Introduction

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 new Request Management Portal (see Technical Notes below for more details).  

This document provides a summarized description of the content changes included in the November 2025 Production release of the SNOMED Clinical Terms^® Managed Service Belgium Edition package. It also includes technical notes detailing the potential known issues.

Content Changes Summary

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

New and Updated Content

International content in this release

This release contains 856 new concepts and 143 inactivated concepts from the latest international edition.

Belgian content in this release

Concepts

Two Belgian concepts were inactivated on account of being duplicate concepts with two existing international concepts. The two concepts were inactivated with historical association value “SAME AS”.

911000172103 |Fracture of wrist (disorder)| was replaced by 1303397005 |Fracture of bone of wrist region (disorder)|

981000172107 |Absenteeism at school (finding)| was replaced by 1279518001 |Absenteeism from school (finding)|.

No Belgian concepts were created.

New translated content

• National Language Reference Sets:

New translations have been introduced to the 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:

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

SNOMED CT derived products  

Reference sets

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:

 Updated Reference sets

The following reference sets were updated (inactive concepts were removed and replacements added if not already present):

100941000172101 Belgian subset for nursing in patient health records (foundation metadata concept)

100951000172104 Belgian subset for nephrology in patient health records (foundation metadata concept)

100971000172106 Belgian subset for neonatology in patient health records (foundation metadata concept)

130971000172101 Belgian subset for intensive care in patient health records (foundation metadata concept)

130981000172103 Belgian subset for infectious diseases in patient health records (foundation metadata concept)

131001000172104 Belgian subset for cardiology in patient health records (foundation metadata concept)

40811000172108 Belgian subset for medical problems in patient health records (foundation metadata concept)

50831000172102 Belgian subset for Vaccination (foundation metadata concept), including the addition of 777424002 |Product containing only Respiratory syncytial virus immune globulin (medicinal product)| and 1345202008 |Vaccine product containing only Chikungunya virus antigen (medicinal product)|.

50841000172109 Belgian subset for AllergyIntolerance, causative agent, drug (foundation metadata concept)

50851000172106 Belgian subset for AllergyIntolerance, causative agent, non-drug (foundation metadata concept)

721000172106 Belgian GP subset (foundation metadata concept)

Technical notes

Request Management Platform

The new version of the Request Management Portal is now live and can be accessed through https://rmp.ihtsdotools.org. Please note that this is a new URL and it is different from the old one (rmp.snomedtools.org). SNOMED CT International has set up a redirection page at the old address to guide users to log in via their SNOMED Account, which will then grant them access to the landing page with links to the RMP.

The new site utilizes Single Sign-On (SSO). This means that once a user is logged into their SNOMED Account, they will be automatically logged into the Request Management Portal and will no longer need to sign in for each request.

If you encounter any issues logging in or using the platform, please contact us immediately on terminologie@health.fgov.be.

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

Technical notes

Notice of changes to the Belgium Edition Release Schedule

As you may already know SNOMED International has transitioned to a monthly delivery schedule for the International Edition of SNOMED CT. The Belgian edition of SNOMED CT has also moved to monthly releases on the 15^th of each month, except for January and August. The first monthly Belgian edition was published in November 2024.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.

Notice of changes to the BE Edition Release package

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