International release

The SNOMED CT UK Clinical edition is based on the July 2022 SNOMED International release.

The SNOMED International release notes can be found online at: SNOMED CT July 2022 International Edition release notes

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser, however, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition:  Daily Build SNOMED CT Browser

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT UK Pathology extension

There are no new pathology concepts in this release.

SNOMED CT UK Drug extension

SNOMED CT UK Drug Extension data is published on a four-weekly cycle.  The reference sets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 35.5.0 release of the SNOMED CT UK Drug Extension will be synchronous with the 22 February 2023 SNOMED CT UK Clinical Extension and the July 2022 SNOMED International Edition.

The following are the counts of new SNOMED concepts added to the respective hierarchy:

There have been concept changes in 6 areas with a total of 604 new concepts, of which 2 are inactive. 403 existing concepts have been made inactive.

Clinical Content Changes

The following are the counts of new SNOMED concepts added to the respective hierarchy:

• Assessment scale – 2
• Disorder – 1
• Finding – 19
• Foundation metadata concept – 1
• Observable entity – 48
• Procedure – 79
• Qualifier value – 1
• Record artifact – 10
• Regime/therapy – 5
• Situation – 9

CHANGES TO HISTORY SUBSTITUTION AND QUERY TABLES FROM 32.12.0

A bug has been identified in how the History Substitution table determines some values for IS_AMBIGUOUS.

The build algorithm traverses chains of historical associations to identify active substitute(s) for each inactive concept. Where the traversed chain involved both WAS-A and MAYBE flavours of association, the algorithm previously collapsed this into a flavour of MAYBE (IS_AMBIGUOUS = 1 or 3). In future it will collapse this into a flavour of WAS-A (IS_AMBIGUOUS = 2). The table size is unaltered; only some values for IS_AMBIGUOUS are changed.

This change in the History Substitution table, however, has a very large direct knock-on effect upon the Query Table: a recomputed Query Table for the 32.10.0 release was 11,769,032 million rows smaller than the published original (11,627,761 rows compared with 23,396,793). Releases of the Query Table starting with 32.12.0 will therefore have similarly reduced row counts.

The algorithmic and semantic basis for the correction to both products is well understood, circumscribed, and defined. The resulting changes involve almost exclusively only the removal of semantically invalid inferences and so are expected to be beneficial overall going forward. However, previous releases of the Query Table did include a small volume of cases of "right answer for wrong reason": some factually correct rows now being removed cannot correctly be derived from the available semantics.

Some level of prior clinical risk may have been associated with the historical publication of incorrect Query Table data in particular. However, a detailed analysis of the Query Table rows now being removed suggests that the huge majority would rarely if ever have been used to drive patient-level care decisions.

SNOMED CT to ICD-10 and OPCS-4 Classification Maps

This release contains maps for ICD-10, OPCS-4.9 and OPCS-4.10 (refSetId: 1382401000000109).

The maps for the 35.2.0 - 30 November 2022 SNOMED CT UK Edition and missing SNOMED International February 2022 content are also included in this release.

OPCS-4.10 must be used to code all episodes finishing on or after 1 April 2023. The OPCS-4.9 maps are included in the release to allow coding of episodes finishing on or before 31 March 2023.  As two versions of OPCS-4 are included, the mapping files will be considerably larger than usual. Information about the lifecycle of the maps can found in the SNOMED CT to ICD-10 and OPCS-4 Cross-Mapping Retired Reference Sets document.

Summary detail	Number
New or existing concepts which have been mapped to ICD-10 or assigned an excuse code (excluding #NEW) during this release cycle.	507
New or existing concepts which have been mapped to OPCS-4 or assigned an excuse code (excluding #NEW) during this release cycle.	772*

NB: Map changes between the current and previous release can be found within the Delta mapping file.                                                                                                                                                   * This figure only represents new concepts mapped to an OPCS-4.10 code or existing concepts where the OPCS-4 map has changed. The total number of changes in the release files will be considerably larger as all active concepts which were previously in scope of OPCS-4.9 are also in the OPCS-4.10 map reference set.

Information for future Releases

There will be no updates to the ICD-10 or OPCS-4.10 classification maps in the 35.6.0 – 22 March 2023 UK Edition release. The March 2023 content will be mapped and included in the 36.6.0 - 05 – 19 April 2023 release, along with the UK maps for the August 2022 to January 2023 International Edition. Further information about the 2023-24 map releases can be found in the 2023-2024 Release Schedule.

Reference sets

No new reference sets have been added to this release.

 Technical notes

There are currently no planned UK changes. Proposed SNOMED International changes can be found in the relevant release folder.

Known issues 

There are no known issues for this release.

International release

The SNOMED CT UK Clinical edition is based on the July 2022 SNOMED International release.

The SNOMED International release notes can be accessed here.

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser, however, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition: Daily Build SNOMED CT Browser

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT UK Pathology extension

There are no new pathology concepts in this release.

SNOMED CT UK Drug extension

The SNOMED CT UK Drug Extension data is published on a four-weekly cycle. The reference sets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 35.2.0 release of the SNOMED CT UK Drug Extension will be synchronous with the 23 November 2022 SNOMED CT UK Clinical Extension and the July 2022 SNOMED International Edition.

The following are the counts of new SNOMED concepts added to the respective hierarchy:

There have been concept changes in 6 areas with a total of 604 new concepts, of which 2 are inactive. 403 existing concepts have been made inactive.

Clinical Content Changes

The following are the counts of new SNOMED concepts added to the respective hierarchy:

• Assessment scale – 3
• Disorder - 1
• Finding – 4
• Morphologic abnormality - 3
• Observable entity – 37
• Procedure – 18
• Qualifier value - 1
• Record artifact – 1
• Regime/therapy – 4
• Situation – 7

UPCOMING CHANGE TO MONKEYPOX CONCEPTS

The WHO (World Health Organization) has recommended a new name for monkeypox disease of ‘mpox’. This change came too late to be represented in this release. We therefore intend to make the necessary changes to reflect this recommendation in the 35.5.0_20230215 (released 20230222) release.

CHANGES TO HISTORY SUBSTITUTION AND QUERY TABLES FROM 32.12.0

A bug has been identified in how the History Substitution table determines some values for IS_AMBIGUOUS.

The build algorithm traverses chains of historical associations in order to identify active substitute(s) for each inactive concept. Where the traversed chain involved both WAS-A and MAYBE flavours of association, the algorithm previously collapsed this into a flavour of MAYBE (IS_AMBIGUOUS = 1 or 3). In future it will collapse this into a flavour of WAS-A (IS_AMBIGUOUS = 2). The table size is unaltered; only some values for IS_AMBIGUOUS are changed.

This change in the History Substitution table, however, has a very large direct knock-on effect upon the Query Table: a recomputed Query Table for the 32.10.0 release was 11,769,032 million rows smaller than the published original (11,627,761 rows compared with 23,396,793). Releases of the Query Table starting with 32.12.0 will therefore have similarly reduced row counts.

The algorithmic and semantic basis for the correction to both products is well understood, circumscribed and defined. The resulting changes involve almost exclusively only the removal of semantically invalid inferences and so are expected to be beneficial overall going forward. However, previous releases of the Query Table did include a small volume of cases of "right answer for wrong reason": some factually correct rows now being removed can not correctly be derived from the available semantics.

Some level of prior clinical risk may have been associated with the historical publication of incorrect Query Table data in particular. However, a detailed analysis of the Query Table rows now being removed suggests that the huge majority would rarely if ever have been used to drive patient-level care decisions.

SNOMED CT to ICD-10 and OPCS-4 Classification Maps

There are no updates to the ICD-10 or OPCS-4.9 classification maps for this release.

The 35.2.0 - 30 November 2022 SNOMED CT UK Edition and missing SNOMED International February 2022 release content will be mapped and included in the 35.5.0 – 22 February 2023 release.

As well as the OPCS-4.9 and ICD-10 maps, the February 2023 release will also include the maps to OPCS-4.10. The OPCS-4.10 maps must not be used in live systems until 1 April 2023 onwards.

Reference sets

No new reference sets have been added to this release.

Technical notes

There are currently no planned UK changes. Proposed SNOMED International changes can be found in the relevant release folder.

Known issues

There are no known issues for this release.

International release

The SNOMED CT UK Clinical edition is based on the July 2022 SNOMED International release.

The SNOMED International release notes can be accessed here.

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser, however, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition: Daily Build SNOMED CT Browser

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT UK Pathology extension

No changes.

SNOMED CT UK Drug extension

The SNOMED CT UK Drug Extension data is published on a four-weekly cycle. The reference sets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 35.0.0 release (with dm+d data from release NHSBSA_9.2.0_20220919000001) of the SNOMED CT UK Drug Extension, will be synchronous with the October 2022 SNOMED CT UK Clinical Extension and the July 2022 SNOMED International Edition.

Clinical Content Changes

The following are the counts of new SNOMED concepts added to the respective hierarchy:

• Assessment scale – 1
• Finding – 5
• Observable entity – 5
• Procedure – 26
• Record artifact – 5
• Foundation metadata concept – 10
• Regime/therapy – 2
• Situation – 2

There are 16 new SNOMED codes that relate to the sending of invitations to receive COVID vaccinations.

CHANGES TO HISTORY SUBSTITUTION AND QUERY TABLES FROM 32.12.0

A bug has been identified in how the History Substitution table determines some values for IS_AMBIGUOUS.

The build algorithm traverses chains of historical associations to identify active substitute(s) for each inactive concept. Where the traversed chain involved both WAS-A and MAYBE flavours of association, the algorithm previously collapsed this into a flavour of MAYBE (IS_AMBIGUOUS = 1 or 3). In the future it will collapse this into a flavour of WAS-A (IS_AMBIGUOUS = 2). The table size is unaltered; only some values for IS_AMBIGUOUS are changed.

This change in the History Substitution table, however, has a very large direct knock-on effect upon the Query Table: a recomputed Query Table for the 32.10.0 release was 11,769,032 million rows smaller than the published original (11,627,761 rows compared with 23,396,793). Releases of the Query Table starting with 32.12.0 will therefore have similarly reduced row counts.

The algorithmic and semantic basis for the correction to both products is well understood, circumscribed, and defined. The resulting changes involve almost exclusively only the removal of semantically invalid inferences and so are expected to be beneficial overall going forward. However, previous releases of the Query Table did include a small volume of cases of "right answer for wrong reason": some factually correct rows now being removed cannot correctly be derived from the available semantics.

Some level of prior clinical risk may have been associated with the historical publication of incorrect Query Table data in particular. However, a detailed analysis of the Query Table rows now being removed suggests that the huge majority would rarely if ever have been used to drive patient-level care decisions.

SNOMED CT to ICD-10 and OPCS-4 Classification Maps

This release incorporates maps for the 34.1.0 -10 August 2022 and 35.0.0 – 05 October SNOMED CT UK Clinical Edition content, along with the UK maps for the February 2022 to July 2022 SNOMED International Edition releases.

The new concept ‘1382401000000109 |Office of Population Censuses and Surveys Classification of Interventions and Procedures Version 4.10 complex map reference set (foundation meta data concept)’ has been authored in this release, in preparation for update to the maps for OPCS-4.10 during the next authoring cycle (please see Information for future releases section below).

Content changes made by SNOMED International (SI) between February 2022 and July 2022, include the inactivation endoscopy procedure concepts stating ‘therapeutic’ or ‘diagnostic’ intent and replacement with concepts without stated intent. This may result in some OPCS-4.10 codes no longer being reached via a map from a SNOMED CT concept. As recommended in the SNOMED CT to ICD-10 and OPCS-4 Map Table Technical Specification and Implementation Guidance (UK Edition) document (section 2.2), systems should already incorporate the ICD-10 and OPCS-4 Titles and Metadata files to allow manual input of any classification codes that can’t be reached from a map. Further Information on SI content changes can be found in the associated release notes.

Summary detail	Number
New or existing concepts which have been mapped to ICD-10 or assigned an excuse code (excluding #NEW) during this release cycle.	1553
New or existing concepts which have been mapped to OPCS-4 or assigned an excuse code (excluding #NEW) during this release cycle.	789

NB: Map changes between the current and previous release can be found within the Delta mapping file.

Information for future releases 

There will be no updates to the ICD-10 or OPCS-4.9 classification maps in the 35.2.0 – 30 November 2022 release. The November 2022 SNOMED CT content will be mapped and included in the 35.5.0 – 22 February 2023.

As well as the OPCS-4.9 and ICD-10 maps, the February 2023 release will also include the maps to OPCS-4.10. The OPCS-4.10 maps must not be used in live systems until 1 April 2023 onwards.

Reference sets 

The following new Reference sets have been added for this release:

1382481000000104   Advance care plan type simple reference set (foundation metadata concept).

1382491000000102   Advance decision findings simple reference set (foundation metadata concept).

1382501000000108   Dietary requirement findings simple reference set (foundation metadata concept).

1382511000000105    Dietary requirement regimes simple reference set (foundation metadata concept).

1382471000000101    Emergency care assessment tool observables simple reference set (foundation metadata concept).

1382451000000105    Emergency care coded findings simple reference set (foundation metadata concept).

1382461000000108    Emergency care coded observations simple reference set (foundation metadata concept).

1382531000000102    Emergency care diagnosis max simple reference set (foundation metadata concept).

1382541000000106    Emergency care sickness absence category.

Technical notes

There are currently no planned UK changes. Proposed SNOMED International changes can be found in the relevant release folder.

Known issues 

There are no known issues for this release.

International Release

The SNOMED CT UK Clinical edition is based on the January 2022 SNOMED International release.

The SNOMED International release notes can be accessed here.

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser. However, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition:  Daily Build SNOMED CT Browser.

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT UK Pathology extension

No changes.

SNOMED CT UK Drug extension

The SNOMED CT UK Drug Extension data is published on a four-weekly cycle. The reference sets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 34.0.0 release (with dm+d data from release NHSBSA_6.3.0_20220627000001) of the SNOMED CT UK Drug Extension, will be synchronous with the July 2022 SNOMED CT UK Clinical Extension and the January 2022 SNOMED International Edition.

Clinical Content Changes

The following are the counts of new SNOMED concepts added to the respective hierarchy:

• Assessment scale – 8
• Finding – 5
• Observable entity – 16
• Procedure – 9
• Record artefact – 1
• Foundation metadata concept – 2
• Regime/therapy – 2
• Situation -17

The following new concepts have been authored to support the response to the Monkeypox:

Concept	Tag	Preferred Term
1373781000000107	finding	Did not attend for first dose of smallpox virus vaccine
1373791000000109	finding	Did not attend for second dose of smallpox virus vaccine
1373801000000108	finding	Did not attend for third dose of smallpox virus vaccine
1373761000000103	finding	Did not attend smallpox virus vaccination
1373821000000104	regime/therapy	Immunisation course to achieve immunity against monkeypox virus
1373811000000105	regime/therapy	Immunisation course to achieve immunity against smallpox virus
1373891000000101	situation	Smallpox virus immunisation course abandoned
1373861000000107	situation	Smallpox virus immunisation course declined
1373911000000103	situation	Smallpox virus immunisation course completed
1373871000000100	situation	Smallpox virus immunisation course not done
1373841000000106	situation	Smallpox virus immunisation course not indicated
1373881000000103	situation	Smallpox virus immunisation course started
1373621000000100	situation	Smallpox virus vaccination dose declined
1373681000000104	situation	Smallpox virus vaccination dose not given
1373651000000105	situation	Smallpox virus vaccination first dose declined
1373691000000102	situation	Smallpox virus vaccination first dose not given
1373771000000105	situation	Smallpox virus vaccination invitation SMS (short message service) text message sent
1373661000000108	situation	Smallpox virus vaccination second dose declined
1373701000000102	situation	Smallpox virus vaccination second dose not given
1373671000000101	situation	Smallpox virus vaccination third dose declined
1373721000000106	situation	Smallpox virus vaccination third dose not given

Changes To History Substitution And Query Tables From 32.12.0

A bug has been identified in how the History Substitution table determines some values for IS_AMBIGUOUS.

The build algorithm traverses chains of historical associations to identify active substitute(s) for each inactive concept. Where the traversed chain involved both WAS-A and MAYBE flavours of association, the algorithm previously collapsed this into a flavour of MAYBE (IS_AMBIGUOUS = 1 or 3). In the future, it will collapse this into a flavour of WAS-A (IS_AMBIGUOUS = 2). The table size is unaltered; only some values for IS_AMBIGUOUS are changed.

This change in the History Substitution table, however, has a very large direct knock-on effect upon the Query Table: a recomputed Query Table for the 32.10.0 release was 11,769,032 million rows smaller than the published original (11,627,761 rows compared with 23,396,793). Releases of the Query Table starting with 32.12.0 will therefore have similarly reduced row counts.

The algorithmic and semantic basis for the correction to both products is well understood, circumscribed, and defined. The resulting changes involve almost exclusively only the removal of semantically invalid inferences and so are expected to be beneficial overall going forward. However, previous releases of the Query Table did include a small volume of cases of "right answer for wrong reason": some factually correct rows now being removed cannot correctly be derived from the available semantics.

Some level of prior clinical risk may have been associated with the historical publication of incorrect Query Table data. However, a detailed analysis of the Query Table rows now being removed suggests that the huge majority would rarely if ever have been used to drive patient-level care decisions.

SNOMED CT to ICD-10 and OPCS-4 Classification Maps

There are no updates to the ICD-10 or OPCS-4.9 classification maps in this release. The August 2022 SNOMED CT content will be mapped and included in the 35.0.0 – 05 October 2022 SNOMED CT UK Clinical Edition, which will also include the UK maps for SNOMED International Edition February 2022 to July 2022 releases.

Reference sets

The following new References have been added for this release:

1373501000000105    Social prescribing issues simple reference set (foundation metadata concept).

1373511000000107    Social prescribing support procedures simple reference set (foundation metadata concept.

Technical notes

There are currently no planned UK changes. The Proposed SNOMED International changes can be found in the relevant release folder.

Known Issues

There are no known issues for this release.

International Release

The SNOMED CT UK Clinical edition is based on the January 2022 SNOMED International release.

The SNOMED International release notes can be accessed here.

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser, however, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition:  Daily Build SNOMED CT Browser

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT UK Pathology Extension

No changes.

SNOMED CT UK Drug Extension

SNOMED CT UK Drug Extension data is published on a four-weekly cycle.  The reference sets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 34.0.0 release (with dm+d data from release NHSBSA_6.3.0_20220627000001)

of the SNOMED CT UK Drug Extension, will be synchronous with the July 2022 SNOMED CT UK Clinical Extension and the January 2022 SNOMED International Edition.

Clinical Content Changes

The following are the counts of new SNOMED concepts added to the respective hierarchy:

• Assessment scale – 2
• Finding – 1
• Observable entity – 4
• Procedure – 3
• Record artifact – 4

Changes to History Substitution and Query Tables from 32.12.0

A bug has been identified in how the History Substitution table determines some values for IS_AMBIGUOUS.

The build algorithm traverses chains of historical associations in order to identify active substitute(s) for each inactive concept. Where the traversed chain involved both WAS-A and MAYBE flavours of association, the algorithm previously collapsed this into a flavour of MAYBE (IS_AMBIGUOUS = 1 or 3). In future it will collapse this into a flavour of WAS-A (IS_AMBIGUOUS = 2). The table size is unaltered; only some values for IS_AMBIGUOUS are changed.

This change in the History Substitution table, however, has a very large direct knock-on effect upon the Query Table: a recomputed Query Table for the 32.10.0 release was 11,769,032 million rows smaller than the published original (11,627,761 rows compared with 23,396,793). Releases of the Query Table starting with 32.12.0 will therefore have similarly reduced row counts.

The algorithmic and semantic basis for the correction to both products is well understood, circumscribed and defined. The resulting changes involve almost exclusively only the removal of semantically invalid inferences and so are expected to be beneficial overall going forward. However, previous releases of the Query Table did include a small volume of cases of "right answer for wrong reason": some factually correct rows now being removed can not correctly be derived from the available semantics.

Some level of prior clinical risk may have been associated with the historical publication of incorrect Query Table data in particular. However, a detailed analysis of the Query Table rows now being removed suggests that the huge majority would rarely if ever have been used to drive patient-level care decisions.

SNOMED CT to ICD-10 and OPCS-4 Classification Maps

This release incorporates maps for the 33.1.0 – 15 June 2022 and 34.0.0 – 22 July SNOMED CT UK Clinical Edition content, along with the UK maps for the September 2021, October 2021, November 2021, and January 2022 SNOMED International Edition releases. Information on content changes made by SNOMED International can be found in the associated release notes.

Summary detail	Number
New or existing concepts which have been mapped to ICD-10 or assigned an excuse code (excluding #NEW) during this release cycle.	1595
New or existing concepts which have been mapped to OPCS-4 or assigned an excuse code (excluding #NEW) during this release cycle.	407

NB: Map changes between the current and previous release can be found within the Delta mapping file.

Information for future releases 

There will be no updates to the ICD-10 or OPCS-4.9 classification maps in the 34.1.0 August 2022 release. The August 2022 SNOMED CT content will be mapped and included in the 35.0.0 – 05 October 2022 SNOMED CT UK Clinical Edition, which will also include the UK maps for SNOMED International Edition February 2022 to July 2022 releases.

Reference Sets

There are no new Reference sets in this release.

Technical Notes

There are currently no planned UK changes. Proposed SNOMED International changes can be found in the relevant release folder at https://confluence.ihtsdotools.org/display/RMT/SNOMED+International+Release+Management+Home.

Known Issues

There are no known issues for this release.

International Release

The SNOMED CT UK Clinical edition is based on the July 2021 SNOMED International release.

The SNOMED International release notes can be accessed here.

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser, however, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition:  Daily Build SNOMED CT Browser

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT UK Pathology Extension

No changes.

SNOMED CT UK Drug Extension

SNOMED CT UK Drug Extension data is published on a four-weekly cycle.  The reference sets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 33.1.0 release (with dm+d data from release NHSBSA_5.4.0_20220530000001)

of the SNOMED CT UK Drug Extension, will be synchronous with the June 2022 SNOMED CT UK Clinical Extension and the July 2021 SNOMED International Edition.

Clinical Content Changes

The following are the counts of new SNOMED concepts added to the respective hierarchy:

• Assessment Scale - 3
• Disorder - 4
• Event - 6
• Finding - 10
• Observable entity - 10
• Procedure - 4
• Record artifact - 6
• Regime/therapy - 0
• Situation - 14

Clinical content to represent Monkeypox information

• Diagnosis of Monkeypox

For any case of suspected or confirmed Monkeypox infection identified clinicians are advised to use the following code: 359814004 |Monkeypox (disorder)|

This code has been in the SNOMED CT UK Edition since 2002 so should be available in clinical systems. If this code is not available in your clinical system, please contact your system supplier.

It is not recommended that the following code is used: 359811007 |Human monkeypox (disorder)|. This code will be made Inactive in a future release of the SNOMED CT UK Edition. 

• Monkeypox outbreak

To support the response to the ongoing Monkeypox outbreak NHS Digital has authored 38 new concepts:

Concept	Tag	Preferred Term
1290681000000106	assessment scale	Monkeypox severity scale
1290801000000102	disorder	Encephalopathy caused by monkeypox virus
1290821000000106	disorder	Corneal disorder caused by monkeypox virus
1290841000000104	disorder	Sepsis caused by monkeypox virus
1290721000000104	event	Close exposure to monkeypox virus
1310721000000106	event	Close exposure via sexual partner to monkeypox virus
1290411000000102	event	Exposure to confirmed case of monkeypox virus
1290711000000105	event	Exposure to monkeypox virus
1290431000000105	event	Exposure to suspected case of monkeypox virus
1290521000000109	event	Occupational exposure to monkeypox virus
1290741000000106	finding	At increased risk of exposure to monkeypox virus
1290781000000103	finding	High priority for vaccination against monkeypox
1290771000000100	finding	High risk category for developing complication from monkeypox
1290751000000109	finding	Low risk category for developing complication from monkeypox
1290761000000107	finding	Moderate risk category for developing complication from monkeypox
1290831000000108	finding	Monkeypox virus detection result positive
1290881000000107	finding	Monkeypox virus detection result unknown
1290861000000103	finding	Monkeypox virus detection result negative
1290811000000100	observable entity	Monkeypox severity scale score
1290531000000106	observable entity	Monkeypox virus qualitative result
1290551000000104	observable entity	Monkeypox virus DNA (deoxyribonucleic acid) qualitative result by PCR (polymerase chain reaction)
1290471000000107	observable entity	Monkeypox virus DNA (deoxyribonucleic acid) qualitative result in specimen
1290461000000100	observable entity	Monkeypox virus RNA (ribonucleic acid) qualitative result by PCR (polymerase chain reaction)
1290541000000102	observable entity	Monkeypox virus RNA (ribonucleic acid) qualitative result in specimen
1290671000000109	procedure	Assessment using monkeypox severity scale
1290661000000102	procedure	Taking of swab for monkeypox virus
1290441000000101	situation	Advice given about monkeypox
1290421000000108	situation	Advice given about monkeypox by telephone
1290391000000102	situation	Educated about monkeypox
1290891000000109	situation	History of monkeypox
1290641000000103	situation	Monkeypox confirmed by laboratory test
1290651000000100	situation	Monkeypox confirmed using clinical diagnostic criteria
1290581000000105	situation	Monkeypox excluded
1290611000000104	situation	Monkeypox excluded by laboratory test
1290621000000105	situation	Monkeypox excluded using clinical diagnostic criteria
1290511000000103	situation	Provision of advice, assessment or treatment delayed due to monkeypox outbreak
1290481000000109	situation	Provision of advice, assessment or treatment limited due to monkeypox outbreak
1290561000000101	situation	Suspected monkeypox

Changes to History Substitution and Query Tables from 32.12.0

A bug has been identified in how the History Substitution table determines some values for IS_AMBIGUOUS.

The build algorithm traverses chains of historical associations in order to identify active substitute(s) for each inactive concept. Where the traversed chain involved both WAS-A and MAYBE flavours of association, the algorithm previously collapsed this into a flavour of MAYBE (IS_AMBIGUOUS = 1 or 3). In future it will collapse this into a flavour of WAS-A (IS_AMBIGUOUS = 2). The table size is unaltered; only some values for IS_AMBIGUOUS are changed.

This change in the History Substitution table, however, has a very large direct knock-on effect upon the Query Table: a recomputed Query Table for the 32.10.0 release was 11,769,032 million rows smaller than the published original (11,627,761 rows compared with 23,396,793). Releases of the Query Table starting with 32.12.0 will therefore have similarly reduced row counts.

The algorithmic and semantic basis for the correction to both products is well understood, circumscribed and defined. The resulting changes involve almost exclusively only the removal of semantically invalid inferences and so are expected to be beneficial overall going forward. However, previous releases of the Query Table did include a small volume of cases of "right answer for wrong reason": some factually correct rows now being removed can not correctly be derived from the available semantics.

Some level of prior clinical risk may have been associated with the historical publication of incorrect Query Table data in particular. However, a detailed analysis of the Query Table rows now being removed suggests that the huge majority would rarely if ever have been used to drive patient-level care decisions.

SNOMED CT to ICD-10 and OPCS-4 Classification Maps

There are no updates to the ICD-10 or OPCS-4.9 classification maps for this release. The June 2022 SNOMED CT content will be mapped and included in the 34.0.0 – 13 July 2022 SNOMED CT UK Clinical Edition, which will also incorporate the maps for the SNOMED International January 2022 content.

Reference Sets

There are no new Reference sets in this release.

Technical Notes

There are currently no planned UK changes. Proposed SNOMED International changes can be found in the relevant release folder. 

Known Issues

There are no known issues for this release.

International Release

The SNOMED CT UK Clinical edition is based on the July 2021 SNOMED International release.

The SNOMED International release notes are accessible here.

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser, however, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition:  Daily Build SNOMED CT Browser

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT UK Pathology Extension

No changes.

SNOMED CT UK Drug Extension

SNOMED CT UK Drug Extension data is published on a four-weekly cycle.  The reference sets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 33.0.0 release (with dm+d data from release NHSBSA_5.0.0_20220502000001)

of the SNOMED CT UK Drug Extension, will be synchronous with the May 2022 SNOMED CT UK Clinical Extension and the July 2021 SNOMED International Edition.

Clinical Content Changes

• Assessment scale – 1
• Disorder – 0
• Finding – 3
• Observable entity – 1
• Procedure – 9
• Record artifact – 2
• Regime/therapy – 0
• Situation – 4

Changes to History Substitution and Query Tables from 32.12.0

A bug has been identified in how the History Substitution table determines some values for IS_AMBIGUOUS.

The build algorithm traverses chains of historical associations in order to identify active substitute(s) for each inactive concept. Where the traversed chain involved both WAS-A and MAYBE flavours of association, the algorithm previously collapsed this into a flavour of MAYBE (IS_AMBIGUOUS = 1 or 3). In future it will collapse this into a flavour of WAS-A (IS_AMBIGUOUS = 2). The table size is unaltered; only some values for IS_AMBIGUOUS are changed.

This change in the History Substitution table, however, has a very large direct knock-on effect upon the Query Table: a recomputed Query Table for the 32.10.0 release was 11,769,032 million rows smaller than the published original (11,627,761 rows compared with 23,396,793). Releases of the Query Table starting with 32.12.0 will therefore have similarly reduced row counts.

The algorithmic and semantic basis for the correction to both products is well understood, circumscribed and defined. The resulting changes involve almost exclusively only the removal of semantically invalid inferences and so are expected to be beneficial overall going forward. However, previous releases of the Query Table did include a small volume of cases of "right answer for wrong reason": some factually correct rows now being removed can not correctly be derived from the available semantics.

Some level of prior clinical risk may have been associated with the historical publication of incorrect Query Table data in particular. However, a detailed analysis of the Query Table rows now being removed suggests that the huge majority would rarely if ever have been used to drive patient-level care decisions.

SNOMED CT to ICD-10 and OPCS-4 Classifications Maps

This release includes the maps for the 32.12.0 – 20 April 2022 and 33.0.0 - 18 May 2022 SNOMED CT UK clinical content, along with the UK maps for the SNOMED International July 2021 content.

The solution deployed to resolve the issue of the previously reported  duplicate rows within the mapping files continues to show no evidence of reoccurrence. However, any historical duplications prior to deployment will remain in the files.

Summary detail
New or existing concepts which have been mapped to ICD-10 or assigned an excuse code (excluding #NEW) during this release cycle.	1924
New or existing concepts which have been mapped to OPCS-4 or assigned an excuse code (excluding #NEW) during this release cycle.	359

NB: Map changes between the current and previous release can be found within the Delta mapping file.

Information for future releases

There will be no updates to the ICD-10 or OPCS-4.9 classification maps in the 33.1.0 – 15 June 2022 release. The June 2022 SNOMED CT content will be mapped and included in the 34.0.0 – 13 July 2022 SNOMED CT UK Clinical Edition, which will also incorporate the maps for the SNOMED International January 2022 content.

Reference Sets

There are no new Reference sets in this release.

Technical Notes

There are currently no planned UK changes. Proposed SNOMED International changes can be found in the relevant release folder.

Known Issues

There are no known issues for this release.

International Release

The SNOMED CT UK Clinical edition is based on the January 2021 SNOMED International release.

The SNOMED International release notes are accessible here.

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser, however, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition:  Daily Build SNOMED CT Browser

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT UK Pathology Extension

No changes.

SNOMED CT UK Drug Extension

SNOMED CT UK Drug Extension data is published on a four-weekly cycle.  The reference sets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 32.12.0 release (with dm+d data from release NHSBSA_4.0.0_20220404000001) of the SNOMED CT UK Drug Extension, will be synchronous with the April 2022 SNOMED CT UK Clinical Extension and the January 2021 SNOMED International Edition.

Clinical Content Changes

The following are the counts of new SNOMED concepts added to the respective hierarchy:

• Assessment scale – 0
• Disorder – 3
• Finding - 0
• Observable entity - 8
• Procedure - 4
• Record artifact - 0
• Regime/therapy - 0
• Situation - 13

Changes to History Substitution and Query Tables from 32.12.0

A bug has been identified in how the History Substitution table determines some values for IS_AMBIGUOUS.

The build algorithm traverses chains of historical associations in order to identify active substitute(s) for each inactive concept. Where the traversed chain involved both WAS-A and MAYBE flavours of association, the algorithm previously collapsed this into a flavour of MAYBE (IS_AMBIGUOUS = 1 or 3). In future it will collapse this into a flavour of WAS-A (IS_AMBIGUOUS = 2). The table size is unaltered; only some values for IS_AMBIGUOUS are changed.

This change in the History Substitution table, however, has a very large direct knock-on effect upon the Query Table: a recomputed Query Table for the 32.10.0 release was 11,769,032 million rows smaller than the published original (11,627,761 rows compared with 23,396,793). Releases of the Query Table starting with 32.12.0 will therefore have similarly reduced row counts.

The algorithmic and semantic basis for the correction to both products is well understood, circumscribed and defined. The resulting changes involve almost exclusively only the removal of semantically invalid inferences and so are expected to be beneficial overall going forward. However, previous releases of the Query Table did include a small volume of cases of "right answer for wrong reason": some factually correct rows now being removed can not correctly be derived from the available semantics.

Some level of prior clinical risk may have been associated with the historical publication of incorrect Query Table data in particular. However, a detailed analysis of the Query Table rows now being removed suggests that the huge majority would rarely if ever have been used to drive patient-level care decisions.

SNOMED CT to ICD-10 and OPCS-4 Classifications Maps

There are no updates to the ICD-10 or OPCS-4.9 classification maps for this release. The maps for the 32.12.0 - 20 April 2022 content will be included in the 33.0.0 - 18 May 2022 SNOMED CT UK Clinical Edition, along with the maps for the SNOMED International July 2021 content.

Information for future releases

Should there be a requirement for the World Health Organization (WHO) to issue further emergency instructions outside of a scheduled SNOMED CT release (as was the case for COVID-19), the end user will need to assign the emergency ICD-10 code(s) manually via the ICD-10 Codes and Titles Metadata files (see the ‘SNOMED CT to ICD-10 and OPCS-4 Map Table Technical Specification and Implementation Guidance (UK Edition)’ release document for additional information). 

Reference Sets

There are no new Reference sets in this release.

Technical Notes

There are currently no planned UK changes. Proposed SNOMED International changes can be found in the relevant release folder.

Known Issues

There are no known issues for this release.

International Release

The SNOMED CT UK Clinical edition is based on the January 2021 SNOMED International release.

The SNOMED International release notes are accessible here.

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser, however, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition:  Daily Build SNOMED CT Browser.

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT UK Pathology Extension

No changes.

SNOMED CT UK Drug Extension

SNOMED CT UK Drug Extension data is published on a four-weekly cycle.  The refsets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 32.10.0 release (with dm+d data from release NHSBSA_2.0.0_20220207000001) of the SNOMED CT UK Drug Extension, will be synchronous with the February 2022 SNOMED CT UK Clinical Extension and the January 2021 SNOMED International Edition.

Clinical Content Changes

The following are the counts of new SNOMED concepts added to the respective hierarchy:

• Regime/therapy – 6
• Procedure – 11
• Finding – 11
• Assessment scale – 3
• Disorder – 0
• Observable entity – 5
• Record artifact – 4
• Situation – 13

SNOMED CT to ICD-10 and OPCS-4 Classification Maps

Summary detail	Number
New or existing concepts which have been mapped to ICD-10 or assigned an excuse code during this release cycle.	188
New or existing concepts which have been mapped to OPCS-4 or assigned an excuse code during this release cycle.	91

NB: Map changes between the current and previous release can be found within the Delta mapping file.

Information for future releases 

There will be no updates to the ICD-10 or OPCS-4.9 classification maps in the 32.12.0 20 April 2022 release. The April 2022 SNOMED CT content will be mapped and included in the 33.0.0 - 18 May 2022 SNOMED CT UK Clinical Edition, which will also incorporate the maps for the SNOMED International July 2021 content.

Should there be a requirement for the World Health Organization (WHO) to issue further emergency instructions outside of a scheduled SNOMED CT release (as was the case for COVID-19), the end user will need to assign the emergency ICD-10 code(s) manually via the ICD-10 Codes and Titles Metadata files (see the ‘SNOMED CT to ICD-10 and OPCS-4 Map Table Technical Specification and Implementation Guidance (UK Edition)’ release document for additional information). 

Reference Sets

There are no new Reference sets in this release.

The following two refsets have been inactivated in this release:

• 999000381000000107 - Correspondence care setting type simple reference set (foundation metadata concept)
• 999000391000000109 - Correspondence document type simple reference set (foundation metadata concept)

Technical Notes

There are currently no planned UK changes. Proposed SNOMED International changes can be found in the relevant release folder.

Known Issues

There are no known issues for this release.

International release

The SNOMED CT UK Clinical edition is based on the January 2021 SNOMED International release.

The SNOMED International release notes can be found online at: SNOMED CT January 2021 International Edition release notes

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser, however, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition: Daily Build SNOMED CT Browser

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT UK Pathology extension

No changes.

SNOMED CT UK Drug extension

SNOMED CT UK Drug Extension data is published on a four-weekly cycle. The refsets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 32.6.0 release (with dm+d data from release NHSBSA_11.2.0_20211115000001) of the SNOMED CT UK Drug Extension, will be synchronous with the December 2021 SNOMED CT UK Clinical Extension and the January 2021 SNOMED International Edition.

Clinical Content Changes

The following are the counts of new SNOMED concepts added to the respective hierarchy:

• Regime/therapy – 11
• Procedure – 15
• Finding – 20
• Assessment scale – 4
• Disorder – 3
• Observable entity – 6
• Record artifact – 1
• Situation – 12

SNOMED CT to ICD-10 and OPCS-4 Classification Maps 

The concept 1365731000000103 Vaccine-induced prothrombotic immune thrombocytopenia (disorder), authored as part of the 32.6.0 - 03-Nov-2021 micro release, is now included in the mapping tables along with the associated ICD-10 map.

Summary detail	Number
New concepts mapped to ICD-10 or assigned an excuse code (excluding #NEW) during this release cycle.	4
Existing concepts mapped to ICD-10 or assigned an excuse code updated during this release cycle.	99
New concepts mapped to OPCS-4 or assigned an excuse code (excluding #NEW) during this release cycle.	33
Existing concepts mapped to OPCS-4 or assigned an excuse code updated during this release cycle.	195

Please Note: Map changes between the current and previous release can be found within the Delta mapping file.

Information for future releases

Should there be a requirement for the World Health Organization (WHO) to issue further emergency instructions outside of a scheduled SNOMED CT release (as was the case for COVID-19), the end user will need to assign the emergency ICD-10 code(s) manually via the ICD-10 Codes and Titles Metadata files (see the ‘SNOMED CT to ICD-10 and OPCS-4 Map Table Technical Specification and Implementation Guidance (UK Edition)’ release document for additional information).

Reference sets 

There are no new Reference sets in this release.

Technical notes 

There are currently no planned UK changes. Proposed SNOMED International changes can be found in the relevant release folder here.

Known issues 

There are no known issues for this release.

International release

The SNOMED CT UK Clinical edition is based on the January 2021 SNOMED International release.

The SNOMED International release notes can be found online at: SNOMED CT January 2021 International Edition release notes

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser, however, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition: Daily Build SNOMED CT Browser

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT UK Pathology extension

No changes.

SNOMED CT UK Drug extension

SNOMED CT UK Drug Extension data is published on a four-weekly cycle. The refsets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 32.5.0 release (with dm+d data from release NHSBSA_9.2.0_20210920000001) of the SNOMED CT UK Drug Extension, will be synchronous with the October 2021 SNOMED CT UK Clinical Extension and the January 2021 SNOMED International Edition.

Clinical Content Changes

The following new SNOMED concepts have been added:

• 1365751000000105

FSN Application for medical exemption from severe acute respiratory syndrome coronavirus 2 vaccination approved (finding)

PT Application for medical exemption from COVID-19 vaccination approved

• 1365761000000108

FSN Application for medical exemption from severe acute respiratory syndrome coronavirus 2 vaccination rejected (finding)

PT Application for medical exemption from COVID-19 vaccination rejected

• 1365731000000103

FSN Vaccine-induced prothrombotic immune thrombocytopenia (disorder)

PT VITT - vaccine-induced immune thrombotic thrombocytopenia

Please note: we will not be updating the NHS Digital SNOMED CT Browser with the 32.6.0 release. These changes will be apparent when we update to the 32.7.0 release in December.

SNOMED CT to ICD-10 and OPCS-4 Classification Maps 

The ICD-10 map for 1365731000000103 Vaccine-induced prothrombotic immune thrombocytopenia (disorder) will be included in 32.7.0 - 01 December 2021 release.

The concepts 1365751000000105 Application for medical exemption from severe acute respiratory syndrome coronavirus 2 vaccination approved (finding) and 1365761000000108 Application for medical exemption from severe acute respiratory syndrome coronavirus 2 vaccination rejected (finding) are out of scope of ICD-10.

Information for future releases 

Should there be a requirement for the World Health Organization (WHO) to issue further emergency instructions outside of a scheduled SNOMED CT release (as was the case for COVID-19), the end user will need to assign the emergency ICD-10 code(s) manually via the ICD-10 Codes and Titles Metadata files (see the ‘SNOMED CT to ICD-10 and OPCS-4 Map Table Technical Specification and Implementation Guidance (UK Edition)’ release document for additional information).

Reference sets 

There are no new Reference sets in this release:

Technical notes 

There are currently no planned UK changes. Proposed SNOMED International changes can be found in the relevant release folder at https://confluence.ihtsdotools.org/display/RMT/SNOMED+International+Release+Management+Home.

Known issues 

There are no known issues for this release.

International release

The SNOMED CT UK Clinical edition is based on the January 2021 SNOMED International release.

The SNOMED International release notes can be found online at:

SNOMED CT January 2021 International Edition release notes

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser, however, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition:  Daily Build SNOMED CT Browser

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT UK Pathology extension

Following the approval of the DAPB4017 Pathology Test and Results Standard by the Data Alliance Partnership Board we are pleased to announce version 1.0.0 of the Unified Test List has now been published on TRUD in machine-readable form as the SNOMED CT UK Pathology Extension.

This release contains 4,220 SNOMED CT concepts:

• 3866 reportable observable entities
• 354 requestable procedure codes
• Replacements for all legacy Pathology Bounded Code List concepts
• Full coverage for Blood Sciences and Microbiology specialisms

Pathology and Diagnostics Information Standards Collaboration Space

SNOMED CT UK Drug extension

SNOMED CT UK Drug Extension data is published on a four-weekly cycle.  The refsets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 32.5.0 release (with dm+d data from release NHSBSA_9.2.0_20210920000001) of the SNOMED CT UK Drug Extension, will be synchronous with the October 2021 SNOMED CT UK Clinical Extension and the January 2021 SNOMED International Edition.

Clinical Content Changes

New SNOMED CT UK clinical extension concepts per hierarchy:

• Regime/therapy – 5 new concepts
• Qualifier value hierarchy – 9 new concepts
• Person hierarchy – 1 new concept
• Event hierarchy – 0 new concepts
• Clinical finding – 5 new concepts
• Assessment scale hierarchy – 2 new concepts
• Disorder hierarchy – 1 new concepts
• Observable entity hierarchy – 43 new concepts
• Procedure hierarchy – 22 new concepts
• Record artifact hierarchy – 34 new concepts
• Situation with explicit context –  37 new concepts

0 UK concepts have been inactivated that are duplicates of international content.

0 foundation metadata concepts have been inactivated.

14 concepts have been inactivated with replacements in the SNOMED CT Pathology extension, in accordance with the Unified Test List design principles for pathology and diagnostics SNOMED CT concepts.

‘On examination’ and ‘Complaining of’ concepts 

We are aware of an ongoing issue with the NHS Digital SNOMED CT browser (Termbrowser) which means the reactivated ‘On examination’ and ‘Complaining of’ concepts are not displayed correctly. We are working to fix the issue. Further updates will be provided here.

There will also be a slight delay in the update of the NHS Digital SNOMED CT browser for the 32.5.0 release.

SNOMED CT codes relating to COVID-19 Vaccination

New SNOMED CT concepts have been added to enable the recording of the maintenance protection course against SARS-CoV-2. The new content and further detailed information can be found in the COVID-19 Vaccination codes section on the COVID-19 Information Standards page.

SNOMED CT to ICD-10 and OPCS-4 Classification Maps 

A solution for the previously reported issue of duplicate rows within the mapping files has been deployed, with no evidence of reoccurrence for this release. We will continue to monitor the situation for future releases, to check for any ongoing issues.

Due to work being carried out to resolve the duplicate row issue, the number of map changes are smaller than usual.  Updates of note include the remapping of over 90 ‘situation’ concepts previously allocated a ‘#NC’ excuse code and the inclusion maps for the COVID-19 vaccination content released in the 32.4.0 Micro – 08 September 2021 SNOMED CT UK Clinical Edition.

Summary detail	Number
New or existing concepts which have been mapped to ICD-10 or assigned an excuse code (excluding #NEW) during this release cycle.	191
New or existing concepts which have been mapped to OPCS-4 or assigned an excuse code (excluding #NEW) during this release cycle.  Please note: All map changes between the current and previous release can be found within the Delta mapping file.	144

Information for future releases 

Should there be a requirement for the World Health Organization (WHO) to issue further emergency instructions outside of a scheduled SNOMED CT release (as was the case for COVID-19), the end user will need to assign the emergency ICD-10 code(s) manually via the ICD-10 Codes and Titles Metadata files (see the ‘SNOMED CT to ICD-10 and OPCS-4 Map Table Technical Specification and Implementation Guidance (UK Edition)’ release document for additional information). 

Reference sets 

There are no new Reference sets in this release.

Notice of deprecation of reference sets 

There are no reference sets due for deprecation in the next release.

Unfortunately, we are not currently in a position to proceed with requests for new reference sets at this time. Any requests we receive are being escalated and NHS Digital is currently reviewing the processes for reference set production. You may wish to submit a request via the Request Submission Portal so it can follow this escalation process.

 Technical notes 

There are currently no planned UK changes. Proposed SNOMED International changes can be found in the relevant release folder.

Known issues 

There are no known issues for this release.

International release

The SNOMED CT UK Clinical edition is based on the January 2021 SNOMED International release.

The SNOMED International release notes can be found online at:

SNOMED CT January 2021 International Edition release notes

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser, however, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition:  Daily Build SNOMED CT Browser

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT UK Drug extension

SNOMED CT UK Drug Extension data is published on a four-weekly cycle.  The refsets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 32.0.0 release (with dm+d data from release NHSBSA_6.3.0_20210628000001) of the SNOMED CT UK Drug Extension, will be synchronous with the July 2021 SNOMED CT UK Clinical Extension and the January 2021 SNOMED International Edition. It will be available on 14 July 2021.

Clinical Content Changes

New SNOMED CT UK clinical extension concepts per hierarchy:

• Regime/therapy – 4 new concepts
• Qualifier value hierarchy – 3 new concepts
• Person hierarchy – 1 new concept
• Event hierarchy – 1 new concept
• Clinical finding – 11 new concepts
• Assessment scale hierarchy – 2 new concepts
• Disorder hierarchy – 2 new concepts
• Observable entity hierarchy – 2 new concepts
• Procedure hierarchy – 15 new concepts
• Record artefact hierarchy – 15 new concepts
• Situation with explicit context – 37 new concepts

18 UK concepts have been inactivated that are duplicates of international content.

A further 10 foundation metadata concepts have been inactivated.

‘On examination’ and ‘Complaining of’ concepts 

Please note we are aware of an ongoing issue with the NHS Digital SNOMED CT browser (Termbrowser) which means the reactivated ‘On examination’ and ‘Complaining of’ concepts are not displayed correctly. We are working to fix the issue. Further updates will be provided here.

There will also be a slight delay in the update of the NHS Digital SNOMED CT browser for the 32.2.0 release.

SNOMED CT codes relating to COVID-19 Vaccination

New SNOMED CT concepts have been added to enable the recording of the maintenance protection course against SARS-CoV-2. The new content and further detailed information can be found in the COVID-19 Vaccination codes section on the COVID-19 Information Standards page.

SNOMED CT to ICD-10 and OPCS-4 Classification Maps

The majority of changes in this release are quality improvements to existing map content,  

Summary detail	Number
New or existing concepts which have been mapped to ICD-10 or assigned an excuse code (excluding #NEW) during this release cycle.	953
New or existing concepts which have been mapped to OPCS-4 or assigned an excuse code (excluding #NEW) during this release cycle.  There is a known issue of duplicate rows within the cross-map files. This has been present for several releases and we are currently investigating the issue.	476

Information for future releases 

Should there be a requirement for the World Health Organization (WHO) to issue further emergency instructions outside of a scheduled SNOMED CT release (as was the case for COVID-19), the end user will need to assign the emergency ICD-10 code(s) manually via the ICD-10 Codes and Titles Metadata files (see the ‘SNOMED CT to ICD-10 and OPCS-4 Map Table Technical Specification and Implementation Guidance (UK Edition)’ release document for additional information). 

Reference sets

There are no new Reference sets in this release:

Notice of deprecation of reference sets 

There are no reference sets due for deprecation in the next release.

Unfortunately, we are not currently in a position to proceed with requests for new reference sets at this time. Any requests we receive are being escalated and NHS Digital is currently reviewing the processes for reference set production. You may wish to submit a request via the Request Submission Portal so it can follow this escalation process.

 Technical notes 

There are currently no planned UK changes. Proposed SNOMED International changes can be found in the relevant release folder.

Known issues 

There are no known issues for this release.

International release

The SNOMED CT UK Clinical edition is based on the January 2021 SNOMED International release.

The SNOMED International release notes can be found online at:

SNOMED CT January 2021 International Edition release notes

You can find upcoming changes to the SNOMED International Edition release using the SNOMED International daily build browser, however, please note that these changes should not be used in the UK until they are released as part of the SNOMED CT UK Edition:  Daily Build SNOMED CT Browser

Please find early visibility of SNOMED International releases using the SNOMED International Release Management page, this incorporates early visibility for the upcoming release and also history of early visibility information.

SNOMED CT Drug extension

SNOMED CT UK Drug Extension data is published on a four-weekly cycle.  The refsets and bonus files supplied as part of the SNOMED CT UK Drug Extension are also updated and released on a four-weekly basis.

The 32.0.0 release (with dm+d data from release NHSBSA_5.0.0_20210503000001) of the SNOMED CT UK Drug Extension, will be synchronous with the May 2021 SNOMED CT UK Clinical Extension and the January 2021 SNOMED International Edition. It will be available on 19 May 2021.

Clinical Content Changes

• Situation with explicit context – 4 new concepts
• Clinical finding – 6 new concepts
• New SNOMED CT UK clinical extension concepts per hierarchy
• Procedure hierarchy – 5 new concepts
• Foundation metadata concepts – 2 new concepts

1 procedure concept has been reactivated for national reporting purposes

‘On examination’ and ‘Complaining of’ concepts

In the January 2021 International release content relating to ‘On examination’ and ‘Complaining of’ concepts have been inactivated. A decision was made by the UK Edition Committee that this content needed to be made active in the UK Clinical extension due to the usage of these concepts in primary care. This content has been reactivated for the 32.0.0 release of the SNOMED CT UK Clinical Edition.

Approximately 2000 ‘On examination’ and ‘Complaining of’ concepts have been reactivated. This means that the concepts become active in the UK clinical extension and the concept id and description ids remain the same. Due to the quantity of content to be reactivated there were technical and time limitations that meant it was not possible to fully replicate the previous hierarchical placement of the concepts. There is an expected consequence that this incomplete restoration of previous hierarchical placement may impact on data extraction and analysis.

To ensure a consistent and reproducible approach to reactivating the ‘On examination’ and ‘Complaining of’ content the previous hierarchical relationships were technically generated and where a single supertype concept was assigned to each concept, this was accepted and became the new supertype of the concept (this may have been either the inferred or stated supertype previously).

 Where the technically generated output reported concepts that had two supertype concepts, the Levenshtein distance between the reactivated Fully Specified Name (FSN) and each candidate supertype concept FSN was calculated and the lowest calculation used to assign the supertype. If the Levenshtein distance was the same, alphabetic order was used to assign the supertype.   

A strategy will be developed to address the review of this content and appropriate inactivation of the content in line with use cases and concept usage in the UK.

Please note we are aware of an issue with the NHS Digital SNOMED CT browser (Termbrowser) which means the reactivated ‘On examination’ and ‘Complaining of’ concepts are not displayed correctly. We are working to fix the issue. Further updates will be provided here.

 Advice on competing International and UK SNOMED CT codes 

NHS Digital are aware of a number of new codes in the January 2021 International data (and thus in the May 2021 UK Edition) of SNOMED CT which may interfere with established UK recording of certain COVID-19 and SARS-CoV-2 data items, in particular diagnostic codes for the long-term effects of COVID-19, SARS-CoV-2 vaccinations and adverse reactions and SARS-CoV-2 antibody test results. A document “COVID-19 and SARS-CoV-2 in SNOMED CT: Advice on competing International and UK codes” has been produced which highlights the issues and provides advice on steps that can be taken to minimise the impact on data quality.

SNOMED CT to ICD-10 and OPCS-4 Classification Maps

The main change to the mapping files is the incorporation of the UK maps for the SNOMED International January 2021 release content. There are also new maps for a small number of new high priority UK concepts, along with some quality improvements to existing map content.  

Summary detail	Number
New or existing concepts which have been mapped to ICD-10 or assigned an excuse code (excluding #NEW) during this release cycle.	2258
New or existing concepts which have been mapped to OPCS-4 or assigned an excuse code (excluding #NEW) during this release cycle.	397

Information for future releases

Should there be a requirement for the World Health Organization (WHO) to issue further emergency instructions outside of a scheduled SNOMED CT release (as was the case for COVID-19), the end user will need to assign the emergency ICD-10 code(s) manually via the ICD-10 Codes and Titles Metadata files (see the ‘SNOMED CT to ICD-10 and OPCS-4 Map Table Technical Specification and Implementation Guidance (UK Edition)’ release document for additional information). 

Reference sets

There are two new reference sets in this release:

• 1326321000000103 Post-COVID assessment service simple reference set
• 1326311000000109 Long term effects of COVID-19 primary care simple reference set

Notice of deprecation of reference sets

As per release documentation published in 30.0.0 August 2020 there are plans to deprecate the following reference sets for the 32.2.0 July 2021 release.

• 999000391000000109 Correspondence document type simple reference set
• 999000191000000106 Care planning patient outgoing referral simple reference set
• 999001591000000108 Assessment scale simple reference set
• 999000261000000107 Adverse reaction propensity simple reference set
• 999002331000000109 Assessment scale observables simple reference set
• 999000381000000107 Correspondence care setting type simple reference set
• 999000401000000107 Device type simple reference set

Unfortunately we are not currently in a position to proceed with requests for new reference sets at this time. Any requests we receive are being escalated and NHS Digital is currently reviewing the processes for reference set production. You may wish to submit a request via the Request Submission Portal so it can follow this escalation process.

Technical notes

There are currently no planned UK changes. Proposed SNOMED International changes can be found in the relevant release folder.

Known issues 

There are no known issues for this release.