SNOMED CT January 2019 International Edition - SNOMED International Release notes
Date | 20190131 |
Document Version | 1.0 |
Release Status | PRODUCTION Release |
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 January 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 January 2019 International Edition release.
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.
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 2019 International Edition release.
Content Development Activity
Summary
Continuous quality improvement and enhancement of existing content is an ongoing process by SNOMED International for every release. The January 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.
Reminder 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. Background 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 implementation after the July 2018 release. |
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Content Quality Improvement
SCT Statistics | New concept additions |
|---|---|
SNOMED CT Concept (SNOMED RT+CTV3) | 11903 |
Body structure (body structure) | 442 |
Clinical finding (finding) | 2114 |
Event (event) | 27 |
Observable entity (observable entity) | 56 |
Organism (organism) | 326 |
Pharmaceutical / biologic product (product) | 7986 |
Physical object (physical object) | 59 |
Procedure (procedure) | 393 |
Qualifier value (qualifier value) | 135 |
Record artifact (record artifact) | 61 |
SNOMED CT Model Component (metadata) | 16 |
Situation with explicit context (situation) | 50 |
Social context (social concept) | 1 |
Specimen (specimen) | 2 |
Staging and scales (staging scale) | 11 |
Substance (substance) | 223 |
Special concept (special concept) | 1 |
SCT Improvement Statistics to Existing Concepts | Number |
|---|---|
Total number of changes | 72,376 |
Change to stated concept definition | 20,294 |
Change to inferred concept definition | 57,325 |
Change in concept definition status from Primitive to Sufficiently Defined | 1,269 |
Description change | 20,288 |
Inactivated concepts | 3,035 |
Inactivated descriptions | 12,663 |
Reactivated concepts | 21 |
Anatomy
New anatomy concepts: 442
Content quality improvements:
Clinical finding
Advance Notice 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 January 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' for the July 2019 release. |
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New concepts for clinical findings and disorders: 2114
Quality Initiative
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 January 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:
Convergent Medical Terminologies (CMT)
New CMT concepts: 1365
The majority of these newly authored concepts are in scope for mapping to ICD-10 and from the following domains:
Procedure Hierarchy
New concepts for procedure hierarchy: 393
Diagnostic imaging - 121 requests were received for new imaging procedure concepts with various imaging modalities.
Repair of hernia - 102 new concepts
Other content quality improvements:
Collaboration/Harmonization Projects
Orphanet
As a result of collaboration with Orphanet (http://www.orpha.net/consor/cgi-bin/index.php) 460 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.
Global Medical Device Nomenclature Agency (GMDNA)
55 new SNOMED CT concepts created and mapped in the Physical object hierarchy to support the GMDN collaboration agreement.
Event
New concepts added: 27
Work continued on the following Content Projects:
Record Artifact
New concepts added: 61
54 new concepts added for care plan.
Organism
New organism concepts added: 326
Content quality improvements:
Pharmaceutical / biologic product
Drug model project
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-January International Release.
Clinical drug (CD) concepts |
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Demo release |
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Groupers based on disposition and/or structure |
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Liposome modifications |
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Medicinal product "containing" (MP-containing) concepts |
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Medicinal product "only" (MP-only) concepts |
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Medicinal product form "containing" (MPF-containing) concepts |
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Medicinal product form "only" (MPF-only) concepts |
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National Extension model |
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Role |
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Veterinary Extension
10 concepts were moved to the Veterinary Extension.
Situation with Explicit Context
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.
Observable Entity
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.
Assessment Scale
Addition of 11 new assessment scale concepts.
Substances
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
Primarily, but not limited to, Substance terms used in the Products hierarchy, the Preferred Term in the US dialect has been made Acceptable in the GB dialect and vice versa.
Also work completed on the removal of some dialect variations (643 concepts):
Acceptability change of the Preferred Term (PT) in US dialect changing from Not acceptable to Acceptable as a GB synonym, and vice versa (GB PT made Acceptable as a synonym in US dialect previously Not acceptable) - 422 concepts.
Removed a dialect variation and now the concepts have a single PT that covers both dialects - 221 concepts.
Other content quality improvements:
Release plans, Substance hierarchy
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.
Internal Quality Improvement
Logic Profile Enhancements
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:
Machine Readable Concept Model (MRCM)
6 new MRCM rules and 3 updates to the existing MRCM in the MRCM refsets and authoring platform were made for the January 2019 release:
The further details can be found here https://snomed.atlassian.net/wiki/display/IAP/MRCM+changes+in+the+January+2019+release
Please note, you may have to register for a Confluence user account in order to access the relevant links above.
Definition Status
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:
FSN: Sufficiently defined by necessary conditions definition status (core metadata concept)
SYN (Preferred): Defined
SYN (Acceptable): Sufficiently defined by necessary conditions definition status
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:
FSN: Not sufficiently defined by necessary conditions definition status (core metadata concept)
SYN (Preferred): Primitive
SYN (Acceptable): Not sufficiently defined by necessary conditions definition status
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.
Potential impact:
The structural subsumption technique, based on definition status and inferred relationships, should not be used to test subsumption between SNOMED CT Expressions. This is because sufficient but not necessary relationships and other DL enhancements are not represented in the inferred relationship file. Accurate expression subsumption now requires use of the OWL refsets and a DL classifier.
The colors and shapes used to represent concept model diagrams should follow the assigned or derived definition status.
Some updates will be required to documentation and education materials.
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 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_20190131.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 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.
Mapped content for January 2019
The map provided for the January 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 mapping@snomed.org
Technical Guide Exemplars
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
ICD-O Map
There are 5 updates for the ICD-O Morphological abnormality map in January 2019 release.
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:
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 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 this International edition, the following Known Issues were identified, and agreed to be resolved in the next editing cycle:
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 this latest release of the 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 this release of the International edition were:
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