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 August 2022 release of SNOMED Clinical Terms^® (SCT) International Release.

It also includes technical notes detailing the known content or technical issues where the root cause is understood, the fix has been discussed and agreed to, but has yet to be implemented.

The SNOMED International Release Notes are available alongside the August 2022 International 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 August 2022 International release.

Please note, you may have to register for a Confluence user account in order to access the links included in these release notes.

Content Development Activity

Summary

Continuous quality improvement and enhancement of existing content is an ongoing process undertaken by SNOMED International in preparation for every release. The August 2022 International Release has seen a continuation of the work driven by contributions from: Kaiser Permanente i.e. 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 advanced via project driven initiatives summarized below.  Additional work items impacting every release are updates to the SNOMED CT derived maps such as ICD-10 and ICD-O; details are 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 here

Updates for Concept Inactivation Values

Please see editorial guidance for changes to concept inactivation values here.

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 subsequent releases including August 2022. 

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.

Body Structure 

New Body Structure Concepts Added

New concepts have been added to improve anatomy content in the area of:

• Glenohumeral ligaments

• Anterior and posterior free margins of the eyelid - this resulted in updates to the model of 40 related concepts.

SEP and Laterality Anatomy Reference Sets

Updated and validated release file for the lateralizable body structure reference set. 

Updated and validated release files for the SEP refsets.

Clinical Finding

Update GCI for Injury Concepts

Unnecessary GCI axioms have been removed from 10 concepts in the injury hierarchy.

Situation With Explicit Context

Inactivation of 'X of Subject'

Based on a consensus decision by the SNOMED International Editorial Advisory Group, concepts of the form "X of subject (person)" have been inactivated and concepts using these as the value for SUBJECT RELATIONSHIP CONTEXT relationships have been replaced by analogous "X (person)" concepts.

Qualifier Value

Substance

Pharmaceutical/Biological Product

Physical Object

Collaboration/Harmonization Agreements

Convergent Medical Terminology (CMT)

141 new concepts have been added for the August 2022 release, predominantly relating to skin disorders, respiratory disorders and injuries. 

Orphanet

Working in collaboration with Orphanet (http://www.orpha.net/consor/cgi-bin/index.php), creation of new concepts for the original set of prioritized rare diseases has been completed. All of the concepts added for the Orphanet project have been mapped to ICD-10.

The Production release of the SNOMED CT to Orphanet Simple Map was published in October 2021. Work is now underway to add further content to the SNOMED CT to Orphanet Simple Map for future releases starting with the next Production release in October 2022.

ICD-11 Update

The August 2022 release has seen continued addition of content for this project.

International Classification for Nursing Practice

1 new nursing procedure concept has been added.

Cancer Synoptic Reporting

Cancer synoptic reports are used by many member countries to record pathology examination of cancer specimens including the College of American Pathologists (US and Canada), Royal College of Pathology (UK), Royal College of Pathology Australasia (Australia, New Zealand), PALGA (The Netherlands), Swedish Society of Pathology, and others.

For more information about this project, please see Cancer Synoptic Reporting Clinical Project Group 

Internal Quality Improvement

Machine Readable Concept Model (MRCM) Changes

No changes made for the August 2022 release.

The next scheduled change for MRCM is due to be published in the September 2022 release, please see early visibility notification for further details.

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 Organization 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 Centers.

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_20200731.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. 

Mapped content for August 2022

The map provided for the August 2022 release has been updated, and now represents a complete map from SNOMED CT International release to ICD-10 2016 version.

• 239 newly authored concepts have been added and mapped.

• The SNOMED to ICD-O (morphology) map has no additional concepts added as a result of the ICD-O 3.2 review or added due to CRS requests.

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

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: https://github.com/IHTSDO/snomed-owl-toolkit

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.