The purpose of this briefing note is to inform the Community of Practise of a proposal to inactivate the 19 concepts in the <<303109001 |Pathogeneses (qualifier value)| subhierarchy.
| Date created | 28 April 2026 |
|---|---|
| Action | For Information Only |
| Status | Open |
20260430 BN Pathogeneses (qualifier value)_ subhierarchy v1.0.pdf (112.4 KB)
This corner of SNOMED was inherited “as is” from the UK’s Clinical Terms Version 3 product in 2002, and has not changed at all since. Natively, in the final release of CTV3, it ended up looking like this:
There were, however, never any modelled relationships within CTV3 itself that used these values, nor have there ever been any in either the International Edition or its UK Extensions. Although the set of codes within <<303109001 Pathogeneses clearly relate to a high level conceptual framework for the categorisation of disease aetiology and pathophysiology that will be very familiar to most clinicians and medical students globally, it is both incomplete and overlapping with other parts of SNOMED that do at least part of the same thing…notably of course its immediate sibling subtaxonomy under 308489006 Pathological process (qualifier value), whose children are today referenced by over 30K inferred relationships.
Of course, that 308489006 Pathological process subtaxonomy also came originally from CTV3 (although it has been changed quite a lot since 2002):
It is however perhaps notable both that all the values below Pathological process had also already been added to CTV3 by 1995, but that Pathological process grouper itself was also only added in 1999. When considered with the similar dating of CTV3’s Xa9Ge Pathogeneses subtaxonomy, this points to an earlier state in CTV3 in which all the values from both groupers may have originally been in one list that, in 1999, was partitioned between pathogenesis and pathological process. More detailed explanatory archaeology is “challenging” after 30 years.
But on the basis of the above, I would support this inactivation.
Many thanks, Jeremy, for sharing the background of this subhierarchy.
Hi @ssantamaria
The U.S. added a concept for 472451000124100 |Reactive, undifferentiated (qualifier value)| in 2021 as a request to represent this as a response value for an HIV test based on the manufacturers insert. This concept is currently a subtype of 11214006 |Reactive (qualifier value)| in the U.S. Edition.
US CRS Request: https://us-request.ihtsdotools.org/#/requests/preview/351667?fromList=true
Reference URL: BioPlex 2200 HIV Ag-Ab Assay | FDA
The U.S. requests that International would consider retaining the following concepts from this subhierarchy in the international edition as active concepts because of their potential use in the laboratory space:
We are not aware of a use case for the other concepts in the subhierarchy and would therefore support their inactivation.
Thanks
John
Thanks for the feedback, John. This sounds fine to me. I will take the input internally and if any questions will post them here.
ETA: @jsnyder I have discussed this with the SI Editors and we agree to keep the two concepts you noted active.
I have no objection to the proposal.
We don’t use of this content in SCTAU, and given the subhierarchy sits outside MRCM scope , it’s unlikely any NRC has used it in modelled content either.
That said, MRCM scope doesn’t cover implementer use (per John’s comment) - refsets and drop-down value sets built outside formal national specifications are another matter, and we have no visibility into those. Not a reason to block inactivation, but worth acknowledging.
I know it’s easier, but from an implementation and analytics perspective, I don’t like bare inactivation without any historical association. Not everything in this subhierarchy will map cleanly, but something like a “possibly equivalent to” pointing toward <<64572001 |Disease (disorder)| or <<308489006 |Pathological process (qualifier value)| where appropriate would at least give downstream users a foothold. Not a blocker, just a preference.
(I also note, the status on the post says closed whereas the brief says it’s open till June 1)
Thanks for the feedback, @mcordell .
We agree that we do not have knowledge of all the potential uses of content. If in the future we learn this content is needed, we can certainly look to reactivate it or create new appropriate content.
Concerning use of a referral to a generic target concept, this is tricky as we have received feedback from other members that referring to a generic target is not helpful or desired. I think this type of discussion about policy should be held with a larger group if needed. I have shared your feedback with Jim Case.
Thank you for the heads up about the BN status. I am not sure how it changed to “closed” as it will be open until 1 June. I have updated it to “open” now.
As the briefing note notification window has closed, 17 concepts in the <<303109001|Pathogeneses (qualifier value)| subhierarchy have been inactivated with reason of “Nonconformance to editorial policy” for the next release. Two concepts from the subhierarchy - 11214006 |Reactive (qualifier value)| and 255386009 |Immune (qualifier value)| - remain active and are now subtypes of 106234000 |General adjectival modifier (qualifier value)|.
