Content Tracker

Release Date	20240801
Release Status	PRODUCTION
Document Version	1.0

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 2024 release of SNOMED Clinical Terms^® (SCT) International Edition.

It also includes 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 2024 International Edition.

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.

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 2024 International Edition.

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

Important Information

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 2024 International Edition 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.

Quality Initiative

The Quality Initiative (QI) project is the implementation of the Quality Strategy. After a successful pilot project for the July 2018 Edition release, the next stage has been implemented for subsequent releases including August 2024. 

Quality improvement tasks are being 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 is being carried out to accurately reflect current clinical knowledge and ensure the semantic reliability of descriptions associated with a concept.  

Update for Pathological Process and Infectious Process

In the disorder hierarchy, a review has been undertaken for concepts where the pair 370135005 |Pathological process (attribute)| = 441862004 |Infectious process (qualifier value)| are included in the model but infectious process is not stated in the descriptions. Remodeling of this content has been carried out.

Number of concepts edited (approx): 20

Update Hierarchy 90128006|Photosensitivity (finding)|

Conditions that may be caused by light, but are not abnormal reactions to light, have been removed from descendants of 90128006 |Photosensitivity (finding)|.

Number of concepts edited (approx): 55

Update 230131008|Graft complications (disorder)|

230131008 |Graft complications (disorder)| has been inactivated with reason 'nonconformance to editorial policy' and replaced with 2 new concepts:

• 1344633008 |Disorder following grafting procedure (disorder)|

• 1344632003 |Disorder due to grafting procedure (disorder)|

Subtypes have been remodeled based on whether there is a causative link to the grafting procedure ('Due to' the procedure) or only a temporal link can be established ('After').

239180007 |Skin graft disorder (disorder)| has been inactivated and replaced with 1344638004 |Disorder following skin grafting procedure (disorder)|. All subtypes have been remodeled with the 'After' relationship to the skin grafting procedure.

Number of concepts edited (approx): 50

Update Hierarchy 278854009|Insertion of hormone implant (procedure)|

As part of a quality review of the 782901001 |Insertion procedure (procedure)| hierarchy, 10 procedure concepts referring to hormone implants were found to be modeled with 257867005 |Insertion - action (qualifier value)|. The descriptions also incorrectly referred to insertion of X hormone implant rather than implantation. These concepts have been remodeled with 129336009 |Implantation - action (qualifier value)|, with updated descriptions to reflect implantation. The previous insertion descriptions have been inactivated.

 Body Structure 

Update Lateralizable Body Structures

Over 4000 body structure concepts have been modeled with laterality and a value of "side" by batch changes to improve the assignment of laterality and classifications. In scope concepts with an incorrect model have been addressed during the review. Additional quality assurance will be undertaken in future as part of the updates for the new anatomy model.

The lateralizable reference set has also been updated to include these changes.

The following concepts failed validation as a result of these changes, these are not valid failures. An update to the validation rule is in development to exclude 'cells' from reporting, the following failures are validated as exceptions: 

• 77810002Clara cell of bronchiole (cell)cellConcept Id= 77810002 should be added to Lateralizable reference set

• 85615000Kultschitzky cell of bronchiole (cell)cellConcept Id= 85615000 should be added to Lateralizable reference set

• 33956004Alveolar macrophage (cell)cellConcept Id= 33956004 should be added to Lateralizable reference set

• 34826000Pneumocyte, type 1 (cell)cellConcept Id= 34826000 should be added to Lateralizable reference set

• 52782001Pneumocyte, type 2 (cell)cellConcept Id= 52782001 should be added to Lateralizable reference set

• 47438009Pneumocyte (cell)cellConcept Id= 47438009 should be added to Lateralizable reference set

Number of concepts edited (approx): 4000

SEP and Laterality Anatomy Reference Sets

The release file for the lateralizable body structure reference set has been updated and validated.

The release file for the SEP reference set has been updated and validated.

Clinical Finding

Inactivation of Mechanical Complication of <x> Disorder Concepts

Concepts representing mechanical complication of <x> device (disorder), mechanical complication of <x> graft (disorder) and mechanical complication of <x> ostomy (disorder) were identified as classification constructs. These concepts have been inactivated using the inactivation reason of Classification-derived component. A briefing note and advice was previously provided for Mechanical complication of <x> device (disorder) concepts. For further information please see here.

Further work will be undertaking in coming releases to improve the modeling for specific complications associated with devices.

Procedure

Radiographic Imaging

Work is progressing for this content tracker for information please see the informational briefing note here.

Remodel Hierarchy 51302004 |Turbinectomy (procedure)|

Remodeling of 51302004 |Turbinectomy (procedure)| hierarchy has been undertaken with creation of new concepts:

• 1340150000 |Coblation-assisted inferior turbinoplasty (procedure)

• 1340152008 |Microdebrider-assisted inferior turbinoplasty (procedure)|

Associated body structures have been added as required.

Number of concepts edited (approx): 7

Remodel Hierarchy 359890009|Fundoplication (procedure)|

Subtypes of 359890009|Fundoplication (procedure)| has been reviewed and remodeled.  235187003 |Partial fundoplication (procedure)| and 359893006 |Total fundoplication (procedure)| are now siblings.

Number of concepts edited (approx): 15

Pharmaceutical/Biological Product

Grouping Concepts for Therapeutic Roles in the Medicinal Product Hierarchy

Please see this Briefing Note for further information about the inactivation of 178 grouping concepts for therapeutic roles in the Medicinal Product hierarchy.

As part of the project all previous subtypes 763087004 |Medicinal product categorized by therapeutic role (product)| have had the 'plays role' additional axiom removed but the 766939001 |Plays role (attribute)| and 766941000 |Therapeutic role (role)| remain in SNOMED CT. Vaccines have been excluded from this work.

Older stated product subtypes of 763087004 |Medicinal product categorized by therapeutic role (product)| (for example, 26580005 |Digestant (product)|) have also been inactivated usually with an inactivation target of the corresponding grouping concept for roles in the substance hierarchy (70 concepts approx.). All grouping concepts for therapeutic roles remain in the substance hierarchy with a caveat added to Editorial guidance regarding known issues.

Update Pharmaceutical Dose Forms with Two or More Intended Sites

Pharmaceutical Dose Forms with more than one intended site will use “and” in their terming and include all intended sites in the model. By representing combinations of intended sites as a conjunction ('and' in the description) this will facilitate searching by end users. The concepts are logically modeled as conjunction.  Updated Editorial Guidance has been drafted.

9 clinical drugs using these dose forms have correspondingly had their descriptions updated to 'and'.

Parenteral dose forms for "infusion and/or injection" are modeled with a GCI. As this is a less common requirement any requests for this type of dose form will be reviewed on a case by case basis

Collaboration/Harmonization Agreements

Convergent Medical Terminology (CMT)

154 new concepts have been added. The main focus areas were ophthalmology and injury.

Orphanet

Working in collaboration with Orphanet efforts are ongoing to update rare disease concepts in SNOMED CT to maintain alignment with Orphanet for the annual update of the SNOMED CT to Orphanet Maps. Work has commenced to annotate content added for the Orphanet project with attribution. 

All of the concepts added for the Orphanet project have been mapped to ICD-10.

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 

International League Against Epilepsy (ILAE)

In line with approved harmonized terminology, this project is working on alignment including restructuring to update the hierarchy  << 313307000 |Epileptic seizure (finding)|.

Changes have been made in the area of focal epilepsy. This includes the addition of a small number of new concepts, updating of descriptions on current concepts, addition of definitions and inactivation of outdated concepts. Work in the area is continuing.

Further information about the project is available here

Gravity Project

22 new concepts were added to support the Gravity Project work with a focus on digital access findings and providing assistance procedures.

Internal Quality Improvement

Machine Readable Concept Model (MRCM) Changes

There are no changes for the MRCM in the August 2024 International Edition.

Future changes that are currently in progress can be viewed via the MRCM Daily Build Browser

Please see early visibility for future planned changes to MRCM.

OWL Axiom Expressions for Annotation Properties

The new annotation properties are 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)

• All subconcepts of 1295447006 |Annotation attribute (attribute)| are represented as "SubAnnotationPropertyOf", instead of "subClassOf" as they previously were

  • 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)

These axiom updates are published in the March 2024 International Edition release. The authoring tool has been updated to ensure all new subconcepts of 1295447006 |Annotation attribute (attribute)| are represented as SubAnnotationPropertyOf(). The remaining changes required for other tools to correctly consume the updated syntax were completed for the June 2024 International Edition release. The addition of content for the Annotations refset was commenced in the July 2024 International Edition release.

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 Edition 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 |SNOMED CT to ICD-10 extended map (foundation metadata concept).

The ICD-10 Mapping Technical Guide (including exemplars) is hosted here https://confluence.ihtsdotools.org/display/DOCICD10

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 2024

The map provided for the August 2024 International Edition has been updated, and now represents a complete map from SNOMED CT International Edition to ICD-10 2016 version.

• 316 newly authored concepts have been added and mapped.

• The SNOMED to ICD-O (morphology) map has null 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

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.