SNOMED

Core Structures
2nd AAHA Software Vendors Summit – April 21, 2009
Terminology of Terminology
• Concept
• embodiment of a particular meaning
• Really a “virtual” element in the system
• The string in concepts table is a member of the related list of
descriptions.
• Description
• Any string used to represent a concept
• Relationship
• (in SNOMED) an object – attribute – value triple connecting
two concepts through an attribute
• Relationships in SNOMED are explicit rather than implicit (as
was the case in SNOMED III)
Terminology of Terminology
• Extension (valid)
• SNOMED content outside of SNOMED core but integrated
such that it can be queried as if it were part of SNOMED
core.
• An official extension is created by an organization that holds
a namespace identifier (more later).
• Subset
• A functional subset of SNOMED is a list of concepts
extracted from core, an extension or both to serve a defined
purpose.
• Navigational subset
• A SNOMED subset that includes adequate hierarchical
information to allow navigation (browsing).
SNOMED Core

• Concepts Table
• Each row in this table represents a medical concept.
• Descriptions Table
• Each row in this table specifies a term that can be applied to describe a single
clinical concept.
• Relationships Table
• Each row in this table specifies a relationship between two clinical concepts. The
nature of each relationship is represented using a special kind of clinical concept.
SNOMED Core

• A concept is described by the term (string) in 2-n

descriptions
• At least the Fully Specified Name (FSN) + Preferred
Term
• Each description refers to (only) 1 concept.
 SNOMED Core

• A concept is the source of 1-n relationships (except the

root concept).
• A concept is the target of 1-n relationships.
• A concept represents the type of relationship.
• A relationship refers to 3 concepts: a source, a target,
and a relationship type.
Concepts Table Fields
Key Fields
ConceptId The unique SNOMED Clinical Terms Identifier for this
Concept.
Data Fields
ConceptStatus The status of a Concept indicates whether it is in active use
and, if not, indicates the reason for withdrawal from current
use.
FullySpecifiedName A unique phrase that describes a Concept in a way that is
intended to be unambiguous.
CTV3ID The Read Code for this Concept.
SNOMEDID The current SNOMED identifier for this Concept.
IsPrimitive Indicates whether a Concept is Primitive or Fully defined by
its current set of Defining characteristics.
Descriptions Table
Key Fields
DescriptionId The unique SNOMED CT Identifier for this Description.
Data Fields
DescriptionStatus The status of a Description indicates whether it is in active use and, if not,
indicates the reason for withdrawal from current use.
ConceptId The unique SNOMED CT Identifier of the associated Concept. (Foreign key
to Concepts Table).
Term The text of a Term used to describe the associated Concept.
InitialCapitalStatus An indication of whether the capitalization status of the first character of the
Term is significant.
DescriptionType An indication of whether the Term is the Fully Specified Name, Preferred
Term or Synonym for the Concept to which this Description applies.

LanguageCode An indication of a Language or Dialect in which this Description is valid. The

language or dialect subset ultimately defines the descriptions for each
concept.
Concepts -> Descriptions
233604007 D2-0007F Pneumonia (concept)

350049016 233604007 Pneumonia (Disorder) 3

621810017 233604007 Pneumonia 1

xxxxxx01x 233604007 Synonym in Core 2

xxxxxxyyy11x 233604007 Synonym in NAHLN Extension 2

xxxxxxzzz11x 233604007 Synonym In Local Extension 2

1 = “preferred” description (term) – preferred by SNOMED, perhaps not your users

2 = synonym (alternate)
3 = fully specified name
Component History Table (future use)
Key Fields

ComponentID The unique SNOMED CT Identifier for the changed Component.

ReleaseVersion The version of SNOMED CT in which this change was made.

Data Fields

ChangeType An indication of the nature of the change.

Status The status of this Component after the change.

Reason An optional text Description of the reason for the change.

Historical Relationships
Key Fields

RelationshipId The unique SNOMED CT Identifier of this Relationship.

Data Fields

ConceptId1 The unique SNOMED CT Identifier of the Concept which is the source of this Relationship.

RelationshipType The unique SNOMED CT Identifier of the Concept which represents the type of relationship
between the related Concepts.

ConceptId2 The unique SNOMED CT Identifier of the Concept which is the target of this Relationship.

CharacteristicType An indication of whether a Relationship specifies a defining characteristic of the source

Concept or a possible qualifying characteristic of that Concept.

Refinability An indication of whether it is possible to refine the target Concept when this relationship is used
as a template for clinical data entry.

RelationshipGroup An integer value that links together Relationships which are part of a logically associated
Relationship group.
Historical Relationships
• Allowed attribute values
• SAME AS (redundant)
• MAYBE A (ambiguous - 2 or more)
• REPLACED BY (major changes)
• WAS A (IS A no longer valid)
• MOVED TO (namespace change)
• MOVED FROM (namespace change)
Relationships Table
Key Fields

RelationshipId The unique SNOMED CT Identifier of this Relationship.

Data Fields

ConceptId1 The unique SNOMED CT Identifier of the Concept which is the source of this Relationship.

RelationshipType The unique SNOMED CT Identifier of the Concept which represents the type of
relationship between the related Concepts.

ConceptId2 The unique SNOMED CT Identifier of the Concept which is the target of this Relationship.

CharacteristicType An indication of whether a Relationship specifies a defining characteristic of the source

Concept or a possible qualifying characteristic of that Concept.

Refinability An indication of whether it is possible to refine the target Concept when this relationship is
used as a template for clinical data entry.

RelationshipGroup An integer value that links together Relationships which are part of a logically associated
Relationship group.
Concept -> Relationship
Concepts Table
SCT ID SNOMED ID Concept Name
71620000 DD-13100 Fracture of Femur
116676008 G-C504 Associated Morphology
72704001 M-12000 Fracture (morphology)

Relationship Table
Concept ID Relationship ID Concept ID
71620000 116676008 72704001
SCTID
• The SCTID data type is a 64-bit integer,
which is subject to the following constraints:
• Only positive integer values are permitted.
• The minimum permitted value is 100,000 (6 digits)
• The maximum permitted value is
999,999,999,999,999,999 (18-digits).
• As result of rules for the partition-identifier and
check-digit, many integers within this range are
not valid SCTIDs.
SCTID
• The SCTID does not contain semantic information
related to the meaning of a concept or term
• It does however have a structure that is designed to
allow different types of terminological components to
be recognized.
• The nature of a component can be derived from the table in
which a component is distributed.
• Partitioning the SCTID avoids reuse of the same identifier for
a different type of component – thus avoiding ambiguity.
• This also allows the nature of the identifier to be recognized
when stored in a record or transferred in a message.
SCTID

SCTID for centrally distributed component.

SCTID

SCTID for a component in an extension.

SCTID Partition Values
00 A concept
01 A description
02 A relationship
03 A subset
04 A Cross Map set
05 A Cross Map target
10 A concept in an extension
11 A description in an extension
12 A relationship in an extension
13 A subset in an extension
14 A Cross Map set in an extension
15 A Cross Map target in an extension