contain all necessary and sufficient conditions. The inferred relationship file is represented in Necessary Normal Form for distribution of relationships. It is a collection of all the necessary conditions and represents a subset of the full semantics from the 2018 July release and onwards. Most users will benefit from the improvements in the inferred relationships without requiring changes to their existing systems.
A set of documentations has been developed to support the Logic Profile Enhancements.
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 online here:
Draft Amendment History