Inactivation of 9258009|Gravid uterus structure (body structure)|

This concept will be inactivated, content that is modeled with this concept will be remodeled with a site of 35039007|Uterine structure (body structure)| along with occurrence <<307159006|Pregnancy time period (qualifier value)|.  

The domain of 246454002 |Occurrence (attribute)| has been extended in the October 2023 release to include << 71388002 |Procedure (procedure)| to support these content changes. Content areas that will be updated include 386811000|Fetal procedure (procedure)| and 386637004|Obstetric procedure (procedure)|.

Inactivation of Concepts Specified Male/Female in Descriptions

Subtypes of 67770001 |Male mammary gland structure (body structure)| and 91532001 |Female mammary gland structure (body structure)| and their associated disorder and specimen concepts.  Further information is available here (Confluence log in required).

Update for Concepts Using 'Caused by'

Clinical finding concepts containing "Caused by" in their FSN will be reviewed and will be updated (if applicable) according to the editorial guidelines related to causation here. 

There is one area where work is still in progress:  

• Clinical finding caused by radiation.

First phase of content updates planned for promotion Q1 2024.

Updates to the Inactivation Reason and Historical Association for 'On Examination' and 'Complaining of' Inactive Content

Many of the 'on examination' and 'complaining of' concepts were previously inactivated with the inactivation reason of |Moved elsewhere| with a historical association value |Extension Namespace 1000000|.

This content will be updated with an inactivation reason of |Non-conformance to editorial policy| and a historical association of |Alternative| to a suitable international concept. 

Ethnic/Racial Group Social Context Content Inactivation

The subtypes of 372148003 |Ethnic group (ethnic group)| and 415229000 |Racial group (racial group)| will be inactivated as they are out of scope for the International Edition.  A briefing note is available here.

Patient/Subject concepts in the Clinical finding and Procedure Hierarchies

Concepts in the Clinical finding and Procedure hierarchies that contain the explicit context of patient or subject will be inactivated and replaced with concepts without this explicit context. For further information please see briefing note.

The Senior Management Team (SMT) recently agreed on a proposed solution to resolve the duplication between the evaluation procedure and observable entity hierarchies. The resolution includes moving the majority of the evaluation procedures to the observable entity hierarchy while retaining the original concept id during the move.

The semantic tag will be updated from evaluation procedure to observable entity, and updates in terming and modeling to align with the observable entity model are expected. This move will allow for concepts of multiple granularities to be classified in a single hierarchy.

Non-defining annotations for “order only,” “observation only,” or “both order and observation” may be added to the concepts to assist with certain use cases. Note that some content areas of evaluation procedures such as panels and procedure methods will not be addressed at this time.

A projected timeline of changes will be developed and shared with the community. Editorial and implementation guidance will be provided with this project. Please see the briefing note for further information.

In discussion - to be determined

Inactivation of 277132007|Therapeutic procedure (procedure)

The concept 277132007 |Therapeutic procedure (procedure) will be inactivated with the inactivation reason of Outdated and a replacement association target of 71388002 |Procedure (procedure)|. The nearly 2000 descendants will be reviewed as to the appropriateness of either the Has intent (attribute) of Therapeutic intent, or a Method (attribute) of Therapy - action.

For further information please see briefing note.

Urinary Bladder

Following feedback from translation, descriptions for concepts that contain the word 'bladder' and the site of 89837001|Urinary bladder structure (body structure)| will be updated to include 'urinary' in the FSN and PT, for example:

126885006|Neoplasm of bladder (disorder)

will be updated to

126885006|Neoplasm of urinary bladder (disorder).

Update for 73632009 |Laparoscopy (procedure)| and Subtypes 

There will be a bulk update to align 73632009 |Laparoscopy (procedure)| and subtypes with the template here: https://confluence.ihtsdotools.org/display/SCTEMPLATES/Laparoscopy+%28procedure%29+-+Draft

These changes include the addition of INCISION ROLE GROUP and INSPECTION ROLE GROUP for all Laparoscopic procedures. 

International Unit in Descriptions for Clinical Drugs

'International Unit' as a description is arbitrary and to be understood each product requires reference to a particular bioefficacy specification for that entity. Therefore, 'international' is not meaningful or comparable as a description at Clinical Drug level. International unit will be represented as 'unit' in Clinical Drug descriptions and 20 concepts will have their descriptions changed to 'unit'  Note: abbreviations will not be used. Editorial Guidance has been drafted.

Inactivation of  “RAST” and “RAST test” from subtypes of 104380004 |Allergen specific antibody measurement (procedure)|

Based on a proposal by the Allergies and Hypersensitivities CRG, descriptions containing “RAST” and “RAST test” will be inactivated from the concepts in this sub-hierarchy as they are not considered real synonyms.

Immunoassays for immunoglobulin specific to an allergen of interest are widely used in the diagnosis of allergic disease. These tests are often incorrectly referred to collectively as "radioallergosorbent tests" ("RAST") because they were the earliest immunoassays to be used extensively.

There are a few concepts of type "X mix radioallergosorbent test (procedure)", where RAST is in fact part of FSN. These concepts will be inactivated as they are ambiguous because they do not mention what allergens are being tested for. Replacement concepts, where individual allergens are spelled out, will be created where the information is available.

Inactivation of Congenital Morphologic Abnormality Concepts

37764001 |Congenital abnormal fusion (morphologic abnormality)| and 67798003 |Congenital premature fusion (morphologic abnormality) will be inactivated and replaced by:

• Abnormal fusion (morphologic abnormality)
• Premature fusion (morphologic abnormality)

These two new concepts do not specify occurrence which is to be modeled separately.  As a result of this change the two new concepts can be used to model fetal disorders.

This change aligns with the Editorial Guide.

Update for Diabetes Insipidus

Based on a report from October 2022 from the Working Group for Renaming Diabetes Insipidus, concepts using the term “Diabetes insipidus” will be renamed and/or replaced with terms that more appropriately represent the pathophysiology of this condition.  The top-level concept replacing "Diabetes insipidus" will be "Arginine vasopressin-related polyuria" and the specific subtypes will be represented by two renamed conditions: 

• Arginine Vasopressin Deficiency (AVP-D)” for central etiologies

• Arginine Vasopressin Resistance (AVP-R)” for nephrogenic etiologies

The legacy descriptions of "Diabetes insipidus", "Central diabetes insipidus" and "Nephrogenic diabetes insipidus" will be retained where appropriate to facilitate retrieval of concepts by their newer names. This affects approximately 18 existing concepts in SNOMED CT.

OWL Axiom Expressions for Annotation Properties

The new annotation properties should be represented in the OWL expression axiom refset as follows:

• The 1295447006 |Annotation attribute (attribute)| is correctly represented as subClassOf
  • 01300ccd-d1d7-417d-a70a-f688e72c4d8c 20231201 1 900000000000012004 733073007 1295447006 SubClassOf(:1295447006 :246061005)

• However, all subconcepts of 1295447006 |Annotation attribute (attribute)| should be represented as "SubAnnotationPropertyOf", instead of "subClassOf" as they currently are.
  • e6cd65fe-cb81-4db4-9ac4-040dc74fce28 20231201 1 900000000000012004 733073007 1295448001 SubClassOf(:1295448001 :1295447006)
  • 3729ce47-a96e-4dc7-9eff-83c34740c414 20231201 1 900000000000012004 733073007 1295449009 SubClassOf(:1295449009 :1295447006)

They should therefore be changed to:

• SubAnnotationPropertyOf(:1295448001 :1295447006)
• SubAnnotationPropertyOf(:1295449009 :1295447006)

However, the authoring tool will then need to be updated to ensure all new subconcepts of 1295447006 |Annotation attribute (attribute)| will be represented as SubAnnotationPropertyOf() in the future.  Numerous other tools will also need to be updated first in order to correctly consume the new format.

There are numerous systems that require updating, and that this will therefore need to be carefully tested and rolled out over the next few months.  As the potential impact was analysed and deemed to be low, the Annotations deployment will still go ahead as planned in the January 2024 International Edition release, whereas these axiom updates will be published in subsequent releases.  Please, therefore, be aware that this issue will persist for the first few International Edition releases of 2024.