Approvals

Draft Amendment History

© International Health Terminology Standards Development Organisation 2016.  All rights reserved.  SNOMED CT® was originally created by The College of American Pathologists.

This document forms part of the International Edition release of SNOMED CT® distributed by International Health Terminology Standards Development Organisation (IHTSDO), and is subject to IHTSDO’s SNOMED CT® Affiliate License, details of which may be found at http://www.ihtsdo.org/our-standards/licensing/.

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Table of Contents

1 Introduction

1.1 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.

The International Health Terminology Standards Development Organization (IHTSDO^®) 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.

1.2 Purpose

This document provides a summarized description of the content changes included in the January 2016 release of SNOMED Clinical Terms^® (SCT) International Release.

It also includes technical notes detailing the known issues which have been identified. 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.

This document is available as part of the January 2016 International Edition release.

1.3 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 during the release.

1.4 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 January 2016 International Edition release.

2 Content Development Activity

2.1 Summary

The January 2016 International Edition release has seen a continuation of the work on the contributions from the Kaiser Permanente Convergent Medical Terminology (CMT), and work to incorporate content from Global Medical Device Nomenclature Agency (GMDNA) into SNOMED CT.  Additionally, enhancements have been made to the anatomy hierarchy, while other project-driven changes have resulted in over 7,500 edits in total including new content additions as well as enhancements to existing content.

2.2 New and Updated Content

2.2.1 Anatomy

• To support revised concept modelling for Osteomyelitis, 45 new anatomy concepts specific to bone marrow structure have been added.

• New anatomy concepts (150 of them) have been added to replace retired ambiguous concepts, see below for details in section 2.3.1.

• To support revised concept modelling related to content tracker artifact: artf234569:   29 new body structures corresponding to specific arterial walls created, see section 2.3.2 below.

2.2.2 Assessment Scale

An additional 31 new concepts related to assessment scales including new subtypes of 445536008|Assessment using assessment scale (procedure) and 273249006|Assessment scales (assessment scale) have been edited.

2.2.3 Convergent Medical Terminologies (CMT)

Update work has been undertaken on the following domains of CMT for the January 2016 release:

1. CMT Cardiology

2. CMT Mental Health

3. CMT Neurology

4. CMT Musculoskeletal

5. CMT Hematology/Oncology

6. CMT Endocrine

7. CMT ENT, GI, Infectious Disease

8. CMT History and Family History

9. CMT Cardiology Update

10. CMT Pediatrics

11. CMT Specimen Type

2.2.4 Dentistry

To continue improvements in coverage of the periodontal domain, 44 new concepts were added; additionally 24 new cephalometry concepts have been added.

2.2.5 Diagnostic Imaging Procedures

New concepts (87 of them) have been added to the procedure hierarchy for diagnostic imaging including 11 SPECT (Single-photon emission computed tomography) CT procedures using a radioactive substance.

2.2.6 Event, Condition, Episode (ECE)

Following the editorial guidance developed by the ECE group, FSN and synonym changes were made to over 3,100 concepts to conform to the 'caused by' term pattern, e.g. infection caused by specific organism. Existing terms remain active to facilitate searching.

The revision has improved consistency in descriptions for infection, poisoning, and adverse reaction, inflammation, and infestation disorders. As part of this revision, content quality issues have been fixed for about 300 concepts; e.g. mismatches between FSN and causative agent in concept modeling, inappropriate use of plurals, spelling variations and other minor errors.

2.2.7 Functioning

Approximately 300 concepts have been added to enhance the functioning content and improve coverage.

2.2.8 LOINC - SNOMED CT Cooperation Project

Substance concepts (84 Non-human DNA, RNA, Ag, Ab, etc) were deprecated from the core international release.

2.2.9 Medical Devices

For this release 226 new concepts, have been added to the SNOMED CT Physical Object hierarchy including over 200 concepts from the latest July 2015 GMDN release.

2.2.10 Nursing Content

As part of the continuing harmonization activities between IHTSDO and ICN, 93 new concepts have been added for nursing intervention activities which are published in the SNOMED CT – ICNP Equivalency table.

2.2.11 Organisms

More than 550 new Organism concepts were created based on SIRS requests as well as a gap analysis of a number of NRC sets submitted to the Microbiology reporting project.

2.2.12 Pharmaceutical/biologic products

After review of the 19^th WHO List of Essential Medicines, April 2015, 350 new Medicinal Entity and Medicinal Form concepts have been added to SNOMED CT to ensure content coverage.

2.2.13 Product Hierarchy Allergen Extracts

Several new "allergy to X" concepts were added related to Substances or products causing allergies or intolerances as Annex II to Regulation (EU) No 1169/2011 of the European Parliament and of the Council of 25 October 2011, on the provision of food information to consumers. This regulation is mandatory in Europe.

2.2.14 Substances

New substance concepts (301 of them), including newly registered drugs, have been created for the Substance Hierarchy.

2.3 Content Quality Improvement

2.3.1 Anatomy

• To remove ambiguity, 75 anatomy concepts have been retired as they do not follow the SEP model; 150 new anatomy concepts have been added to replace these ambiguous concepts. As a result of these changes, over 100 concepts modeled in both the disorder and procedure hierarchies have been updated by these new anatomy concepts.

• Addressed the issue caused by the confusion between jaw region and jaw bone. Jaw region includes jaw bone, skin, gum, teeth etc. The word 'jaw' is commonly interpreted as jaw bone. The ambiguous concepts have been retired and replaced by the concepts including 'region' in FSN and jaw region structure for concept modeling. The concepts for jaw bone remain unchanged.

2.3.2 Disorders

• Osteomyelitis disorders (150 of them) have been reviewed and remodelled.

• Rework to the modelling of the hierarchy 239954007|Soft tissue lesion of shoulder region (disorder) to remove improper inferences.

• These changes are related to the following content tracker artf222441: Concept addition: "Parasitic respiratory tract infection" - new concept added Infection of respiratory tract caused by parasite (disorder).

• Updates to existing X disease associated with AIDS concepts, including retirements and new concepts added in the pattern X disease co-occurrent with human immunodeficiency virus infection.

• These changes are related to the following content tracker artifacts: artf234569:

  • As noted above,29 new body structures corresponding to specific arterial walls created;

  • 29 concepts corresponding to the descendants of 9406001 | dissecting aneurysm of artery (disorder) | remodeled with the finding sites above and a morphology of  5399005 | dissecting hemorrhage (morphologic abnormality) |;

  • 9 concepts that contain the words “dissecting aneurysm” in the FSN retired and replaced by new concepts with FSNs of the type, Dissection of x artery (disorder);

  • 29 descendants of 9406001 | dissecting aneurysm of artery (disorder) | moved under Arterial dissection (disorder)

  • Concept ID 26845001 | dissecting aneurysm (morphologic abnormality) | retired.

2.3.3 Findings

These changes are related to the following content tracker artifacts: artf231228:

415531008|Skin AND/OR mucosa finding (finding) fast track document, review of this hierarchy and addition of a new grouper concept Lesion of skin and/or skin-associated mucous membrane (finding) with the finding site 707861009|Structure of skin and/or skin-associated mucous membrane (body structure) to distinguish the skin associated mucosal findings from all others.

2.3.4 Substances

As part of the Substance Hierarchy redesign project, 120 concepts related to therapeutic intention have been retired. Children of these concepts have been reclassified based on their chemical structure and/or their mechanism of action.

2.3.5 Revision of Infectious and Congenital Disease Content

A project to improve the consistency and quality of the Infectious disease hierarchy has begun with the remodeling of over 2000 of the estimated 6400 concepts that are subtypes of 40733004 - Infectious disease.  There will be minor changes in the inferred structure of members of this hierarchy as this project proceeds, but the overall improvement to the content will provide more robust and correct inferences.

2.4 SNOMED CT derived products

2.4.1 ICD-10 map

The SNOMED CT to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (© World Health Organization 1994) 2010 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 IHTSDO 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_iissscRefset_ComplexMapFull_INT_20150731.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)|.

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 2010 release.

Mapped content for January 2016

The map provided for the January 2016 release has been updated, and now represents a complete map from SNOMED CT International release to ICD-10 2010 version. We would welcome feedback on any issues that users of the map may detect when using the map. Issues should be submitted via mapping@ihtsdo.org

2.4.2 ICD-9-CM map

The SNOMED CT to the International Classification of Diseases, Ninth Revision, Clinical Modification, 2013 Version map (SNOMED CT to ICD-9-CM Map) is included in the SNOMED CT International release.

This is the last update as the SNOMED CT to ICD-9-CM map is deprecated with support effective 31 January 2016 and without support effective 31 July 2016. The map will continue to be available after the deprecation on IHTSDO's Confluence site (https://confluence.ihtsdotools.org/display/TOOLS) to any users who wish to access it during their transition to SNOMED CT or ICD-10-CM.