US Edition of SNOMED CT(R): September 2016 Release Introduction The US Edition of SNOMED CT is a combination of the full July 2016 SNOMED CT International Release and the US Extension to SNOMED CT. The US Edition eliminates the need for implementers to manually combine the US Extension and the International Release. In 2015, the IHTSDO has announced the deprecation and withdrawal of support for RF1 format. The NLM will align with the deprecation timeline for the US Edition RF1 release. The September 2016 Release of the US Edition of SNOMED CT will mark the last time that NLM will make the RF1 release file available for download. For future releases, users must download the RF2 version of the US Edition of SNOMED CT. September 2016 US Extension Statistics * New concepts added: 565 * (disorder) 406 * (finding) 93 * (situation) 22 * (procedure) 20 * (qualifier) 13 * (person) 2 * (morphologic) 2 * (body) 2 * (substance) 1 * (specimen) 1 * (product) 1 * (physical) 1 * (event) 1 * Concepts inactivated 1 * Concepts moved to core (this release) 0 * Concepts moved to core (all time) 53 * Concepts promoted to core (this release) 0 * Concepts promoted to core (all time) 257 (and not defaulted back to extension) * Concepts defaulted to core (this release) 1 * Concepts defaulted to core (all time) 5 (and not promoted again back to extension) * Concepts moved from core (this release) 0 * Concepts moved from core (all time) 4 * Active concepts in US Extension 5356 * Retired concepts in US Extension 368 (including moved concepts) * Active descriptions in US Extension 13801 * Synonyms of International Edition concepts 439 * Active (inferred) rels in US Extension 21654 * Between of International Edition concepts 106 * Active (inferred ISA) rels in US Edition 850696 * Retired (inferred ISA) rels in US Edition 363187 The US Edition of SNOMED CT is provided in UTF-8 encoded tab-delimited flat files which can be imported into any database or other software application. The US Edition of SNOMED CT is not software. NLM performs quality assurance checks to ensure that US Edition data fully conforms to both RF1 and RF2 specifications. File description Edition files are designed as tab-delimited text files to be used as relational tables with each line in the file representing a row in the table. The first row of each table contains column headings. All other rows contain data. The September 2016 US Edition is distributed in both RF1 and RF2 formats in two separate zip file: SnomedCT_RF1Release_US1000124_20160901.zip (63 MB) and SnomedCT_RF2Release_US1000124_20160901.zip (409 MB). Edition Files contain US Extension specific content and the full International release content providing a comprehensive compilation of the content from both sources. US Edition releases in both RF1 and RF2 contain files that correspond to SNOMED CT files and are described in the "SNOMED CT(R) Technical Implementation Guide, International Release." The TIG can be found on the IHTSDO SNOMED CT Documentation page https://confluence.ihtsdotools.org/display/DOC/Release+Documents More information on the US Edition of SNOMED CT is available at https://www.nlm.nih.gov/healthit/snomedct/index.html File Structure bytes Readme_en_20160901.txt 10798 bytes Delta Refset Content der2_cRefset_AssociationReferenceDelta_US1000124_20160901.txt 31685 bytes der2_cRefset_AttributeValueDelta_US1000124_20160901.txt 112694 bytes der2_Refset_SimpleDelta_US1000124_20160901.txt 65 bytes Language der2_cRefset_LanguageDelta-en_US1000124_20160901.txt 2049917 bytes Map der2_iisssccRefset_ExtendedMapDelta_US1000124_20160901.txt 706113 bytes der2_sRefset_SimpleMapDelta_US1000124_20160901.txt 540306 bytes Metadata der2_cciRefset_RefsetDescriptorDelta_US1000124_20160901.txt 1290 bytes der2_ciRefset_DescriptionTypeDelta_US1000124_20160901.txt 101 bytes der2_ssRefset_ModuleDependencyDelta_US1000124_20160901.txt 1157 bytes Terminology sct2_Concept_Delta_US1000124_20160901.txt 211052 bytes sct2_Description_Delta-en_US1000124_20160901.txt 1275723 bytes sct2_Identifier_Delta_US1000124_20160901.txt 92 bytes sct2_Relationship_Delta_US1000124_20160901.txt 2227101 bytes sct2_StatedRelationship_Delta_US1000124_20160901.txt 1262348 bytes sct2_TextDefinition_Delta-en_US1000124_20160901.txt 352331 bytes Documentation doc_Icd10cmMapReleaseNotes_Current-en-US_US1000124_20160301.pdf 284236 bytes doc_Icd10cmMapTechnicalGuideExemplars_Current-en-US_US1000124_20160301.xlsx 147087 bytes doc_Icd10cmMapTechnicalSpecifications_Current-en-US_US1000124_20160301.pdf 663223 bytes doc_Icd10MapTechnicalGuideExemplars_Current-en-US_US1000124_20160301.xlsx 113959 bytes doc_SnomedCTReleaseNotes_Current_en-US_US1000124_20160901.pdf 542912 bytes tls_Icd10cmHumanReadableMap_US1000124_20160301.tsv 42540830 bytes Full Refset Content der2_cRefset_AssociationReferenceFull_US1000124_20160901.txt 15317644 bytes der2_cRefset_AttributeValueFull_US1000124_20160901.txt 68654297 bytes der2_Refset_SimpleFull_US1000124_20160901.txt 12721 bytes Language der2_cRefset_LanguageFull-en_US1000124_20160901.txt 332737926 bytes Map der2_iisssccRefset_ExtendedMapFull_US1000124_20160901.txt 79479404 bytes der2_sRefset_SimpleMapFull_US1000124_20160901.txt 91582926 bytes Metadata der2_cciRefset_RefsetDescriptorFull_US1000124_20160901.txt 12889 bytes der2_ciRefset_DescriptionTypeFull_US1000124_20160901.txt 619 bytes der2_ssRefset_ModuleDependencyFull_US1000124_20160901.txt 12106 bytes Terminology sct2_Concept_Full_US1000124_20160901.txt 32436960 bytes sct2_Description_Full-en_US1000124_20160901.txt 206733400 bytes sct2_Identifier_Full_US1000124_20160901.txt 92 bytes sct2_Relationship_Full_US1000124_20160901.txt 534245494 bytes sct2_StatedRelationship_Full_US1000124_20160901.txt 101059035 bytes sct2_TextDefinition_Full-en_US1000124_20160901.txt 743509 bytes Snapshot Refset Content der2_cRefset_AssociationReferenceSnapshot_US1000124_20160901.txt 14153091 bytes der2_cRefset_AttributeValueSnapshot_US1000124_20160901.txt 49704496 bytes der2_Refset_SimpleSnapshot_US1000124_20160901.txt 12721 bytes Language der2_cRefset_LanguageSnapshot-en_US1000124_20160901.txt 291186804 bytes Map der2_iisssccRefset_ExtendedMapSnapshot_US1000124_20160901.txt 64320635 bytes der2_sRefset_SimpleMapSnapshot_US1000124_20160901.txt 91341641 bytes Metadata der2_cciRefset_RefsetDescriptorSnapshot_US1000124_20160901.txt 10539 bytes der2_ciRefset_DescriptionTypeSnapshot_US1000124_20160901.txt 489 bytes der2_ssRefset_ModuleDependencySnapshot_US1000124_20160901.txt 3969 bytes Terminology sct2_Concept_Snapshot_US1000124_20160901.txt 25887359 bytes sct2_Description_Snapshot-en_US1000124_20160901.txt 168342876 bytes sct2_Identifier_Snapshot_US1000124_20160901.txt 92 bytes sct2_Relationship_Snapshot_US1000124_20160901.txt 284517285 bytes sct2_StatedRelationship_Snapshot_US1000124_20160901.txt 87666678 bytes sct2_TextDefinition_Snapshot-en_US1000124_20160901.txt 722751 bytes License requirement The US Edition to SNOMED CT is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov. This material includes SNOMED Clinical Terms(R) (SNOMED CT(R)) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO). All rights reserved. SNOMED CT was originally created by the College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHSTDO. You must have a UMLS license and UTS account to access SNOMED CT International and US Edition files. License information is available from the UTS at https://uts.nlm.nih.gov. Known Issues In addition to the known issues reported by the IHTSDO for the International Release of SNOMED CT (https://confluence.ihtsdotools.org/pages/viewpage.action?spaceKey=RMT&title=IHTSDO+Known+Issue+register), the following are known bugs for the US Edition of SNOMED CT: • Duplicated stated relationships. An issue within the authoring tooling platform leads to duplicated stated relationships in the Stated Relationships file. A technical fix in the future will correct the issues. • A large number of US Extension inferred relationships have an effectivetime later than the associated International release. The US NRC will continue to work with the IHTSDO on solutions. Currently there is no timeframe set for fix. • A small number of US Extension concepts with an ISA relationship to an inactive CORE concept. The US NRC is working with the IHTSDO on a fix which will be updated in future US Edition releases. • An inactive extension concept (1561000119105|20160901) without corresponding historical relationship. Found in the AttributeValue file. Currently no fix is planned. • An active extension concept (1561000119105) without an active ISA relationship. Transferred to core (20130731) and the core later inactivated (20150131). The US NRC is working with the IHTSDO on a fix which will be updated in future US Edition releases. • The SNOMED CT to ICD-10-CM map (6011000124106) data are not synchronized with the 21060901 data. A patch will be sent once the data are synchronized. • Discrepancy of relationship IDs in the RF1 20150901 and 20160301 releases. All relationshipids have been corrected in the 20160301 release. • A number of extension concepts are without an IS A relationships in the RF1 relationships file. The reported concepts have IS A relationships in the RF2 release. The error is due to the deprecation of RelationshipId data from the CORE (due to the deprecation policy). No fix is scheduled due to deprecation of RF1; it is advised that RF2 is used. Feedback and suggestions We welcome questions, comments or suggestions to improve the quality, accuracy and usability of the Edition. Please send feedback to NLM Customer service to custserv@nlm.nih.gov, or submit your request via https://support.nlm.nih.gov/ics/support/ticketnewwizard.asp?style=classic&deptID=28054&category=snomed_ct U.S. National Library of Medicine September 1, 2016