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^®), trading as 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.

We kindly encourage all Belgian users to submit their feedback on the content of the Belgian Edition through the NRC's Request Management Portal. 

This document provides a summarized description of the content changes included in the July 2025 Production release of the SNOMED Clinical Terms^® Managed Service Belgium Edition package.

It also includes technical notes detailing the potential known issues. 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.

2.1 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.

This extension contains concepts, relationships and reference sets with their Dutch, French and German translations.

3.2 New and Updated Content

International content in this release

This release contains 1260 new concepts and 453 inactivated concepts from the latest international edition.

Belgian content in this release

Concepts

3 new Belgian concepts in the foundation metadata concept hierarchy have been created to define new reference sets (see below). No Belgian concepts were inactivated.

New translated content

General Practitioner language reference sets: the following table contains the total number of translations included in the GP language reference set:

New translations have been introduced to the three national language reference sets, both for concepts that had not been yet translated and for concepts that already contained translations. Some existing translations were inactivated or updated. The following table contains the total number of currently active translations available in the present version of the Belgian language reference sets:

Update to 10861000172102 |Belgian addition to ICD-10 extended map reference set (foundation metadata concept)|

Four inactive local concepts were replaced in the extended map with new international concepts with the same meanings.

The inactive concepts are:
881000172103 |Disorder of tendon of lower limb (disorder)|
801000172109 |Open wound of skin (disorder)|
1021000172105 |Tendinitis of elbow (disorder)|
971000172109 |Acute cough (finding)|

And the replacements are, respectively:
1297243009 |Disorder of tendon of lower limb (disorder)|
321000161101 |Open wound of skin (disorder)|
1363606006 |Tendinitis of elbow (disorder)|
788062371000119104 |Acute cough (finding)|

Summary of records changed in all files

The release currently contains reference sets that serve one of the following 2 purposes :

- Reference sets to support the implementation of SNOMED CT in eHR software for clinical data entry/capture. These reference sets have a six-monthly release cycle.
- Reference sets to support data interoperability (mainly subsets representing value lists of BE FHIR profiles required by the Care Sets). These reference sets have a monthly release cycle.

A new version of a reference set is only published when there is a change compared to the previous version. Reference sets that do not require an update (meaning having no delta) are not republished despite their release cycle.

Summary of the different existing refsets and their purpose:

3 new interoperability refsets were published in this release:

181051000172108 |Belgian subset for AllergyIntoleranceExposureRoute (foundation metadata concept)|

181061000172105 |Belgian subset for AllergyIntoleranceNoAllergy (foundation metadata concept)|

181041000172106 |Belgian subset for AllergyIntoleranceType (foundation metadata concept)|

The following reference sets were updated:

50841000172109 Belgian subset for AllergyIntolerance, causative agent, drug EN (PT)

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 the SNOMED CT Managed Service - Belgium Extension Release, the following Known Issues were identified, and agreed to be resolved in the next editing cycle.

As you may already know SNOMED International has transitioned to a monthly delivery schedule for the International Edition of SNOMED CT. The move towards more frequent releases of SNOMED CT has several benefits, including:

• Inclusion of suggested changes in a shorter timeframe.

• Better interoperability, as a result of entities being able to consume release content that is more aligned with other organizations.

• The prevention of circular dependencies that occur in longer projects, due to the move towards smaller, more manageable authoring projects.

• More automated validation services, as a result of the inherent removal of the Alpha/Beta stages in the Release cycle.

Whilst most users will continue unaffected (as they can simply continue to download the releases every 6 months as always), this transition will necessarily involve a few changes to process/packages:

• Delta files have been removed from both International and Managed Service release packages, including the Belgium Extension.  A Delta Generation service will be provided for those who need it. The Delta Generation Tool allows users to create their own Delta between two fixed release dates - you can find it here:

  • https://github.com/IHTSDO/delta-generator-tool/releases

• The ICD-O/ICD-10 Maps will continue to be published in each Monthly International Edition release package (in line with that month's content) for the foreseeable future, unless we experience issues with the new process in Production, and they need to be removed at a later date.

The Belgian edition of SNOMED CT is also released monthly on the 15^th of each month, except for January and August. The first monthly Belgian edition was published in November 2024.

In line with the refined implementation of Annotations, we are updating all Extensions in order to align them with the updated version of the refsets in the International Edition Release package (which were first published in June 2024).

• The languageCode field was specified as the two characters of ISO|-639-1 code for the language of the annotation text. The change includes support for specifying dialect when it is applicable by adhering to RFC 5646, which allows the combination of two characters of ISO 639-1 code and two uppercase letters of country code (ISO 3166) separated by a hyphen.  The changes apply to both the Member Annotations String Value Reference Set + Component Annotation String Value reference set:

  • The column "languageCode" has therefore been changed to "languageDialectCode".

    • Component Annotations (1292992004)

      • OLD:    id    effectiveTime    active    moduleId    refsetId    referencedComponentId    languageCode    typeId    value

      • NEW:   id    effectiveTime    active    moduleId    refsetId    referencedComponentId    languageDialectCode    typeId    value

    • Member Annotations (1292995002)

      • OLD:   id    effectiveTime    active    moduleId    refsetId    referencedComponentId    referencedMemberId    languageCode    typeId    value

      • NEW:  id    effectiveTime    active    moduleId    refsetId    referencedComponentId    referencedMemberId    languageDialectCode    typeId    value