Introduction

The SNOMED CT International Patient Summary (IPS) refset is designed to standardize and record basic medical data that includes the most important clinical information to patient safety and healthcare. The SNOMED CT IPS refset terms have been harmonized with and supports the contents of the HL7 International Patient Summary (HL7 IPS) and CEN's European Standard for the Patient Summary. 

This refset includes a set of SNOMED CT content from the International Release as defined by the scope in 2.1. below. 

This document provides information about the IPS RF2 refset package.  It does not include a discussion or recommendation regarding the broader set of all SNOMED CT terms that are related to the IPS. 

Background

In 2019, SNOMED International and Health Level Seven International (HL7) announced the formalization of a license agreement in which a relevant "Free for Use" Set of SNOMED CT coded concepts will be used within the HL7 International Patient Summary (HL7 IPS). HL7 is a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services. The HL7 IPS is a minimal and non-exhaustive patient summary dataset, specialty-agnostic, condition-independent, but readily usable by clinicians for the cross-border unscheduled care of a patient. The collaboration is consistent with the aims of both organizations to support international harmonization. Further information about the IPS can be found on the International Patient Summary website: https://international-patient-summary.net/ 

Scope

An IPS document is an electronic health record extract containing essential healthcare information for use in the unscheduled, cross-border care scenario, as well as for local, regional and other care scenarios.

The SNOMED CT International Patient Summary (IPS) is international in scope and in addition to harmonization with HL7 IPS, is aligned with CEN's European Standard for the Patient Summary. The IPS free set consists of more than 8,000 SNOMED CT terms for use in implementations of the HL7 CDA R2 and FHIR IPS Implementation Guides world-wide. The SNOMED CT IPS contains concepts that can record the following data: 

• General information about the patient (e.g., gender)

• Medical summary of most important clinical data (e.g., allergies, current medical problems, major surgical procedures)

• A list of current medications

• Diagnostic results, immunizations, and history of procedures

Use cases:

Organizations, information systems, or mHealth apps creating or receiving an HL7 IPS may or may not have a SNOMED CT License. For organizations, regions, or countries that have a SNOMED CT License, the SNOMED CT IPS Reference Set enables easier specification of the patient summary requirements and better interoperability, while for those organizations, regions, or countries that do not have SNOMED CT Licenses, the Free Set (or IPS Terminology package) enables use the data for care and to store within their EHRs. For some, it may provide a starting point for migration to use the use of SNOMED CT. For further information on usage please consult the SNOMED International IPS Terminology User Guide. We invite additional use case examples to be sent to info@snomed.org. 

Content

The IPS refset primarily contains concepts that can be used to record general information about the patient, medical summary of the most important clinical patient data, and a list of the current medication the patient is taking.  The refset has been updated to reflect requested additions and changes published in the July 2024 release of SNOMED CT as follows:

• 2289 additional members based on:

  • 2253 requested additions

  • 36 additions as a result of changes in the published release

• 48 members became inactive as a result of changes in the published release.

Design

Version

The dependent version of SNOMED CT is the July 2024 International Edition release.

Ownership

Whilst SNOMED International are the owners of SNOMED CT, clinical validation and ownership is provided by the HL7 International. Further information about the content inclusion of the HL7 IPS should be directed to the HL7 IPS working group.   

Frequency

The first Production version of the RF2 refset was published after the July 2022 International Edition release of SNOMED CT. Subsequently it will be maintained annually, in line with each July release of SNOMED CT International Edition.

Obtaining the Release

The SNOMED CT IPS RF2 refset is available from SNOMED International and is maintained and updated annually, in line with the latest SNOMED CT International release.

Access within SNOMED International member countries is provided by the Member National Release Centre in each country, via the relevant Member page. Affiliates of SNOMED International in non-member countries can access the refset through their Member Licensing and Distribution SERVICE (MLDS) account. Please contact info@snomed.org for more information if required.

Feedback

Please provide feedback on usage of, or potential improvements to this refset to info@snomed.org with "IPS RF2 Refset" in the subject box.

Technical Notes

RF2 package format

The RF2 package convention dictates that it contains all relevant files, regardless of whether or not there is content to be included in each particular release.  Therefore, the package contains a mixture of files which contain both header rows and content data, and also files that are intentionally left blank (including only a header record).  The reason that these files are not removed from the package is to draw a clear distinction between:

1. ...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in this or future releases, and 

2. ...files that just happen to contain no data in this particular release (and are therefore included in the package but left blank, with only a header record), but are still relevant to RF2, and could therefore potentially contain data in future releases.

This allows users to easily distinguish between files that have purposefully been removed or not, as otherwise if files in option 2 above were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.

RefSet Identification

Changes to the Release effectiveTime

After consultation with the community in 2023, SNOMED International changed the date of the effective time for the International Edition releases from the last day of each month, to the first of each month.  

The effective time for the “January” editions, for examples, have changed from 31st to 1st January.  The effective time for the dependent “July 2024” International Edition, therefore, is 20240701.

To ensure alignment with the dependent International release for the 2024 IPS package, the effectiveTime is therefore also set to 20240701 for all IPS components.

Changes to the Release package format

In line with the new implementation of Annotations in all SNOMED International products, two new refsets have been added to the International Edition Release package, from December 2023 onwards:

• der2_scsRefset_ComponentAnnotationStringValueSnapshot_INT_20240701.txt

• der2_sscsRefset_MemberAnnotationStringValueSnapshot_INT_20240701.txt

The latest version of the IPS release is based upon the July 2024 International Edition, and therefore these Annotations file types will also be included in the IPS release package from the July 2024 IPS release onwards, until further notice:

• der2_scsRefset_IPSComponentAnnotationStringValueFull_INT_20240701.txt

• der2_scsRefset_IPSComponentAnnotationStringValueSnapshot_INT_20240701.txt

• der2_sscsRefset_IPSMemberAnnotationStringValueFull_INT_20240701.txt

• der2_sscsRefset_IPSMemberAnnotationStringValueSnapshot_INT_20240701.txt

Metadata now incorporated into the Derivative Packages

After consultation in 2023, SNOMED International are in the process of improving our Derivative release packages by including the relevant metadata in the Derivative packages, as well as in the International Edition.

These Derivatives are solely single refsets/maps, and so don’t mean anything to end users without the supporting terms and other components from the International content.  The nature of these products is therefore such that we necessarily create Derivative packages that are inherently dependent on the relevant International Edition content.  Previously, therefore, we have always created the metadata components (refset/module concepts, descriptions, relationships, etc) in the International Edition release packages, with the Derivative products being dependent on the relevant International content.  Whilst this dependency on the International content continues, the transition involves the inclusion the metadata components in the Derivative packages themselves, as well as in the International Edition packages. 

The consensus is that including the Metadata components in the Derivative packages will bring benefits to both the Derivative maintainers, and also to the end users who will no longer need to pull this particular data down from the dependent International Edition in order to use the Derivative products.   It enables maintainers to move to a more efficient model of hosting the Derivative content in termServer branches, rather than importing Delta files from external tools.  They are included for additional information, and do not have to be consumed - so please utilise them as required.

This means that from the 2024 IPS release onwards, it will include additional metadata components that used to reside solely in the International Edition.  These will include the IPS module & refset concepts, as well as the supporting components such as descriptions and language refset records, etc.

If you have any feedback on the metadata components, please contact us on release@snomed.org