Narrative description:

87009000 Fundus of abomasum (body structure) describes a part of the stomach of ruminant animals. More famously, 88495008 Hump of camel (body structure) used to be a cause for much hilarity when found by non-veterinary clinicians under 77568009 Back structure, excluding neck (body structure). Concepts describing the anatomy, clinical findings, and procedures unique to non-human animals used to be part of the SNOMED CT International Release, but were moved to an extension maintained by the Veterinary Terminology Service Laboratory (VTSL) at the Virginia-Maryland Regional College of Veterinary Medicine.

A significant quantity of other content in the International Release derives from Clinical Terms Version 3 (CTV3), one of the two precursor terminologies that were originally merged in 2000 to form modern-day SNOMED. However, CTV3 contained a lot of content only relevant within the United Kingdom (e.g. 152630006 CH7 sent to: [FPC] or [HB] (finding)). Over the years, much of this UK-specific content has been expunged from the International Edition, usually by the MOVED_ELSEWHERE mechanism to transfer it back to the UK. However. some remains.

Identified content may not have an agreed meaning (or utility) internationally but may still have meaning within individual regions/jurisdictions. In this situation, the content would be inactivated in the International Edition of SCT and be "moved to" another extension.

In the same way, any NRC now engaged in maintaining their own national extension will likely receive requests for new codes to cover clinically legitimate expressivity that is missing from both the latest International Edition or their current NRC extension of it. However, some of that requested expressivity will obviously be also relevant internationally rather than only within the clinical jurisdiction of the particular NRC to whom the requirement was first raised. In such a situation, the NRC can choose to add the request to the international request portal, and wait. Alternatively, for reasons of expediency, they may choose to create and release a new concept within their own extension whilst simultaneously suggesting it for "promotion" to the International Release. Should that suggestion subsequently be taken up, and a new and directly equivalent concept be stood up in some later version of the International Release, then by convention the original NRC code will be made inactive, the reason for its inactivation given as 'component moved elsewhere', and a MOVED_TO association asserted pointing at the International namespace.

Details:

Known issues:

1. What happens if the concepts original ID is retained following the move to the extension - should this be permitted in the context of a concept that is explicitly flagged as MOVED_ELSEWHERE?
2. We cannot be sure that a given concept has not been used by someone who is not the recipient of the "MOVED_TO" namespace
3. While the namespace identifier is included as part of the wider metadata for the particular inactivation (one is given as the target of an accompanying MOVED TO association), some have requested that some other identifier be included either as well or instead that more usefully identifies the recipient organisation. For example, a module identifier.
4. While this process has been described for "moved to" a local extension, there is a need to clarify the position regarding concepts which have been promoted from a local extension to the international release

Examples

Simple Example

305938004 Referral by GP locum (procedure)
MOVED TO 370137002 Extension Namespace {1000000} (namespace concept)
(MOVED FROM) 461401000000107 Referral by locum general practitioner (procedure)

311148003 Administrative officer secretarial - Royal Air Force (occupation)
MOVED TO 370137002 Extension Namespace {1000000} (namespace concept)
(MOVED FROM) 401371000000106 Royal Air Force administrative officer, secretarial (occupation)

152666007 Temp.res.<15 days claim: [FP19] or [GP19] (finding)
MOVED TO 370137002 Extension Namespace {1000000} (namespace concept)
(MOVED FROM) 27821000000105 Temp.res.<15 days claim: [FP19] or [GP19]
THEN                  SAME AS 12551000000105 Temporary resident claim (less than 15 days) (procedure)

195170003 [X]Intracerebral haemorrhage in hemisphere, unspecified (disorder)
MOVED TO 370137002 Extension Namespace {1000000} (namespace concept)
(MOVED FROM) 402531000000107 [X]Intracerebral haemorrhage in hemisphere, unspecified
BUT     SAME AS 274100004 Cerebral hemorrhage (disorder)

223190001 [X]Failure in dosage in electroshock or insulin-shock therapy (disorder)
MOVED TO 370137002 Extension Namespace {1000000} (namespace concept)
(MOVED FROM) 385961000000108 [X]Failure in dosage in electroshock or insulin-shock therapy (finding)
BUT                      MAY BE 216961002 Failure in dose in electroshock therapy (event)
BUT                      MAY BE 216962009 Failure in dose in insulin-shock therapy (event)

207019006 [D]Gangrene (situation)
MOVED TO 370137002 Extension Namespace {1000000} (namespace concept)
(MOVED FROM) 497701000000108 [D]Gangrene (situation)
BUT                      SAME AS 372070002 Gangrenous disorder (disorder)

Impact

(Describe how specific stakeholders are affected by the inactivation)

• Authors

• To give appropriate consideration to providing a suitable link to an existing concept from the International Edition for those who may have used the concept but are not users of the "MOVED_TO" extension

• Release Management Team

• SNOMED International Release Management Team:
  • Ensure appropriate consultation with the community of practice and sufficient warning for bulk changes
• The "MOVED_TO" Release Management Team:
  • Ensure that all returned concepts receive new local conceptIDs
  • Manage the conceptID churn between existing and returned content
• Extension Release Management Teams which were not part of the 'MOVED_TO" namespace:
  • Manage the concept inactivation and "REPLACED_BY" or "POSSIBLY EQUIVALENT_TO" content

• Developers

• Update Refsets and expected results of ECL queries

• End Users

• Update Refsets and expected results of ECL queries

Potential improvement:

1. Provide tooling functionality to support either "POSSIBLY_EQUIVALENT_TO" or "REPLACED_BY" links to existing content from the International Edition where appropriate and WAS_A for those concepts which have no replacement
2. Provide a text field to state the reason why the concept has been moved
3. Consider giving the namespace identifier along with the text description
4. Provide greater support to the recipients of the concepts we have MOVED_FROM the International Edition

Supporting resources: