# Table of Contents

- [SNOMED CT Editorial Guide | Specifications SNOMED CT Editorial Guide | SNOMED International Documents](#snomed-ct-editorial-guide-specifications-snomed-ct-editorial-guide-snomed-international-documents)
- [Guidelines for Management of Translation of SNOMED CT | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents](#guidelines-for-management-of-translation-of-snomed-ct-practical-guides-snomed-ct-translation-management-guide-snomed-international-documents)
- [Introduction | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents](#introduction-practical-guides-snomed-ct-translation-management-guide-snomed-international-documents)
- [Planning Issues | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents](#planning-issues-practical-guides-snomed-ct-translation-management-guide-snomed-international-documents)
- [Translation Preparation | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents](#translation-preparation-practical-guides-snomed-ct-translation-management-guide-snomed-international-documents)
- [Improving Translation Quality | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents](#improving-translation-quality-practical-guides-snomed-ct-translation-management-guide-snomed-international-documents)
- [Maintenance of a Translation | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents](#maintenance-of-a-translation-practical-guides-snomed-ct-translation-management-guide-snomed-international-documents)
- [Supporting Documents | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents](#supporting-documents-practical-guides-snomed-ct-translation-management-guide-snomed-international-documents)
- [Example EMR EHR Requirements Guide | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents](#example-emr-ehr-requirements-guide-practical-guides-snomed-ct-ehr-requirements-guide-snomed-international-documents)
- [Translation Process | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents](#translation-process-practical-guides-snomed-ct-translation-management-guide-snomed-international-documents)
- [Guidelines for Translation of SNOMED CT | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents](#guidelines-for-translation-of-snomed-ct-practical-guides-snomed-ct-translation-guide-snomed-international-documents)
- [User Interface | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents](#user-interface-practical-guides-snomed-ct-ehr-requirements-guide-snomed-international-documents)
- [Translation process and post-translation issues | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents](#translation-process-and-post-translation-issues-practical-guides-snomed-ct-translation-guide-snomed-international-documents)
- [Edition, Language and Content | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents](#edition-language-and-content-practical-guides-snomed-ct-ehr-requirements-guide-snomed-international-documents)
- [Supporting documents | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents](#supporting-documents-practical-guides-snomed-ct-translation-guide-snomed-international-documents)
- [Sources of information | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents](#sources-of-information-practical-guides-snomed-ct-translation-guide-snomed-international-documents)
- [Introduction | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents](#introduction-practical-guides-snomed-ct-translation-guide-snomed-international-documents)
- [An introduction to terminological principles | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents](#an-introduction-to-terminological-principles-practical-guides-snomed-ct-translation-guide-snomed-international-documents)
- [Maintenance | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents](#maintenance-practical-guides-snomed-ct-ehr-requirements-guide-snomed-international-documents)
- [Additional Resources | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents](#additional-resources-practical-guides-snomed-ct-ehr-requirements-guide-snomed-international-documents)
- [Analytics and Reporting | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents](#analytics-and-reporting-practical-guides-snomed-ct-ehr-requirements-guide-snomed-international-documents)
- [Introduction | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents](#introduction-practical-guides-snomed-ct-ehr-requirements-guide-snomed-international-documents)
- [SNOMED CT as a health terminology | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents](#snomed-ct-as-a-health-terminology-practical-guides-snomed-ct-translation-guide-snomed-international-documents)
- [Introducción | Practical Guides Intro a SCT para proveedores | SNOMED International Documents](#introducci-n-practical-guides-intro-a-sct-para-proveedores-snomed-international-documents)
- [Glossary of Terms | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents](#glossary-of-terms-practical-guides-snomed-ct-translation-management-guide-snomed-international-documents)
- [Introducción a SNOMED CT para proveedores | Practical Guides Intro a SCT para proveedores | SNOMED International Documents](#introducci-n-a-snomed-ct-para-proveedores-practical-guides-intro-a-sct-para-proveedores-snomed-international-documents)
- [Vendor Introduction to SNOMED CT | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents](#vendor-introduction-to-snomed-ct-practical-guides-vendor-introduction-to-snomed-ct-snomed-international-documents)
- [Introduction | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents](#introduction-practical-guides-vendor-introduction-to-snomed-ct-snomed-international-documents)
- [Interoperability | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents](#interoperability-practical-guides-snomed-ct-ehr-requirements-guide-snomed-international-documents)
- [Storage | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents](#storage-practical-guides-snomed-ct-ehr-requirements-guide-snomed-international-documents)
- [Licensing | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents](#licensing-practical-guides-vendor-introduction-to-snomed-ct-snomed-international-documents)
- [Referencias | Practical Guides Intro a SCT para proveedores | SNOMED International Documents](#referencias-practical-guides-intro-a-sct-para-proveedores-snomed-international-documents)
- [¿Qué es un Centro Nacional de Referencia? | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#-qu-es-un-centro-nacional-de-referencia-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Distribución de SNOMED CT | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#distribuci-n-de-snomed-ct-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Introducción | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#introducci-n-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Estrategias y consideraciones de implementación | Practical Guides Intro a SCT para proveedores | SNOMED International Documents](#estrategias-y-consideraciones-de-implementaci-n-practical-guides-intro-a-sct-para-proveedores-snomed-international-documents)
- [Tooling | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#tooling-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [Engaging stakeholders | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#engaging-stakeholders-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [Enhancing EHR Design with SNOMED CT | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents](#enhancing-ehr-design-with-snomed-ct-practical-guides-vendor-introduction-to-snomed-ct-snomed-international-documents)
- [Fases de la organización del CNR | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#fases-de-la-organizaci-n-del-cnr-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Participación de las partes interesadas | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#participaci-n-de-las-partes-interesadas-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Appendix : User Experience of SNOMED CT | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents](#appendix-user-experience-of-snomed-ct-practical-guides-vendor-introduction-to-snomed-ct-snomed-international-documents)
- [Beneficios para los proveedores | Practical Guides Intro a SCT para proveedores | SNOMED International Documents](#beneficios-para-los-proveedores-practical-guides-intro-a-sct-para-proveedores-snomed-international-documents)
- [Licencias | Practical Guides Intro a SCT para proveedores | SNOMED International Documents](#licencias-practical-guides-intro-a-sct-para-proveedores-snomed-international-documents)
- [Mejorando el diseño de la historia clínica electrónica con SNOMED CT | Practical Guides Intro a SCT para proveedores | SNOMED International Documents](#mejorando-el-dise-o-de-la-historia-cl-nica-electr-nica-con-snomed-ct-practical-guides-intro-a-sct-para-proveedores-snomed-international-documents)
- [Guía del Centro Nacional de Referencia (CNR) | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#gu-a-del-centro-nacional-de-referencia-cnr-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Translating SNOMED CT | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents](#translating-snomed-ct-practical-guides-snomed-ct-translation-guide-snomed-international-documents)
- [Solicitudes de cambios | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#solicitudes-de-cambios-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Benefits to Vendors | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents](#benefits-to-vendors-practical-guides-vendor-introduction-to-snomed-ct-snomed-international-documents)
- [Implementation Strategies and Considerations | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents](#implementation-strategies-and-considerations-practical-guides-vendor-introduction-to-snomed-ct-snomed-international-documents)
- [SNOMED CT Browsers | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#snomed-ct-browsers-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [SNOMED CT National Release Center Guide | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#snomed-ct-national-release-center-guide-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [NRC Organization Phases | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#nrc-organization-phases-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [Introducción a SNOMED CT | Practical Guides Intro a SCT para proveedores | SNOMED International Documents](#introducci-n-a-snomed-ct-practical-guides-intro-a-sct-para-proveedores-snomed-international-documents)
- [Herramientas | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#herramientas-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Implementation Consultancy | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#implementation-consultancy-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [Introduction | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#introduction-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [Apéndice 1. - Experiencia del usuario de SNOMED CT | Practical Guides Intro a SCT para proveedores | SNOMED International Documents](#ap-ndice-1-experiencia-del-usuario-de-snomed-ct-practical-guides-intro-a-sct-para-proveedores-snomed-international-documents)
- [SNOMED International Governance, Advisory Groups and Events | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#snomed-international-governance-advisory-groups-and-events-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [Further information | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#further-information-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [SNOMED CT Starter Guide | Practical Guides | SNOMED International Documents](#snomed-ct-starter-guide-practical-guides-snomed-international-documents)
- [Navegadores de SNOMED CT | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#navegadores-de-snomed-ct-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [What Is a National Release Center? | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#what-is-a-national-release-center-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [El papel del CNR en relación con el licenciamiento de SNOMED CT | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#el-papel-del-cnr-en-relaci-n-con-el-licenciamiento-de-snomed-ct-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Educación y capacitación | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#educaci-n-y-capacitaci-n-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Introduction | Practical Guides | SNOMED International Documents](#introduction-practical-guides-snomed-international-documents)
- [SNOMED CT Benefits | Practical Guides | SNOMED International Documents](#snomed-ct-benefits-practical-guides-snomed-international-documents)
- [Knowledge Base | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#knowledge-base-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Desarrollo de contenidos y personalización de SNOMED CT | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#desarrollo-de-contenidos-y-personalizaci-n-de-snomed-ct-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Introduction | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#introduction-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Content Development | Practical Guides | SNOMED International Documents](#content-development-practical-guides-snomed-international-documents)
- [Responsabilidades del CNR | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#responsabilidades-del-cnr-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Substrate | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#substrate-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [SNOMED CT Implementation | Practical Guides | SNOMED International Documents](#snomed-ct-implementation-practical-guides-snomed-international-documents)
- [References | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents](#references-practical-guides-vendor-introduction-to-snomed-ct-snomed-international-documents)
- [The Role of NRCs related to SNOMED CT Licensing | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#the-role-of-nrcs-related-to-snomed-ct-licensing-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [Elección de un enfoque de implementación | Practical Guides Intro a SCT para proveedores | SNOMED International Documents](#elecci-n-de-un-enfoque-de-implementaci-n-practical-guides-intro-a-sct-para-proveedores-snomed-international-documents)
- [Release Schedule and File Formats | Practical Guides | SNOMED International Documents](#release-schedule-and-file-formats-practical-guides-snomed-international-documents)
- [Más información | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#m-s-informaci-n-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Distribution of SNOMED CT | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#distribution-of-snomed-ct-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [Asesoramiento para la implementación | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#asesoramiento-para-la-implementaci-n-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [The Importance of Effective Search | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#the-importance-of-effective-search-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Use Cases for Searches | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#use-cases-for-searches-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [SNOMED CT Search and Data Entry Guide | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#snomed-ct-search-and-data-entry-guide-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Search by Identifiers | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#search-by-identifiers-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Gobernanza, grupos consultivos y eventos de SNOMED International | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents](#gobernanza-grupos-consultivos-y-eventos-de-snomed-international-practical-guides-gu-a-del-centro-nacional-de-referencia-cnr-snomed-international-documents)
- [Content Development and SNOMED CT customization | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#content-development-and-snomed-ct-customization-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [Vendor Case Studies | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#vendor-case-studies-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Change Requests | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#change-requests-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [SNOMED CT Clinical Decision Support Guide | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#snomed-ct-clinical-decision-support-guide-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Use Cases Directly Connected to Data Entry | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#use-cases-directly-connected-to-data-entry-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Appendix A - Decision Support Case Studies | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#appendix-a-decision-support-case-studies-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Education and Training | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#education-and-training-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [Duodecim | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#duodecim-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [EBMPracticeNet | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#ebmpracticenet-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Pharmacy Health Information Technology Collaborative | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#pharmacy-health-information-technology-collaborative-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Data Entry | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#data-entry-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Practice Fusion | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#practice-fusion-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Use Cases Where Search Browsers are Required | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#use-cases-where-search-browsers-are-required-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Extension and Customization | Practical Guides | SNOMED International Documents](#extension-and-customization-practical-guides-snomed-international-documents)
- [Using SNOMED CT in Clinical Information | Practical Guides | SNOMED International Documents](#using-snomed-ct-in-clinical-information-practical-guides-snomed-international-documents)
- [Guidelines | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#guidelines-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Mapping | Practical Guides | SNOMED International Documents](#mapping-practical-guides-snomed-international-documents)
- [Using SNOMED CT Features to Support Optimized Searches | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#using-snomed-ct-features-to-support-optimized-searches-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Use Mnemonics and Personal Favorites for Data Entry | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#use-mnemonics-and-personal-favorites-for-data-entry-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Overview | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#overview-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Distinguish Identical Terms of Different Concepts | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#distinguish-identical-terms-of-different-concepts-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Translations and Language Preferences | Practical Guides | SNOMED International Documents](#translations-and-language-preferences-practical-guides-snomed-international-documents)
- [Introduction | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#introduction-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [SNOMED CT Concept Model | Practical Guides | SNOMED International Documents](#snomed-ct-concept-model-practical-guides-snomed-international-documents)
- [Optimizing Searches | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#optimizing-searches-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Display Navigation Results Effectively | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#display-navigation-results-effectively-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [SNOMED CT Basics | Practical Guides | SNOMED International Documents](#snomed-ct-basics-practical-guides-snomed-international-documents)
- [Using the Subtype Hierarchy | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#using-the-subtype-hierarchy-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [University of Utah | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#university-of-utah-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Rationalize Search Results by Subsumption Checking | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#rationalize-search-results-by-subsumption-checking-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Distribution | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents](#distribution-practical-guides-snomed-ct-reference-set-guide-snomed-international-documents)
- [Communications | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#communications-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [SNOMED CT Reference Set Guide | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents](#snomed-ct-reference-set-guide-practical-guides-snomed-ct-reference-set-guide-snomed-international-documents)
- [Improve Search Speed | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#improve-search-speed-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Value Set | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents](#value-set-practical-guides-snomed-ct-reference-set-guide-snomed-international-documents)
- [Requirements and Use Cases | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents](#requirements-and-use-cases-practical-guides-snomed-ct-reference-set-guide-snomed-international-documents)
- [Reference Set Development | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents](#reference-set-development-practical-guides-snomed-ct-reference-set-guide-snomed-international-documents)
- [Logical Architecture | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#logical-architecture-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Terminology Services Overview | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents](#terminology-services-overview-practical-guides-snomed-ct-terminology-services-guide-snomed-international-documents)
- [Optimize Display of Search Results | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#optimize-display-of-search-results-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Sundhedsplatformen | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#sundhedsplatformen-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Extended Searches | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#extended-searches-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [SNOMED CT Terminology Services Guide | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents](#snomed-ct-terminology-services-guide-practical-guides-snomed-ct-terminology-services-guide-snomed-international-documents)
- [Requirements | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents](#requirements-practical-guides-snomed-ct-postcoordination-guide-snomed-international-documents)
- [Communication | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents](#communication-practical-guides-snomed-ct-reference-set-guide-snomed-international-documents)
- [National Institutes of Health: Intramural Research Program | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#national-institutes-of-health-intramural-research-program-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Terminology Service Categories | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents](#terminology-service-categories-practical-guides-snomed-ct-terminology-services-guide-snomed-international-documents)
- [First Databank | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#first-databank-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Introduction to Search | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#introduction-to-search-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Terminology Service Types | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents](#terminology-service-types-practical-guides-snomed-ct-terminology-services-guide-snomed-international-documents)
- [Avoid Multiple Hits on the Same Concept | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#avoid-multiple-hits-on-the-same-concept-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Search by Text | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#search-by-text-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)
- [Choosing an Approach to Implementation | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents](#choosing-an-approach-to-implementation-practical-guides-vendor-introduction-to-snomed-ct-snomed-international-documents)
- [Appendix B: Editions, Versions and Extensions | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents](#appendix-b-editions-versions-and-extensions-practical-guides-snomed-ct-terminology-services-guide-snomed-international-documents)
- [Kaiser Permanente | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#kaiser-permanente-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Service Implementation Considerations | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents](#service-implementation-considerations-practical-guides-snomed-ct-terminology-services-guide-snomed-international-documents)
- [Introduction | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents](#introduction-practical-guides-snomed-ct-terminology-services-guide-snomed-international-documents)
- [The Organization Behind SNOMED CT | Practical Guides | SNOMED International Documents](#the-organization-behind-snomed-ct-practical-guides-snomed-international-documents)
- [Organizational Case Studies | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#organizational-case-studies-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Implement and Use | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents](#implement-and-use-practical-guides-snomed-ct-reference-set-guide-snomed-international-documents)
- [Introduction | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents](#introduction-practical-guides-snomed-ct-reference-set-guide-snomed-international-documents)
- [Learning More About SNOMED CT | Practical Guides | SNOMED International Documents](#learning-more-about-snomed-ct-practical-guides-snomed-international-documents)
- [Terminology Service Roles | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents](#terminology-service-roles-practical-guides-snomed-ct-terminology-services-guide-snomed-international-documents)
- [Orion Health | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents](#orion-health-practical-guides-snomed-ct-clinical-decision-support-guide-snomed-international-documents)
- [Expressions in the EHR | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents](#expressions-in-the-ehr-practical-guides-snomed-ct-postcoordination-guide-snomed-international-documents)
- [Reference Set | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents](#reference-set-practical-guides-snomed-ct-reference-set-guide-snomed-international-documents)
- [Entering Expressions in an EHR | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents](#entering-expressions-in-an-ehr-practical-guides-snomed-ct-postcoordination-guide-snomed-international-documents)
- [Display EHR Data | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents](#display-ehr-data-practical-guides-snomed-ct-terminology-services-guide-snomed-international-documents)
- [Alternatives to Postcoordination | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents](#alternatives-to-postcoordination-practical-guides-snomed-ct-postcoordination-guide-snomed-international-documents)
- [NRC Responsibilities | Practical Guides SNOMED NRC Guide | SNOMED International Documents](#nrc-responsibilities-practical-guides-snomed-nrc-guide-snomed-international-documents)
- [Design | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents](#design-practical-guides-snomed-ct-postcoordination-guide-snomed-international-documents)
- [Appendix B: Deprecated Reference Set Types | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents](#appendix-b-deprecated-reference-set-types-practical-guides-snomed-ct-reference-set-guide-snomed-international-documents)
- [System Components | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents](#system-components-practical-guides-snomed-ct-postcoordination-guide-snomed-international-documents)
- [Store Expression Identifier | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents](#store-expression-identifier-practical-guides-snomed-ct-postcoordination-guide-snomed-international-documents)
- [Constrained Searches | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents](#constrained-searches-practical-guides-snomed-ct-search-and-data-entry-guide-snomed-international-documents)

---

# SNOMED CT Editorial Guide | Specifications SNOMED CT Editorial Guide | SNOMED International Documents

The SNOMED CT Editorial Guide provides the information necessary to model concepts in SNOMED CT.

_**These guidelines should be applied to new content. While there are many concepts in the existing content that are not in compliance with this guidance, the process of correcting existing content will be carried out as time and resources permit.**_

SNOMED CT is distributed in sets of electronic files. Supporting software tools are not necessarily provided directly by SNOMED International.

* * *

[Introduction to Editorial Guide](https://docs.snomed.org/snomed-ct-specifications/snomed-ct-editorial-guide/readme/introduction-to-the-snomed-ct-editorial-guide)

[Introduction to SNOMED CT](https://docs.snomed.org/snomed-ct-specifications/snomed-ct-editorial-guide/readme/snomed-ct-introduction)

[Introduction to Concept Model](https://docs.snomed.org/snomed-ct-specifications/snomed-ct-editorial-guide/readme/concept-model-overview)

[Authoring](https://docs.snomed.org/snomed-ct-specifications/snomed-ct-editorial-guide/readme/authoring)

* * *

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© Copyright 2026 International Health Terminology Standards Development Organisation, all rights reserved.

This document is a publication of International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED International owns and maintains SNOMED CT®.

Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. This document may be subject to updates. Always use the latest version of this document published by SNOMED International. This can be viewed online and downloaded by following the links on the front page or cover of this document.

SNOMED®, SNOMED CT® and IHTSDO® are registered trademarks of International Health Terminology Standards Development Organisation. SNOMED CT® licensing information is available at [http://snomed.org/licensingarrow-up-right](http://snomed.org/licensing)
. For more information about SNOMED International and SNOMED International Membership, please refer to [http://www.snomed.orgarrow-up-right](http://www.ihtsdo.org/)
 or contact us at [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#4821262e270821203c3b2c2766273a2f)
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# Guidelines for Management of Translation of SNOMED CT | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents

This document provides a comprehensive framework for managing the translation of SNOMED CT. The content is based on recent experiences learned from translating SNOMED CT into several languages.

The guidelines address core issues when planning, preparing, performing, maintaining, and improving the translation process. Recommendations regarding organization, competences, infrastructure, workflow etc. are presented. The guidelines also consider translation to multiple languages or dialects.

The guidelines are useful for project managers and other key members involved in planning, performing and maintaining SNOMED CT translations.

This document should be studied and applied in tandem with [Guidelines for Translation of SCT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/)
.

* * *

[Introduction](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction)

[Planning Issues](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues)

[Translation Preparation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/3-translation-preparation)

[Translation Process](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process)

[Maintenance of a Translation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation)

[Improving Translation Quality](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/6-improving-translation-quality)

* * *

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© Copyright 2026 International Health Terminology Standards Development Organisation, all rights reserved.

This document is a publication of International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED International owns and maintains SNOMED CT®.

Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. This document may be subject to updates. Always use the latest version of this document published by SNOMED International. This can be viewed online and downloaded by following the links on the front page or cover of this document.

SNOMED®, SNOMED CT® and IHTSDO® are registered trademarks of International Health Terminology Standards Development Organisation. SNOMED CT® licensing information is available at [http://snomed.org/licensingarrow-up-right](http://snomed.org/licensing)
. For more information about SNOMED International and SNOMED International Membership, please refer to [http://www.snomed.orgarrow-up-right](http://www.ihtsdo.org/)
 or contact us at [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#640d0a020b240d0c1017000b4a0b1603)
.

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# Introduction | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#background)

Background


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SNOMED CT is a comprehensive clinical **terminology** that is used to code, retrieve, and analyse health data. It constitutes a basis on which healthcare organisations can plan and document health processes, perform outcome researches, analyse healthcare quality and costs, and develop effective therapeutic recommendations. It resulted from the merger of SNOMED RT (Reference Terminology) and Clinical Terms Version 3. The terminology contains concepts, descriptions and relationships that are necessary to precisely represent clinical information across the scope of health care.

The international edition of SNOMED CT comprises about 360,000 active concepts and is growing. Each concept is **represented** by active descriptions, i.e. "Fully specified names", "Preferred terms", and other synonyms. The concepts are arranged in **hierarchies** (systems of concepts) covering areas like symptoms and signs, disorders, operations, treatments, drugs, administrative items, etc. – i.e. all these categories of information are needed in a health record.

When implemented in software applications, SNOMED CT can be used to represent clinically relevant information consistently, reliably and comprehensively as an integral part of the electronic health record (EHR). Information systems can use the concepts, hierarchies and relationships as a common reference point.

The global dissemination of SNOMED CT increases the need to provide the terminology in many languages. SNOMED CT has a built-in framework to manage languages and dialects. Entire or partial translations of SNOMED CT are available in US English, UK English, Spanish, French, German, Maori, Danish, Swedish, Norwegian, Estonian, Finnish, Dutch, and even some Sanskrit. The translations can be explored in the SNOMED International SNOMED CT browser by searching the relevant extensions (e.g. for Spanish open the [Spanish editionarrow-up-right](https://browser.ihtsdotools.org/?perspective=full&conceptId1=404684003&edition=MAIN/SNOMEDCT-ES/2022-10-31&release=&languages=es,en)
). Translations are also in progress in other SNOMED International Member countries.

The basic objective of any SNOMED CT translation is to provide accurate representations of SNOMED CT concepts in such a way that they are **understandable** , **reproducible** and **useful** (URU): the principle of _concept-based translation_ must be borne in mind. Due to the inevitably normative nature of a translated version of SNOMED CT, defining a set of linguistic guidelines, including syntactical, morphological, and orthographic rules, is crucial.

Since SNOMED CT is meant to be applied in numerous and various settings by users from the most heterogeneous backgrounds, realms and languages, the communicational aspect of concept definition becomes an issue of paramount importance. A qualitative translation of SNOMED CT is a standardisation of the country’s terminology, in this instance for health and social care.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#purpose-and-scope)

Purpose and Scope


------------------------------------------------------------------------------------------------------------------------------------------------------------

These guidelines constitute a part of the SNOMED International quality assurance system for content and are based upon the collective experience from countries that have already translated, are planning to, or are in the process of translating SNOMED CT.

Within the scope of translation of SNOMED CT, these guidelines offer recommendations regarding the management of a translation project. Members of SNOMED International will be able to find advice and documented experience to support their translation efforts and help avoid mistakes. The Guidelines enable projects to build on best practices from both a qualitative and a cost effective perspective and contribute to “lessons learned”.

The guidelines identify critical steps of the translation project, but are not prescriptive regarding the detailed sequence of the steps in the translation process, since some steps are highly dependent on how the project is organised locally.

This document is a companion guideline for use in combination with the [_Guidelines for Translation of SNOMED CT_](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/)
.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#translation-method)

Translation Method

The process described within this document provides for a two-step quality review mechanism that is to be used by translators as well as clinicians. A third level of quality control and assurance (“Improving translation quality”) is described in section 6.

Reverse translation where the produced translations are translated back into English to compare the result to the original English description as a method for quality control is not part of these guidelines since no members has done this yet.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#out-of-scope)

Out of Scope

This guideline does not include general project management principles, or, reference specific project management methodologies.

This document does not include linguistic guidelines applicable to translations of SNOMED CT. The linguistic guidelines are found in the [_Guidelines for Translation of SNOMED CT_](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/)
.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#assessment-of-translation-quality)

Assessment of Translation Quality

Translation Project Owners (TPOs) should strive to ensure that translations comply with the URU (understandability, reproducibility, usefulness) principles on which SNOMED CT was originally based and that information contained in the translated concepts is semantically equivalent to the meaning in the core source terminology (international release). SNOMED International has developed a document describing how to assess translation quality and evaluate the level of compliance. The document “A methodology and toolkit for evaluating SNOMED CT translation quality”, outlines and defines a number of requirements or “quality characteristics” (QCs) and associated metrics.

There are three types of QCs. In the context of translation quality assessment:

*   structured QCs that relate to the management and organisation of the translation project
    
*   process QCs that relate to the activities taking place during the actual translation
    
*   outcome QCs that relate to the target language translation result.
    

A “short-list” of 9 QCs was identified and for each QC, quality metrics (what and how to measure, how to evaluate, etc.), sample questionnaires (to assist with the evaluation) were developed, and an overall “rating” assigned.

It is recommended that TPOs refer to Appendix A of the [_Guidelines for Translation of SNOMED CT_](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/)
 and to the methodology and toolkit document to ensure that they incorporate any quality metrics designated **mandatory** into their project and quality plans. Metrics to measure translation quality may also be re-formulated as contractual clauses in formal agreements between a TPO and a Translation Services Provider (TSP) for services and service levels to be provided.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#audience)

Audience


------------------------------------------------------------------------------------------------------------------------------------------

The primary target group for this document are the TPOs: SNOMED International Members, or, other bodies who have been granted permission to translate SNOMED CT, and project managers in charge of managing SNOMED CT translation projects.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#attribution)

Attribution


------------------------------------------------------------------------------------------------------------------------------------------------

This document was originally created as one of the key deliverables of the former Translation Standard Processes Project Group (TSPPG), under the guidance and direction of the Translation Special Interest Group (SIG). This second version has been revised and expanded by the Translation User Group (TUG).

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#guide-overview)

Guide Overview


------------------------------------------------------------------------------------------------------------------------------------------------------

Key activities and actors in the translation process are described in section 4. This is distinguished from:

*   project planning activities described in [Planning Issues](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues)
    
*   translation preparation activities described in [Translation Preparation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/3-translation-preparation)
    
*   translation process described in [Translation Process](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process)
    
*   maintenance of translation described in [Maintenance of a Translation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation)
    
*   improving translation quality described in [Improving Translation Quality](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/6-improving-translation-quality)
    

A brief list of terms and definitions specific for this document can be found in [Glossary of Terms](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/7-glossary-of-terms)
, and a reference list is found in [Supporting Documents](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/8-supporting-documents)
.

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*   [Background](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#background)
    
*   [Purpose and Scope](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#purpose-and-scope)
    
*   [Translation Method](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#translation-method)
    
*   [Out of Scope](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#out-of-scope)
    
*   [Assessment of Translation Quality](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#assessment-of-translation-quality)
    
*   [Audience](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#audience)
    
*   [Attribution](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#attribution)
    
*   [Guide Overview](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction#guide-overview)
    

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# Planning Issues | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#the-challenge)

The Challenge


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The translation of SNOMED CT must remain faithful to terminological and linguistic principles and at the same time be able to produce national terminologies useful for clinicians in their daily work. This is no easy task and will require several considerations regarding competences of the staff.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#key-considerations-for-the-project-manager)

Key Considerations for the Project Manager

In the initial phase of the translation project, a number of vital decisions have to be made:

*   who has solid knowledge of SNOMED CT concept model?
    
*   who has solid expertise within the healthcare specialties we will focus on?
    
*   what type of education and training is needed – to whom and when?
    
*   who will be responsible for the translated content, from source language to target language?
    
*   which types of IT tools are needed to support translation and the translation process administration/translation management?
    
*   how to ensure the translators have access to relevant information, such as tools, appropriate version of SNOMED CT, maps etc.
    
*   who should write the linguistic guidelines and make principle decisions?
    
*   what should be the strategy for the sequence in which the terminology is to be translated?
    
*   how should the translation process be organised to guarantee the quality of the translation products?
    

In the sections below, these questions will be addressed.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#establishing-the-organisation)

Establishing the Organisation


---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#establishing-a-team-of-specialists)

Establishing a Team of Specialists

To achieve a successful outcome, a number of specialists must be engaged in all parts of the translation process. The following roles have been identified:

*   subject matter specialist, such as health and social care professionals
    
*   medical translators, e.g.:
    
    *   translators of patient information material in the medical area
        
    *   translators of research papers
        
    *   interpreters
        
    
*   linguists
    
*   terminologists
    
*   technical coordinator (to create subsets, translation batches, releases, statistics, QA)
    

Knowledge to be considered for all roles:

*   knowledge of current use of health and social care terminology, classification and health informatics
    
*   knowledge of semantics and concept based translation
    
*   knowledge of the structure and content of SNOMED CT.
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#establishing-the-translation-process)

Establishing the Translation Process

The translation can be done in-house or by an external translation service provider. In both cases it is important to specify prerequisites and expectations relating to the process and products. Based on experience from other projects, examples of such prerequisites, include:

*   emphasis on concept-based translation
    
*   assurance of delivery on time
    
*   contract with the translators
    
*   an agreed number of translated concepts per given time
    
*   maximum allowable error rate
    
*   maximum allowable number of concepts submitted to the editorial board
    
*   use of subject matter experts
    
*   workflow and quality assurance
    
*   agreement on the point in time when a concept’s translation is complete
    
*   agreement on which translation tools should be used
    
*   agreement on how feedback should be collected and processed.
    

Please also see section 2.8 Risk management.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#call-for-tender-and-contract-issues-for-translation-service-provider)

Call for Tender and Contract Issues for Translation Service Provider

Based on the specifications for the translation process and the products and services to be delivered, a procurement process should be initiated and a contract signed with the translation service provider. Since such tendering instruments and procurement processes are often dependent on national legislation or other conditions, they are not described further in this guideline.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#establishing-the-editorial-board)

Establishing the Editorial Board

Parts of the translation project need to be coordinated by an editorial board. The board’s major tasks are to

*   support the translation process, see [Translation Process](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process)
    
*   manage the linguistic guidelines and make principle decisions
    
*   continuously make and publish decisions on linguistic principles, and
    
*   follow up on translation quality.
    

The interdisciplinary editorial board should ideally be composed of professionals with educational and empirical backgrounds within areas like health and social care terminologies, linguistics, translation science, language technology, terminology and health informatics, with knowledge and understanding of SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#establishing-an-underlying-supportive-technical-infrastructure)

Establishing an Underlying Supportive Technical Infrastructure


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Administering the translation process requires high performance, reliable IT tools. An ideal toolkit should:

*   show all information associated with a concept, most importantly descriptions, relations and hierarchy
    
*   provide a base for terminological services
    
*   support the translation process and the translation team members in every step of the process, including creation, change, delete and edit as well as collaboration, quality assurance and feedback
    
*   control access to the information being processed at any point in time
    
*   produce statistics about progress of the translation work in any stage of the process
    
*   show the current status of the ’life cycle’ of each concept throughout the entire translation process
    
*   show workload and progress of activity for all project participants
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#establishing-linguistic-guidelines)

Establishing Linguistic Guidelines


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The target language version of SNOMED CT should reflect established national linguistic rules, and health and social care staff should recognise the preferred terms used in their daily activities. Well-maintained linguistic guidelines and principle decisions are the prerequisite for a high quality translation, and the use of these are therefore prescriptive for everyone in the translation process. An initial version of the linguistic guidelines should be ready in advance of the first education session for translators, reviewers and editors. The framework and the content of the linguistic guidelines and principle decisions are described in the [_**Guidelines for translation of SNOMED CT**_](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#identifying-quality-characteristics)

Identifying Quality Characteristics


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The task of creating quality characteristics and metrics for translations was based on the IHTSDO Quality Assurance Framework. The work was undertaken by the IHTSDO Translation Quality Assessment Project Group that defined quality characteristics for Structure, Process and Outcome. These are described in length in a separate document, _**“A Methodology and toolkit for Evaluating SNOMED CT Translation Quality”**_ and include\*\* _:_\*\*

*   participants knowledge of terminology and terminology translation processes including translators and reviewers competencies
    
*   content of style guides and reference materials in the target language
    
*   access to translation software
    
*   concept-based translation principle
    
*   translation reviews, two-level or two-stage review process necessary.
    
*   ongoing communication, co-operation and translation project process adjustments between the TPO and the TSP
    
*   term equivalence
    
*   clinical acceptability
    
*   compliance with Translation Standards and Guidelines
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#international-cooperation)

International Cooperation


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### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#quality-of-the-international-release-of-snomed-ct)

Quality of the International Release of SNOMED CT

Despite ongoing maintenance, errors and inconsistencies occur in the International Release of SNOMED CT both at the concept model level as well as at the description level. Participants in the translation process will undoubtedly identify a number of these.

The translation project should provide a procedure to document these and provide methods and tools for reporting back to SNOMED International during the translation process.

It is recommended to do this via the NRC and use the SNOMED International Content Request Service (CRS) for reporting any anomalies and inconsistencies found in the [CRS Guide](https://docs.snomed.org/snomed-ct-user-guides/crs-guide/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#education-and-training-of-team-members)

Education and Training of Team Members


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The translation team members will need education and training regarding the structure and content of SNOMED CT, the translation process and access to the documents and tools supporting it. The following examples outline essential education and training requirements:

*   SNOMED CT overview: An introduction to SNOMED CT should be provided for everyone involved in the translation process. [The e-learning pathway for translation of SNOMED CTarrow-up-right](https://courses.ihtsdotools.org/product?catalog=TRA)
     from SNOMED International is provided for this purpose.
    
*   Subset administration training: This training should be given to selected members of the team involved in planning, identifying, creating and allocating the selected subsets of SNOMED CT that are going to be translated.
    
*   Education in linguistic guidelines and training in how to use them: This should be provided for all translators, reviewers and editors.
    
*   Translation tools training: This will vary depending on the roles and responsibilities of all translation team members but all will need specifically focused training in the use of any supporting translation tools used to perform their roles
    
*   Language technology training such as searching and analysing text corpora if such resources are available.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#risk-management)

Risk Management


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It is essential to have methods and routines for monitoring both progress and quality control in place from the very start of the project. Indicators to monitor progress and quality should be defined and shared with project team members. Risk factors should be identified, and the indicators should be able to reflect project status within high-risk areas. Based on previous project experiences, the following examples of important risk factors which could lead to deficient or insufficient implementation or, inadequate quality of the translation products have been identified:

*   poor planning of the translation project at it purpose
    
*   insufficient financing to undertake the project as outlined in plans
    
*   deficient contracts between the TSP and the TPO
    
*   failure of the translation agency to deliver on time
    
*   insufficient translators with experience with the clinical language
    
*   insufficient organisation of the review process and editorial work
    
*   insufficient time allocated for the translation process
    
*   deficient quality assurance of translations with TSP
    
*   insufficient knowledge of SNOMED CT
    
*   insufficient IT tools to support translation and validation
    
*   insufficient training in use of tools
    
*   insufficient access to or use of subject matter experts
    
*   insufficient training in the conceptual principles for translation
    
*   insufficient project management
    
*   ambiguities and errors in the source language
    
*   source language terms only relevant for certain countries
    
*   inappropriate sequence of subsets for translation
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Translation+Management+Guide&entry.670899847=Planning%20Issues)

[PreviousIntroductionchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/1-introduction)
[NextTranslation Preparationchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/3-translation-preparation)

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*   [The Challenge](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#the-challenge)
    
*   [Key Considerations for the Project Manager](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#key-considerations-for-the-project-manager)
    
*   [Establishing the Organisation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#establishing-the-organisation)
    
*   [Establishing a Team of Specialists](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#establishing-a-team-of-specialists)
    
*   [Establishing the Translation Process](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#establishing-the-translation-process)
    
*   [Call for Tender and Contract Issues for Translation Service Provider](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#call-for-tender-and-contract-issues-for-translation-service-provider)
    
*   [Establishing the Editorial Board](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#establishing-the-editorial-board)
    
*   [Establishing an Underlying Supportive Technical Infrastructure](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#establishing-an-underlying-supportive-technical-infrastructure)
    
*   [Establishing Linguistic Guidelines](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#establishing-linguistic-guidelines)
    
*   [Identifying Quality Characteristics](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#identifying-quality-characteristics)
    
*   [International Cooperation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#international-cooperation)
    
*   [Quality of the International Release of SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#quality-of-the-international-release-of-snomed-ct)
    
*   [Education and Training of Team Members](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#education-and-training-of-team-members)
    
*   [Risk Management](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/2-planning-issues#risk-management)
    

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# Translation Preparation | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents

All concepts cannot be translated simultaneously and it is necessary to determine which parts of the terminology should be translated in the project and in which sequence. The preparation therefore includes the selection (creation, allocation) of specific translation subsets. Also, in the preparation, re-use of translations from other NRC’s and code systems should be considered.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/3-translation-preparation#translation-subset-selection)

Translation Subset Selection


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The aim of subset selection is to provide translators and reviewers with the best possible prerequisites for their work. The project will benefit from using the same translator working with concepts within the same subject field, e.g. heart conditions including body structures, disorders and procedures.

The choice of order of areas to be translated can be determined by local use cases or by choosing to translate concepts that create maximal efficiency. Different approaches for identifying the initial subsets can be chosen depending on local needs. For example, one could prioritise concepts:

*   which recur, link, qualify and confer meaning to other concepts in different contexts, e.g. body structures and qualifier values. Translating such concepts in the beginning of the project maximises re-use of translations, which increases both efficiency and consistency. It is advisable to translate concepts representing attribute targets for clinical finding and disorder concepts before translating the clinical finding hierarchy, using ECL queries. This supports both consistency and efficiency.
    
*   which are relatively easy to translate, because they are similar and/or well-defined – for the same reasons
    
*   which are to be part of pilot projects in a given health or social care context, or part of a specific research project – especially if your resources are limited.
    

One can also choose to avoid certain branches or types of concepts. Some branches are more difficult to translate than others, because they incorporate more culture- or country-specific concepts. For instance, if there is no private health care in your country, you will have little use for the 49 concepts for _private referral to._ Other branches may contain much more detail than you require. For instance, the branch 418019003 |Accidental event (event)| contains an astonishing wealth of accidents, e.g. 214871001 |Motor vehicle nontraffic accident involving collision, not on public highway, between motor vehicle, except off-road motor vehicle, and pedestrian, passenger on motorcycle injured (event)|. Translating these may require much time for relatively little gain. The same could be said about parts of the food hierarchy. Translating 226674006 |Welsh cake (substance)| into Norwegian makes little sense.

Selection of subsets is preferably managed by a team including specialists in health and social care, terminologists and experts on SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/3-translation-preparation#re-use-of-translations-from-external-sources-nrcs-or-from-different-code-systems)

Re-use of Translations from external Sources (NRC’s or from different code systems)


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

A pragmatic approach for adding translations may be to “borrow” existing translations from external sources, e.g. other medical terminologies or translations produced by NRC’s in different member countries who share the same target language(s) or other code systems, such as Orphanet if already translated into the target language.

When considering the reuse of “legacy” translations, it is important to first analyse any differences in scope, regional variation and formal aspects. In order for the descriptions to become part of the national SNOMED CT extension, the NRC should verify that the translated concepts have the same meaning and granularity, and that the translation has been produced in a qualitative manner including clinical validation, similar to the SNOMED CT translation approach. If this is the case, it is still possible that the translation needs to be adapted in order to comply with regional appropriateness, formal requirements and linguistic guidelines.

Depending on the nature of the external source, there are a number of considerations when selecting and recycling existing translations:

*   Translations belonging to the same code system, i.e. SNOMED CT but produced by different NRC’s. In other words, the concept in the source language has the same ID, has the same meaning and position in the hierarchy. The target audience however is a different country or region, and the language flavour may imply semantic, lexical as well as formal differences. For instance, the Belgian NRC uses Dutch descriptions produced by the NRC of The Netherlands as a starting point for untranslated concepts. Even though grammar and spelling is standardised for Dutch in both regions, there may be discrepancies in meaning between Belgium and The Netherlands that need to be verified. In addition, different guidelines related to formatting and formal choices may apply in the two member countries. E.g. in The Netherlands the FSN is translated whereas in Belgium this is not the case.
    

**Example:**

**703226008 | Familial cerebral saccular aneurysm (disorder) |**

**Belgian Dutch language reference set**

PT: familiaal cerebraal sacculair aneurysma

AS: familiaal intracranieel sacculair aneurysma

AS: familiaal besaneurysma

**Nederlandse taalreferentieset**

FSN: familiair sacculair cerebraal aneurysma (aandoening)

PT: familiair sacculair cerebraal aneurysma

AS: familiair sacculair hersenaneurysma

Translations belonging to different code systems but for which there is a semantic mapping between (source language) concepts. For instance, the SNOMED CT to Orphanet Map Release is the product of a joint project carried out under a collaboration agreement between the two parties. As this map links rare diseases managed by Orphanet to concepts in SNOMED CT, it could be an option for NRC’s to also recycle the translated terms available in Orphanet. As translation guidelines applied by Orphanet may deviate, the NRC needs to make sure that also the formal aspects of the recycled descriptions correspond to their own formal requirements. E.g. CMT2B is an acceptable synonym in Orphanet, however in SNOMED CT every acronym needs to be followed by the fully written out form.

**Example:**

**Orphanet:**

PT: Klassiek syndroom van Ehlers-Danlos

AS: Klassiek EDS

**SNOMED CT:**

PT: syndroom van Ehlers-Danlos, klassiek type

AS: EDS (Ehlers-Danlos-syndroom), klassiek type

AS: Ehlers-Danlos-syndroom, klassiek type

Translations belonging to different code systems and for which there is only a lexical similarity between the concepts in the source language. It may be risky to recycle translations from external sources as the meaning of terms that share the same lexical morphology in the source language may be different (i.e. homonyms but also different level of granularity).

Examples of external resources:

*   WHO:
    
    *   ICD-10/ICD-11
        
    *   the Anatomical Therapeutic Chemical (ATC) classification system
        
    
*   International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH): MedDRA
    
*   SAM V2 (Belgium)
    
*   Terminologia Anatomica
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/3-translation-preparation#creating-a-text-corpus)

Creating a text corpus


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Easy access to medical texts is highly valuable when translating SNOMED CT into the target language. There might already exist text corpora consisting of medical texts in the target language for research purposes at universities or other higher education institutions. If so, this could be re-used for translation of SNOMED CT.

If there is no corpus available, creating one should be considered. It should be noted, however, that this might require quite some time and resources. Criterias such as balance, sampling and representativeness should be taken into account when considering which content to include in a corpus. Also right tooling for searching and analysing the corpus should be made easily available for the translators. One option is to collaborate with researchers of corpus linguistics when creating a text corpus. Another is to seek assistance from a National Language Bank if there is one in the country.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Translation+Management+Guide&entry.670899847=Translation%20Preparation)

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[NextTranslation Processchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process)

Last updated 5 months ago

*   [Translation Subset Selection](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/3-translation-preparation#translation-subset-selection)
    
*   [Re-use of Translations from external Sources (NRC’s or from different code systems)](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/3-translation-preparation#re-use-of-translations-from-external-sources-nrcs-or-from-different-code-systems)
    
*   [Creating a text corpus](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/3-translation-preparation#creating-a-text-corpus)
    

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# Improving Translation Quality | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents

When the translation cycle has ended, there are several ways to enhance the quality. First and foremost, feedback mechanisms should be facilitated. Also, the NRC could take initiatives based on text analysis to ensure that the descriptions are in alignment with the actual usage among specialists.

Results of this process may be:

*   target language synonyms are proposed and added
    
*   a change to the preferred term is proposed
    
*   a new concept is proposed
    
*   a concept is not used in clinical practice or should be inactivated
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/6-improving-translation-quality#feedback-mechanisms)

Feedback Mechanisms


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The NRC should establish an infrastructure where end users can give feedback on issues like misspellings, missing synonyms, acceptability changes or even translation errors. This infrastructure could be a portal based on tickets which allows for queuing, prioritising and communication between the user and the NRC. Several countries are using a submission portal, e.g. Norway and the Netherlands. A decision on who should be granted the rights to submit issues, has to be decided: Open feedback or restricted to licence holders, for example. Also, the users should be able to access the translation guidelines and - where applicable - the principle decisions (see chapter 5).

The feedback infrastructure could also be made available through the national SNOMED CT Browser. In the Swedish edition the functionality of a Concept Feedback button is activated in the interface of each concept entry in the browser. The button gives access to a feedback form, which will be sent to the Swedish NRC when completed.

Feedback can also be a part of a strategy to reach out to users in the clinical and social care setting. The German translation is based on community based feedback from users from countries such as Germany, Austria and Switzerland. Such crowdsourcing could also be performed at a more local level, like a hospital, which was the case of the Spanish translation during a period.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/6-improving-translation-quality#text-analysis)

Text Analysis


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If there are medical text corpora available in the target language, it is possible to perform text analysis to improve the quality of the translation. Analysing genres such as casuistics or medical journal articles could provide a list of terms being used frequently by medical experts. The Norwegian NRC is exploring how automatic extraction of terms in such texts can be performed to check whether terms are missing in the translations. This can be done in collaboration with academic institutions as it requires specific tools.

This approach is an inversion of using text corpora and text analysis during the translation and validation process. The point of departure are terms being used in texts, not identifying translated terms representing the concept during the translation process.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Translation+Management+Guide&entry.670899847=Improving%20Translation%20Quality)

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*   [Feedback Mechanisms](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/6-improving-translation-quality#feedback-mechanisms)
    
*   [Text Analysis](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/6-improving-translation-quality#text-analysis)
    

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# Maintenance of a Translation | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents

Once a translation is completed, the burden of translation lessens considerably. However, translating SNOMED CT is shooting at a moving target, or like chasing Aristotle’s famous turtle: whenever a finish line has been crossed, the turtle has moved on.

With every new release, SNOMED CT expands with new concepts; moreover, the definition or even the FSN of the concepts that are already translated may change and render an earlier translation inaccurate. In order to keep a translation usable, it must be maintained.

This chapter will address the different streams of incoming work of mature translations (new content, changes in existing content, reactivated content). Also, maintaining consistency, updating guidelines and principle decisions after the initial translation is included.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation#new-content)

New Content


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New content is added to the SNOMED CT International Edition by monthly releases.

On average, 700 new concepts per month based on releases in 2022, with significant variability in hierarchy composition.

*   all of them require translation _if_ the complete SNOMED CT is to be available in the target language. Most of the new concepts require manual translation, but for selected areas such as clinical drugs, template-based batch translation might be leveraged, but this depends on the target language characteristics and the results of ongoing research.
    
*   less than 5% of new concepts are direct replacements of ambiguous inactivated concepts with a similar translation
    
*   15-20% of new concepts are aligned with the SNOMED CT International Drug Model. Those usually benefit (and sometimes require, like most clinical drugs) template-based translation or quality assurance, as naming conventions for multi-ingredient clinical drugs are complex to craft or review manually
    
    *   average 50-100 new descriptions in existing concepts. In concept-based translations those might be ignored, or triaged to a simplified manual inspection workflow that closes the task if no changes are deemed necessary.
        
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation#changes-in-existing-content)

Changes in Existing Content


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Changes in the lexical representation of existing source concepts are made in every new international release.

*   FSN changes usually require manual inspection to identify potential shifts in meaning or a need to align to recent remodelling or new naming conventions (e.g. recent new perspective on osteotomies).
    
    *   In recent releases FSN changes usually arise from the enforcement of new naming conventions and the QI project. While the new conventions are usually only enforced on new content and on areas being revised by the QI project, translation projects might prefer on a case by case basis to extend the revision to existing translations sharing the same source pattern.
        
    
*   Inactivated source descriptions may require manual inspection as old translations might have been influenced by obsolete (e.g. deprecated organism names) or terms inactivated as not semantically equivalent.
    
*   Changes in preferred terms should not affect concept-based translations that base their synonyms on descriptions that accurately represent the meaning of the source FSN. However, the use of translation memories, machine pre-translations and template-based text generation might have introduced undesirable characteristics of term-to-term translations if the target preferred term is directly derived from the source preferred term.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation#reactivated-content)

Reactivated Content


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Reactivated concepts usually represent a very small portion of content updates, but they might result in duplicate translations in some cases.

Inactivated concepts that have active translated descriptions are not usually considered a priority to trigger reviews, but in some cases they are relevant to local implementations and require follow up (particularly if the concept was inactivated as ambiguous.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation#content-change-reports)

Content Change Reports


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SNOMED International publishes monthly release notes which give an overall view of the content change in the last release. However, for translation there is a need for a record of each change. Also, NRCs which have only translated parts of the international edition, there is also a need for filtering out changes which affect the national edition.

NRCs which are using Managed Service, can access the Reporting Platform, where several reports are available for the national extension, for example the Inactivated translation concepts report.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1272634488-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FLWaBsNxFVew6RgxiYZZQ%252Fuploads%252Fgit-blob-d07fb1c8f4ea954070cd311c13aa4f345a3e3368%252F202999423.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=ada2c87f&sv=2)

Figure 8: Screenshot of the Inactivated translated concept report (Reporting Platform) for Norwegian (january 2022)

Content change reports are also available in other SNOMED CT tool environments, such as TermSpace:

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1272634488-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FLWaBsNxFVew6RgxiYZZQ%252Fuploads%252Fgit-blob-08dcc53155de41c50b793dbea2a4ca8aebdfcc97%252F202999424.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=22357dfb&sv=2)

Figure 8: Screenshot of content change report of the international edition during the March 2022 release in the TermSpace environment.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation#other-source-for-change)

Other Source for Change


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Other translation maintenance tasks originate in other sources than changes in SNOMED CT international edition: external feedback, internal quality improvement projects, or changes in editorial policies or style guides.

*   change requests from users detecting typos or incorrect translations issues detected by the translation team
    
*   translation consistency across different translation periods (complete translations take years and editorial policies might change over time)
    
*   changes in naming conventions related to the ongoing QI project might require extensive revision of previous translation.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation#maintaining-consistency-updating-guidelines-and-principle-decisions)

Maintaining Consistency, Updating Guidelines and Principle Decisions


---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

When taking the step from initial translation to translation maintenance, a much smaller team will be required. Although in an ideal world one would keep a large and diverse group of clinicians and domain experts to review the recurring translations, this will most likely not be feasible once the initial translation project is ended. One should still strive for building up a system where domain expertise is available to a reasonable extent, such as a pool of volunteers or through formal collaboration with medical specialist organisations or by other means. A key question is, also, whether it possible to both have a small team and ensure national consensus

In a situation where the complete set of concepts in SNOMED CT are translated (this is the case e.g. in Sweden) the translation cycles might be performed quite fast and specialised terms may not receive an optimal translation, even if the overall translation is of reasonable quality. In this situation, the improvements of the translation will be organic and driven by demands of users. Such a translation will be a result of actual use: SNOMED CT areas and branches that are subjects for development projects on different levels will be reviewed as the need arises.

During the translation project, but of course to an even greater extent once the initial project is completed, staff may leave and be replaced. This poses the challenge to preserve knowledge and maintain the expertise required to keep the new translations consistent with the older translations. Each new member of staff must be trained in the use of the guidelines, tools and processes.

During or after the translation project inconsistencies in translations may come to light. For instance, in Dutch the word ‘thyroid’ can be translated to ‘schildklier’, ‘thyroïd’ or ‘glandula thyroidea’. The first two are equally frequently used and thus different translators and reviewers will not choose consistently unless there is a guideline that governs the choice.

One approach for handling guidelines is to collect fundamental linguistic and terminological guidelines of the translation in a basic document that is kept stable over the years. Editorial agreements on principle issues which are raised during every translation cycle are documented in a separate, complementary document. This document is where decisions about individual term choices are to be found, i.e. which term of two or more possible ones the translator should choose (see [Figure 5-3arrow-up-right](https://confluence.ihtsdotools.org/display/DOCMANAGETRANS/5.+Maintenance+of+a+Translation#Figure-3)
). The translators could also find instructions on how to spell an expression, if there are several spelling variants. The document also contains advice on such fairly general expressions that recur in the SNOMED CT material and which in the translation work should be handled in a similar way. This document is continuously replenished, which means that newer decisions revoke older ones.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1272634488-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FLWaBsNxFVew6RgxiYZZQ%252Fuploads%252Fgit-blob-68cda5cfa69a2689fe541511b9525492cbf7d70d%252F202999425.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=d0b27d1c&sv=2)

Figure 9: Spreadsheet with principle issues for translation, Swedish version

Once a guideline is established, to achieve consistency it is not sufficient to apply it to all future translations; all finished translations that contain the term must be revised so that they will adhere to the guideline in the next edition. The efficient usage of ECL queries, including the description filters, is useful for detecting inconsistencies. This issue also emphasises the need for an easy and effective tool for batch changes.

The use and implementation of the terminology, or changes in a new version of the international edition, may periodically provide new insights that require updates of the linguistic guidelines; which in its turn may require revision of older translations.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Translation+Management+Guide&entry.670899847=Maintenance%20of%20a%20Translation)

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[NextImproving Translation Qualitychevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/6-improving-translation-quality)

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*   [New Content](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation#new-content)
    
*   [Changes in Existing Content](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation#changes-in-existing-content)
    
*   [Reactivated Content](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation#reactivated-content)
    
*   [Content Change Reports](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation#content-change-reports)
    
*   [Other Source for Change](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation#other-source-for-change)
    
*   [Maintaining Consistency, Updating Guidelines and Principle Decisions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/5-maintenance-of-a-translation#maintaining-consistency-updating-guidelines-and-principle-decisions)
    

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# Supporting Documents | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents

Documents consulted for the development of these guidelines:

*   [SNOMED CT Translation Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/)
    
*   Språkliga riktlinjer för översättningen av SNOMED CT till svenska, Version 11. Socialstyrelsen, Stockholm 2010-12-31.
    
*   ISO 704:2022 Terminology work – Principles and methods.
    
*   ISO 860:2007 Terminology work – Harmonization of concepts and terms.
    
*   ISO 1087-1:2019 Terminology work – Vocabulary – Part 1: Theory and application.
    
*   ISO 15188:2001 Project management guidelines for terminology standardization.
    
*   ISO 17100:2015 Translation services.
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Translation+Management+Guide&entry.670899847=Supporting%20Documents)

[PreviousGlossary of Termschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/7-glossary-of-terms)

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# Example EMR EHR Requirements Guide | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents

This guide provides a set of high-level examples of categories and requirements to consider when procuring an Electronic Medical Record (EMR) or Electronic Health Record (EHR) system that incorporates SNOMED CT. Designed to be broadly applicable across different countries and regions, the document aims to assist National Release Centers (NRCs) in identifying relevant procurement requirements, while also offering vendors insights into typical SNOMED CT expectations. It emphasizes that specific requirements should be tailored to individual use cases. The guide is intended for a diverse audience involved in EMR/EHR procurement and implementation, including planners, clinical experts, technical teams, and vendors. Key topics covered include content and language, user interface, analytics, maintenance, storage, interoperability, and additional resources.

[Introduction](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-ehr-requirements-guide/1-introduction)

Example Requirements

[Edition, Language and Content](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-ehr-requirements-guide/2-edition-language-and-content)

[User Interface](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-ehr-requirements-guide/3-user-interface)

[Analytics and Reporting](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-ehr-requirements-guide/4-analytics-and-reporting)

[Maintenance](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-ehr-requirements-guide/5-maintenance)

[Storage](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-ehr-requirements-guide/6-storage)

[Interoperability](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-ehr-requirements-guide/7-interoperability)

[Additional Resources](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-ehr-requirements-guide/8-additional-resources)

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© Copyright 2026 International Health Terminology Standards Development Organisation, all rights reserved.

This document is a publication of International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED International owns and maintains SNOMED CT®.

Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. This document may be subject to updates. Always use the latest version of this document published by SNOMED International. This can be viewed online and downloaded by following the links on the front page or cover of this document.

SNOMED®, SNOMED CT® and IHTSDO® are registered trademarks of International Health Terminology Standards Development Organisation. SNOMED CT® licensing information is available at [http://snomed.org/licensingarrow-up-right](http://snomed.org/licensing)
. For more information about SNOMED International and SNOMED International Membership, please refer to [http://www.snomed.orgarrow-up-right](http://www.ihtsdo.org/)
 or contact us at [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#0a63646c654a63627e796e652465786d)
.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=EHR+Requirements+Guide&entry.670899847=Example%20EMR%20EHR%20Requirements%20Guide)

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# Translation Process | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents

There is not a single best workflow to recommend for SNOMED CT translation. The workflow most suitable to a country’s needs depends on what part of SNOMED CT is likely to be used, the resources (including translators) available and the order in which translation principles are prioritised.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#team-selection)

Team Selection


-------------------------------------------------------------------------------------------------------------------------------------------------------------

It takes a village to translate SNOMED CT, that is to say a group of people with different roles and expertise:

*   Terminologists ensure the semantic correctness of the translations: to check whether the translations convey and imply the exact same meaning as the concepts expressed with the FSN and concept relationships. The NRC should contact SNOMED International in case of discrepancies between descriptions and definitions, between English descriptions, and to report duplicate concepts (see chapter 4.5). SNOMED International can facilitate translation by providing text definitions.
    
*   Healthcare professionals, as the target users of the translations, should indicate which translations are most frequently used and recognizable in the healthcare environment.
    

SNOMED CT contains many concepts that refer to procedures or disorders that are highly specialised, have become obsolete, or convey the same meaning through entirely different descriptions. No single healthcare professional or terminologist can interpret them all. You will need a team of specialists from the relevant healthcare disciplines, who can indicate what an obscure term means, how it is referred to in your language and whether it is relevant for your country or not. If you translate a use case specific reference set, you may be able to limit your team to a single specialty. In that case, the terminologist will need to ensure that the translations are not interpreted into a too specific context, which would render them unsuitable for other use.

*   Linguists are required to ensure consistent, concise, grammatical translations that are free of spelling errors. They are more likely to notice and avoid standard (non-medical) translation pitfalls that a healthcare professional new to translation might fall into. Linguists are often trained to use text corpora for translation purposes. Translation, especially in such huge quantities, is a profession in itself: a group of healthcare professionals simply will not make as neat a job of it. By preference, the translators should be specialised in medical translation or assisted by a medical linguist.
    

Some of these skills may be combined. For example, the Netherlands found it useful to train young Medical Doctors in the use, purpose and structure of SNOMED CT, so they can check both semantic correctness and recognizability of the translation, increasing efficiency. Alternatively, translators can be trained as terminologists, or healthcare professionals with a linguistics background can be found. However, combining multiple skills or expertise in a single person will make it harder to find suitable people and increase the cost of their labour.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#prioritise-translation-principles)

Prioritise Translation Principles


---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

[The Guidelines for Translation of SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/)
 discuss the translation principles that are vital to know when translating SNOMED CT, including the idea of concept-based translation. Translations should be unambiguous, linguistically correct, consistent and both recognisable and acceptable to healthcare professionals. Unfortunately, these requirements conflict. In order to resolve these daily dilemmas most quickly, you should prioritise them and let this priority influence your workflow. If you rate recognisability and acceptability highest, then the healthcare professional should have the final say over each translation. If on the other hand you value consistency and linguistic correctness more, then a medical linguist or translator should have that honour. This prioritisation should be done in close collaboration with the editorial board and made available in the national language guidelines for translation.

In difficult cases an editorial board can ensure consensus about the best possible translation (or compromise). The use of synonyms can be used to support different jargons between specialist groups, spelling variants or even patient-friendly terms. To distinguish translations that adhere to all principles from those that deliberately violate some (e.g. contain spelling errors, are meant for patients rather than medical professionals, or are ambiguous) you can choose to create multiple language reference sets. Please note that adding synonyms or language reference sets does increase the burden of maintenance.

You should also decide in advance how to handle obsolete or erroneous concepts. Do you want to translate them anyway (which leads to an imperfect result), ignore them (which leads to an incomplete translation) or resolve them with SNOMED International (which leads to a large amount of work both for you and for SNOMED International) However, it is highly recommended to submit obsolete and erroneous concepts to improve the quality and reduce the burden of future translations into other languages. The time spent on discussion regarding bad concepts will multiply for each new translation unless they are resolved by Snomed International.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#determine-the-workflow)

Determine the Workflow


-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------

There is no single best workflow. The choices you have made above restrict the number of workflows that are suitable to your situation. However, some principles hold true in all cases:

*   Each translation should be concept-based. Concept-based translation is explained [The principle of concept based translation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#the-principle-of-concept-based-translation)
    
*   Each translation should be viewed by at least two team members, and any change made, however trivial, should be reviewed by a colleague.
    
*   You will need an editorial board to maintain linguistic guidelines, correcting any translations that do not comply, and resolve difficult cases.
    
*   You should be able to track the process of each translated concept through the workflow.
    
*   You need some kind of quality assurance (described in “A methodology and toolkit for evaluating SNOMED CT translation quality”).
    

Different member countries have translated using very heterogeneous workflows. The previous version of this document recommended the workflow in Figure 4, based on the experiences of Sweden and Denmark.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1272634488-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FLWaBsNxFVew6RgxiYZZQ%252Fuploads%252Fgit-blob-340978b5db3e0e7b591b32b26bf615da77cde81c%252F202999421.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=f1933dc&sv=2)

Figure 4: Translation process recommended after Swedish and Danish translation

This workflow was short and thus efficient, but required translators, reviewers or editors who possessed knowledge within healthcare, linguistics and terminology. In this setup clinical validation is expected to be done in the post translation process.

Conversely, the Netherlands adopted a complex workflow where each expertise owned its own workflow status (see Figure 5). This made it easier to find suitable team members, but increased the amount of time needed per translation and required abundant and careful communication to coordinate the different expertise groups.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1272634488-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FLWaBsNxFVew6RgxiYZZQ%252Fuploads%252Fgit-blob-2c0a63323c1ce2b874c77d91694d04de6ac845d6%252F202999418.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=b93b9921&sv=2)

Figure 5: Translation process in the Netherlands

The Belgian workflow distinguishes two types of reviewers: the domain specialist who validate the translation from a clinical point of view and the linguist who verify the grammatical adequacy of the term (see Figure 6)

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1272634488-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FLWaBsNxFVew6RgxiYZZQ%252Fuploads%252Fgit-blob-ad0f6edd16daba0f3bbc305d263c7d1466d62b91%252F202999419.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=b5bf5c3b&sv=2)

Figure 6: Translation process in Belgium

In Norway, domain specialists selected the subsets, an external agency translated, and medical students of the final year did the review with the support of domain experts, see Figure 7. A coordination unit consisting of four terminologists (two health care workers and two linguists) facilitated the process and resolved issues continuously, either by itself or by consulting the domain experts or the Editorial Board.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1272634488-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FLWaBsNxFVew6RgxiYZZQ%252Fuploads%252Fgit-blob-b607be0ef22996d86893f5503d6f1c47e83c07b5%252F202999420.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=3bcf4952&sv=2)

Figure 7: Translation process in Norway

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#pros-and-cons-of-different-workflows)

**Pro’s and con’s of different workflows**

Workflow

Pro’s

Con’s

**Standard**

*   Fewer review steps
    
*   Requires only small team
    

*   No clinical validation during translation process
    

**Belgium**

*   Validation of terms can only be done by experts who have clinical experience and who belong to the target audience (future users of SNOMED CT in EHR): involving them is important for buy-in
    
*   Clinical validation by more than one domain expert implies choice of terms used in clinical practice
    
*   Leveraging existing translations reduces time
    
*   Domain experts do not need to bother about formal aspects of the translate terms as linguists verify its adequacy and consistency, and make sure that the guidelines are being adhered to
    

*   It is difficult to match selected concepts with specific domain expertise of clinical validators.
    
*   Domain experts with clinical practice are difficult to recruit and lack time to work on projects
    

**Netherlands**

*   Easy to recruit team members: professional translators, healthcare professionals for medical validation, training med students as terminologists
    
*   Minimising burden on the healthcare professionals (who are most difficult to recruit)
    
*   Thorough review of each concept by multiple persons and from multiple expertises
    

*   Expensive
    
*   Medical review step introduces a lot of inconsistency in translations
    

**Norway**

*   External translation agency can provide large-scale translations
    
*   Easy to recruit students as clinical validators
    
*   Reducing burden on healthcare professionals
    
*   More economical to use students as clinical validators (wage/hour)
    
*   Lesser degree of personal preference with regard to term choice among multiple synonyms
    

*   External translators tend to translate word-by-word in specialised areas
    
*   Less clinical experience and knowledge among students, giving rise to translation errors and higher burden on terminological coordination, especially in specialised areas
    
*   Difficult for The National Editorial Board to acquire sufficient knowledge of SNOMED CT.
    

**Table: Pro’s and con’s of different workflows**

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#progress-monitoring-and-follow-up)

Progress Monitoring and Follow-Up


---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The following issues related to the translation process should be monitored and considered:

*   regular adjustment of the linguistic guidelines;
    
*   adjustment of the resources in the translation processes in order to continuously optimise the process;
    
*   workflow statistics;
    
*   correction of translations that do not comply with the linguistic guidelines. This includes changing older translations to comply with a new guideline.
    

The following issues of project progress should be monitored:

*   follow-up on quantity, e.g. the number of approved translated concepts, the number of unresolved problem concepts sent to the editorial board, the number of errors made by the translators;
    
*   follow-up on quality, e.g. how well the translation complies with the linguistic guidelines, how well the translation complies with language corpora and concordances of respected medical journals and other relevant sources;
    

follow-up on costs;

*   follow-up on deviations from goals;
    
*   follow-up on translation service provider issues;
    
*   follow-up on performance of IT tools.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#content-enhancement-during-translation)

Content Enhancement during Translation


-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The translation process provides an excellent form of quality assurance for SNOMED CT, both in terms of a review of existing content, and also the identification of SNOMED CT concepts which could be added to the release, either as international content additions or by addition to national extensions where these exist. Guidance for content requests can be found here - [SNOMED CT Content Request Service](https://docs.snomed.org/snomed-ct-user-guides/crs-guide/)
.

If promoting national concepts to the international edition, the FSN and PT have to be translated into English (US). This requires in depth knowledge of the Editorial Guide and naming conventions related to the hierarchy the concepts belong to.

Regarding all requests, whether to the International or National Release, should be supplied with a detailed description of the problem, along with a statement of requirements to inform the resolution. In the case of requests originating from translation activities, this should include details of the problem related to translation with a description including concept/description translations to provide additional clarity.

An NRC may use their own tool, such as JIRA, to collect and filter requests for SNOMED International; or they can use a tool that SNOMED International provides: [https://be-rmp.snomedtools.org/fr/arrow-up-right](https://be-rmp.snomedtools.org/fr/)
. This latter tool is convenient because it can be used to escalate an issue to SNOMED International.

The Translation User Group (TUG) uses a [JIRA environmentarrow-up-right](https://jira.ihtsdotools.org/projects/SCTF/summary)
 to signal and discuss translation issues among translating countries. This is a good venue to ask how other countries have solved a particular translation issue. When the group agrees that the issue is with the international edition and warrants a change request, the group can submit the request through CRS using the TUG’s project code.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#collaborating-with-other-nrcs)

Collaborating with other NRCs


-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The Translation User Group meets regularly with a dual purpose: to create and update guidelines such as these, and also to share experiences and expertise. When you encounter a particular translation dilemma, such as an ambiguous source concept or term, you can raise an issue in our JIRA project: [https://jira.ihtsdotools.org/projects/SCTF/summaryarrow-up-right](https://jira.ihtsdotools.org/projects/SCTF/summary)
.

We invite every organisation or professional developing a SNOMED CT translation to join the group. Details can be found on [https://confluence.ihtsdotools.org/display/TRANSLATIONUSERGROUP/Translation+User+Group+Homearrow-up-right](https://confluence.ihtsdotools.org/display/TRANSLATIONUSERGROUP/Translation+User+Group+Home)
 .

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#translation-to-multiple-languages-or-dialects)

Translation to Multiple Languages or Dialects


---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Performing translation and validation to a target language which is official in several countries potentially involving different NRCs will normally require a different approach, such as Spanish, French and German. However, a language being shared across borders, may present differences regarding spelling or lexical choices which have to be taken into account. This section will present some experiences of multiple languages and dialects.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#the-swiss-experience)

**The Swiss Experience**

The Swiss Extension includes German, French and Italian. The following are the experiences and workflows of the Swiss NRC.

The concepts are initially translated by the internal translation service of the Federal Office of Public Health (FOPH). eHealth Suisse then checks whether the initial translations comply with the guidelines and the translation guides of the respective language of SNOMED International. If necessary, the translations are additionally validated by experts.

Depending on the language, a different process is initiated.

The German translations are compared with existing translations from Germany or Austria and supplemented if necessary. Subsequently, the German translations are submitted to the German Translation Group (GTG). The translations are checked again by the GTG and, if necessary, supplemented with further synonyms. After review, the translations are published in the German Community Browser of SNOMED International and a public commenting phase is started. During this phase, anyone can comment on the translations. Once the commenting phase has been completed and evaluated, the translations will be incorporated into the joint German edition of the GTG.

French translations that are not already in SNOMED's "Common French Translation" will be submitted to the French Translation Collaboration Group and included in the "Common French Translation". Unlike the German-language group, the French-language group does not provide for public comment.

Italian translations do not go through an International Working Group, as none currently exists. Italian translations are validated by appropriate subject matter experts after the initial translation, if needed, and then imported directly into the Swiss Extension.

Based on the Swiss experience, there are advantages and disadvantages of a sequential and a parallel translation process:

Sequential translation

Parallel translation

**Advantages**

Translators can use existing translations as a guide and also perform quality assurance.The organisation and coordination effort is lower.

It takes significantly longer to translate a concept into all desired languages.

If the first translation is not correct, it can affect subsequent translations.

**Disadvantages**

The organisational and coordination effort is greater than for sequential.

Depending on the language, the translation process can be different, which makes the whole process more complex.

The entire translation process is shorter because translations are done into all desired languages at the same time.

In validation, experts can rely on all translations.

Feedback from one language can be immediately incorporated into the other languages.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Translation+Management+Guide&entry.670899847=Translation%20Process)

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*   [Team Selection](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#team-selection)
    
*   [Prioritise Translation Principles](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#prioritise-translation-principles)
    
*   [Determine the Workflow](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#determine-the-workflow)
    
*   [Pro’s and con’s of different workflows](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#pros-and-cons-of-different-workflows)
    
*   [Progress Monitoring and Follow-Up](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#progress-monitoring-and-follow-up)
    
*   [Content Enhancement during Translation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#content-enhancement-during-translation)
    
*   [Collaborating with other NRCs](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#collaborating-with-other-nrcs)
    
*   [Translation to Multiple Languages or Dialects](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#translation-to-multiple-languages-or-dialects)
    
*   [The Swiss Experience](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/4-translation-process#the-swiss-experience)
    

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# Guidelines for Translation of SNOMED CT | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents

These general guidelines may be used as a template to develop national guidelines. In addition to linguistic and terminological guidelines, this document includes general recommendations about the steps involved in a translation workflow process, and, information about source documents or references that must be made available to those involved in the translation process.

* * *

[Introduction](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/1-introduction)

[An introduction to terminological principles](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/2-an-introduction-to-terminological-principles)

[SNOMED CT as a health terminology](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology)

[Translating SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct)

[Sources of information](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/5-sources-of-information)

[Translation process and post-translation issues](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/6-translation-process-and-post-translation-issues)

* * *

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© Copyright 2026 International Health Terminology Standards Development Organisation, all rights reserved.

This document is a publication of International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED International owns and maintains SNOMED CT®.

Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. This document may be subject to updates. Always use the latest version of this document published by SNOMED International. This can be viewed online and downloaded by following the links on the front page or cover of this document.

SNOMED®, SNOMED CT® and IHTSDO® are registered trademarks of International Health Terminology Standards Development Organisation. SNOMED CT® licensing information is available at [http://snomed.org/licensingarrow-up-right](http://snomed.org/licensing)
. For more information about SNOMED International and SNOMED International Membership, please refer to [http://www.snomed.orgarrow-up-right](http://www.ihtsdo.org/)
 or contact us at [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#88e1e6eee7c8e1e0fcfbece7a6e7faef)
.

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# User Interface | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents

The success of an implementation of SNOMED CT is often driven by the quality and approach that has been employed in the development of the user interface. This is where end users will interact and use SNOMED CT and a poor implementation will have a considerable impact on the quality of data entered. These points provide some guidance on what should be expected from vendors in systems using SNOMED CT.

1.  Use SNOMED CT for searching, display, storage, communication, knowledge linkage, querying and analytics in the following clinical domains (or specific data elements)
    
    *   Problems, Diagnosis and Clinical Findings
        
    *   Reason for Admission
        
    *   Procedures (e.g. Planned Procedures, Performed Procedures)
        
    *   Allergies
        
    
2.  Support searching for SNOMED CT concepts using any term that is preferred or acceptable in the national language reference set.
    
3.  The vendor shall include one of the following options for each SNOMED CT coded data element (depending on user preferences and local requirements for standardization of interface terms):
    
    *   Upon selection of a concept, use the term entered by the user to display the selected concept; OR
        
    *   Upon selection of a concept, use the preferred term from the national language reference set) to display the selected concept; OR
        
    *   Upon selection of a concept, use the preferred term from the regional or institution specific language reference set to display the selected concept.
        
    
4.  The vendor shall allow searching and selection of only those concepts from the SNOMED CT subset that has been specifically bound to that data element.
    
5.  The vendor shall display the most frequently selected concepts at the top of the list, for elements bound to a subset containing more than 20 concepts.
    
6.  As the user types each character into a SNOMED CT coded data element, limit the selection of concepts to those with a preferred or acceptable term that matches the characters types (using a ‘word prefix any order’ algorithm), and use auto-complete when only one option is available for selection.
    
7.  When displaying the list of possible matches, display the concept with the shortest matching term first.
    
8.  For each free text data element that records clinical information (e.g. Past history, Clinical notes) use SNOMED CT-enabled techniques (e.g. Natural Language Processing) to suggest possible SNOMED CT encoding (including appropriate contextual information), for selection and confirmation by the user.
    
9.  Support the capture of SNOMED CT post-coordinated expressions using predefined expression templates and automatically-generated interface terms – for laterality, allergies and family history.
    
10.  Use SNOMED CT concept identifiers stored in the EHR to suggest patient-specific clinical knowledge to the clinician, and to test clinical decision support rules.
    
11.  Use SNOMED CT codes stored in the EHR, together with SNOMED CT and other map-enabled coding systems (e.g. SNOMED to ICD-10) to suggest appropriate codes for the clinician to select (if required).
    
12.  The system shall be sufficiently performant to return the first (X) results in a given time period (e.g. less than 1s).
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=EHR+Requirements+Guide&entry.670899847=3.%20User%20Interface)

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# Translation process and post-translation issues | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents

Recommendations on the various steps of the translation process can be found in the document [_Guidelines for Management of Translation of SNOMED CT_](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-management-guide/)
. This section summarises the main steps.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/6-translation-process-and-post-translation-issues#translation)

Translation


------------------------------------------------------------------------------------------------------------------------------------------------------------------------

There should always be at least two persons involved in the initial translation – a translator and a proof-reader (to verify the initial translation). It is crucial that translators have high level linguistic skills as well as a good insight in health care. The role of the translators is to:

*   translate source language concept into the target language
    
*   proof-read the translated concept description in the target language before passing it on for further review
    
*   raise questions so that principle decisions are made by the Editorial Board (or similar group), concept description in the target language whenever they deem necessary.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/6-translation-process-and-post-translation-issues#review)

Review


--------------------------------------------------------------------------------------------------------------------------------------------------------------

Apart from proof-reading, proper review should be carried out by health and social care professionals. They act as quality assessors and their tasks are to:

*   confirm that the translated description reflect the underlying concept (the description’s linguistic quality, which should comply with the linguistic guidelines and general rules of the target language, should be checked by professional translators or linguists)
    
*   approve the description that meets the requirements of good translation as in this document and national guidelines
    
*   return unacceptable translations to the translator for correction
    
*   if necessary, address questions on fundamental decisions to the Editorial Board
    
*   consult with the Editorial Board with "questions of doubt"
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/6-translation-process-and-post-translation-issues#editing)

Editing


----------------------------------------------------------------------------------------------------------------------------------------------------------------

The Editorial Board should consist of an interdisciplinary team made up of professionals with pedagogical and empirical backgrounds in medicine and nursing, linguistics and terminology, information science or technology, paramedical disciplines with sound knowledge and understanding of the English language.

The tasks of the Editorial Board are to:

*   define and maintain the guidelines to which all participants involved in the translation process must adhere
    
*   determine the validity of textbooks and references provided to translators and reviewers
    
*   act as an advisory body for translators and reviewers
    
*   make and develop the key decisions that are inevitably required during the translation process
    
*   ensure that all participants are continuously updated on new decisions
    
*   deal with particularly complicated translations and questions from translators, reviewers and others
    
*   approve the terms that meet the requirements after revision of the “terms/cases of doubt”
    
*   collect and register errors and related issues regarding SNOMED CT content in the International Release to be submitted through CRS by the NRC.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/6-translation-process-and-post-translation-issues#progress-monitoring-and-follow-up)

Progress monitoring and follow-up


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

A project manager and/or coordinator should be appointed to carry out a continuous assessment of the progress of the translation, general project administration and surveillance. The monitoring and follow-up roles are described in the document _Guidelines for Management of Translation of SNOMED CT_

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/6-translation-process-and-post-translation-issues#post-translation-issues)

Post-translation issues


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The clinical validation of the translated descriptions plays an important role in the translation of the SNOMED CT terminology into the target language. Some descriptions reflect very complicated or rarely used concepts, and there is a risk that both translator and reviewer, despite all efforts, may have misunderstood the concept in the source terminology. There is also a risk that a particular description, however correct it may be, may be psychologically unacceptable to clinicians if they are used to employing a particular description or phrase for a particular concept. Validation should therefore be carried out by health and social care providers to ensure that the translation is useful in clinical, cultural and social settings.

In addition to the validation of the translated descriptions, a policy for the maintenance of the target language terminology and feedback to SNOMED international is required. If a concept added in a national extension is to be included in the SNOMED CT International Release it must have a FSN in English.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Translation+Guide&entry.670899847=Translation%20process%20and%20post-translation%20issues)

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*   [Translation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/6-translation-process-and-post-translation-issues#translation)
    
*   [Review](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/6-translation-process-and-post-translation-issues#review)
    
*   [Editing](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/6-translation-process-and-post-translation-issues#editing)
    
*   [Progress monitoring and follow-up](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/6-translation-process-and-post-translation-issues#progress-monitoring-and-follow-up)
    
*   [Post-translation issues](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/6-translation-process-and-post-translation-issues#post-translation-issues)
    

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# Edition, Language and Content | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents

It is important that vendors work with valid editions, versions and derivatives of SNOMED CT that are relevant in the context of the country. This is also pertinent when considering the native language of local healthcare systems, if this is relevant and the native language is available.

1.  The vendor shall incorporate SNOMED CT as the primary, clinical terminology in the EHR, including the international edition, national edition, and any relevant local extensions.
    
2.  The vendor shall be responsible to update SNOMED CT within 12 months of a new version of the deployed SNOMED CT edition being published (e.g. international, national or local edition). This process should include updating all SNOMED CT components that have been added or changed, and other derivative artifacts that refer to SNOMED CT components.
    
3.  The vendor shall implement SNOMED CT in the native language of implementing country/organization.
    
4.  The vendor shall create or source all SNOMED CT subsets and maps required by the customer. All such subsets and maps shall undergo an approved quality assurance process required by the customers to support user interface value lists, CDS trigger rules, queries, reports and messages.
    
5.  The vendor shall provide a strategy for feedback mechanism to submit new content and/or add content locally e.g. vendors shall engage with the NRC if additional content is required.
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=EHR+Requirements+Guide&entry.670899847=2.%20Edition%2C%20Language%20and%20Content)

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# Supporting documents | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents

**SNOMED CT Document Library**

[SNOMED CT Document Library](https://docs.snomed.org/)

* * *

**National translation guidelines developed by the SNOMED International member countries:**

[https://www.snomed.org/our-customers/membersarrow-up-right](https://www.snomed.org/our-customers/members)

**Documents consulted for the development of these guidelines**

Cabré Castellvi, T. (1999). _Terminology: Theory, Methods and Applications._ Amsterdam/Philadelphia: John Benjamins.

COTSOES (2003). _Recommendations for Terminology Work._ Retrieved from [http://www.cotsoes.org/en-publicationsarrow-up-right](http://www.cotsoes.org/en-publications)

INFOTERM (2005). _Guidelines for Terminology Policies._ Paris: UNESCO.

International Health Terminology Standards Development Organisation (2012). _A methodology and_ _toolkit for evaluating SNOMED CT Translation Quality_. Retrieved from [https://confluence.ihtsdotools.org/download/attachments/18780052/TQA\_background\_20120810\_v0%2015.doc?api=v2arrow-up-right](https://confluence.ihtsdotools.org/download/attachments/18780052/TQA_background_20120810_v0%2015.doc?api=v2)

ISO 1087-1 ((1969, 1990, 1998) 2000). _Terminology work – Vocabulary – Part 1: Theory and application._ Geneva: International Organization for Standardization.

ISO 704 ((1987, 2000) 2009). _Terminology work – Principles and methods._ Geneva: International Organization for Standardization.

Molina, L., & Albir, A.H. (2000). Translation Techniques Revisited: A Dynamic and Functionalist Approach. _Meta, XLVII_(4), 497-512.

Nuopponen, A. (2018). Terminological Concept Systems. In _Languages for Special Purposes: An International Handbook_ (pp. 453-468). Berlin/Boston: Mouton De Gruyter. doi: 10.1515/9783110228014-023

Odgen, C., & Richards, I. (1923/1989). _The Meaning of Meaning: Study of the Influence of Language Upon Thought and of the Science of Symbolism_ (8 ed.). Harvest/HBJ.

Pavel, S., & Nolet, D. (2001). _Handbook of Terminology._ Ottawa: Public Works and Government Services Canada.

Wüster, E. (1979/1985). _Einführung in die Allgemeine Terminologielehre und Terminologische Lexikographie._ Copenhagen Business School.

**Further reading**

Bodenreider, O., Smith, B., & Burgun, A. (2004). The Ontology-Epistemology Divide. A Case Study in Medical Terminology. In A. Varzi, & L. Vieu (Eds.), _Proceedings of FOIS 2004, International Conference on Formal Ontology and Information Systems._ Turin, 4-6 November 2004.

Cimino, J. (1998). Desiderata for controlled medical vocabularies in the twenty-first century. _Methods_ _Inf Med., 37_(4-5), 394-403. Retrieved from PMID: 9865037; PMCID: PMC3415631

Madsen, B. (2004). _Handbog i begrebsarbeidje Del 1 & 2 (Handbook of concept work)._ Sundhedsstyrelsen _(National Board of Health)_. Copenhagen.

Madsen, B. (2015). Concept modeling vs. data modeling in practice. In F. Steurs & H. Kockaert (Eds.), _Handbbook of Terminology_ (pp. 250-275). Amsterdam/Philadelphia: John Benjamins Publishing Company.

Reynoso G.A., March A.D., Berra C.M., Strobietto R.T., Barani M., Lubatti M. et al. (2008.). Development of the Spanish Version of the Systematized Nomenclature of Medicine: Methodology and Main Issues. _Prc AMIA Symp_ , (pp. 694-8).

Spackman, K. A., Dionne R., Mays R., & Role J. ( 2002). Role grouping as an extension to the description logic of Ontology, motivated by concept modeling in SNOMED. _Proc AMIA Symp._ , (pp. 712-6).

Spackman, K. A., & Reynoso G. (2004). Examining SNOMED from the perspective of formal ontological principles: Some preliminary analysis and observations. In U. Hahn (Ed.), _Proceedings of the KR 2004 Workshop on Formal Biomedical Knowledge Representation._ (pp. 72-80). BC, Canada: Whistler.

Toft, B. H. (2004). _Virksomhedsdatabaser – hvorfor og hvordan? En praktisk guide til terminologiarbejde_ (Industriel Databases – Why and How? A Practical Guide to Terminology Work). University of Southern Denmark.

Wermuth, M.-C., Walravens, M., & Lambot M.-A. (2022). Collaboration and communities of practice in the field of medical ontology translation. (P. Cadwell, F. Federici, & S. O’Brien, Eds.) _The Journal of Specialised Translation_(37), 75-98.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Translation+Guide&entry.670899847=Supporting%20documents)

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# Sources of information | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents

Information on sources of information can be found in the Editorial Guide on the following webpages:

*   [Organism Naming Conventionsarrow-up-right](https://confluence.ihtsdotools.org/display/DOCEG/Organism+Naming+Conventions)
    
*   [US vs. GB Englisharrow-up-right](https://confluence.ihtsdotools.org/display/DOCEG/US+vs.+GB+English)
    
*   [Antibodies and antigensarrow-up-right](https://confluence.ihtsdotools.org/display/DOCEG/Antibodies+and+antigens)
    
*   [Antivenomarrow-up-right](https://confluence.ihtsdotools.org/display/DOCEG/Antivenom)
    

In addition, NRCs should create and maintain a document that specifies which sources are authoritative and should accompany the translation process so that all translators involved have a common basis for determining which sources are acceptable. Translators and other professionals involved in the translation process should also have access to a range of reliable and recognised sources of information in their own language. Both external and internal sources can be used. For example, the Dutch NRC uses the following external sources:

*   Pinkhof Geneeskundig woordenboek (Pinkhof medical dictionary)
    
*   Terminologia anatomica ([https://www.anatomicalterms.info/)arrow-up-right](https://www.anatomicalterms.info/))
    
*   the same thesauri for organisms as given by SNOMED International in the Editorial Guide
    
*   Orphanet (the quality of translation can be questionable, but it is often the only source for a rare disease)
    
*   Farmacotherapeutisch kompas (for substances)
    
*   the archive of the _Nederlands Tijdschrift voor Geneeskunde_ (NTvG) (Dutch Journal of Medicine)
    

The following internal sources are used:

*   a self-created Java API that suggests possible translations based on the concept definition (only for concepts that meet certain criteria, e.g. are fully defined)
    
*   a spell checker that incorporates the Pinkhof Geneeskundig woordenboek (Pinkhof medical dictionary)
    
*   indexed comments logged for each previous translation
    
*   guidelines agreed during the translation project, both general and specific phrases
    
*   recorded discussions on proposed guidelines (so that the rationale for a guideline can be looked up or it can be checked whether a guideline was considered but rejected)
    
*   previous translations, for consistency
    

For reasons of lack of quality, the Dutch translation of ICD-10 or ICPC is deliberately not used.

In addition to sources in the local language, English sources can also be useful in determining the exact nature and meaning of a term.

Wherever possible, selected internal working documents, textbooks, reference works, etc. should be directly accessible in electronic form for anyone to find information on a particular concept by means of text examples, definitions or expressions containing a particular word or phrase.

Machine translation systems such as Google Translate and DeepL or online translation tools such as eTranslation ([https://ec.europa.eu/cefdigital/wiki/display/CEFDIGITAL/eTranslationarrow-up-right](https://ec.europa.eu/cefdigital/wiki/display/CEFDIGITAL/eTranslation)
) can be a potential help, but should be used with caution. Currently, the accuracy of translation is not yet sufficient to translate clinical content with the exactness required from a clinical risk perspective. However, MT can be helpful in providing an initial translation that can then be reviewed; or it can be limited to template concepts.

In the following sections relevant existing electronic information sources and internet references (Section [Electronic information sources and internet references](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/5-sources-of-information#electronic-information-sources-and-internet-references)
) are listed, followed by an overview of sources that can be created by means of corpus tools or automated suggestions (Section [Sources of information](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/5-sources-of-information#id-5.2-self-created-corpora)
). It is advisable to check the validity and quality of each source, especially the national editions of international sources.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/5-sources-of-information#electronic-information-sources-and-internet-references)

Electronic information sources and internet references


-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Section 4.4.2.1 Organism names (bacteria, viruses, plants, animals, etc.) already contains a list of specific resources for bacteria, viruses, parasites, etc.. The following additional sources may also be helpful:

**Ready access to already approved, translated terms**

*   It should be possible for translators and other persons involved in the translation process to refer to previously approved terms containing similar constructions and/or word combinations.
    

**Online dictionaries and databases**

*   _Dictionnaire médical de l'Académie de Médecine_ – version 2022 ([http://dictionnaire.academie-medecine.fr/index.phparrow-up-right](http://dictionnaire.academie-medecine.fr/index.php)
    )
    
*   _Oxford Concise Medical Dictionary_ (10de edition). (2020). Oxford University Press. ([https://doi.org/10.1093/acref/9780198836612.001.0001arrow-up-right](https://doi.org/10.1093/acref/9780198836612.001.0001)
    )
    
*   IATE (Interactive Terminology for Europe) ([https://iate.europa.eu/homearrow-up-right](https://iate.europa.eu/home)
    )
    
*   WordNet ([http://globalwordnet.org/resources/wordnets-in-the-world/arrow-up-right](http://globalwordnet.org/resources/wordnets-in-the-world/)
    )
    
*   info (ATI) ([https://www.anatomicalterms.info/arrow-up-right](https://www.anatomicalterms.info/)
    )
    

**National corpora**

**Internal working documents** such as:

*   national guidelines for translation
    
*   overview of the principle decisions of the Editorial Board or a similar competent body
    
*   lists of examples of translated terms and/or corrected terms representing specific semantic or morphosyntactic features
    

**Textbooks** on the different areas of clinical practice

**Reference files or books** such as:

*   national versions of medical dictionaries or lexicons
    
*   national version of the chemistry nomenclature
    
*   national version of _Nomina Anatomica, Terminologia Anatomica_ or other nomenclatures
    
*   national version of the _International Classification of Diseases_ (ICD-11)
    
*   national versions of other classifications
    

**Explorative resources**

These sources should be used with care and serve as inspiration, but not as an authoritative source as they contain, for example, synonyms that are not entirely interchangeable or outdated terminology and the like. Examples are:

*   Wikipedia
    
*   Pubmed ([https://pubmed.ncbi.nlm.nih.gov/)arrow-up-right](https://pubmed.ncbi.nlm.nih.gov/))
    
*   MeSH ([https://www.ncbi.nlm.nih.gov/mesh/)arrow-up-right](https://www.ncbi.nlm.nih.gov/mesh/))
    
*   Orphanet ([https://www.orpha.net/consor/cgi-bin/index.php?lng=ENarrow-up-right](https://www.orpha.net/consor/cgi-bin/index.php?lng=EN)
    )
    
*   OMIM® (Online Mendelian Inheritance in Man®) ([https://www.omim.org/arrow-up-right](https://www.omim.org/)
    )
    
*   INN (International Nonproprietary Names) ([https://www.who.int/teams/health-product-and-policy-standards/innarrow-up-right](https://www.who.int/teams/health-product-and-policy-standards/inn)
    )
    
*   com: to search in multiple English dictionaries ([https://www.onelook.com/reverse-dictionary.shtmlarrow-up-right](https://www.onelook.com/reverse-dictionary.shtml)
    )
    

**Medical publications**

*   electronic versions of articles from renowned national medical journals (these can be valuable references for the use of specific terms and abbreviations of foreign and local origin. It should be noted, however, that the expressions chosen in these journals may not always be linguistically correct or consistent if they are foreign language expressions. One should also consider the publication date, as terminology may have changed following new discoveries or techniques).
    
*   clinical guidelines and quality assessment documents
    
*   medical protocols
    
*   national standardised guidelines for procedures
    

**Recommended internet references**

*   A list of valid internet references with useful information should also be established. The recommended resources can be found in the Editorial Guide (see list of webpages at the beginning of chapter 5). Some relevant taxonomies or nomenclatures in English may be available in the target language.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/5-sources-of-information#self-created-corpora)

Self-created corpora


-----------------------------------------------------------------------------------------------------------------------------------------------------------------

**Online tools**

*   The Sketch Engine ([http://www.sketchengine.co.uk/arrow-up-right](http://www.sketchengine.co.uk/)
    )
    
*   CLaRK ([http://www.bultreebank.org/clark/arrow-up-right](http://www.bultreebank.org/clark/)
    )
    
*   CorpusExplorer ([http://www.CorpusExplorer.dearrow-up-right](http://www.corpusexplorer.de/)
    )
    
*   AntConc ([http://www.antlab.sci.waseda.ac.jp/software.htmlarrow-up-right](http://www.antlab.sci.waseda.ac.jp/software.html)
    )
    
*   CoCab ([http://chasen.aist-nara.ac.jp/~kaoru-ya/cocab/arrow-up-right](http://chasen.aist-nara.ac.jp/~kaoru-ya/cocab/)
    )
    

**Automated suggestions**

*   a self-created Java API that suggests possible translations based on the concept definition (only for concepts that meet certain criteria, e.g. are fully defined)
    
*   spell checkers that incorporate national medical dictionaries
    
*   indexed comments logged for each previous translation in an online translation environment
    
*   guidelines agreed during the translation project, both general and specific phrases
    
*   recorded discussions on guidelines proposals
    
*   previous translations, for consistency
    
*   lexicon-based translation tools such as CoMeTT, used by the Belgian CSCT (for a detailed description see Wermuth, M.-C., Walravens, M., & Lambot M.-A. (2022). Collaboration and communities of practice in the field of medical ontology translation. (P. Cadwell, F. Federici, & S. O’Brien, Eds.) _The Journal of Specialised Translation_(37), 75-98).
    

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*   [Electronic information sources and internet references](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/5-sources-of-information#electronic-information-sources-and-internet-references)
    
*   [Self-created corpora](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/5-sources-of-information#self-created-corpora)
    

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# Introduction | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents

SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) is a comprehensive clinical **terminology** used to code, query and analyze health data. The terminology system is maintained and distributed by SNOMED International, the trading name of the International Health Terminology Standards Development Organisation (IHTSDO), established in 2007.

SNOMED CT provides a basis on which health care organisations can plan and document health care processes, conduct outcome research, analyze health care quality and costs, and develop effective treatment recommendations. It is the result of the merger of SNOMED RT (Reference Terminology) and Clinical Terms Version 3. The terminology includes the concepts, terms and relationships necessary to accurately represent clinical information across the healthcare system. SNOMED CT contains more than **350,000** active **concepts**. Each concept can be represented by several **descriptions**. There are three types of Descriptions: Fully Specified Name (FSN), Synonym (Syn) and Definition. The concepts are arranged in concept classes with different meanings called hierarchies, covering information required in a health record such as symptoms and signs, disorders, operations, treatments, medication, administrative elements, etc.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/1-introduction#purpose-and-scope-of-this-document)

Purpose and scope of this document


-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The present guidelines are based on the SNOMED International Editorial Guide ([http://snomed.org/egarrow-up-right](http://snomed.org/eg)
) and are intended for translators of SNOMED CT. They have been developed by the members of the Translation User Group and summarise the main editorial principles of SNOMED International. They can be used as a starting point for the development of national guidelines for the translation of SNOMED CT from English into the national languages of the SNOMED CT member countries. Additional information on editorial rules can be found in the Confluence editorial templates ([https://confluence.ihtsdotools.org/display/SCTEMPLATES/SCT+Modeling+Templates+and+description+patternsarrow-up-right](https://confluence.ihtsdotools.org/display/SCTEMPLATES/SCT+Modeling+Templates+and+description+patterns)
).

The present document is to be used in conjunction with the current version of the _Guidelines for Management of Translation of SNOMED CT_ (see SNOMED CT Document Library [https://confluence.ihtsdotools.org/display/DOC/SNOMED+CT+Document+Libraryarrow-up-right](https://confluence.ihtsdotools.org/display/DOC/SNOMED+CT+Document+Library)
) which contain recommendations for managing a translation project. Suggestions for amendments or additions to these guidelines should be sent to [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#dab3b4bcb59aa9b4b5b7bfbef4b5a8bd)
.

It is essential that those involved in translation of SNOMED CT concepts and in the verification, validation and approval processes of new national descriptions are familiar with the terminological principles on which SNOMED CT is based. It is equally important that the translation work complies with the SNOMED CT Editorial Guide and that translators are aware of issues such as how to select terms and lexical variants, how to use the appropriate translation technique, and how to ensure linguistic consistency.

The present document also contains general recommendations on the steps involved in a translation workflow process, as well as information on source documents and references that are useful during translation.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/1-introduction#assessment-of-translation-quality)

Assessment of translation quality

Translation project owners (TPOs) should ensure that translations comply with the principles on which SNOMED CT was originally based: **understandability** , **reproducibility** and **usefulness** (URU). **Understandable** means that the meaning of a concept can be understood by most healthcare providers without reference to private or inaccessible information; **reproducible** means that several users apply the concept to the same situations; **useful** means that the concept has a practical value for the users that is self-evident or can be easily explained. Furthermore, the information contained in the translated concepts must be semantically equivalent to the information contained in the core source terminology (International Release). SNOMED International has developed a document that describes how to assess the quality of the translation and the degree of consistency. The document entitled _A methodology and toolkit for evaluating SNOMED CT translation quality_ (2012) outlines and defines a set of requirements or “quality characteristics” (QCs) and related metrics.

There are three types of QCs for assessing translation quality:

*   Structural QCs, which cover the management and organization of the translation project;
    
*   Process QCs, which refer to the activities during the actual translation process;
    
*   Result QCs, which refer to the translation result in the target language.
    

In this document, a shortlist of (9) QCs is drawn up and for each QC quality score (what and how to measure, how to evaluate, etc.) there are sample questionnaires (to support the evaluation) as well as a general “rating”.

It is recommended that TPOs refer to Annex A of the current document and to the Methodology and Toolkit document to ensure that they include all quality metrics identified as **mandatory** for use in their project and quality plans. Metrics for measuring translation quality can be reformulated as contractual clauses in formal agreements between a TPO and a Translation Service Provider (TSP) on the services to be provided and the level of service.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/1-introduction#change-requests)

Change requests

Requests about inconsistencies, errors or proposed changes to the core terminology (International Release) should be submitted through Content Request Service (CRS) . For more information, see[CRS Guide](https://docs.snomed.org/snomed-ct-user-guides/crs-guide/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/1-introduction#audience)

Audience


-------------------------------------------------------------------------------------------------------------------------------

The target group of this document are all persons directly involved in the translation of SNOMED CT into another language, i.e. translators, reviewers, domain experts, validators as well as managers and members of an editorial board or equivalent group of experts who define the linguistic and terminological guidelines for the specific translation of the target language.

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*   [Purpose and scope of this document](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/1-introduction#purpose-and-scope-of-this-document)
    
*   [Assessment of translation quality](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/1-introduction#assessment-of-translation-quality)
    
*   [Change requests](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/1-introduction#change-requests)
    
*   [Audience](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/1-introduction#audience)
    

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# An introduction to terminological principles | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents

Understanding of terminology and specialized knowledge representation is a key factor for successful scientific translation. SNOMED CT translations must therefore be based on **terminological principles** developed by Terminology Science (TS). This discipline is a branch of linguistics that deals with specialized vocabulary. It focuses on the study of lexical units (words) with a specialized meaning called **terms**. Terms are analyzed from the point of view of their origin, formal structure, meaning and their functional characteristics. Since terms are used to denote **concepts** , TS also deals with the formation and development of concepts and relationships between concepts and their classification in **concept systems**. Furthermore, TS formulates the principles of concept **definition** and the evaluation of existing definitions. In view of the fact that the properties and functioning of terms depend to a large extent on their lexical environment, it is common practice to consider not individual terms but the entire terminology used in a particular field of knowledge (also called subject area) as the main subject of TS.

In the following, we will give a summary description of concepts and terms, concept systems, and definitions. Please see the international terminology standard ISO 1087-1:2000 for a systemic description of these notions.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/2-an-introduction-to-terminological-principles#concepts-and-terms)

Concepts and terms


-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The **semiotic triangle** (Figure 1) introduced by Ogden and Richards (1923/1989) is of central importance in terminology work. This triangle is a model of how symbols are related to the objects they represent. It consists of 3 elements: concept (“**Thought or Reference** ”), designation (“**Symbol** ”) and object (“**Referent** ”). A **concept** is the mental image of concrete or abstract objects in reality and consists of characteristics based on properties observed in an object or in its relationship to other objects. Concepts are represented by a **designation** (symbol) such as words (in general language), **terms** (in specialized language) or other perceivable notations (e.g. graphics, numbers, etc.). In SNOMED CT the concepts are represented by so-called **Descriptions**(see Section 3.4).

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2317125167-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FRqD57MbRYSFSsKbOrkOa%252Fuploads%252Fgit-blob-6cba598f8304de534f2c6d8c2441b5460f900f44%252F142134385.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=bb911ba9&sv=2)

**Figure 1** – The semiotic triangle (Odgen and Richards 1923/1989)

The dotted line between the referent (object) and the symbol (description) indicates that there is no direct connection between the two, as the object must be conceptualised before it can be rendered. There is also no one-to-one (i.e. one term refers to one concept) but a many-to-one relation between concept and term (different terms refer to one and the same concept). Examples are the English terms “typhoid fever” and “infection by Salmonella Typhi” for the concept |typhoid fever|. This is called **synonymy** , which is a frequent phenomenon in clinical terminology. Conversely, one term can refer to different concepts (i.e. one and the same term has different meanings), which is called **polysemy**. For example, the term “drug” refers, depending on the context, to the following concepts: (1) |substance used for diagnostic/treatment/ prevention purposes|; (2) |chemical substance used as narcotic or hallucinogen|; (3) |substance used in dyeing or chemical operations (obsolete)|.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/2-an-introduction-to-terminological-principles#concept-systems)

Concept systems


-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The main goal of terminology work is to clarify and standardize concepts and terms to facilitate unambiguous communication in natural (human) language. Concepts are related to other concepts (conceptual relations) and form networks or **concept systems** , which are extremely useful in many contexts: they provide an overview of a subject area and make it possible to delimit and define concepts, to form new descriptions, to evaluate existing and competing descriptions, and to structure systematic representations of a given domain. Since concept systems are important tools for analysing and translating concepts, they play a crucial role in terminology work.

According to ISO 1087-1:2000 **conceptual relationships** can be divided into hierarchical relationships (generic is-a relationships), partitive relationships (whole-part relationships) and associative (non-hierarchical) relationships. In SNOMED CT generic and attribute relationships are used to define concepts in a formal language that is understandable to both humans and computers (Figure 2).

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2317125167-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FRqD57MbRYSFSsKbOrkOa%252Fuploads%252Fgit-blob-9fcdde6e4550f9d405bef19acfdcf73f587f7564%252F142134384.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=e11fbd27&sv=2)

**Figure 2** – Hierarchical and attribute relationships in SNOMED CT; example with the stated view of concept 18027006 |Transplantation of liver (procedure)| (International Edition 2021-07-31)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/2-an-introduction-to-terminological-principles#definitions)

Definitions


---------------------------------------------------------------------------------------------------------------------------------------------------------------------

In terminology work, the definition of a concept is extremely important. A definition describes the characteristics of a concept to delimit it from neighboring concepts. Definitions are therefore essential for the clear assignment of terms to the underlying concepts. There are different types of definitions (analytical, encyclopaedical). Definitions can be written in natural language or in a (semi-)formal language.

Definitions play a key role in the translation of SNOMED CT (see Section 4). Descriptions cannot be translated literally but their meaning (i.e. their conceptual content) must first be clarified. This is the only way to ensure that the meaning of the description is correctly reflected in the target language. In SNOMED CT concepts are defined in different ways (see Section 3.2).

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*   [Concepts and terms](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/2-an-introduction-to-terminological-principles#concepts-and-terms)
    
*   [Concept systems](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/2-an-introduction-to-terminological-principles#concept-systems)
    
*   [Definitions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/2-an-introduction-to-terminological-principles#definitions)
    

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# Maintenance | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents

The ability to incorporate changes from International and National editions of SNOMED CT is key to a successful, long-term implementation. SNOMED International provides release twice a year and national release centers may provide the same or more. These updates contain important changes that may be due to changes in medical knowledge or patches on feedback from the community, and it is important that vendors are able to process these updates.

1.  Ensure that the version of the given SNOMED CT edition being used within the solution is no more than 2 versions (n-2) behind the most current version. Components that may change between versions may include:
    
    *   Concepts: new concepts added, concepts made inactive.
        
    *   Descriptions (with terms): new terms added, terms made inactive, terms changed (minor typing mistakes may have been corrected).
        
    *   Relationships: new relationships, relationships made inactive, additional inferred relationships from classifying the terminology.
        
    *   Refsets: new refsets, new members to a refset, members made inactive within a refset, a refset made inactive.
        
    
2.  Ensure all subsets and maps used in user interfaces, reports, queries, etc. are maintained with each new version of SNOMED CT to ensure continued clinical validity.
    
3.  If the vendor is required to create a SNOMED CT extension, they must follow the general principles of SNOMED CT, including allocating globally unique identifiers, concept permanence (i.e. never reusing the same concept id for a different concept), and maintaining a robust audit trail for all inactivation’s (including when the code was inactivated and what codes have replaced it).
    

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# Additional Resources | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents

Contact [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#aec7c0c8c1eeddc0c1c3cbca80c1dcc9)
 for additional resources or questions pertaining to the SNOMED CT Example EMR/EHR Requirements Guide.

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# Analytics and Reporting | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents

One of the main drivers for deploying SNOMED CT is to structure data and benefit from the ontology to gain clinical insights into patient data that may otherwise be unavailable in unstructured data. The use of maps of data already coded using local systems to SNOMED CT will help to move towards the rich analysis that SNOMED CT enables, as well as using maps to provide the step from SNOMED CT to national & international classifications for statistical reporting.

1.  Use maps from local code systems to SNOMED CT to enable ad hoc querying, reporting and analysis of legacy clinical data or for national or local reporting.
    
2.  Use maps to national and international classifications to enable analysis and reporting of data, including legacy and current data.
    
3.  Applications supporting data reporting, extraction and/or clinical decision support rules shall (where appropriate) use SNOMED CT’s defining relationships in the determination of the correct results or outcomes.
    

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# Introduction | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents

This document presents a set of high-level examples of categories and requirements that could be considered when procuring a SNOMED CT enabled EMR or EHR system. These requirements remain relatively generic in order to be broadly applicable across Member countries and territories.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-ehr-requirements-guide/1-introduction#goals-and-objectives)

Goals and Objectives


------------------------------------------------------------------------------------------------------------------------------------------------------------

The intent of this document is to spark thinking within each Member’s National Release Center (NRC) in terms of the categories and types of requirements they may want to consider (and build on) in their local procurements. This document will also provide vendors with example SNOMED CT requirements that might be requested of products being procured.

Disclaimer:

*   Please note that the exact SNOMED CT requirements that should be included in an EMR or EHR procurement depend upon the specific use case.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-ehr-requirements-guide/1-introduction#target-audience)

Target Audience


--------------------------------------------------------------------------------------------------------------------------------------------------

The target audience for this Example Guide includes:

*   People from various disciplines who may be involved at any point in the procurement of an EMR/EHR system that includes SNOMED CT – from initial planning, analysis and clinical content definition and implementation through to use of the resulting clinical information. This spans people involved with planning and deciding to proceed and resource a SNOMED CT implementation, people involved in reference set development, terminology management, clinical subject matter experts, technical implementation and all aspects of deployment and use. It also includes people involved in clinical information retrieval, analyses, decision support and other aspects of knowledge representation.
    
*   Vendors that may be interested in responding to procurement opportunities that include requirements for EMR/EHR systems containing SNOMED CT. The intent is to provide vendors with an understanding of generic or baseline requirements for provisioning a SNOMED CT – enabled system.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-ehr-requirements-guide/1-introduction#topics)

Topics


--------------------------------------------------------------------------------------------------------------------------------

The topics covered in this SNOMED CT Example EMR/EHR Requirements Guide include:

*   Edition, Language and Content
    
*   User Interface
    
*   Analytics and Reporting
    
*   Maintenance
    
*   Storage
    
*   Interoperability
    
*   Additional Resources
    

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*   [Goals and Objectives](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-ehr-requirements-guide/1-introduction#goals-and-objectives)
    
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*   [Topics](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-ehr-requirements-guide/1-introduction#topics)
    

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# SNOMED CT as a health terminology | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents

The following sections outline the main features of the structure of SNOMED CT and particular aspects of interest to translators. More detailed information on the structure of SNOMED CT can be found in the [SNOMED CT Guidesarrow-up-right](https://docs.snomed.org/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#concept-systems-and-ontologies)

Concept systems and ontologies


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Conceptual relationships can be coded in formal structures or so-called **ontologies**. The construction of ontologies is based on conceptual networks derived from **expert knowledge**. The aim is to represent domain-specific knowledge (i.e. the conceptualization of a particular domain) in a formal, computer-readable and consensus-based way in accordance with criteria agreed upon by a community of experts. The elements of knowledge are defined according to a set of properties and linked via explicit relationships of different kinds (both hierarchical and non-hierarchical such as partitive, cause-effect, etc.). Since the concepts and relations are represented formally, the information can be processed electronically, allowing different kinds of operations such as data retrieval and standardized data exchange.

SNOMED CT is a **terminological ontology** that combines the terminological approach of concept system creation described in [Concept systems and ontologies](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#concept-systems-and-ontologies)
 with knowledge-based ontology design. It is developed by domain experts for domain experts as knowledge resource for information exchange for use in various applications. The system uses a relationship-based representation of concepts (Concept 1 Concept 2) by means of the formal ontology language Description Logic (e.g. _Common Cold_ _Virus_).

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#snomed-ct-definitions)

SNOMED CT definitions


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In SNOMED CT concepts are defined in three different ways.

(1) The meaning of a SNOMED CT concept is expressed in a human-readable form by its Fully Specified Name (FSN). This is a Description that represents the meaning of a concept in a way that is unambiguous and independent of the context in which it is used (for a detailed description, see Section [SNOMED CT as a health terminology](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#id-3.4-description-types)
).

(2) Each concept also has a formal concept definition that provides a computer-processable representation of the meaning of the concept. Conceptual relationships are generated in two ways, either by human users proposing a new concept or automatically by the SNOMED CT OWL description logic classifier. The manually created representation is referred to as “stated view” (Figure 3).

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2317125167-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FRqD57MbRYSFSsKbOrkOa%252Fuploads%252Fgit-blob-93b2ac7d8df98b14b8004fd5e79fc0b747bd2357%252F142134435.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=e3ce4d8f&sv=2)

Figure 3: Diagrammatic representation of the relationships as “stated view” of the concept 195216008 |Left sided cerebral hemisphere cerebrovascular accident (disorder)| (International Edition 2021-07-31)

The automatically generated representation is referred to as “inferred view” (Figure 4).

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2317125167-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FRqD57MbRYSFSsKbOrkOa%252Fuploads%252Fgit-blob-cab2602d19cd9f468f82da708c4c97fdc5d54a6c%252F142134434.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=c5cd14da&sv=2)

Figure 4. Diagrammatic representation of the relationships as “inferred view” of the concept 195216008 |Left sided cerebral hemisphere cerebrovascular accident (disorder)| (International Edition 2021-07-31)

For translators it is of outmost importance to look also at the formal definition of the concept as SNOMED CT translations should be concept-based. The formal definition can help to understand the meaning and to increase translation consistency.

The formal rules of description logic can also be used to support meaning-based retrieval from records containing SNOMED CT expressions or concepts (more information, please refer to /).

Textual definitions that describe the meaning of a concept in natural language (see [SNOMED CT as a health terminology](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#id-3.4-description-types)
 and Figure 5). Only a minority of concepts have a textual definition.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2317125167-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FRqD57MbRYSFSsKbOrkOa%252Fuploads%252Fgit-blob-dce1de4f312edc8f8a48003f27ac0ddb1b4922be%252F142134433.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=8564b090&sv=2)

**Figure 5** – Illustration of the three SNOMED CT Description types in the US English language refset of concept 609328004 |Allergic disposition (finding)| (International Edition 2021-07-31) F - Fully Specified Name; S - Synonym; D - Definition

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#the-hierarchical-and-multi-axial-structure-of-snomed-ct)

The hierarchical and multi-axial structure of SNOMED CT


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SNOMED CT contains more than 350,000 concepts from **clinical and non-clinical** concept fields or **domains** (e.g. Body Structure, Clinical Finding, Procedure, Substance, Event, Environment or geographical location, Physical object, etc.). These concepts are arranged in 19 top-level **hierarchies** according to the domain to which they belong (Figure 6).

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2317125167-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FRqD57MbRYSFSsKbOrkOa%252Fuploads%252Fgit-blob-03f52df42ab88025373357abaa3a2d7158a87f23%252F142134432.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=4832c716&sv=2)

**Figure 6** – The 19 SNOMED CT top level hierarchies as displayed in the SNOMED International browser () taxonomy view

At the top of the SNOMED CT hierarchy is the **root concept** (|SNOMED CT concept|), which represents the terminology itself. All other concepts are derived from this root concept through at least one sequence of is-a relationship. This means that the root concept is a **supertype** of all other concepts and all other concepts are subtypes of the root concept. The direct subtypes of the root concept are called “Top Level Concepts”; each of these Top Level Concepts, together with its many subtype descendants, forms a branch of the hierarchy that contains similar types of concepts and also names the branches of the subtype hierarchy. For example, the intermediate concept 788951001 |Hemorrhage of digestive system (disorder)|, which has 17 children, is itself a type of |Disease| which is a type of |Clinical finding|. The further down the hierarchy, the more granular, or in other words more precise, a concept is. This principle is referred to as **granularity** (Figure 7).

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2317125167-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FRqD57MbRYSFSsKbOrkOa%252Fuploads%252Fgit-blob-2592c0c8e7a5dc61b509abe4d426c3af1dcf6244%252F142134431.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=f90779b&sv=2)

**Figure 7** – Granularity (SNOMED International browser () summary view, International Edition 2021-07-31)

The top rectangle in Figure 7 shows the hierarchy view up to the root concept for each parent |Bleeding (finding)| and |Disorder of digestive system (disorder)| of the concept 788951001 |Hemorrhage of digestive system (disorder)|. The lower rectangle shows some of the 17 child concepts, while the middle rectangle shows the concept Descriptions. The rectangle to the right shows the concept’s relationships.

As many clinical concepts are multidimensional by nature, concepts can have more than one parent. This creates a polyhierarchical structure, which increases the amount of information provided. As the formal representation language of SNOMED CT uses both hierarchical and attributive relationships, the multidimensional character of concepts can be expressed accordingly. Figure 8 shows the polyhierarchical structure of SNOMED CT concepts.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2317125167-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FRqD57MbRYSFSsKbOrkOa%252Fuploads%252Fgit-blob-085f0be31d4b7c63c415b150f83a782f12dfcad3%252F142134430.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=50a1e9e0&sv=2)

**Figure 8** – Polyhierarchical structure of concepts (as shown in SNOMED International \[Starter Guide\](https://confluence.ihtsdotools.org/display/DOCSTART/SNOMED+CT+Starter+Guide))

Figure 9 shows the full polyhierarchical view of the concept 788951001|Hemorrhage of digestive system (disorder)|.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2317125167-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FRqD57MbRYSFSsKbOrkOa%252Fuploads%252Fgit-blob-d2be6b9ff2977273865cc5080e159c93879943f7%252F142134429.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=188ffddc&sv=2)

**Figure 9** – Full polyhierarchical view of concept 788951001 |Hemorrhage of digestive system (disorder)| (International Edition 2021-07-31) using Ontoserver Shrimp browser ()

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#description-types)

Description types


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Each concept is represented at least by two types of Descriptions: one **Fully Specified Name** **(FSN)** and **Synonyms (SYN),** one of which is marked as the**Preferred Term (PT)**(Figure 10). The presence of a Description of type definition is optional.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2317125167-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FRqD57MbRYSFSsKbOrkOa%252Fuploads%252Fgit-blob-b526c6dd1ceb3a08ac9411b2847e945a8e18d625%252F142134428.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=1bd54a70&sv=2)

**Figure 10** – SNOMED CT descriptions

The FSN is “a description that represents the meaning of a concept in a way that is unambiguous and independent of the context in which it is used” (SNOMED International 2020). Therefore, an FSN can also be considered as a kind of definition or explanation as it describes the content of the concept as explicit as possible (see Section 3.2). If a synonym, the logical definition or the logical definition or the text definition conflicts with the FSN, the FSN is the gold standard or so-called “Source of Truth”. The FSN should be able to stand alone as complete, unambiguous & comprehensible.

A FSN is composed of a term and a “semantic tag” between parenthesis at its end (e.g. |Myocardial biopsy (procedure)|). The tag indicates the hierarchy to which the concept belongs (e.g. procedure, disorder, organism, etc.). Each concept has a FSN, which is unique in SNOMED CT in a given language, even in cases of FSNs with identical terms that refer to concepts belonging to different categories. For example, |Hematoma (morphologic abnormality)| is the FSN that represents what the pathologist sees under the microscope, whereas |Hematoma (disorder)| is the FSN that indicates the clinical diagnosis of a hematoma. This FSN is not intended for display in clinical records, but is used to clarify the hierarchical relationships of concepts.

A FSN is only used when the user needs to be able to distinguish between hierarchies (which is not necessary in most use cases for healthcare professionals as they will use a reference set or a single hierarchy as value set for their EHR fields).

Every concept must have at least one active fully specified name in US English. This is the point of reference for the meaning of concepts in the SNOMED CT International Edition. Language reference sets must include a single preferred fully specified name for each concept in a language context. For concepts that are part of an extension, the preferred fully specified name in a language specified by that extension may be the point of reference.

A _synonym_ is “a word or phrase that expresses the meaning of a SNOMED CT concept in a specific language” (SNOMED International 2020). Each concept may have multiple synonyms, one of which is marked as “preferred” to support consistent recording of the underlying concept. The Preferred Term (PT) is “the term deemed to be the most clinically appropriate way of expressing a concept in the specified language context” (SNOMED International 2020). It is the recommended description to display a concept. The PT should be unique within its own hierarchy and should not contain homonyms. The other synonyms are marked as ‘Acceptable’. Synonyms are useful for retrieval purposes.

Each national edition of SNOMED CT must include at least one Fully Specified Name and one Preferred Term to represent each concept. Each Description has a unique numeric Description Identifier in addition to a Description Type.

Further information on concept Descriptions can be found in the [SNOMED CT Starter Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/)
.

A textual description or definition (see Section 2.3) is also a Description Type, but it is not mandatory. It is provided for a limited number of concepts, where there is a requirement for additional detail, such as specifying the alignment of a SNOMED CT concept with a specific clinical definition of a condition. For example, the concept 22649008 |Photodermatitis (disorder)| i[s defined as “An abnormal inflammatory skin condition resulting from exposure to ultraviolet light, most commonly sunlight. May result from phototoxic or photoallergic reactions or botharrow-up-right](http://snomed.info/id/11530004)
” (Table 1).

Text definitions can, but do not have to be translated. SNOMED International intends to introduce more Description types in the future and make them configurable. For example, a Description type could be configured for search terms that include Descriptions (i.e. terms) that are inappropriate for display and data exchange but useful for clinicians to quickly retrieve them at the data collection interface. Examples are Descriptions containing spelling errors, Descriptions that are not correct but commonly used in clinical practice (e.g. “uterine fibroma" for “uterine leiomyoma”) or polysemous acronyms (e.g. “IRA” which stands both for “acute renal insufficiency” and “acute respiratory insufficiency”.

Description type

Description

Fully Specified Name

Photodermatitis (disorder)

Synonym (Preferred)

Photodermatitis

Synonym (Acceptable)

Photosensitivity dermatitis

Text definition

An abnormal inflammatory skin condition resulting from exposure to ultraviolet light, most commonly sunlight. May result from phototoxic or photoallergic reactions or both.

**Table 1** – SNOMED CT description types for the concept 22649008 |photodermatitis (disease)| in the Great Britain English language reference set

For translation purposes the three types of Definitions can be useful (see Section 4). Professional translators without medical expertise will have greater difficulty understanding all SNOMED CT by their formal relationships. Therefore, natural language definitions and textual sources that provide information on the contextual use of a concept are important additional tools.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#snomed-ct-logical-definitions-attributes-and-relationships)

SNOMED CT logical definitions, attributes and relationships


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In the SNOMED CT ontology, each concept is logically defined through its relationships to other concepts. For the definition of a concept, attribute-value pairs are used in addition to the hierarchical “is a” relationships. An attribute represents a characteristic of the meaning of a concept to which a value is assigned.

The attributes that can be applied depend on the concept model. The concept model defines which attribute value-pairs can be applied to which (sub)hierarchy of concepts and how those attribute-value pairs need to be grouped together to ensure correct unambiguous understanding of the concept definition (see the Editorial Guide for a detailed description of concept models). For example, a procedure may have a method, and a disorder may have an etiology, but a procedure cannot have an etiology, and disorder cannot have a method. Defining characteristics represent the values of a range of relevant attributes. Depending on the nature of the concept, there are more than 100 approved attributes to be used in the concept model. The permitted range of values for an attribute depends on the rules specified in the concept model.

All SNOMED CT concepts are linked at least by one is-a relationship to the immediate superordinate(s) concept(s) and by zero to many attributive relationships. Both types of relationships together form the (formal) definition of a concept. Relationships are not limited to concepts and can also refer to numerical values in products.

There are two types of defined concepts: fully defined and primitive concepts.

A fully (or sufficiently) defined concept has at least one sufficient definition that distinguishes it from any concepts or expressions that are neither equivalent to, nor subtypes of, the defined concept.

For example, the concept 74400008 |Appendicitis (disorder)| is sufficiently defined by the following definition because any concept for which these defining relationships are true, is either the disorder appendicitis or a subtype of appendicitis.

A primitive concept has a concept definition that is not sufficient to computably distinguish it from other concepts.

For example, the concept 5596004 |atypical appendicitis (disorder)| is primitive because the following definition is not sufficient to distinguish atypical appendicitis from its parent concept <<<74400008 |appendicitis (disorder) nor it sibling:

See below the definition |Atypical appendicitis|, its parent |Appendicitis| and its sibling |Catarrhal appendicitis|. These three concepts share the same SNOMED CT logical definition in the stated view. The clinical information not represented in the SNOMED CT logical definition of |Atypical appendicitis| and |Catarrhal appendicitis| is _emphasized_ , making them primitive concepts.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#snomed-international-editorial-guide-and-confluence-templates)

SNOMED International Editorial Guide and Confluence Templates


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SNOMED International has numerous resources to promote the understanding and use of SNOMED CT. These documents are available in the Document Library, which is a collection of SNOMED CT documents, including introductory material, practical guides, technical specifications and reference material.

The Editorial Guide provides detailed information on the rules under which the international content of SNOMED CT is authored. It describes the scope, hierarchies, authoring principles, style guidelines and concept model rules of SNOMED CT for each domain ([http://snomed.org/egarrow-up-right](http://snomed.org/eg)
).

For example, when translating the Body structure hierarchy, translators are presented with a large number of concepts represented by terms containing the words “structure”, “part of”, “entire” and “all”, which should be interpreted with caution (for more details see Appendix B of the Editorial Guide).

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*   [Concept systems and ontologies](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#concept-systems-and-ontologies)
    
*   [SNOMED CT definitions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#snomed-ct-definitions)
    
*   [The hierarchical and multi-axial structure of SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#the-hierarchical-and-multi-axial-structure-of-snomed-ct)
    
*   [Description types](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#description-types)
    
*   [SNOMED CT logical definitions, attributes and relationships](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#snomed-ct-logical-definitions-attributes-and-relationships)
    
*   [SNOMED International Editorial Guide and Confluence Templates](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/3-snomed-ct-as-a-health-terminology#snomed-international-editorial-guide-and-confluence-templates)
    

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Copy

    74400008 |Appendicitis (disorder)| ===     
        64572001 |Disease (disorder)| : 
            {
                116676008 |associated morphology| = 23583003 |inflammation| ,
                363698007 |finding site| = 66754008 |appendix structure|
            }

Copy

    74400008 |Appendicitis (disorder)|
    
    <<< 64572001 |Disease (disorder)| : 
        {
        116676008 |associated morphology| = 23583003 |inflammation|,
        363698007 |finding site| = 66754008 |appendix structure|
        5596004 |Atypical appendicitis (disorder)| 
        }
    
    <<< 64572001 |Disease (disorder)| : 
        {
        116676008 |associated morphology| = 23583003 |inflammation|,
        363698007 |finding site| = 66754008 |appendix structure|
        8744003 |Catarrhal appendicitis (disorder)|
        }
    
    <<< 64572001 |Disease (disorder)| : 
    {
        116676008 |associated morphology| = 23583003 |inflammation|,
        363698007 |finding site| = 66754008 |appendix structure|
        }

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# Introducción | Practical Guides Intro a SCT para proveedores | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin#antecedentes)

Antecedentes


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Los términos clínicos de SNOMED (SNOMED CT) son la terminología sanitaria líder a nivel mundial. Diseñado para su uso dentro de sistemas de registros médicos electrónicos, SNOMED CT es un componente clave en soluciones efectivas para permitir la recuperación basada en el significado de volúmenes crecientes de información clínica y para respaldar el intercambio de información interoperable. Lanzado por primera vez en 2002, SNOMED CT ha crecido en madurez y desde 2007 es propiedad y es mantenido por IHTSDO, una organización sin fines de lucro que en 2017 adoptó formalmente el nombre comercial de SNOMED International. SNOMED International tiene muchos miembros y miles de licenciatarios: [https://www.snomed.org/membersarrow-up-right](https://www.snomed.org/members)
.

SNOMED CT se utiliza para representar información clínica en forma codificada, con el nivel de expresividad apropiado para la documentación clínica y también como soporte para la recuperación, el análisis y la elaboración de informes basados en el significado.

SNOMED CT es un recurso valioso. Sin embargo, su valor sólo se materializa cuando se integra en sistemas bien diseñados que aprovechan sus características clave. Esta guía presenta esas características y describe las diferentes opciones para implementar y utilizar SNOMED CT en aplicaciones de software para ofrecer beneficios tangibles.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin#objetivo)

Objetivo


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Esta "Introducción de SNOMED CT para proveedores" proporciona una introducción a SNOMED CT práctica e informativa, centrada principalmente en las necesidades de los proveedores y desarrolladores de expediente clínico electrónico y otras aplicaciones relacionadas con las tecnologías de la información para la atención médica.

Esta introducción para proveedores proporciona una base firme sobre la cual construir un conocimiento más detallado. Puede consultar la información básica sobre SNOMED CT, incluidos sus beneficios, en la [Guía de inicio de SNOMED CTarrow-up-right](http://snomed.org/sg)
. La información técnica detallada en las guías técnicas está disponible en la [Biblioteca de documentos de SNOMED CTarrow-up-right](http://snomed.org/doc)
. El [Portal de soporte para la implementación de SNOMED CT arrow-up-right](https://www.implementation.snomed.org/)
también es una buena fuente de referencia y tiene una sección específica sobre la implementación de SNOMED CT junto con más información útil. SNOMED International trabaja con los proveedores para facilitar la adopción, integración e implementación de SNOMED CT en sus soluciones, mejorando la oferta para el mercado global; por favor, consulte [https://www.snomed.org/vendorsarrow-up-right](https://www.snomed.org/vendors)
 para obtener más detalles. En la Sección 8 se proporciona más información sobre otros recursos disponibles.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin#publico-objetivo)

Público objetivo


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Esta "Introducción de SNOMED CT para proveedores " está dirigida a personas involucradas en el desarrollo de sistemas de expediente clínico electrónico y servicios relacionados. El documento también puede ser de interés para un público más amplio, incluida cualquier persona involucrada en el diseño, desarrollo, adquisición, implementación, configuración o gestión de sistemas y servicios de expediente clínico electrónico.

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*   [Antecedentes](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin#antecedentes)
    
*   [Objetivo](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin#objetivo)
    
*   [Público objetivo](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin#publico-objetivo)
    

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# Glossary of Terms | Practical Guides SNOMED CT Translation Management Guide | SNOMED International Documents

Term

Description

Source

**concept**

unit of knowledge created by a unique combination of characteristics

ISO 1087: 2019

**SNOMED CT concept**

a clinical idea to which a unique concept identifier has been assigned.

[concept](https://docs.snomed.org/snomed-ct-glossary/c/concept)

**CRS**

SNOMED International Content Request Service

**definition**

representation of a concept by a descriptive statement which serve to differentiate it from related concepts

ISO 1087: 2019

**description**

An association between a human-readable phrase (term) and a particular SNOMED CT concept

Each of the descriptions in SNOMED CT is given a separate row in the Descriptions Table. Each description is assigned a unique description identifier and connects a term and a concept.

[SNOMED CT Glossary](https://docs.snomed.org/snomed-ct-glossary/d/description)

**linguistic guidelines**

set of rules of grammar or terminology to be observed for the type of concept in question

**QI project**

A Snomed International project deployed to improve internal structural consistency and ensure compliance with editorial policy related to the stated modelling of content

**realm**

The authority, expertise, or preference that influences the required range or frequency of use of components. A Realm may be a nation, an organisation, a professional discipline, a specialty, or an individual user.

[SNOMED CT Glossary](https://docs.snomed.org/snomed-ct-glossary/r/realm)

**relationship**

An association between a source concept and a destination concept (each identified by a conceptId). The nature of the association is indicated by a relationship type. Each relationship is represented by a row in the Relationships Table.

[SNOMED CT Glossary](https://docs.snomed.org/snomed-ct-glossary/r/relationship)

**source language**

language of the source language content

ISO 17100:2015

**target language**

language into which the source language content is translated

ISO 17100:2015

**term**

designation of a general concept in a specific subject field

ISO 1087-1:2019

**translate**

render information in the source language into the target language in written form

ISO 17100:2015

**TSP**

Translation Service Provider; person or organisation supplying translation services

ISO 17100:2015

**TPO**

Translation Project Owner

**TUG**

The Translation User Group

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# Introducción a SNOMED CT para proveedores | Practical Guides Intro a SCT para proveedores | SNOMED International Documents

La Introducción para Proveedores a SNOMED CT ofrece una introducción práctica e informativa a SNOMED CT, enfocada principalmente en las necesidades de los proveedores y desarrolladores de registros electrónicos de salud (EHR) y otras aplicaciones relacionadas con las tecnologías de la información en salud.

Está dirigida a personas involucradas en el desarrollo de sistemas de EHR y servicios relacionados. El documento también será de interés para un público más amplio, incluyendo a cualquiera que participe en el diseño, desarrollo, adquisición, implementación, configuración o gestión de sistemas y servicios de EHR.

* * *

[Introducción](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin)

[Beneficios para los proveedores](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores)

[Introducción a SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin-a-snomed-ct)

[Elección de un enfoque de implementación](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin)

[Estrategias y consideraciones de implementación](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/estrategias-y-consideraciones-de-implementacin)

[Mejorando el diseño de la historia clínica electrónica con SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct)

[Licencias](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/licencias)

[Referencias](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/referencias)

[Apéndice 1. - Experiencia del usuario de SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct)

* * *

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© Copyright 2026 International Health Terminology Standards Development Organisation, all rights reserved.

This document is a publication of International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED International owns and maintains SNOMED CT®.

Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. This document may be subject to updates. Always use the latest version of this document published by SNOMED International. This can be viewed online and downloaded by following the links on the front page or cover of this document.

SNOMED®, SNOMED CT® and IHTSDO® are registered trademarks of International Health Terminology Standards Development Organisation. SNOMED CT® licensing information is available at [http://snomed.org/licensingarrow-up-right](http://snomed.org/licensing)
. For more information about SNOMED International and SNOMED International Membership, please refer to [http://www.snomed.orgarrow-up-right](http://www.ihtsdo.org/)
 or contact us at [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#147d7a727b547d7c6067707b3a7b6673)
.

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# Vendor Introduction to SNOMED CT | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents

The Vendor Introduction to SNOMED CT provides an informative practical introduction to SNOMED CT focused primarily on the needs of vendors and developers of EHRs and other related applications in healthcare information technology.

It is targeted at people engaged in the development of EHR systems and related services. The document will also be of interest to a broader audience including anyone engaged in designing, developing, procuring, deploying, configuring or managing EHR systems and services.

[](https://github.com/SNOMED-Documents/snomed-vendor-guide/blob/main/introduction/1.-introduction.md)

[Introduction](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/1-introduction)

[](https://github.com/SNOMED-Documents/snomed-vendor-guide/blob/main/what-is-loinc/2.-what-is-loinc.md)

[Benefits to Vendors](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors)

[](https://github.com/SNOMED-Documents/snomed-vendor-guide/blob/main/clinical-use-case/3.-clinical-use-case.md)

[Introduction to SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/3-introduction-to-snomed-ct)

[](https://github.com/SNOMED-Documents/snomed-vendor-guide/blob/main/content-development-principles/4.-content-development-principles.md)

[Choosing an approach to Implementation](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation)

[](https://github.com/SNOMED-Documents/snomed-vendor-guide/blob/main/information-models-and-terminology-binding/5.-information-models-and-terminology-binding.md)

[Implementation Strategies and Considerations](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations)

[](https://github.com/SNOMED-Documents/snomed-vendor-guide/blob/main/technical-application/6.-technical-application.md)

[Enhancing EHR design with SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct)

[Licensing](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/7-licensing)

[Useful References](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/8-references)

[Appendix 1 - User Experience of SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct)

* * *

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© Copyright 2025 International Health Terminology Standards Development Organisation, all rights reserved.

This document is a publication of International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED International owns and maintains SNOMED CT®.

Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. This document may be subject to updates. Always use the latest version of this document published by SNOMED International. This can be viewed online and downloaded by following the links on the front page or cover of this document.

SNOMED®, SNOMED CT® and IHTSDO® are registered trademarks of International Health Terminology Standards Development Organisation. SNOMED CT® licensing information is available at [http://snomed.org/licensingarrow-up-right](http://snomed.org/licensing)
. For more information about SNOMED International and SNOMED International Membership, please refer to [http://www.snomed.orgarrow-up-right](http://www.ihtsdo.org/)
 or contact us at [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#442d2a222b042d2c3037202b6a2b3623)
.

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# Introduction | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/1-introduction#background)

Background


----------------------------------------------------------------------------------------------------------------------------------------

SNOMED Clinical Terms (SNOMED CT) is the leading global healthcare terminology. Designed for use within Electronic Health Record (EHR) systems, SNOMED CT is a key component in effective solutions to enable meaning-based retrieval from growing volumes of clinical information and to support interoperable information exchange. First released in 2002, SNOMED CT has grown in maturity and since 2007 has been owned and maintained by a not-for-profit organization IHTSDO, that in 2017 formally adopted the trading name SNOMED International. SNOMED International has many Members and thousands of licensees - [https://www.snomed.org/membersarrow-up-right](https://www.snomed.org/members)
.

SNOMED CT is used to represent clinical information in a coded form, with the level of expressivity appropriate for clinical documentation, and also with extensive support for meaning-based retrieval, analysis and reporting.

SNOMED CT is a valuable resource. However, its value is only realized when integrated within well-designed systems that take advantage of its key features. This guide introduces those features and outlines different options for implementing and utilizing SNOMED CT in software applications to deliver tangible benefits.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/1-introduction#objective)

Objective


--------------------------------------------------------------------------------------------------------------------------------------

This "Vendor Introduction to SNOMED CT" provides an informative practical introduction to SNOMED CT focused primarily on the needs of vendors and developers of EHRs and other related applications in healthcare information technology.

This Vendor Introduction provides an authoritative basis on which to build more detailed knowledge. Basic information about SNOMED CT including its benefits can be found in the [SNOMED CT Starter Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/)
. In-depth technical information can be found in technical guides available from the [SNOMED CT Documentation Library](https://docs.snomed.org/)
. The [SNOMED CT Implementation Support Portal arrow-up-right](https://www.implementation.snomed.org/)
is also a good reference source and has a particular section on Implementing SNOMED CT as well as other useful information. SNOMED International works with vendors to ease adoption, integration and implementation of SNOMED CT into vendor solutions to enhance offerings for the global market, see [https://www.snomed.org/vendorsarrow-up-right](https://www.snomed.org/vendors)
 for more details. Further information about other available resources is provided in Section 8.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/1-introduction#target-audience)

Target Audience


--------------------------------------------------------------------------------------------------------------------------------------------------

This "Vendor Introduction to SNOMED CT" is targeted at people engaged in the development of EHR systems and related services. The document will also be of interest to a broader audience including anyone engaged in designing, developing, procuring, deploying, configuring or managing EHR systems and services.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Vendor+Introduction&entry.670899847=Introduction)

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*   [Background](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/1-introduction#background)
    
*   [Objective](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/1-introduction#objective)
    
*   [Target Audience](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/1-introduction#target-audience)
    

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# Interoperability | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents

The final important aspect of SNOMED CT implementations is how interoperability is implemented. SNOMED CT is a very powerful tool to ensure the safe, unambiguous transfer of patient data between organizations and the use of SNOMED CT concept identifiers is at the foundation of this.

1.  Use SNOMED CT concept identifiers and/or SNOMED CT expressions to populate SNOMED CT coded data elements for all relevant message exchanges.
    
2.  Use SNOMED CT to share data, based on national/local data standards.
    
3.  The system shall have the capacity to take in mappings to other terminologies/classifications where available such as ICD-10, ICPC2, LOINC, Orphanet codes, and make the mappings available in the relevant contexts. This may include on-screen display and inclusion in generated documents, reports and data extracts.
    

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# Storage | Practical Guides SNOMED CT EHR Requirements Guide | SNOMED International Documents

How SNOMED CT is used and stored against patient records is another factor that can drive a successful implementation or not. The use of the SNOMED CT concept identifier is a mandatory requirement and for all the points in this section, it is important that implementations are quality assured and prove that these requirements are met.

1.  Must store SNOMED CT concept identifiers in the health records
    
2.  Store the SNOMED CT concept identifier (or SNOMED CT expression) together with the term selected by the user in the EHR for SNOMED CT coded data element.
    
3.  Ensure that the context of each SNOMED CT concept identifier or expression is clearly represented in either the information structure or the terminology (but not both).
    
4.  Ensure that all inactivated concepts, descriptions and relationships remain available to support querying over historical clinical data.
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=EHR+Requirements+Guide&entry.670899847=6.%20Storage)

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# Licensing | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents

The three types of license that govern use of SNOMED CT are Affiliate licenses, Sub-licenses and National licenses.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/7-licensing#affiliate-licenses)

Affiliate licenses


-----------------------------------------------------------------------------------------------------------------------------------------------------

Vendors and other organizations that develop or distribute products or services that include or provide access to SNOMED CT must be SNOMED International Affiliates.

An Affiliate license is a contractual agreement between SNOMED International and the Affiliate. The Affiliate license grants rights to use SNOMED CT worldwide, subject to:

*   Meeting conditions for reporting its use and making appropriate payment where used in non-member territories
    
*   Holding and conforming to the conditions of a National license for use in Member Countries
    

The Affiliate license agreement can be found at: [http://snomed.org/licensearrow-up-right](http://snomed.org/license)
.

To obtain a [SNOMED International Affiliate Licensearrow-up-right](https://www.snomed.org/get-snomed)
:

*   In an Member country, please check the relevant Member web page for advice on how to register: [http://snomed.org/membersarrow-up-right](http://snomed.org/members)
    
*   In countries that are not Members, or in Member countries that use the MLDS, you can request a license using the SNOMED CT Member Licensing and Distribution Service (MLDS): [https://mlds.ihtsdotools.orgarrow-up-right](https://mlds.ihtsdotools.org/)
    .
    

Organizations that use SNOMED CT must all be either an SNOMED International Affiliate or a sub-licensee of an SNOMED International Affiliate. SNOMED International Affiliates are required to issue sublicenses to organizations (or individuals) who use their products or services, unless the user organization is itself an SNOMED International Affiliate. More information on sublicenses is available later in this section.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/7-licensing#sub-licenses)

Sub-licenses


-----------------------------------------------------------------------------------------------------------------------------------------

Affiliate license holders who supply SNOMED CT enabled products or services to others are required to:

*   Issue and manage sub-licenses and make information about these available to SNOMED International
    
*   Report and ensure appropriate payment when SNOMED CT is used in non-member territories
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/7-licensing#national-licenses)

National Licenses


---------------------------------------------------------------------------------------------------------------------------------------------------

Members can impose additional requirements related to the use of SNOMED CT International Edition in their territory. For example they may require use of their National Extension of SNOMED CT.

Members may issue National licenses to SNOMED International Affiliates. A National license usually grants use of a National SNOMED CT Extension which may include translations, content additions and reference sets. The terms of a National license may apply similar conditions on the use of the National Extension as the SNOMED CT Affiliate License applies to the International Edition. It may also be part of a broader licensing scheme covering other nationally licensed works.

National licenses can only be issued to SNOMED International Affiliates. However, if an applicant for a National License is not already an Affiliate, the Member may issue an Affiliate License on behalf of SNOMED International. Note that an Affiliate license issued in this way is still an agreement between SNOMED International and the licensee and the terms of the Affiliate License Agreement are the same.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/7-licensing#license-charges)

License charges


-----------------------------------------------------------------------------------------------------------------------------------------------

*   SNOMED International does not charge for licensed use of SNOMED CT in Member countries
    
*   Members are permitted to charge for the use of SNOMED CT within their country, provided that these charges are limited to cost recovery
    
*   There are fees for use of SNOMED CT in non-Member territories
    
    *   These charges depend on the wealth of the country in which the use of SNOMED CT occurs. For detail of the fee structures see [https://www.snomed.org/licensingarrow-up-right](https://www.snomed.org/licensing)
        .
        
    *   Intended use in non-Member territories must be reported to SNOMED International (via MLDS: [https://mlds.ihtsdotools.orgarrow-up-right](https://mlds.ihtsdotools.org/)
        ) before this use begins.
        
    
*   [Fee-waivers arrow-up-right](https://www.snomed.org/fee-exemptions)
    may apply for limited use of SNOMED CT in SNOMED International approved research projects and 'public good' initiatives.
    
*   Fees for Web and Mobile Apps can be found here [https://www.snomed.org/licensingarrow-up-right](https://www.snomed.org/licensing)
    .
    

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-b7ddca8f9ef07ad0e80559844c863e0e3a917aac%252F259854385.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=a9dac74d&sv=2)

**Figure 17.Responsibilities of Affiliate license holders to report usage and where appropriate to pay the fees which are due**

Further details can be found via the SNOMED International website at [http://snomed.org/licensearrow-up-right](http://snomed.org/license)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/7-licensing#online-browser-licensing)

Online Browser Licensing


-----------------------------------------------------------------------------------------------------------------------------------------------------------------

SNOMED International has published guidance about licensing implications of web-based SNOMED CT browsers and other publicly available software or services and which incorporate, or provide access to SNOMED CT: [https://confluence.ihtsdotools.org/download/attachments/73368648/Ihtsdo\_Guidance\_PublicAccessBrowserAndTools\_20141211.pdfarrow-up-right](https://confluence.ihtsdotools.org/download/attachments/73368648/Ihtsdo_Guidance_PublicAccessBrowserAndTools_20141211.pdf)

* * *

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*   [Affiliate licenses](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/7-licensing#affiliate-licenses)
    
*   [Sub-licenses](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/7-licensing#sub-licenses)
    
*   [National Licenses](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/7-licensing#national-licenses)
    
*   [License charges](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/7-licensing#license-charges)
    
*   [Online Browser Licensing](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/7-licensing#online-browser-licensing)
    

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# Referencias | Practical Guides Intro a SCT para proveedores | SNOMED International Documents

La Introducción para el Proveedor está pensada como un punto de partida útil para los Proveedores. Se puede acceder a información más detallada y a una variedad de documentos informativos y materiales de capacitación desde el sitio web de SNOMED International [www.snomed.orgarrow-up-right](http://www.snomed.org/)
 y la biblioteca documental de SNOMED CT [http://snomed.org/docarrow-up-right](http://snomed.org/doc)
.

La siguiente tabla proporciona enlaces a muchos de los recursos clave para obtener más información sobre SNOMED CT.

Tópico

Referencia clave

**Información general sobre SNOMED CT** Los materiales incluyen: ¿qué es SNOMED CT?, valor y beneficios, e información sobre licencias, software y herramientas y otros productos de SNOMED CT. También sitios enfocados en proveddores, miembros e implementadores.

[https://www.snomed.org/what-is-snomed-ctarrow-up-right](https://www.snomed.org/what-is-snomed-ct)
[https://www.snomed.org/value-of-snomedctarrow-up-right](https://www.snomed.org/value-of-snomedct)
 [https://www.snomed.org/licensingarrow-up-right](https://www.snomed.org/licensing)
 [https://www.snomed.org/software-toolsarrow-up-right](https://www.snomed.org/software-tools)
[https://www.snomed.org/other-snomed-productsarrow-up-right](https://www.snomed.org/other-snomed-products)

[https://www.snomed.org/vendorsarrow-up-right](https://www.snomed.org/vendors)
[https://www.snomed.org/membersarrow-up-right](https://www.snomed.org/members)
[https://www.snomed.org/implementersarrow-up-right](https://www.snomed.org/implementers)

**Biblioteca de documentos SNOMED CT** Acceso a una amplia gama de documentos sobre SNOMED CT

[http://snomed.org/docarrow-up-right](http://snomed.org/doc)

**Navegadores SNOMED CT** El Navegador Internacional de SNOMED y una lista de otras herramientas para explorar contenido de SNOMED CT

[http://browser.ihtsdotools.org/arrow-up-right](http://browser.ihtsdotools.org/)
 [https://www.implementation.snomed.org/browsersarrow-up-right](https://www.implementation.snomed.org/browsers)

**SNOMED CT en acción** Ejemplos del uso de SNOMED CT en todo el mundo.

[https://www.snomed.org/snomed-in-actionarrow-up-right](https://www.snomed.org/snomed-in-action)

**Guía de inicio de SNOMED CT** Una introducción general a SNOMED CT que complementa esta guía.

[http://snomed.org/starterguidearrow-up-right](http://snomed.org/starterguide)

**Servidor de e-Learning de SNOMED CT** Acceso a una creciente gama de recursos de educación en línea sobre SNOMED CT. Incluidos cursos formales y materiales de libre acceso

[http://snomed.org/elearningarrow-up-right](http://snomed.org/elearning)
[https://www.snomed.org/educationarrow-up-right](https://www.snomed.org/education)

**Presentaciones de la Expo SNOMED CT** Material de presentaciones

[https://www.youtube.com/@snomedct/playlistsarrow-up-right](https://www.youtube.com/@snomedct/playlists)

**Acerca de SNOMED International** Más información sobre la organización que posee y mantiene SNOMED CT

[https://www.snomed.org/about-usarrow-up-right](https://www.snomed.org/about-us)
[https://www.snomed.org/get-involvedarrow-up-right](https://www.snomed.org/get-involved)
[http://snomed.org/membersarrow-up-right](http://snomed.org/members)
[https://www.snomed.org/our-partnershipsarrow-up-right](https://www.snomed.org/our-partnerships)
[https://www.snomed.org/snomed-ct-marketplacearrow-up-right](https://www.snomed.org/snomed-ct-marketplace)

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[PreviousLicenciaschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/licencias)
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# ¿Qué es un Centro Nacional de Referencia? | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

Un Centro Nacional de Referencia (CNR) es un punto de contacto oficial dentro de la jurisdicción de un Miembro que tiene la responsabilidad de servir de interfaz entre SNOMED International, los usuarios y Afiliados nacionales y otros Miembros.

**Figura 1 Un Centro Nacional de Referencia es el principal punto de contacto para SNOMED International, los usuarios y otros Miembros.**

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2133369718-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FI7N0Q2Su8RGW5pAlIrWt%252Fuploads%252Fgit-blob-cee6ed4ccd8ca2651f33a0d54725fa08d1f701f2%252F259854827.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=736025cd&sv=2)

SNOMED International exige que cada Miembro tenga una organización designada que cumpla un pequeño conjunto de responsabilidades básicas del CNR. Estas responsabilidades incluyen recibir la Edición Internacional de SNOMED CT de SNOMED International, ponerla a disposición de los licenciatarios en el País Miembro, y promover y apoyar la adopción y despliegue de SNOMED CT en el País Miembro. Algunos CNR también ofrecen productos y servicios adicionales para apoyar el uso nacional de SNOMED CT. Siempre que se cumplan las responsabilidades básicas, cada Miembro es libre de decidir si su CNR debe prestar o no otros servicios o productos relacionados.

En el caso de los Miembros que opten únicamente por distribuir la versión internacional de SNOMED CT, el CNR puede limitarse a una o dos personas que se encarguen de los servicios mínimos necesarios. Los CNR de otros Miembros son organizaciones más grandes que tienen muchas otras responsabilidades relacionadas con SNOMED CT y también gestionan el uso de otras normas de informática sanitaria dentro de ese país. Un CNR puede establecerse como un nuevo organismo u organización dentro del País Miembro, o puede integrarse en un organismo u organización ya existente.

Como principal punto de contacto tanto para los Afiliados nacionales como para SNOMED International, el CNR desempeña un papel central en la colaboración eficaz y eficiente con los distintos socios. El término "National Release Center" es utilizado por SNOMED International, pero un Miembro puede dar un nombre diferente a la organización que cumple esta función en su país.

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# Distribución de SNOMED CT | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

Una de las principales responsabilidades de un CNR es poner a disposición de los Afiliados la Edición Internacional de SNOMED CT y/o la Extensión Nacional de SNOMED CT. Por lo tanto, cada CNR debe ser capaz de proporcionar orientación sobre el acceso a SNOMED CT, el control de versiones y su gestión. Además, el CNR debe ser capaz de orientar a los usuarios sobre los servicios terminológicos específicos que presta y sobre el uso de los desarrollos nacionales de SNOMED CT, como las Extensiones Nacionales, los Conjuntos de Referencia, etc.

SNOMED International mantiene y ofrece contenidos y derivados compartidos que constituyen la base de SNOMED CT. Esto se conoce como la Edición Internacional de SNOMED CT.

SNOMED CT se distribuye como conjuntos de archivos que contienen componentes terminológicos y derivados. Contienen los datos básicos necesarios para implementar SNOMED CT en varios modos en formatos tecnológicamente neutros. El formato, el contenido y los nombres de los archivos entregados se ajustan a las especificaciones y directrices de SNOMED CT publicadas en la [Especificación de Archivos de Publicación de SNOMED CTarrow-up-right](https://confluence.ihtsdotools.org/display/DOCRELFMT)
.

**Los componentes representan el contenido de la terminología.**

La representación estándar de SNOMED CT para el contenido es en forma de tres archivos interrelacionados. El archivo Concepto contiene identificadores únicos para ideas clínicas, el archivo Descripción vincula términos legibles por humanos con conceptos específicos y el archivo Relación representa las asociaciones entre conceptos.

**Los derivados facilitan el uso eficaz de la terminología.**

La representación estándar de SNOMED CT para los derivados es un formato de archivo coherente pero flexible, conocido como Reference set format. Los Conjuntos de Referencia pueden utilizarse para una amplia gama de propósitos, incluidos los subconjuntos, preferencias lingüísticas, listas ordenadas, jerarquías, anotaciones y mapeos hacia o desde otras terminologías, clasificaciones y sistemas de códigos.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-distribucin-de-snomed-ct#acceso-a-los-archivos-de-publicacion-de-snomed-ct)

Acceso a los archivos de publicación de SNOMED CT:


---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Tanto los Miembros de SNOMED International como los Afiliados fuera de los Países Miembros acceden a los archivos de publicación a través de los Servicios de Licencia y Distribución de SNOMED CT (MLDS) de SNOMED International.

Todos los archivos distribuidos a los Miembros están disponibles en la página del producto "Edición Internacional de SNOMED CT" en el MLDS, y se puede acceder a ellos aquí: [https://mlds.ihtsdotools.org/#/ihtsdoReleases/ihtsdoRelease/167 arrow-up-right](https://mlds.ihtsdotools.org/#/ihtsdoReleases/ihtsdoRelease/167)
. Se puede encontrar acceso e información sobre el MLDS aquí: [https://mlds.ihtsdotools.org.arrow-up-right](https://mlds.ihtsdotools.org/)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-distribucin-de-snomed-ct#ciclo-de-vida-de-las-versiones)

Ciclo de vida de las versiones


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SNOMED International proporciona actualizaciones periódicas de la edición internacional de SNOMED CT. SNOMED CT se publica mensualmente el primer día de cada mes. Puede encontrar más información en [https://www.snomed.org/releases.arrow-up-right](https://www.snomed.org/releases)

Del mismo modo, los Miembros y Afiliados que mantienen Extensiones deben publicar versiones actualizadas de sus Extensiones para alinearlas con la Edición Internacional de SNOMED CT.

**Publicaciones de los Miembros**

Es necesario introducir cambios periódicos en SNOMED CT para satisfacer las necesidades y requisitos de los usuarios y mejorar la calidad del propio SNOMED CT. Un CNR debe ser consciente de que cualquier cambio en SNOMED CT puede repercutir en las Extensiones Nacionales y en las guías. Por lo tanto, cada versión requiere una conciliación para garantizar que todas las Extensiones Nacionales sigan estando en consonancia con la Edición Internacional.

Si se añaden o desactivan componentes de SNOMED CT (conceptos, descripciones o relaciones), será necesario evaluar cómo afectan estos cambios a una Extensión Nacional, y es posible que sea necesario realizar ajustes en los desarrollos nacionales. Por ejemplo:

*   Los conceptos añadidos pueden requerir traducción y también pueden ser candidatos a añadirse a los Conjuntos de Referencia nacionales.
    
*   Los conceptos desactivados que sean Miembros de un Conjunto de Referencia Nacional pueden necesitar ser sustituidos por un concepto activo adecuado.
    

**Archivos de publicación**

Con cada versión de SNOMED CT se ponen a disposición dos tipos diferentes de archivos de versión:

*   Publicación Completa (Full release): contiene el historial completo de cada componente
    
*   Publicación de Instantánea (Snapshot Release): contiene el estado actual de cada componente
    

_Nota sobre la versión Delta (__**incluye los cambios realizados entre una versión y la siguiente)**__: Se han eliminado los archivos Delta del paquete de publicación de SNOMED International, de las extensiones de servicios gestionados y de los paquetes derivados. No obstante, existe una Herramienta de Generación Delta para quienes la necesiten. La herramienta de generación de deltas permite a los usuarios crear su propio delta entre dos fechas de publicación fijas y puede encontrarla aquí:_ [https://github.com/IHTSDO/delta-generator-tool/releases.arrow-up-right](https://github.com/IHTSDO/delta-generator-tool/releases)

La Edición Internacional se suministra en ambos tipos de versión. Sin embargo, como la instantánea puede generarse a partir de la versión completa, la especificación sólo exige que las organizaciones que mantienen extensiones proporcionen una versión completa de su extensión.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Spanish+NRC+Guide&entry.670899847=Distribuci%C3%B3n%20de%20SNOMED%20CT)

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*   [Acceso a los archivos de publicación de SNOMED CT:](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-distribucin-de-snomed-ct#acceso-a-los-archivos-de-publicacion-de-snomed-ct)
    
*   [Ciclo de vida de las versiones](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-distribucin-de-snomed-ct#ciclo-de-vida-de-las-versiones)
    

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# Introducción | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-introduccin#antecedentes)

Antecedentes


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Cuando un país se adhiere a SNOMED International adquiere una serie de derechos y obligaciones relacionados con los productos de SNOMED International, incluidos los Términos Clínicos de SNOMED (SNOMED CT). Todos los Países Miembros desempeñan un papel clave en los órganos de gobierno y asesoramiento de SNOMED International. Por lo tanto, unirse a SNOMED International conlleva la necesidad de aprender cómo funciona SNOMED International, las funciones de los Miembros de SNOMED International y las formas prácticas de maximizar los beneficios de la membresía.

Un primer paso importante es designar a una organización como Centro Nacional de Referencia (CNR) para que cumpla los requisitos operativos de afiliación, incluida la gestión de la distribución nacional de SNOMED CT. Esta guía es un documento introductorio de alto nivel para los Centros Nacionales de Referencia (CNR).

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-introduccin#objetivo)

Objetivo


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El objetivo de la "Guía del Centro Nacional de Referencia de SNOMED International" (Guía del CNR) es ofrecer un punto de partida práctico y útil para los Países Miembros. Proporciona orientación sobre las responsabilidades de los CNR y las relaciones entre los CNR, SNOMED International y los implementadores y usuarios dentro de un País Miembro.

Este documento también pretende orientar sobre cómo los CNR pueden apoyar una implementación eficaz y eficiente de SNOMED CT en sus países. Sin embargo, no ofrece una introducción general a SNOMED CT. Los lectores interesados en obtener más información sobre la terminología de SNOMED International deben consultar la Guía de inicio de SNOMED CT.

La Guía de inicio de SNOMED CT puede consultarse aquí: [Guía de inicioarrow-up-right](http://snomed.org/starterguide)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-introduccin#publico-objetivo)

Público objetivo


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Los destinatarios de la Guía de CNR son las personas responsables de establecer, gestionar y trabajar en un Centro Nacional de Referencia. Aunque está destinada principalmente a los nuevos Miembros, esta guía también constituye una referencia útil para el personal del CNR en los Países Miembros existentes.

Los lectores de esta guía deberían saber lo que es un Miembro y qué es un Afiliado. El Glosario de SNOMED International puede utilizarse para aclarar palabras y frases específicas utilizadas.

El glosario SNOMED CT puede consultarse aquí: [glosarioarrow-up-right](http://snomed.org/glossary)

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*   [Antecedentes](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-introduccin#antecedentes)
    
*   [Objetivo](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-introduccin#objetivo)
    
*   [Público objetivo](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-introduccin#publico-objetivo)
    

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# Estrategias y consideraciones de implementación | Practical Guides Intro a SCT para proveedores | SNOMED International Documents

*   ¿En qué medida el uso de SNOMED CT diferenciará este producto de otros?
    
*   ¿A qué casos de uso se puede aplicar SNOMED CT?
    
*   ¿Qué rutas de migración se ofrecerán a los clientes para pasar de sus sistemas de codificación actuales a SNOMED CT?
    
*   ¿SNOMED CT se implementará en un producto de expediente clínico electrónico existente o como una nueva variante del producto?
    
*   ¿Se hará la implementación en más de una etapa y, de ser así, cuáles serán esas etapas?
    
*   ¿Qué partes del sistema, si las hay, serán proporcionadas por proveedores externos?
    
*   ¿En qué medida y durante qué período se mantendrán en paralelo los diseños descritos?
    
*   ¿SNOMED CT será una terminología de diseño o una terminología de ejecución?
    
*   ¿SNOMED CT será la terminología de interfaz o solo la terminología de almacenamiento, interoperabilidad e informes?
    

En la Sección 4 se describieron diversos enfoques de implementación. En esta sección se hace referencia a los enfoques resumidos en la Sección 4 y se analizan algunas posibles estrategias de implementación de SNOMED CT, los factores que influyen en el éxito de la implementación y las posibles medidas de éxito.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/estrategias-y-consideraciones-de-implementacin#implementacion-por-etapas)

Implementación por etapas


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Existen numerosas vías para la implementación incremental de SNOMED CT. Estos permiten controlar el momento y el grado en que se reemplazan los diseños y recursos terminológicos existentes.

Algunos proveedores han optado por introducir SNOMED CT como parte de un producto nuevo y diferenciado en su línea de productos.

Muchos proveedores han introducido SNOMED CT incrementalmente, con una interrupción mínima de los procesos de sus clientes o usuarios finales. Si un proveedor crea un nuevo producto, es probable que lo más adecuado sea una implementación en una sola etapa.

La Sección 4 resume una variedad de enfoques de implementación que difieren en el grado en que utilizan las diferentes características de SNOMED CT.

**Implementaciones de una etapa versus varias etapas**

Las implementaciones de una sola etapa pueden:

*   Minimizar el impacto de múltiples ciclos de capacitación de los clientes y usuarios.
    
*   Lanzar una variante significativa de un producto al mercado.
    

Las implementaciones de múltiples etapas pueden:

*   Minimizar el impacto de cada etapa.
    
*   Adaptar incrementalmente el alcance del cambio de acuerdo a las necesidades y deseos de los clientes.
    

Un posible ejemplo de una implementación por etapas podría implicar la siguiente secuencia:

*   Inicialmente: Retrabajar el diseño de los mensajes electrónicos utilizados para interoperar con datos en otros sistemas, luego se puede incluir a SNOMED CT como parte de la carga útil dentro de estos mensajes (Enfoque 1).
    
*   Subsecuentemente: Reelaborar extractos de datos e informes existentes, utilizando índices de SNOMED CT, para garantizar una transición exitosa a una dependencia de informes basados en SNOMED CT (Enfoque 3).
    
*   Subsecuentemente: Conservar la terminología existente en la interfaz de usuario, pero mapeándola a un almacén donde se registra SNOMED CT junto con el sistema de códigos existente (enfoque 4)
    
*   Subsecuentemente: Migración al uso de SNOMED CT en la interfaz de usuario para nuevos registros (Enfoque 5).
    
*   Subsecuentemente: Adopción de nuevas herramientas de análisis que exploten los significados contenidos en SNOMED CT (Enfoque 7).
    
*   Subsecuentemente: Ampliar el uso de SNOMED CT para capturar datos más estructurados en forma de expresiones de SNOMED CT (Enfoque 9).
    
*   Finalmente: Utilización de todas las funciones de SNOMED CT en todo el expediente clínico electrónico (enfoque 10).
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/estrategias-y-consideraciones-de-implementacin#relaciones-y-dependencias)

Relaciones y dependencias


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Las preocupaciones comerciales y técnicas sobre la dependencia en componentes o soluciones de terceros pueden ser una razón válida para el desarrollo interno de todos los "servicios terminológicos" necesarios.

Sin embargo, es posible que exista una variedad de recursos terminológicos listos para usar, como los subconjuntos de SNOMED CT, que se puedan reutilizar, por ejemplo, para mejorar la experiencia de registro de datos del usuario. Algunos de estos recursos pueden utilizarse en todo el mundo y de forma gratuita, mientras que otros pueden estar disponibles bajo algún tipo de licencia. La dependencia en un tercero para mantener los derivados, como los subconjuntos, se puede eliminar asumiendo esa responsabilidad internamente. Se distinguen por tanto tres opciones distintas:

*   Adoptar y utilizar un recurso terminológico de terceros (por ejemplo, un subconjunto), confiando en que el propietario lo mantenga.
    
*   Adaptar un recurso terminológico existente (por ejemplo, un subconjunto) y así asumir la responsabilidad de mantener una versión separada.
    
*   Entrar en una relación de colaboración, por ejemplo para mantener conjuntamente el subconjunto.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/estrategias-y-consideraciones-de-implementacin#estrategias-de-lenguaje-y-dialecto)

Estrategias de lenguaje y dialecto


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La implementación de SNOMED CT puede simplificar enormemente la configuración de un producto de expediente clínico electrónico con términos expresados en el idioma o dialecto requerido por el cliente. Una estrategia de implementación de SNOMED CT debe aprovechar los beneficios de SNOMED CT para la configuración local de idiomas y dialectos. Por ejemplo, al utilizar un Conjunto de Referencia de Lenguaje de SNOMED CT, que representa los términos preferidos y aceptables en un idioma o dialecto determinado, se puede reconfigurar un subconjunto previamente utilizado para completar un cuadro desplegable para mostrar términos en un dialecto diferente. Para otras partes, como los encabezados de un formulario, también es posible utilizar los Conjuntos de Referencia de Lenguaje de SNOMED CT como fuente de referencia. El alcance del uso de Conjuntos de Referencia de Lenguaje debe considerarse como parte de una estrategia de producto.

Para aprovechar las capacidades de idioma y dialecto de SNOMED CT, un proveedor puede utilizar el contenido local proporcionado por un Centro Nacional de Referencia.

Se puede utilizar una variante de idioma o dialecto requerida por el cliente en cualquiera de los siguientes escenarios:

*   Se utiliza la Edición Internacional de SNOMED CT y ésta refleja el lenguaje utilizado en los registros sanitarios.
    
*   Se necesita un dialecto específico de un idioma, como Inglés Australiano, Inglés del Reino Unido o Inglés de Estados Unidos.
    
*   Hay un idioma local dominante, pero este no se utiliza en la atención médica ni en los registros de salud (que se registran utilizando un idioma o dialecto ya disponible en SNOMED CT).
    
*   Se hablan varios idiomas, por ejemplo, en Canadá, donde se puede utilizar cualquiera de ellos.
    
*   La traducción de SNOMED CT está destinada únicamente a ser utilizada como terminología de referencia, es decir, no para su uso en la interfaz de usuario.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/estrategias-y-consideraciones-de-implementacin#medidas-de-exito-de-la-implementacion)

Medidas de éxito de la implementación


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El grado de éxito de la implementación de SNOMED CT se puede evaluar de muchas maneras, incluida la evaluación basada en evidencia de:

*   Logro de los beneficios planeados, junto con la continuidad del valor existente proporcionado por el sistema
    
*   La capacidad de los clientes y usuarios de adaptarse a los cambios con un mínimo de capacitación o interrupción.
    
*   Alcance y calidad de la interoperabilidad con sistemas externos y su valor para los clientes: Mensajes electrónicos que conservan el significado del contenido clínico con reutilización efectiva en el sistema receptor
    
*   Funcionamiento ininterrumpido y sin perturbaciones de la organización sanitaria durante el periodo de introducción y uso de SNOMED CT
    
    *   Resultados de salud de los pacientes
        
    *   Satisfacción del personal
        
    *   Remuneración y/o prestigio empresarial
        
    
*   Reconocimiento entre pares por el buen trabajo
    
*   Éxito en la explotación de trabajos compartidos, como subconjuntos o consultas disponibles
    
*   Costo mínimo y beneficio máximo de las publicaciones sucesivas de SNOMED CT
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/estrategias-y-consideraciones-de-implementacin#factores-que-influyen-en-el-exito-de-la-implementacion)

Factores que influyen en el éxito de la implementación


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**Perspectiva del proveedor**

Los factores que pueden influir en el éxito de la implementación, desde la perspectiva del proveedor, incluyen:

*   Planificación cuidadosa, comprensión de los objetivos clave y compromiso con los clientes.
    
*   Adecuación exitosa de las necesidades del usuario a las características relevantes de SNOMED CT y establecimiento de objetivos realistas para alcanzar beneficios específicos.
    
*   Selección de una hoja de ruta de implementación adecuadamente organizada que brinde continuidad al servicio y una experiencia de usuario mejorada de manera incremental.
    
*   Selección juiciosa de las diferentes técnicas y herramientas.
    
*   Representación consistente de la información clínica almacenada.
    
*   Optimización de la recuperación y análisis de información.
    
*   Maximizar la reutilización de artefactos de configuración existentes, como consultas o subconjuntos
    
*   Separación de la terminología: configuración discreta de datos y eliminación de la codificación rígida de la terminología directamente en el código del software.
    

**Perspectiva del cliente**

Los factores que pueden influir en el éxito de la implementación, desde la perspectiva del cliente, incluyen:

*   Facilidad y eficacia del registro y visualización de datos de SNOMED CT. Por ejemplo, la velocidad de registro de datos, la facilidad de búsqueda y navegación, el alcance limitado de búsqueda basada en el contexto, la agregación de detalles y el resaltado de la información crítica. Todas estas son aspectos muy importantes para los médicos.
    
*   Carga mínima de configuración y capacitación adicional para los usuarios.
    
*   Oportunidades adecuadas para ajustar el producto y su configuración a las necesidades locales, incluida la explotación de diseños locales preexistentes.
    
*   Valor significativo de las actividades de preparación para implementar el producto y los servicios asociados.
    
*   Calidad del producto, su flexibilidad y un valor futuro suficiente para retenerlo más allá del período contractual actual.
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Spanish-Vendor-Guide&entry.670899847=Estrategias%20y%20consideraciones%20de%20implementaci%C3%B3n)

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*   [Implementación por etapas](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/estrategias-y-consideraciones-de-implementacin#implementacion-por-etapas)
    
*   [Relaciones y dependencias](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/estrategias-y-consideraciones-de-implementacin#relaciones-y-dependencias)
    
*   [Estrategias de lenguaje y dialecto](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/estrategias-y-consideraciones-de-implementacin#estrategias-de-lenguaje-y-dialecto)
    
*   [Medidas de éxito de la implementación](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/estrategias-y-consideraciones-de-implementacin#medidas-de-exito-de-la-implementacion)
    
*   [Factores que influyen en el éxito de la implementación](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/estrategias-y-consideraciones-de-implementacin#factores-que-influyen-en-el-exito-de-la-implementacion)
    

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# Tooling | Practical Guides SNOMED NRC Guide | SNOMED International Documents

There are numerous tools that NRCs may need, depending on the extent to which they customize or extend the SNOMED CT International Edition.

The tools necessary for an NRC depend on what services the NRC will deliver and what approach the NRC will take to deliver its services. However, at a minimum, an NRC needs a platform where SNOMED CT can be made available to users, i.e. a tool to support distribution to users of the International Edition (received from SNOMED International) and potential National Extensions. Moreover, if the NRC decides to develop National Extensions, including a national translation or national Reference sets, tools are also required to support these tasks. Figure 8 shows various types of tooling that an NRC can use to support its work with SNOMED CT.

Figure 8. Tools useful for an NRC.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3066103899-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FP1frmzZuNvoHsCrG7SKQ%252Fuploads%252Fgit-blob-dbc6c3b892adb3b0db63fce13bd909feaa9c6202%252F26837065.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=35fa1922&sv=2)

Later sections of this document present the typical practice and tools related to each of the above work tasks .

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/tooling#snomed-international-tooling-service)

SNOMED International Tooling service


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NRCs are free to choose or develop tools to enable distribution and management of SNOMED CT and national derivatives in their countries. However, SNOMED International puts great effort into development of SNOMED International tooling services, which represent a range of services and tools that have been made available to support SNOMED International, Members, and the Community of Practice. Over time, SNOMED International aims to include tools necessary to support the full range of essential NRC functions in its tooling services.

Tooling service developments are now based on SNOMED International's Open Tooling Framework (OTF) and the source code is made available under an Apache v2 open source licence (where feasible). This framework is a set of standardized application programming interfaces (APIs), bound by a set of principles that define fundamental software services. These services are consumed by business applications, which are being developed to satisfy the tooling requirements of SNOMED International and its Members.

SNOMED International tooling services are listed at [https://www.snomed.org/software-toolsarrow-up-right](https://www.snomed.org/software-tools)
.

Details of [implementation toolingarrow-up-right](https://www.implementation.snomed.org/implementation-tooling)
 are also provided on the SNOMED CT Implementation Support Portal.

.

* * *

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[PreviousEducation and Trainingchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training)
[NextSNOMED CT Browserschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-ct-browsers)

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# Engaging stakeholders | Practical Guides SNOMED NRC Guide | SNOMED International Documents

Working with SNOMED CT and clinical terminology involves many different stakeholders with different objectives and different roles. An NRC can promote successful SNOMED CT adoption by engaging clinicians, vendors, system owners, etc. and supporting awareness of each stakeholder's role in the process of SNOMED CT adoption, implementation and use. However, engagement of users can be difficult, and it is therefore important that the NRC consider how best to engage the various stakeholders. Some Members choose to establish dedicated forums where users and vendors can be regularly updated on the latest initiatives and developments. Alternatively, newsletters and national conferences can be effective in maintaining communication and engagement with relevant stakeholders. For an NRC, such initiatives may also be used to encourage stakeholders to become involved in SNOMED CT development or implementation at an international level through involvement in SNOMED International, for example as participants in Advisory Groups, Project Groups or Clinical Reference Groups.

There are various ways to promote the engagement of stakeholders, but is important to approach the stakeholders selectively on topics which are relevant to a specific user group. If the user can see the point and feel convinced of the potential benefits and the importance of their engagement, they will be more likely to feel encouraged to participate and take responsibility.

_**Advice for engaging stakeholders:**_

*   **Disseminate SNOMED CT potential and benefits:** Who is it for? What can it do? What are the benefits?
    
*   **Give examples** that relate to the work of the specific stakeholder/user group.
    
*   **Engage in regular contact** to give stakeholders the opportunity to raise issues (and get them resolved) collectively.
    
*   **Find SNOMED CT Champions:** Find someone or a group that has successfully implemented SNOMED CT and leverage that success to engage others. Encourage these champions to tell others about their experience of the practical value of using SNOMED CT.
    
*   **Explain how SNOMED CT fits within the systems and standards already in use:** Usually users don't know how SNOMED CT will influence current practice.
    
*   **Take on national initiatives** : Focused subset and content development activities are very useful for engaging clinical groups.
    

* * *

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[PreviousImplementation Consultancychevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/implementation-consultancy)
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Last updated 7 months ago

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# Enhancing EHR Design with SNOMED CT | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#storing-clinical-records-with-snomed-ct)

Storing Clinical Records with SNOMED CT


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Storing SNOMED CT encoded clinical records involves the storage of:

*   Codes: Concept codes (SNOMED CT Identifiers for concept)
    
*   Terms: User-selected terms (which may be SNOMED CT terms)
    

In some implementations of SNOMED CT this may also involve the storage of:

*   Expressions composed of multiple codes
    
*   Identifiers for expressions which are held in an Expression Library
    

Clinical data which is stored using SNOMED CT will use SNOMED CT concept identifiers. SNOMED CT Identifiers are represented as a string consisting of between 6 and 18 digits. Further detail can be found in the Release File Specification: [SNOMED CT Identifiers](https://docs.snomed.org/snomed-ct-specifications/snomed-ct-release-file-specification/snomed-ct-identifiers/6-snomed-ct-identifiers)
.

In most cases, the term selected by the user is also stored. The structural representation of stored clinical information is important. This must store similar information consistently, and the storage design must support effective querying.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#binding-and-mapping-to-snomed-ct)

Binding and Mapping to SNOMED CT


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User interfaces commonly restrict the data that can be selected by the user and stored. Electronic messages are also often constrained in terms of the permissible values that may be meaningfully included in each field. Decisions are made on whether some semantics, such as the priority for a procedure, is expressed in a reserved part of the message structure, or if it is expressed as part of the SNOMED CT expression within the message.

As part of implementation there may be a need to either:

*   Bind SNOMED CT to relevant parts of the design, and/or
    
*   Create and use a map between a pre-existing terminology and SNOMED CT
    

The implementer should balance the cost of developing and maintaining an inter-terminology map, with their target quality for that map. Unless an existing terminology scheme represents clinical ideas in a comparable way to SNOMED CT then a perfect (i.e. lossless and reversible) map may not be possible.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#data-entry-with-snomed-ct)

Data Entry with SNOMED CT


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Existing data entry interfaces may be modified to incorporate SNOMED CT in the required places, often as a direct replacement of another coding scheme.

Data entry features which may be enhanced or enabled using SNOMED CT include:

*   Search and entry of single codes
    
    *   Optimized design of a search tool for effective use with SNOMED CT is addressed in the [Search and Data Entry Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/)
        .
        
    
*   Clinical data entry interfaces comprising numerous data items, including selection from short pick lists, and selectable singe items (check boxes).
    
    *   Data entry interfaces have discrete items or lists of items from SNOMED CT 'bound' to a field. An example would be the binding of a single SNOMED CT Concept to a checkbox, so that when checked the SNOMED CT Identifier for the concept is stored in the clinical record.
        
    *   Pick list can be configured by 'binding' to a SNOMED CT subset, or by enumerating the members of the pick list within the interface design.
        
    
*   The encoding of free text data entry using SNOMED CT, for validation by a user
    
    *   Using Natural Language Processing tools which work with SNOMED CT
        
    
*   The use of images as a way of selecting coded entries e.g. anatomical images
    
    *   This is a variation in which SNOMED CT is bound to regions of an image, rather than a coded or text based field
        
    

Attention is needed to identify which parts of the data entry interface are both in scope of SNOMED CT and which the implementer intends to be encoded using SNOMED CT. For example, when implementing a scored assessment with many questions, an implementer may choose to encode only the assessment result with SNOMED CT.

SNOMED CT allows a level of precision of meaning that is rarely matched by the content of proprietary terminology systems. For this and other reasons, there may need to be modifications or enhancements to the user interface and how it allows users to search, enter and express clinical ideas.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#maintaining-snomed-ct-enabled-products)

Maintaining SNOMED CT Enabled Products


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Routine scheduled maintenance of EHRs is anticipated and supported by SNOMED CT, which also has a program of continuous improvement. Unlike some classification or coding schemes, SNOMED CT updates, adds and inactivates content where it is useful to do so.

The changes to SNOMED CT content include changes to the status of a concept or term e.g. from active to inactive. Relationships between concepts change for a variety of reasons, including the refinement of a concept definition, in response to new medical understanding, or the introduction of new concepts.

The most common activities relating to changes to SNOMED CT content are:

*   Substituting a prior version of a subset with its more recent version, for example, in a data entry interface
    
*   Substituting an inactivated Concept with a suitable nominated replacement
    
*   Substituting an inactivated Term with a suitable alternative
    
*   Evaluating the impact to an existing subset
    
*   Updating of bindings and SNOMED CT queries
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#messaging-with-snomed-ct)

Messaging with SNOMED CT


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Implementation of SNOMED CT within a system is not always concurrent to the adjustment of external electronic clinical data flows. The design of the electronic message, and the definition of the data extract which is used to populate the message, may need to be modified to accommodate its SNOMED CT payload. Similarly to data storage, an electronic message may require the inclusion of:

*   Codes: Concept codes (SNOMED CT Identifiers for concepts)
    
*   Terms: User-selected terms (which may be SNOMED CT terms)
    

For a more extensive use of the features of SNOMED CT, messages may include:

*   Expressions composed of multiple codes
    
*   Identifiers for expressions which are held in an Expression Library
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#migrating-clinical-records-between-systems)

Migrating Clinical Records between Systems


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Some implementation strategies include the bulk migration of data between different versions of their system or between different systems. In this or similar circumstances, the tasks of data Extraction, Transformation and subsequent Loading \['ETL'\] are performed.

Data migration can include the use of:

*   Maps between items from the existing terminology to the SNOMED CT equivalent
    
*   Transformation of data between the different physical data structures (or the more abstract 'information models') of the source and the target system
    

SNOMED CT supports multiple different ways for a concept to be expressed and stored. A concept may also have some parts of its meaning expressed within the data structure itself. For example, some of the different ways in which SNOMED CT can be used to represent a 'family history of' a disorder include:

*   As a single SNOMED CT coded item
    
*   As a SNOMED CT expression comprising two or more SNOMED CT concepts, one of which gives the context of Family History
    
*   By representing the 'family history' via a dedicated table within the storage schema reserved for family history records, and populating this with the SNOMED CT Concept for the relevant disorder
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#reporting-with-snomed-ct)

Reporting with SNOMED CT


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System outputs such as mandatory reports need to be supported at each implementation stage.

Reports can be used to guide resource allocation, for reimbursement, or for clinical quality evaluation, so the ability to provide these reports before and after any systems change is important to customers. Beyond the initial task of replicating existing reports and results, the analysis power of SNOMED CT can be exploited to generate new reports or types perhaps not previously possible.

SNOMED International distributes a map from SNOMED CT to ICD-10. This supports the generation of ICD-10 classified data from data originally recorded using SNOMED CT, or later mapped to SNOMED CT.

Transition to the use of SNOMED CT for clinical records will require, in some cases, re-development of the data processing to populate the reports. However, in many cases SNOMED CT will enhance previous reporting capabilities.

* * *

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*   [Storing Clinical Records with SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#storing-clinical-records-with-snomed-ct)
    
*   [Binding and Mapping to SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#binding-and-mapping-to-snomed-ct)
    
*   [Data Entry with SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#data-entry-with-snomed-ct)
    
*   [Maintaining SNOMED CT Enabled Products](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#maintaining-snomed-ct-enabled-products)
    
*   [Messaging with SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#messaging-with-snomed-ct)
    
*   [Migrating Clinical Records between Systems](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#migrating-clinical-records-between-systems)
    
*   [Reporting with SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/6-enhancing-ehr-design-with-snomed-ct#reporting-with-snomed-ct)
    

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# Fases de la organización del CNR | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

Establecer un CNR que funcione bien no es una tarea trivial, y es necesario conocer los pasos necesarios para lograr un CNR activo y eficaz a fin de planificar y contratar adecuadamente. Los procesos de creación y funcionamiento de un CNR pueden describirse en tres fases: establecimiento, despliegue y mantenimiento.

**Figura 3. Diferentes fases de creación y funcionamiento de los CNR**

\*\*

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2133369718-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FI7N0Q2Su8RGW5pAlIrWt%252Fuploads%252Fgit-blob-3f05e3a4110d5e8611d576aff71ab62626ca84ab%252F259854831.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=561f4a2e&sv=2)

\*\*

Cada CNR puede asumir diversas responsabilidades para facilitar la implantación y el uso de SNOMED CT en el País Miembro. Estas responsabilidades abarcan desde el desarrollo, la distribución y el mantenimiento de SNOMED CT hasta el apoyo a los proyectos de implementación de SNOMED CT, así como la formación de las personas implicadas en el uso y la implantación de SNOMED CT. En la fase de creación de un CNR, es vital tomar decisiones sobre cuáles servicios se prestarán y cuáles desarrollos nacionales emprenderá el CNR. Estas decisiones también incluyen decidir la organización del CNR, los procesos de trabajo, el calendario, etc. Por supuesto, es posible que el ámbito de actividad del CNR aumente (o disminuya) en el futuro, a medida que cambien las necesidades.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-fases-de-la-organizacin-del-cnr#lista-de-decisiones-para-la-creacion-del-cnr)

Lista de decisiones para la creación del CNR


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Antes de crear un CNR, deben tenerse en cuenta las siguientes preguntas para poder determinar la mejor organización y flujo de trabajo posibles del CNR, junto con la contratación y formación adecuadas del personal para adecuar las competencias necesarias del CNR al enfoque y los objetivos nacionales previstos. La lista no es exhaustiva, pero incluye algunas consideraciones básicas que los actuales Miembros han considerado importantes.

Decisiones para la administración de un CNR Para la administración de un CNR, deben tomarse decisiones en relación con los procesos de trabajo, calendarios y la asignación de recursos.

*   ¿Cuál es el calendario previsto para la creación y puesta en marcha del CNR?
    
*   ¿Cuál es la finalidad/estrategia de SNOMED CT en mi país?
    
*   ¿Qué recursos se destinarán a adaptar la Edición Internacional a las necesidades nacionales?
    
*   ¿Quién se encargará de gestionar las tareas específicas?
    

**Uso de SNOMED CT con otras terminologías, clasificaciones y modelos** Normalmente, un País Miembro también utiliza otras terminologías, sistemas de clasificación o modelos de información, y es importante que un CNR tenga una estrategia clara sobre cómo SNOMED CT se va a alinear con el uso actual o previsto de estos otros productos en el País Miembro.

*   ¿Qué conjunto de terminologías estándar (además de SNOMED CT) se utilizará en el país? ¿Son obligatorias o se sugieren?
    
*   ¿Se requieren mapeos entre SNOMED CT y otras terminologías o clasificaciones?
    
*   ¿Existen interdependencias con otros productos (clasificaciones/sistemas de codificación/iniciativas de modelos de información) que puedan afectar a las versiones, el contenido, etc. de SNOMED CT?
    

**Ajuste/extensiones nacionales** Un CNR debe considerar en qué medida deben realizarse ajustes nacionales a SNOMED CT (traducciones, extensiones, conjuntos de referencia, etc.) para desarrollar la Extensión Nacional de SNOMED CT y ajustarla a las necesidades y casos de uso deseados para el País Miembro.

*   ¿Se necesita una traducción de SNOMED CT al idioma y/o dialectos aplicables al país?
    
*   ¿Se requieren conjuntos de referencia nacionales para limitar la cantidad de conceptos de SNOMED CT que se utilizarán en casos de uso específicos, ámbitos clínicos, etc., y para respaldar el uso coherente de SNOMED CT en estos ámbitos?
    
*   ¿Se necesitan contenidos nacionales (extensiones de la Edición Internacional de SNOMED CT) para satisfacer necesidades nacionales específicas?
    
*   ¿Quién gestionará a largo plazo los derivados, por ejemplo los conjuntos de referencia y los mapas? ¿El CNR o alguien más?
    

**Aplicación y casos prácticos** Un CNR puede adoptar estrategias muy diferentes para apoyar la implantación y el uso de SNOMED CT en el País Miembro específico, por lo que un CNR debe considerar si apoyará, o en qué medida, implantaciones específicas de SNOMED CT. También debe considerar cómo se llevará a cabo la colaboración con las partes interesadas relacionadas.

*   ¿Quién es responsable de qué, por ejemplo en los proyectos de implementación?
    
    *   ¿Qué se hará a nivel nacional?
        
    *   ¿Cuál es la responsabilidad de las distintas partes interesadas (CNR, médicos, organizaciones sanitarias, proveedores de TI, etc.)?
        
    
*   ¿Qué organizaciones utilizan ya SNOMED CT en el país y cómo se va a colaborar con ellas?
    
*   ¿Qué nivel/tipo de apoyo se ofrecerá?
    
*   ¿Hay algún caso de uso prioritario que se quiera comunicar?
    
*   ¿Se tiene previsto especificar normas de conformidad para el uso de SNOMED CT en su país?
    

**Educación** Un CNR debe tener un plan claro sobre su papel en relación con la educación y capacitación sobre SNOMED CT de los distintos grupos de partes interesadas del país.

*   ¿Tiene previsto ofrecer algún documento de orientación además de los que proporciona SNOMED International?
    
*   ¿Tiene previsto impartir capacitaciones sobre SNOMED CT? ¿A distintos niveles?
    
*   ¿Traducirán todos los materiales de SNOMED International (más allá de la terminología de SNOMED CT, por ejemplo, materiales educativos, directrices de traducción, directrices de despliegue) a su idioma nacional, o se acepta el uso del inglés?
    

**Herramientas** Es importante que un CNR explore y discuta cuáles herramientas específicas se necesitan para llevar a cabo el trabajo del CNR y determinar qué herramientas utilizará el CNR.

*   ¿Utilizará sus propias herramientas o las de SNOMED International?
    
*   ¿De qué sistemas/procesos/herramientas se dispone actualmente que puedan aprovecharse para llevar a cabo las actividades como CNR?
    
*   ¿Qué herramientas se necesitan para apoyar las actividades de su CNR? ¿De dónde se obtendrán (de SNOMED International, proveedores, desarrollo propio)?
    

La consideración de cada una de las preguntas anteriores dará lugar a otras preguntas que deberán responderse para obtener una visión general/estimación realista de la magnitud y los tipos de recursos necesarios para alcanzar los objetivos identificados. Por ejemplo, no basta con decidir que se quiere hacer una traducción de SNOMED CT a la lengua nacional. Esta decisión también requiere que se detalle cuándo y cómo se planea hacerlo, quién debe encargarse del trabajo y la disponibilidad del financiamiento necesario.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-fases-de-la-organizacin-del-cnr#equilibrar-ambiciones-y-recursos)

Equilibrar ambiciones y recursos


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Si un CNR decide desarrollar una amplia gama de servicios y productos para apoyar el uso de SNOMED CT en el País Miembro, probablemente promoverá la adopción exitosa de la terminología. Sin embargo, es importante que el CNR establezca ambiciones y plazos realistas en relación con los recursos disponibles. Los Miembros deben considerar y definir cuidadosamente las visiones nacionales para el uso de SNOMED CT en el País Miembro. Por lo tanto, los Miembros deben ser claros sobre la forma en que esperan que se utilice SNOMED CT, que, una vez más, debe estar en consonancia con la estrategia y la infraestructura nacionales.

Puede ser útil considerar un proceso de desarrollo por etapas, en el que el CNR priorice las iniciativas que deben llevarse a cabo inmediatamente y deje a un lado las iniciativas que podrían programarse más adelante. Esto es mejor que poner la expectativa demasiado alta, ya que iniciar demasiados proyectos puede ser difícil.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-fases-de-la-organizacin-del-cnr#comunicacion-con-otros-cnr)

Comunicación con otros CNR


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En cada etapa del desarrollo de un CNR es esencial entrar en contacto con otros CNR para conocer las formas existentes de organizar y dirigir un CNR y aprender de las experiencias de los demás. SNOMED International facilita la comunicación entre los Miembros de diferentes maneras, por ejemplo a través de talleres durante las reuniones presenciales que se llevan a cabo dos veces al año o mediante la participación en el Foro de Miembros (descrito más adelante en este documento).

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-fases-de-la-organizacin-del-cnr#gobernanza-del-cnr)

Gobernanza del CNR


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Cada CNR necesita una estructura de gobierno clara para garantizar que el trabajo del CNR y las decisiones estratégicas estén siempre alineadas con las necesidades de los usuarios, las prioridades estratégicas nacionales, los desarrollos e iniciativas de SNOMED International, el trabajo de los colaboradores, etc. Por lo tanto, el CNR debe considerar cuál estructura de gobierno sería la adecuada para satisfacer las necesidades del CNR, ya que las necesidades pueden variar en función del alcance de los servicios y de la Extensión Nacional que el CNR decida desarrollar.

En su forma más simple, la gobernanza del CNR puede llevarse a cabo como una gestión operativa de la responsabilidad de dirigir el trabajo diario del CNR. Alternativamente, puede ser necesario contar con comités formales que asesoren sobre la dirección del CNR. Esto podría ser necesario, por ejemplo, si se desarrolla una Extensión Nacional, ya que ello puede implicar la necesidad de un comité editorial que defina y mantenga las políticas editoriales y garantice su cumplimiento.

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*   [Lista de decisiones para la creación del CNR](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-fases-de-la-organizacin-del-cnr#lista-de-decisiones-para-la-creacion-del-cnr)
    
*   [Equilibrar ambiciones y recursos](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-fases-de-la-organizacin-del-cnr#equilibrar-ambiciones-y-recursos)
    
*   [Comunicación con otros CNR](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-fases-de-la-organizacin-del-cnr#comunicacion-con-otros-cnr)
    
*   [Gobernanza del CNR](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-fases-de-la-organizacin-del-cnr#gobernanza-del-cnr)
    

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# Participación de las partes interesadas | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

El trabajo con SNOMED CT y la terminología clínica implica a muchas partes interesadas con objetivos y funciones diferentes. Un CNR puede promover el éxito de la adopción de SNOMED CT implicando a médicos, proveedores, propietarios de sistemas, etc. y fomentando la concienciación sobre el papel de cada parte interesada en el proceso de adopción, implementación y uso de SNOMED CT. Sin embargo, comprometer a los usuarios puede resultar difícil, por lo que es importante que el CNR estudie la mejor manera de implicar a las distintas partes interesadas. Algunos Miembros optan por crear foros específicos en los que usuarios y vendedores pueden recibir información actualizada sobre las últimas iniciativas y novedades. Alternativamente, los boletines informativos y las conferencias nacionales pueden ser eficaces para mantener la comunicación y el compromiso con las partes interesadas pertinentes. En el caso de un CNR, estas iniciativas también pueden utilizarse para animar a las partes interesadas a implicarse en el desarrollo o la implementación de SNOMED CT a nivel internacional a través de la participación en SNOMED International, por ejemplo como participantes en Grupos Asesores, Grupos de Proyecto o Grupos Clínicos de Referencia.

Hay varias formas de promover la participación de las partes interesadas, pero es importante dirigirse a ellas de forma selectiva sobre temas que sean relevantes para un grupo de usuarios específico. Si el usuario puede ver el sentido y se siente convencido de los beneficios potenciales y de la importancia de su compromiso, será más probable que se sienta animado a participar y asumir responsabilidades.

_**Consejos para implicar a las partes interesadas:**_

*   **Difundir el potencial y las ventajas de SNOMED CT:** ¿A quién va dirigido? ¿Qué puede hacer? ¿Cuáles son las ventajas?
    
*   **Dé ejemplos** relacionados con el trabajo del grupo específico de partes interesadas/usuarios.
    
*   Manténgase **en contacto periódicamente** para dar a las partes interesadas la oportunidad de plantear problemas (y resolverlos) colectivamente.
    
*   **Buscar campeones de SNOMED CT:** Encuentre a alguien o a un grupo que haya implementado con éxito SNOMED CT y aproveche ese éxito para implicar a otros. Anime a estos campeones a contar a otros su experiencia sobre el valor práctico del uso de SNOMED CT.
    
*   **Explicar cómo encaja SNOMED CT en los sistemas y normas ya en uso:** Por lo general, los usuarios no saben cómo influirá SNOMED CT en la práctica actual.
    
*   **Asumir iniciativas nacionales** : Las actividades centradas en subconjuntos y en el desarrollo de contenidos son muy útiles para implicar a los grupos clínicos.
    

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# Appendix : User Experience of SNOMED CT | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents

No matter which EHR design is used for implementing SNOMED CT, they will each incorporate some form of interaction between the end users and SNOMED CT. The way that SNOMED CT is implemented makes a significant difference to the user experience. Various simple techniques can be used to seamlessly integrate SNOMED CT with user interfaces that match the needs of clinical users.

This section offers high-level guidance on ways to deliver a positive user experience of SNOMED CT as part of an EHR system. More details on topics discussed in this section can be found in the Documents in the SNOMED CT Document Library and the [Search and Data Entry Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#snomed-ct-concept-identifiers)

SNOMED CT Concept Identifiers


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Unlike some classification schemes in which the characters used in each code convey some meaning, SNOMED CT concept identifiers are a sequence of digits which in no way reflect the meaning of the concept. For this reason, there is usually no value gained by displaying the identifier to the user, and in most cases it should be hidden to simplify the user interface. Instead users should see and interact with the terms used to represent the concepts, and the SNOMED CT concept identifier should purely be used in the stored record.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#preferred-term-and-synonyms)

Preferred Term and Synonyms


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Where SNOMED CT is being used as an interface terminology, the preferred term for each concept should be used as the default for display on the user interface. Each concept may have a different preferred term in different languages, dialects, specialties or care settings, and so these can be configured to a specific clinical environment. To improve the ease for users in searching for a given concept, user interfaces may support searching over any acceptable synonym for each concept. Preferred terms and acceptable synonyms are defined in SNOMED CT using a Language reference set, which references the subset of descriptions used in a given language, dialect, specialty or care setting. SNOMED International distributes two language reference sets (for US-English and UK-English), and various member countries distribute their own national Language reference sets. Additional language reference sets may be created at the regional, specialty, institute or software product level to truly customize the local user's experience.

Where a separate interface terminology is being used, each term may be bound (or mapped) to an appropriate SNOMED CT concept. When the interface term is selected, the identifier of the bound SNOMED CT concept is stored in the record. It is important when an interface terminology is being used that the mapping to SNOMED CT is of sufficient quality (ideally equivalent) to support the use cases for which the data will be used. Using an interface terminology, for example, may be useful for structured data entry, where only part of the meaning is represented by the selected term, and the rest by the surrounding interface context. An example of this is illustrated in Figure 18. In this example, when the radio button next to the term 'Full' is selected (from the 'Mobility' section on the user interface), the concept 160680006 |fully mobile (finding)| is recorded in the health record to fully represent the meaning of the selection and make future queries on this data more reliable.

Figure 18. Example of interface terminology used as part of structured data entry

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-d0af47c8621f2895f704195fb7f0ebd357934368%252F254968724.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=90129f7a&sv=2)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#fully-specified-name)

Fully Specified Name


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Identical words or phrases may sometimes have multiple meanings. In these cases, it may be helpful to display the fully specified name (FSN) of a concept in order to disambiguate each identical term.

For example, Figure 19 illustrates three terms that match the search for "cold" which have very different meanings. In practice, such ambiguities can also be minimized by appropriate search constraints (e.g. only two of these results refer to disorders).

Figure 19. Search results matching "cold" with their FSNs displayed to the right

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-ce68f52418359cc0a1bdb57cfcbc60dafe32c42d%252F254968723.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=4481f495&sv=2)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#constraining-search-results)

Constraining Search Results


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SNOMED CT is a large terminology with broad coverage. Consequently, unconstrained searches can result in long and unhelpful lists of matching terms. Ideally, users should only be presented with content relevant to their task. There are several ways to constrain search results to deliver a shorter and more relevant list of search results, including constraining concepts:

*   To a particular hierarchy
    
    *   For example, only concepts from the procedure hierarchy
        
    
*   To the subtypes of a given grouper concept
    
    *   For example, only concepts that are subtypes of the |pharmaceutical dose form| concept
        
    
*   Based on membership of a defined subset of concepts or descriptions
    
    *   For example, only body structure concepts referenced by the |lateralizable body structure reference set|
        
    
*   Based on particular attributes of the concept
    
    *   For example, only disorder concepts defined with an |associated morphology| of |inflammation|
        
    

If searches are not constrained, the result may include a long list of irrelevant concepts, from which it is difficult for a user to find the appropriate term. Unrestricted searches also lead to errors in coding where similar terms are associated with concepts from different hierarchies. For example the term "emphysema" can refer to a morphological abnormality in the lung or to the disease caused by this abnormality. While these concepts are related, using morphological abnormality as a patient diagnosis will lead to incorrect retrieval results.

An example of constraining to a particular hierarchy is shown in Figure 20. This example illustrates a search, which is performed with two different constraints. On the left the results are limited to the 'clinical finding' hierarchy, and on the right they are limited to the 'procedure' hierarchy.

It should be noted that some SNOMED CT hierarchies are never relevant for clinical data entry. In particular, concepts in the |SNOMED CT Model Component| hierarchy are technical artifacts that should be excluded from searches used for clinical data entry.

Figure 20. A search constrained to the procedure hierarchy (on the left) and the disorder hierarchy (on the right)

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-c2121cca0f6f3b458d475644975ff38a9fb1255a%252F254968722.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=427e494a&sv=2)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#ordering-search-results)

Ordering Search Results


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For many purposes it is helpful to order search results by ascending term length. This ensures that the terms that match the search string without other additions are seen first. Other list sequences may have their own merits but alphabetical ordering is often unhelpful, except in a very short list of search results.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#tree-navigation)

Tree Navigation


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A user interface may include the use of tree navigation to allow the user to navigate up or down content arranged in a tree structure, expanding and collapsing nodes as required. A tree hierarchy may also be used to arrange search results into a nested list that displays the most general matches first, with more specific matching subtypes nested below them.

The SNOMED CT subtype hierarchy may, in some cases, be used for these purposes. Alternative navigation structures can also be developed using an ordered reference set, which is customized to a specific use case. For example, users may wish to navigate to diagnosis content using customized groupings relevant only to the local region.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#data-entry-forms)

Data Entry Forms


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For structured types of data entry, templated forms are often used. In these cases, SNOMED CT concepts or expressions can be bound to each relevant field, option or list item. Preparing these bindings is part of the customization of an implementation to use SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#encoding-free-text)

Encoding Free Text


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Another type of interface that some tools provide enables free text to be coded using Natural Language Processing (NLP) enhanced by the semantics within SNOMED CT. This can provide an excellent user experience for typed or dictated data entry, but requires careful attention to quality to avoid inappropriate coding.

* * *

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*   [SNOMED CT Concept Identifiers](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#snomed-ct-concept-identifiers)
    
*   [Preferred Term and Synonyms](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#preferred-term-and-synonyms)
    
*   [Fully Specified Name](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#fully-specified-name)
    
*   [Constraining Search Results](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#constraining-search-results)
    
*   [Ordering Search Results](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#ordering-search-results)
    
*   [Tree Navigation](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#tree-navigation)
    
*   [Data Entry Forms](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#data-entry-forms)
    
*   [Encoding Free Text](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct#encoding-free-text)
    

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# Beneficios para los proveedores | Practical Guides Intro a SCT para proveedores | SNOMED International Documents

Esta sección identifica los beneficios clave para los proveedores que se obtienen tras la implementación de SNOMED CT. Resume los beneficios generales que incentivan la adopción, adquisición e implementación de sistemas habilitados con SNOMED CT. También se destacan los beneficios directos para los proveedores derivados del uso de una terminología global común que permite una recuperación eficaz basada en el significado, facilita la correspondencia con la CIE-10 y otras clasificaciones, y apoya la delimitación y personalización para cumplir con los requisitos nacionales, regionales o especializados específicos. La Figura 1 ilustra los beneficios para los hospitales y clínicas que adquieren sistemas habilitados con SNOMED CT; también es posible ofrecer sistemas habilitados con SNOMED CT a otros entes, como gobiernos, establecimientos de investigación clínica y financiadores y proveedores de salud que también pueden obtener beneficios similares.

\*\*

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-b574d237d0a5e3695aca86cf708975929a067e11%252F259854936.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=59746599&sv=2)

\*\*

**Figura 1. Los proveedores se benefician del valor de SNOMED CT para satisfacer los requisitos de una variedad de partes interesadas**

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores#beneficios-generales-de-snomed-ct)

**Beneficios generales de SNOMED CT**


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SNOMED CT apoya la representación consistente de contenido clínico integral y de alta calidad en los registros clínicos. El valor de SNOMED CT se ve reforzado por su sólida validación clínica y un diseño que facilita el crecimiento evolutivo para satisfacer requisitos emergentes, como el análisis de datos.

El uso de un expediente clínico electrónico mejora la comunicación y aumenta la disponibilidad de información relevante. Si la información clínica se almacena de forma que permita una recuperación basada en el significado, los beneficios aumentan enormemente. Los beneficios adicionales varían desde mayores oportunidades de apoyo

a la toma de decisiones en tiempo real hasta informes retrospectivos más precisos para la investigación y la gestión, así como una mejor calidad y consistencia de los datos en el punto de la recopilación de los datos. Como resultado, el uso de SNOMED CT beneficia a pacientes y médicos de manera individual, así como a poblaciones, y respalda la atención basada en evidencia.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores#los-registros-medicos-habilitados-con-snomed-ct-benefician-a-las-personas)

Los registros médicos habilitados con SNOMED CT benefician a las personas


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Los registros clínicos de salud habilitados con SNOMED CT benefician la atención que los médicos brindan a las personas al:

*   Permitir que se registre información clínica relevante utilizando representaciones comunes y consistentes de conceptos clínicos durante la consulta.
    
*   Permitir que las guías y los sistemas de apoyo a la toma de decisiones verifiquen el registro adecuado de la información y brinden asesoramiento en tiempo real, por ejemplo, a través de alertas clínicas.
    
*   Apoyar el intercambio de información apropiada con otras personas involucradas en la prestación de la atención a un paciente a través de la captura de datos que permita la comprensión e interpretación de la información de manera común por parte de todos los proveedores.
    
*   Permitir búsquedas precisas y completas que identifiquen cohortes de pacientes para el seguimiento o cambios de tratamiento según las guías adecuadas.
    
*   Eliminar barreras lingüísticas (SNOMED CT es multilingüe).
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores#poblaciones-beneficiarias-de-los-registros-de-salud-habilitados-con-snomed-ct)

Poblaciones beneficiarias de los registros de salud habilitados con SNOMED CT


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Los registros clínicos de salud habilitados con SNOMED CT benefician a los creadores de políticas y tomadores de decisiones interesados en la salud de la población al:

*   Facilitar la identificación temprana de problemas de salud emergentes, el monitoreo de la salud poblacional y la respuesta a los cambios en las prácticas clínicas.
    
*   Permitir un acceso preciso y específico a información relevante, reduciendo el costo por duplicaciones y errores.
    
*   Permitir la entrega de datos relevantes para respaldar la investigación clínica y contribuir con evidencia para futuras mejoras en el tratamiento.
    
*   Mejorar las auditorías de la prestación de atención médica proporcionando capacidad para el análisis detallado de los registros clínicos (por ejemplo, para investigar desviaciones y excepciones).
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores#los-registros-medicos-habilitados-con-snomed-ct-respaldan-la-atencion-medica-basada-en-evidencia)

Los registros médicos habilitados con SNOMED CT respaldan la atención médica basada en evidencia


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Los registros médicos habilitados con SNOMED CT apoyan la toma de decisiones en la atención médica basadas en evidencia al:

*   Permitir la vinculación entre los registros clínicos y las guías o protocolos clínicos existentes.
    
*   Apoyar el desarrollo de la evidencia adecuada que se puede usar en el desarrollo de guías clínicas.
    

En consecuencia, puede obtenerse:

*   Mejora en la calidad de la atención que experimentan las personas.
    
*   Reducción de los costos por pruebas y tratamientos inadecuados y/o duplicados.
    
*   Reducción de la frecuencia y el impacto de los eventos adversos en la atención médica.
    
*   Mejor relación costo-eficacia y mejor calidad de la atención prestada a las poblaciones.
    

Estos beneficios generales hacen que SNOMED CT sea incluido cada vez más como requisito en el proceso para la adquisición de sistemas clínicos en los Países Miembros y en otros lugares. Los beneficios para la población derivados del uso de SNOMED CT también pueden motivar a los organismos responsables de la gobernanza, la financiación y la gestión de la prestación de servicios de atención sanitaria a incluirlo en sus planes estratégicos.

Como resultado, se recomienda, incentiva o exige cada vez más el uso de SNOMED CT para hacer que los Miembros obtengan los beneficios de su inversión y de la propiedad de SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores#beneficios-estrategicos-para-los-proveedores)

Beneficios estratégicos para los proveedores


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**Mantenerse competitivo y relevante en el mercado**

*   SNOMED CT está cada vez más presente como un requisito en los procesos de adquisición de sistemas de expediente clínico electrónico
    
*   Incluso cuando no se menciona explícitamente, SNOMED CT puede contribuir a satisfacer los requisitos de los sistemas que tengan que ver con:
    
*   Historial clínico
    
*   Apoyo a la toma de decisiones
    
*   Informes y reportes
    
*   Indicadores de calidad de la atención
    
*   Mapeos para la CIE-10 y otras clasificaciones
    
*   Datos de referencia estándar, por ejemplo, listas de alérgenos
    

**Venta en mercados internacionales**

*   SNOMED CT está diseñado como la terminología global para la atención médica.
    
*   Los productos diseñados para utilizar SNOMED CT se pueden implementar en muchos países diferentes
    
*   SNOMED CT está disponible para uso gratuito en los Territorios Miembros; consulte [https://www.snomed.org/membersarrow-up-right](https://www.snomed.org/members)
    
*   Los Países Miembros acogen favorablemente los sistemas que hacen un uso eficaz de SNOMED CT
    
*   Varios países especifican SNOMED CT como la terminología clínica requerida o preferida
    
*   SNOMED CT se utiliza en más de ochenta países
    

**Cumplir con las expectativas de los médicos**

*   SNOMED CT hace que la recopilación de datos por parte de los médicos sea fácil, segura y reutilizable
    
*   SNOMED CT permite que la información se registre con un nivel de detalle apropiado para el mantenimiento de registros clínicos.
    
*   Mapas de clasificaciones para respaldar la asignación de códigos de clasificación y evitar la duplicación de registros para fines clínicos y de clasificación o informes
    
*   El nivel de detalle clínico está alineado con las necesidades para la toma de decisiones clínicas y los sistemas de apoyo a las decisiones clínicas.
    
*   SNOMED CT cubre una amplia gama de conceptos clínicos requeridos por diferentes especialidades clínicas.
    
*   SNOMED CT mejora las características de los sistemas, con lo que aumenta la aceptación por parte de los médicos, lo que influye en las decisiones de adquisición y lo convierte en un activo esencial para la implementación.
    
*   Los casos de uso probados de sistemas clínicos que son efectivos dadas sus características innovadoras gracias a SNOMED CT son clave para obtener nuevos negocios.
    

**Normas de apoyo**

*   SNOMED CT es un estándar terminológico para la representación inequívoca de información clínica.
    
*   La estandarización crea puentes para la comunicación efectiva y la reutilización de datos del expediente clínico electrónico
    
*   SNOMED CT constituye una base configurable para estándares nacionales y locales
    
*   SNOMED International trabaja con otros organismos de normalización para cumplir con los requerimientos de interoperabilidad.
    

**Retener clientes existentes**

*   SNOMED CT se puede introducir de forma gradual, minimizando las molestias a los clientes existentes.
    
*   La disponibilidad de SNOMED CT evita la pérdida de clientes cuando se adoptan los requisitos de SNOMED CT
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores#beneficios-practicos-para-los-vendedores)

Beneficios prácticos para los vendedores


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**Terminología común**

*   Una única terminología validada clínicamente y mantenida internacionalmente minimiza la necesidad de respaldar sistemas de códigos locales que duplican esfuerzos y crean soluciones incompatibles.
    
*   SNOMED CT cubre un amplio espectro de información clínica representada en los registros de salud que se puede utilizar para satisfacer las necesidades de la mayoría de las especialidades.
    
*   SNOMED CT se actualiza periódicamente para mantenerse al día con los cambios en los patrones de salud y el conocimiento clínico emergente.
    
*   La gestión del proceso de envío de solicitudes está respaldado con la garantía de calidad de SNOMED CT
    
*   El mecanismo de extensiones de SNOMED CT permite agregar conceptos para cumplir con los requisitos nacionales o locales dentro del marco de una terminología común.
    

**Facilidad de adopción**

*   Si bien la Sección 4 cubre las diferentes formas en que SNOMED CT se puede implementar en un sistema de expediente clínico electrónico, la más simple de ellas requiere un esfuerzo mínimo.
    
*   Los proveedores pueden optar por implementar SNOMED CT de forma nativa o elegir integrarlo con soluciones desarrolladas por muchos otros especialistas en servicios de terminología.
    

**Interfaces de usuario mejoradas**

*   SNOMED CT proporciona jerarquías de navegación y otras técnicas efectivas para restringir y eficientar las búsquedas.
    
*   SNOMED CT proporciona a los diseñadores de interfaces conceptos que tienen un significado inequívoco y sinónimos que se pueden emplear directamente.
    
*   SNOMED CT también permite realizar búsquedas sobre cualquier sinónimo de un concepto, aumentando así las posibilidades de encontrar el concepto necesario.
    

**Análisis mejorado**

*   Las definiciones de conceptos de SNOMED CT permiten una consulta flexible y potente de la información clínica
    
*   El análisis se puede mejorar aún más con herramientas que explotan la inferencia con lógica descriptiva, es decir, el cálculo que utiliza las [relaciones definitoriasarrow-up-right](https://confluence.ihtsdotools.org/display/DOCGLOSS/defining+relationship)
     de los conceptos.
    

**Uso de datos clínicos para cumplir con los requerimientos de informes externos**

*   Los mapas desde y hacia SNOMED CT permiten reutilizar los datos clínicos para informes estadísticos y de gestión utilizando otros sistemas de códigos y clasificaciones.
    

**Integración de productos de terceros**

*   El uso de SNOMED CT permite que los sistemas utilicen servicios comunes que agregan funcionalidades a los sistemas de expediente clínico electrónico. Por ejemplo:
    
    *   Integración con servicios de sistemas de soporte de decisiones y guías basados en conocimiento codificado mediante SNOMED CT.
        
    *   Un ejemplo común de esto son los proveedores de bases de conocimiento de medicamentos para respaldar la toma de decisiones en la prescripción.
        
    
*   Integración con productos y servicios complementarios para facilitar la gestión de enfermedades específicas o la participación en proyectos de investigación clínica.
    

**Adaptación para cumplir con los requerimientos**

*   SNOMED CT permite configuraciones que satisfacen los requisitos para:
    
*   Entornos multilingües
    
*   Diferentes especialidades clínicas
    
*   Diferentes entornos clínicos
    
*   Soporte para diferentes tipos de implementación
    
*   Los proveedores pueden utilizar las capacidades de configuración de SNOMED CT para cumplir con diferentes requisitos de los usuarios, pero udsando una plataforma común.
    
*   Los elementos de una configuración se pueden reutilizar para satisfacer casos de uso similares.
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Spanish-Vendor-Guide&entry.670899847=Beneficios%20para%20los%20proveedores)

[PreviousIntroducciónchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin)
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Last updated 5 months ago

*   [Beneficios generales de SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores#beneficios-generales-de-snomed-ct)
    
*   [Los registros médicos habilitados con SNOMED CT benefician a las personas](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores#los-registros-medicos-habilitados-con-snomed-ct-benefician-a-las-personas)
    
*   [Poblaciones beneficiarias de los registros de salud habilitados con SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores#poblaciones-beneficiarias-de-los-registros-de-salud-habilitados-con-snomed-ct)
    
*   [Los registros médicos habilitados con SNOMED CT respaldan la atención médica basada en evidencia](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores#los-registros-medicos-habilitados-con-snomed-ct-respaldan-la-atencion-medica-basada-en-evidencia)
    
*   [Beneficios estratégicos para los proveedores](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores#beneficios-estrategicos-para-los-proveedores)
    
*   [Beneficios prácticos para los vendedores](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores#beneficios-practicos-para-los-vendedores)
    

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# Licencias | Practical Guides Intro a SCT para proveedores | SNOMED International Documents

Los tres tipos de licencia que rigen el uso de SNOMED CT son las Licencias de Afiliados, las Sublicencias y las Licencias Nacionales.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/licencias#licencias-de-afiliados)

Licencias de Afiliados


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Los proveedores y otras organizaciones que desarrollan o distribuyen productos o servicios que incluyen o brindan acceso a SNOMED CT deben ser Afiliados de SNOMED International.

Una Licencia de Afiliado es un acuerdo contractual entre SNOMED International y el Afiliado. La Licencia de Afiliado otorga derechos para utilizar SNOMED CT en todo el mundo, sujeto a:

*   Cumplir las condiciones para informar sobre su uso y realizar el pago correspondiente cuando se utilice en Territorios No Miembros
    
*   Mantener y cumplir las condiciones de una Licencia Nacional para su uso en los Países Miembros. El Acuerdo de Licencia de Afiliado se puede encontrar en: [http://snomed.org/licensearrow-up-right](http://snomed.org/license)
    .
    

Para obtener una [Licencia de afiliado internacional de SNOMEDarrow-up-right](https://confluence.ihtsdotools.org/display/DOCGLOSS/Affiliate+License)
:

*   En un País Miembro, consulte la página web del Miembro correspondiente para obtener asesoramiento sobre cómo registrarse: [http://snomed.org/membersarrow-up-right](http://snomed.org/members)
    
*   En Países No Miembros o en Países Miembros que utilizan el MLDS, puede solicitar una licencia utilizando el Servicio de Distribución y Licencias para Miembros de SNOMED CT (MLDS): [https://mlds.ihtsdotools.orgarrow-up-right](https://mlds.ihtsdotools.org/)
    .
    

Las organizaciones que utilizan SNOMED CT deben ser Afiliadas de SNOMED International o Sublicenciatarias de un Afiliado de SNOMED International. Los Afiliados de SNOMED International deben emitir Sublicencias a organizaciones (o individuos) que utilicen sus productos o servicios, a menos que la organización usuaria sea en sí misma un Afiliado de SNOMED International. Más información sobre las Sublicencias se encontrará disponible más adelante en esta sección.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/licencias#sublicencias)

Sublicencias


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Los titulares de Licencias de Afiliados que suministran productos o servicios habilitados con SNOMED CT a otros deben:

*   Emitir y gestionar Sublicencias y poner la información sobre las mismas a disposición de SNOMED International
    
*   Informar y garantizar el pago adecuado cuando se utilice SNOMED CT en Países No Miembros.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/licencias#licencias-nacionales)

Licencias nacionales


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Los miembros pueden imponer requisitos adicionales relacionados con el uso de la Edición Internacional de SNOMED CT en su territorio. Por ejemplo, pueden requerir el uso de su Extensión Nacional de SNOMED CT.

Los Miembros pueden emitir Licencias Nacionales a los Afiliados de SNOMED International. Una Licencia Nacional generalmente otorga el uso de una Extensión Nacional de SNOMED CT que puede incluir traducciones, adiciones de contenido y Conjuntos de Referencias. Los términos de una Licencia Nacional pueden tener condiciones similares al uso de la Extensión Nacional, tal como se aplica con la Licencia de Afiliado de SNOMED CT a la Edición Internacional. También puede ser parte de un sistema de licencias más amplio que cubra otros escenarios para la Licencia Nacional.

Las Licencias Nacionales sólo se pueden emitir a Afiliados de SNOMED International. Sin embargo, si un solicitante de una Licencia nacional aún no es un Afiliado, el Miembro podrá emitir una Licencia de Afiliado en nombre de SNOMED International. Tenga en cuenta que una Licencia de afiliado emitida de esta manera sigue siendo un acuerdo entre SNOMED International y el licenciatario y los términos del Acuerdo de Licencia de Afiliado son los mismos.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/licencias#cargos-por-licencia)

Cargos por licencia


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*   SNOMED International no cobra por el uso autorizado de SNOMED CT en los Países Miembros
    
*   Los Miembros pueden cobrar por el uso de SNOMED CT dentro de su país, siempre que estos cargos se limiten a la recuperación de costos.
    
*   Existen tarifas por el uso de SNOMED CT en Países No Miembros
    
    *   Estos cargos dependen de la riqueza del país en el que se utiliza SNOMED CT. Para conocer detalles de la estructura de las tarifas, consulte [http://snomed.org/licensearrow-up-right](http://snomed.org/license)
        .
        
    *   El uso previsto en Países No Miembros debe notificarse a SNOMED International (a través de MLDS: [https://mlds.ihtsdotools.orgarrow-up-right](https://mlds.ihtsdotools.org/)
        ) antes de que comience este uso.
        
    
*   Se pueden aplicar [exenciones de tarifas arrow-up-right](https://www.snomed.org/fee-exemptions)
    para el uso limitado de SNOMED CT en proyectos de investigación aprobados por SNOMED International y para iniciativas de "bien público".
    
*   Las tarifas para aplicaciones web y móviles se pueden encontrar aquí: [https://www.snomed.org/licensingarrow-up-right](https://www.snomed.org/licensing)
    .
    

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-8d1bb978cfb3a8ba30d85d7b71a9fa92a5de0f14%252F259854956.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=4bf42a8e&sv=2)

**Figura 17. Responsabilidades de los titulares de licencias de afiliados de informar sobre el uso y, cuando corresponda, de pagar las tarifas adeudadas.**

Se pueden encontrar más detalles en el sitio web de SNOMED International en [http://snomed.org/licensearrow-up-right](http://snomed.org/license)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/licencias#licencias-de-navegadores-en-linea)

Licencias de navegadores en línea


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SNOMED International ha publicado una guía sobre las implicaciones de licenciamiento de los navegadores SNOMED CT basados en la web y otros softwares o servicios disponibles y que incorporan o brindan acceso a SNOMED CT: [https://confluence.ihtsdotools.org/download/attachments/73368648/Ihtsdo\_Guidance\_PublicAccessBrowserAndTools\_20141211.pdfarrow-up-right](https://confluence.ihtsdotools.org/download/attachments/73368648/Ihtsdo_Guidance_PublicAccessBrowserAndTools_20141211.pdf)

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[PreviousMejorando el diseño de la historia clínica electrónica con SNOMED CTchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct)
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Last updated 5 months ago

*   [Licencias de Afiliados](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/licencias#licencias-de-afiliados)
    
*   [Sublicencias](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/licencias#sublicencias)
    
*   [Licencias nacionales](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/licencias#licencias-nacionales)
    
*   [Cargos por licencia](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/licencias#cargos-por-licencia)
    
*   [Licencias de navegadores en línea](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/licencias#licencias-de-navegadores-en-linea)
    

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# Mejorando el diseño de la historia clínica electrónica con SNOMED CT | Practical Guides Intro a SCT para proveedores | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#almacenamiento-de-registros-clinicos-con-snomed-ct)

Almacenamiento de registros clínicos con SNOMED CT


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El almacenamiento de registros clínicos codificados mediante SNOMED CT implica el almacenamiento de:

*   Códigos: Códigos de concepto (Identificadores de conceptos de SNOMED CT)
    
*   Términos: Términos seleccionados por el usuario (que pueden ser términos de SNOMED CT)
    

En algunas implementaciones de SNOMED CT esto también puede implicar el almacenamiento de:

*   Expresiones compuestas por múltiples códigos
    
*   Identificadores de expresiones que se almacenan en una Biblioteca de Expresiones
    

Los datos clínicos que se almacenan mediante SNOMED CT utilizarán identificadores de concepto de SNOMED CT. Los identificadores de SNOMED CT se representan como una cadena que consta de entre 6 y 18 dígitos. Se pueden encontrar más detalles en la Especificación del Archivo de Publicación: [Identificadores de SNOMED CTarrow-up-right](https://confluence.ihtsdotools.org/display/DOCRELFMT/6+SNOMED+CT+Identifiers)
.

En la mayoría de los casos también se almacena el término seleccionado por el usuario. La representación estructural de la información clínica almacenada es importante. Se debe almacenar información similar de forma consistente y el diseño de almacenamiento debe apoyar las consultas efectivas.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#vinculacion-y-mapeo-a-snomed-ct)

Vinculación y mapeo a SNOMED CT


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Las interfaces de usuario comúnmente restringen los datos que el usuario puede seleccionar y almacenar. Los mensajes electrónicos también suelen estar limitados en términos de los valores permitidos que pueden incluirse completamente en cada campo. Se toman decisiones sobre si cierta semántica, como la prioridad de un procedimiento, se expresa en una parte específica de la estructura del mensaje o si se expresa como parte de la expresión de SNOMED CT dentro del mensaje.

Como parte de la implementación, puede ser necesario:

*   Vincular SNOMED CT a algunas partes relevantes del diseño y/o
    
*   Crear y utilizar un mapa entre una terminología preexistente y SNOMED CT
    

El implementador debe equilibrar el costo de desarrollar y mantener un mapa Inter terminológico con la calidad deseada para ese mapa. A menos que exista un esquema terminológico que represente las ideas clínicas de una manera comparable a SNOMED CT, puede que no sea posible crear un mapa perfecto (es decir, sin pérdidas y bidireccional).

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#registro-de-datos-con-snomed-ct)

Registro de datos con SNOMED CT


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Las interfaces de registro de datos existentes pueden modificarse para incorporar SNOMED CT en donde sea requerido, a menudo se incorpora como reemplazo directo de otro esquema de codificación.

Las funciones de registro de datos que se pueden mejorar o habilitar mediante SNOMED CT incluyen:

*   Búsqueda y registro de códigos individuales
    
    *   En la Guía de búsqueda y Registro de datos se aborda el diseño optimizado de una herramienta de búsqueda para un uso eficaz con SNOMED CT. Se encuentra disponible en la biblioteca de documentos de SNOMED CT en [http://snomed.org/docarrow-up-right](http://snomed.org/doc)
        .
        
    
*   Interfaces de registro de datos clínicos que comprenden numerosos elementos de datos, incluida la selección en listas de selección cortas y elementos individuales seleccionables (casillas de verificación).
    
    *   Las interfaces de registro de datos tienen elementos discretos o listas de elementos de SNOMED CT "vinculados" a un campo. Un ejemplo sería la vinculación de un concepto de SNOMED CT a una casilla de verificación, de modo que cuando se marque, el identificador de SNOMED CT para el concepto se almacene en el registro clínico.
        
    *   La lista de selección se puede configurar "vinculándola" a un subconjunto de SNOMED CT o enumerando los miembros de la lista de selección dentro del diseño de la interfaz.
        
    
*   La codificación del registro de datos de texto libre mediante SNOMED CT, para su validación por parte de un usuario
    
    *   Uso de herramientas de procesamiento del lenguaje natural que funcionan con SNOMED CT
        
    
*   El uso de imágenes como forma de seleccionar entradas codificadas, por ejemplo, imágenes anatómicas.
    
    *   Esta es una variación en la que SNOMED CT está vinculado a regiones de una imagen, en lugar de a un campo codificado o basado en texto.
        
    

Es necesario prestar atención a identificar tanto cuáles partes de la interfaz de registro de datos están dentro del alcance de SNOMED CT y cuáles el implementador pretende codificar utilizando SNOMED CT. Por ejemplo, al implementar una escala de evaluación con muchos valores, un implementador puede optar por codificar solo el resultado de la evaluación con SNOMED CT.

SNOMED CT permite un nivel de precisión de significado que rara vez es igualado por el contenido de los sistemas terminológicos propietarios. Por esta y otras razones, puede ser necesario realizar modificaciones o mejoras en la interfaz de usuario y en la forma en que los usuarios pueden buscar, registrar y expresar ideas clínicas.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#mantenimiento-de-productos-habilitados-con-snomed-ct)

Mantenimiento de productos habilitados con SNOMED CT


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SNOMED CT anticipa y apoya el mantenimiento programado de rutina de los EXPEDIENTES CLÍNICOS ELECTRÓNICOS y también cuenta con un programa de mejora continua. A diferencia de algunos esquemas de clasificación o codificación, SNOMED CT actualiza, agrega e inactiva contenido cuando es útil hacerlo.

Los cambios en el contenido de SNOMED CT incluyen cambios en el estado de un concepto o término, por ejemplo, de activo a inactivo. Las relaciones entre conceptos cambian por diversas razones, incluido el refinamiento de la definición de un concepto, en respuesta a una actualización médica o la introducción de nuevos conceptos.

Las actividades más comunes relacionadas con los cambios en el contenido de SNOMED CT son:

*   Sustituir una versión anterior de un subconjunto por su versión más reciente, por ejemplo, en una interfaz de registro de datos
    
*   Sustitución de un Concepto inactivado por un sustituto adecuado
    
*   Sustitución de un Término inactivado por una alternativa adecuada
    
*   Evaluación del impacto que tendrá un subconjunto existente
    
*   Actualización de enlaces y de consultas de SNOMED CT
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#mensajeria-con-snomed-ct)

Mensajería con SNOMED CT


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La implementación de SNOMED CT dentro de un sistema no siempre es simultánea con el ajuste de los flujos de datos clínicos electrónicos externos. Es posible que sea necesario modificar el diseño de los mensajes electrónicos y la definición del extracto de datos que se utiliza para completar los mensajes a fin de dar cabida a la carga útil de SNOMED CT. De manera similar al almacenamiento de datos, un mensaje electrónico puede requerir la inclusión de:

*   Códigos: Códigos de concepto (Identificadores de conceptos de SNOMED CT)
    
*   Términos: Términos seleccionados por el usuario (que pueden ser términos de SNOMED CT)
    

Para un uso más amplio de las funciones de SNOMED CT, los mensajes pueden incluir:

*   Expresiones compuestas por múltiples códigos
    
*   Identificadores de expresiones que se almacenan en una biblioteca de expresiones.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#migracion-de-registros-clinicos-entre-sistemas)

Migración de registros clínicos entre sistemas


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Algunas estrategias de implementación incluyen la migración masiva de datos entre diferentes versiones de su sistema o entre diferentes sistemas. En esta o similares circunstancias, se realizan las tareas de Extracción, Transformación y Carga de datos \['ETL'\].

La migración de datos puede incluir el uso de:

*   Mapas entre elementos de la terminología existente con el equivalente de SNOMED CT
    
*   Transformación de datos entre las diferentes estructuras físicas de datos (o los 'modelos de información' más abstractos) del sistema de origen y del sistema de destino
    

SNOMED CT admite formas diferentes de expresar y almacenar un concepto. Un concepto también puede tener algunas partes de su significado expresadas dentro de la propia estructura de datos. Por ejemplo, algunas de las diferentes formas en que se puede utilizar SNOMED CT para representar una "historia familiar" de un trastorno incluyen:

*   Como un único elemento codificado por SNOMED CT
    
*   Como una expresión de SNOMED CT que comprende dos o más conceptos de SNOMED CT, uno de los cuales proporciona el contexto de la historia familiar
    
*   Representando la 'historia familiar' a través de una tabla dedicada dentro del esquema de almacenamiento reservado para registros de historia familiar y completándola con el concepto de SNOMED CT para el trastorno relevante.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#informes-con-snomed-ct)

Informes con SNOMED CT


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Los productos del sistema, como los informes obligatorios, deben respaldarse en cada etapa de implementación.

Los informes se pueden utilizar para orientar la asignación de recursos, para el reembolso o para la evaluación de la calidad clínica, por lo que la capacidad de proporcionar estos informes antes y después de cualquier cambio en los sistemas es importante para los clientes. Más allá de la tarea inicial de replicar informes y resultados existentes, el poder de análisis de SNOMED CT se puede aprovechar para generar nuevos informes o tipos de informes que quizás antes no eran posibles.

SNOMED International distribuye un mapa de SNOMED CT a CIE-10. Este permite la generación de datos clasificados en CIE-10 a partir de datos registrados originalmente con SNOMED CT o posteriormente asignados a SNOMED CT.

La transición al uso de SNOMED CT para registros clínicos requerirá, en algunos casos, el rediseño del procesamiento de datos para completar los informes. Sin embargo, en muchos casos SNOMED CT mejorará las capacidades de generación de informes anteriores.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Spanish-Vendor-Guide&entry.670899847=Mejorando%20el%20dise%C3%B1o%20de%20la%20historia%20cl%C3%ADnica%20electr%C3%B3nica%20con%20SNOMED%20CT)

[PreviousEstrategias y consideraciones de implementaciónchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/estrategias-y-consideraciones-de-implementacin)
[NextLicenciaschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/licencias)

Last updated 5 months ago

*   [Almacenamiento de registros clínicos con SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#almacenamiento-de-registros-clinicos-con-snomed-ct)
    
*   [Vinculación y mapeo a SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#vinculacion-y-mapeo-a-snomed-ct)
    
*   [Registro de datos con SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#registro-de-datos-con-snomed-ct)
    
*   [Mantenimiento de productos habilitados con SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#mantenimiento-de-productos-habilitados-con-snomed-ct)
    
*   [Mensajería con SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#mensajeria-con-snomed-ct)
    
*   [Migración de registros clínicos entre sistemas](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#migracion-de-registros-clinicos-entre-sistemas)
    
*   [Informes con SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/mejorando-el-diseo-de-la-historia-clnica-electrnica-con-snomed-ct#informes-con-snomed-ct)
    

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# Guía del Centro Nacional de Referencia (CNR) | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

La Guía del Centro Nacional de Referencia (CNR) ofrece una introducción a SNOMED International y a SNOMED CT para quienes trabajan en, o planean desarrollar, un Centro Nacional de Referencia. También es aplicable a los países que estén considerando unirse a SNOMED International y a sus Miembros.

* * *

[Introducción](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-introduccin)

[¿Qué es un Centro Nacional de Referencia?](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-qu-es-un-centro-nacional-de-referencia)

[Responsabilidades del CNR](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/responsabilidades-del-cnr)

[Fases de la organización del CNR](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-fases-de-la-organizacin-del-cnr)

[El papel del CNR en relación con el licenciamiento de SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-el-papel-del-cnr-en-relacin-con-el-licenciamiento-de-snomed-ct)

[Asesoramiento para la implementación](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-asesoramiento-para-la-implementacin)

[Participación de las partes interesadas](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-participacin-de-las-partes-interesadas)

[Educación y capacitación](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-educacin-y-capacitacin)

[Herramientas](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/herramientas)

[Navegadores de SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/navegadores-de-snomed-ct)

[Distribución de SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-distribucin-de-snomed-ct)

[Solicitudes de cambios](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/solicitudes-de-cambios)

[Desarrollo de contenidos y personalización de SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-desarrollo-de-contenidos-y-personalizacin-de-snomed-ct)

[Gobernanza, grupos consultivos y eventos de SNOMED International](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-gobernanza-grupos-consultivos-y-eventos-de-snomed-international)

[Más información](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-ms-informacin)

* * *

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© Copyright 2026 International Health Terminology Standards Development Organisation, all rights reserved.

This document is a publication of International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED International owns and maintains SNOMED CT®.

Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. This document may be subject to updates. Always use the latest version of this document published by SNOMED International. This can be viewed online and downloaded by following the links on the front page or cover of this document.

SNOMED®, SNOMED CT® and IHTSDO® are registered trademarks of International Health Terminology Standards Development Organisation. SNOMED CT® licensing information is available at [http://snomed.org/licensingarrow-up-right](http://snomed.org/licensing)
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 or contact us at [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#e28b8c848da28b8a9691868dcc8d9085)
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Last updated 5 months ago

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# Translating SNOMED CT | Practical Guides SNOMED CT Translation Guide | SNOMED International Documents

SNOMED CT translations are required for the implementation of the terminology in non-English speaking countries. The most important goal when translating is to ensure semantic equivalence between the source (International Release) and target language (National Releases). Therefore the principle of **concept-based translation** must be applied: Translations should never be literal (i.e. should **not** start from the term to be translated), but should always be based on the Fully Specified Name (FSN), which describes the meaning of the term in natural language. The next step is to look at the position of the concept in the ontology (i.e. the formal concept model) to investigate the formal definition of the concept.

An example is the translation of |Pericardium| to Norwegian (Figure 11). Medical dictionaries and encyclopedias list “perikard” and “hjertesekk” (literally “heart sac”) as synonyms and valid translations. For most practical uses, this would be true. However, the translator should keep in mind the fine granularity of the SNOMED CT concept hierarchy, in which the |Pericardium| is a superordinate concept that includes several subordinate concepts, including the |Pericardial sac|. Considering the concepts in the hierarchy, the proper translation of |Pericardium| is “perikard”, while “hjertesekk” is equivalent to |Pericardial sac|.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2317125167-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FRqD57MbRYSFSsKbOrkOa%252Fuploads%252Fgit-blob-df1e2ad4fc685ba75dcd6ac070c13dd6b2fb1197%252F142134446.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=c414938b&sv=2)

**Figure 11** – Example of concept-based vs literal translation approach

As the ontology may contain errors, it is important that translators are aware of possible inconsistent or erroneous formal relationships and report modelling that contradicts the FSN.

SNOMED CT is a comprehensive terminology designed to meet the needs of a broad group of health care professionals in a range of settings. Translations should comply with the principles on which SNOMED CT was originally based: **understandability** , **reproducibility** and **usefulness** (URU). Therefore, the translation should adhere to the principles elaborated by Terminology Science for useable terms: terms should be transparent and reflect the essential characteristics of the designated concept; terms should satisfy the requirements of the users’ needs, i.e. they should be in accordance with clinical usage and they must be equally well understood by the different health professionals who use them. For each target language national linguistic guidelines, including syntactic, morphological and orthographic rules, are developed to support this approach.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#basic-approach)

Basic approach


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Interdisciplinary cooperation in terminology work is crucial (Infoterm 2005). The ideal approach to the translation process should therefore be close collaboration between healthcare professionals, terminologists, linguists, and professional translators. This ensures conceptual equivalence between source and target terms and linguistic correctness. In contrast, literal term-based translations based on purely linguistic morphologic-syntactic analysis may provide terms that appear correct at first glance, but which do not correctly reflect the true meaning of the underlying concept. At the same time, the observance of linguistic, systematic and orthographic principles is absolutely necessary to ensure the consistency and practicability of the terminology as well as the predictability of the translations, which improves findability.

In practice, this means that a number of basic principles must be followed with regard to the morpho-syntactic structure of terms to ensure consistency, but in cases where there are serious conflicts with everyday clinical language, clinical use should have priority.

In practice, this means that a number of basic principles must be followed with regard to the morpho-syntactic structure of terms to ensure consistency, but in cases where there are serious conflicts with everyday clinical language, clinical use should have priority.

The following sections address the main issues that translators may face. The goal of any translation is to achieve consistent, usable, and clinically acceptable translation equivalents in the target language.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#the-principle-of-concept-based-translation)

The principle of concept based translation

The translation of complex terms requires a relatively high level of domain knowledge to ensure that each translation (term or phrase) is an accurate representation of the original concept. Therefore, the translation team must carefully check that the meaning of each source concept is clearly understood, including the hierarchical position of the concept and its relationship to other concepts. In Dutch, for example, the literal translation of the English term “arthrosis” without prior analysis of its meaning (“disorder of one or more joints”) generates the incorrect term “arthrosis”( which is the Dutch term for |Osteoarthritis|) instead of the correct concept-based translation "arthropathie".

It is recommended to follow the translation workflow steps illustrated in Figure 12:

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2317125167-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FRqD57MbRYSFSsKbOrkOa%252Fuploads%252Fgit-blob-c3aae0e3e275078fa7bbd980cdb40be4c1e0e7e0%252F142134445.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=ea8e1091&sv=2)

**Figure 12** – Recommended translation workflow steps

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#general-linguistic-principles)

General linguistic principles


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The following paragraphs deal with general aspects of translation that are relevant for all languages.

For each target language, national linguistic guidelines, including syntactic, morphological and orthographic rules, must be provided to describe the specific rules of the target language.

### 

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Language for Specific Purposes

Since the target group of the national edition of SNOMED CT are professionals, high quality language for specific purposes terms should prevail. It is recommended to establish some preliminary general principles for the choice of lexical variants before starting the translation work.

In Danish and German, for example, it is common to use pure Latin or Greek in the field of anatomy, while diagnostic terms or terms describing procedures are often **hybrids** or mixed forms (so called**neoclassical compounds** such as _gastroenteritis_ and _mammography_), or, in some cases, also general language terms.

Colloquial expressions (medical slang words such as _blue pipes_ for veins or _cabbage_ for a _coronary artery bypass graft_ or CABG) should be avoided; if needed, they can be added as synonyms.

Recommendations or guidelines issued by a national language council, authority or body should generally be followed. However, it may be necessary to formulate specific morphological and spelling rules that apply to the terminology of the target language. Specific practices related to the construction of medical terms published in national medical journals should also be taken into account.

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Ambiguities in the source language

As mentioned in the previous sections, all translations should start with a thorough analysis of the conceptual meaning of the FSN and the concept's formal definition.

It is possible that the conceptual meaning is not correctly reflected by the formal definition in the International Edition. In this case, it is recommended that the NRC reports the error to SNOMED International via the Content Request Service (CRS) ([http://snomed.org/crsarrow-up-right](http://snomed.org/crs)
). Licensed organisations from non-member countries can report directly through CRS. Issues can also be raised for discussion in the JIRA SNOMED CT Translation Feedback Group prior to submitting a CRS request to see how the concept's meaning has been interpreted in other countries. The correct translation can then be produced after a response is received.

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Selection of the right term

The term (i.e. a word, a group of words or compound, or an expression) is the essential component of communication in a specialised subject field. The primary meaning in a language for specific purposes is therefore conveyed in its specialised vocabulary, which should consist of terms that meet the following requirements:

*   **Unambiguity** : the term should be understood in the same way by any professional that uses it.
    
*   **Linguistic accuracy** : a term should conform to the language-specific morphological, syntactic, orthographical and phonotactic conventions.
    
*   **Transparency/motivation** : a term should be systematic and self-explanatory, i.e. it should reflect the characteristics of the underlying concept.
    
*   **International recognizability** : terms based on Latin and Greek word elements may be preferred; e.g. universal scientific terms such as “hepatocystis”, “nephritis”, “appendectomy”, “hepatitis”, etc.).
    
*   **Psychological acceptability** : term usability should be taken into account whenever possible (in accordance with the rules of standard language, and not slang).
    
*   **Systematicity and consistency** : semantically similar concepts should be expressed by terms with similar morphological and syntactical structures. It may be interesting to consider the use of translation templates to enhance consistency of translation across similar concepts (see Section 4.3).
    
*   **Conciseness** : a term should be concise and in keeping with the principle of linguistic One should be aware that descriptions of the type FSN and Synonym are technically limited to 255 characters (definitions are limited to 4096 characters).
    

These general requirements apply to all specialized knowledge fields, including medicine. When translating the clinical terminology SNOMED CT the equivalents in the target language should be carefully selected, especially with regard to the Fully Specified Names (FSNs) and the Preferred Terms (PTs) intended for clinical use. The terminological rules for well-formed terms are less strict with regard to Acceptable Synonyms that may reflect clinical jargon (e.g. the language use of clinical care providers, specialists, nurses, physiotherapists, and others) and support search queries (e.g. “heart attack” as synonym for “myocardial infarction”).

However, it is important that only full (and not near) synonyms are made available. For instance, it is not helpful for understanding/translating a concept if the PT of one concept is the synonym of another (within the same hierarchy). There should be a balance between expressivity on the one hand (through sufficient synonym coverage) and accuracy on the other.

In terminological practice, it is not possible to meet all requirements simultaneously in any language. Psychological acceptance, in particular, often hampers compliance with some of the principles. For example, commonly used eponyms such as “Apgar Score” or “Down's Syndrome” contradict the search for transparency and also challenge the principles of international recognition. Also the simultaneous use of different term types for the same concept (e.g. terms consisting of noun + noun vs. noun + prepositional phrase vs. noun + adjective combinations) challenge systematicity and consistency (e.g. “incision of brain” vs “intracerebral incision”).

The creation of language-specific rules for the translation of SNOMED CT should therefore be carried out with the greatest possible thoroughness and care and should take into account not only linguistic and terminological aspects but also psychological ones. The needs and expectations of the users remain the primary concern and clinical acceptance of the terminology is of crucial importance.

The national translation guidelines should be based on the general editorial framework of SNOMED CT and, where necessary, be adapted to the needs of the respective national language.

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Translation of the Fully Specified Name

FSNs may or may not be translated: there are both arguments for and against the FSN translation.

Arguments in favor are:

*   Translating the FSN helps identifying duplicate concepts
    
*   Translating the FSN provides local terminologists with a description that is unique, unambiguous and independent from context
    
*   The stringent wording of the translated FSN allows more options for the PT (e.g. use of acronyms)
    

Arguments against are:

*   The FSN is the source of truth
    
*   The FSN should be immutable, which does not allow for inaccurate translation
    
*   The editor may not allow multiple FSNs for countries with multiple languages
    
*   The translation of the FSN requires more resources
    

The decision whether or not to translate the FSN depends on the individual NRCs.

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Concept equivalence

Concept equivalence means that a word or phrase means exactly the same thing in the source and target languages. Determining equivalence requires a deep understanding of the source language and culture. A literal (word-for-word) translation is in many cases wrong, because you first need to understand the meaning behind the words.

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Cultural variations

Cultural differences must always be taken into account when translating. The question of conceptual equivalence or the lack of such equivalence must therefore be given special attention.

Due to its historical development, part of the source language terminology of SNOMED CT is based on British or American administrative structures or clinical practices that are not necessarily internationally valid. This is currently the case with regard to subhierarchies such as Social context, Regimen/therapy, Environment or Geographical location, Substance and Pharmaceutical/Biological product hierarchies. In the case of drug and vaccine concepts, for example, the pharmaceutical form of drugs may vary from country to country. At the same time, local regulations may dictate which drugs should be included in the national edition. The pharmaceutical/biological products subhierarchy is therefore a typical example of a hierarchy that requires a complete overhaul involving local pharmacologists to adapt to local needs, and preferably to define a national extension.

Although it is theoretically possible to find national equivalents (e.g. paraphrases) that make such culture-dependent (i.e. not locally anchored) concepts understandable, the local applicability of such culture-dependent concepts is questionable. One example is the US concept of |veteran hospital|, a special kind of medical facility where former US soldiers receive medical care. It may therefore be necessary to develop new subhierarchies within a national edition in order to do justice to culture-specific concepts. In summary, it is advisable to identify the subhierarchies with concepts that are not nationally valid before the national translation process begins. The decision on how to deal with these concepts should then be made locally. Not translating these concepts is a viable option. If it is felt that these concepts should be local to the UK or US, SNOMED International can be asked to move them to these extensions.

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False friends

False friends are word pairs from two languages that are similar in writing (orthographic) or pronunciation (phonetic) but that differ significantly in meaning. The words can either be related in origin but developed differently or have a purely coincidental similarity. False friends can lead to an unrecognized false translation when translated literally. Examples are the English term “ventilator” (meaning a device used to maintain an airflow into and out of the lungs of a patient who is unable to breathe) and the German term “Ventilator” (meaning fan; the correct German equivalent in the clinical context for “ventilator” is “Beatmungsgerät”).

Similar problems arise when a term in one language covers a broader concept than in the other language. An example are **holonyms** , i.e. terms that denote a whole whose part is designated by another term (e.g. “hand" in relation to "finger”). Conversely, **meronyms** denote a component or a part of something (e.g. “finger” in relation to “hand”). Translation problems arise when there is no 1:1 correspondence between source and target language. For example, the English terms “drug” and “substance” are holonyms without equivalents in some other languages. Depending on the specific term, the translator has to look for alternative equivalents such as meronyms (e.g. Danish “præparat eller medicament” as the equivalent of “drug” and “misbruger stoffer” as the equivalent of “misuses drugs”) or to use the conjunction en/of (e.g. in Dutch “medicatie en/of drugs”) to emphasize that both are included in the concept’s meaning.

Concept-based translation makes it possible to check the equivalence between terms and concepts. It is particularly important that all team members, especially translators and reviewers, are made aware of the difference between literal and concept-based translation.

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Translation techniques


--------------------------------------------------------------------------------------------------------------------------------------------------------------------

There are various techniques that can be used differently for each language to translate SNOMED CT terms. Table 2 gives an overview of the most common techniques.

**Equivalence / Reformulation**

Using a different language-specific term to refer to the same concept

heart burn → cardiac arrest

halsbrand → hjertestop

**Literal translation**

Word-for-word translation

external blind → cystocele affecting pregnancy

ekstern blind → cystocele med indvirkning på graviditet (“cystocele with effect on pregnancy”)

**Borrowing**

Using the source term in the target language

cardiac output → shaken baby syndrome

cardiac output → shaken baby-syndrom

**Calque**

Creating or using a neologism in the target language by adopting the structure of the source language

closed fracture of metacarpal bone

lukket fraktur af metakarpal-knogle (“closed fracture of metacarpal bone”)

**Amplification (description)**

Using a paraphrase to explain a term that has no equivalent in the target language

battered wife → high birth weight

hustru der har været udsat for vold i hjemmet (“wife who has been exposed to violence in the home”) → barn heavy-for-date uanset gestationsalder (“child heavy-for-dates regardless of gestational age”)

**Table 2** – Examples of translation techniques with description of the morpho-syntactic structure of the source and target language terms

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Naming conventions


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When creating descriptions for concepts, certain linguistic rules must be observed. Additional rules apply to the individual hierarchies. Both the general and the hierarchy-dependent rules for the (English) International Edition are described in detail in the Editorial Guide.

In a translation context, the following issues are important.

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General conventions

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Morphological patterns of descriptions

In general, the morphological patterns of Descriptions in all SNOMED CT hierarchies should be as consistent as possible. As it is crucial to take into account the morphological and syntactic features of the target language, the national guidelines provide specific instructions on the recommended Description patterns in a given language (e.g. consistent naming of diseases such as “Type 2 diabetes mellitus” vs “Diabetes type 2” in Germanic languages such as Dutch and Norwegian).

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Verbs and tenses

The Editorial Guide contains a set of rules for the use of verbs and tenses (inclusive gerunds) in English to be used in the different hierarchies (e.g. the use of verbs in the past tense such as “Hand tendon ganglion excised” indicates that the procedure was performed). When translating it is important that these rules are implemented as accurately and consistently as possible in the target language. The language-specific implementation of these rules can be described in the national guidelines (e.g, how to translate the English gerund).

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Word order

The word order within noun phrases should match the syntax of general language. In certain cases, however, it is necessary to deviate from the normal word order. For example, in English adjectives are used attributively (i.e. before the noun; e.g. "regular pulse"). In SNOMED CT a number of terms represent the results of tests or examinations; in these cases the adjective comes after the noun ("pulse regular" instead of "regular pulse"), which allows the results to be listed in a drop-down format in a software application. This format, in which all terms begin with the same word (in this case the Observable Unit + the Value, a combination that converts the concept into a finding), makes it easier to keep track of all possible outcomes.

The rules regarding word order and rule-based exceptions can be specified in the national guidelines.

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Choice of lexical variants

Depending on language and domain (e.g. anatomy, physiology, clinical medicine) medical terms can have different forms:

*   Latin/Greek terms: _diabetes mellitus_ , _pes valgus_
    
*   Hybrid terms (i.e. Latin/Greek terms morphologically and syntactically adapted to the national language): _common hepatic artery_ (Latin/Greek: _arteria hepatica communis_), _arteriosclerotic retinopathy_ (Latin/Greek:_retinopathia arteriosclerotica_)
    
*   National language terms: _stomach ache, placing a patient on a bedpan, bad taste in mouth._
    

Which forms should be used for the translation of SNOMED CT depends on the conventions of the respective target language and/or the domain and are to be defined in the national guidelines.

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Naming conventions for specific hierarchies

The following sections discuss a number of specific issues relevant to translation into the different target languages. The relevance of each topic may vary depending on the target language.

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Organism names (bacteria, viruses, plants, animals, etc.)

The organism hierarchy uses international taxonomic names to a large extent, which can be found in the Editorial Guide. Where this is not in contradiction with national language policies, the names of organisms should be retained as universal (international) scientific terms and should be consistent with existing spelling rules, in particular as regards capitalization of terms (e.g. “Chlamydia pneumoniae”, “Spirochaete dentium”, “Dependovirus”, etc.; it is important to note that the current version of SNOMED CT may contain incorrect lower case letters.)

SNOMED CT also tends to lag behind the very fast developments in the micro-organism thesauri. It contains many obsolete names as separate concepts, which have become synonymous with another concept. Such issues are quickly resolved when pointed out. The Editorial Guide lists specific resources for bacteria, viruses, parasites, and so forth.

The Organism hierarchy has no relation types with which to specify properties. As a result, it contains instead a large number of grouper concepts such as “gram-negative bacterium”. In English, groupers are represented by the common names "infectious agents" or "arthropod organisms". If a common name is used in English, it is recommended to use a common name in the target language as well. Most organism concepts correspond to a taxonomic entry in the Linnaean taxonomy, but some, such as gram-negative bacteria, have only a common name. In that case, you should translate to a common name in the target language.

Explicit rules for the use of international taxonomic names in the Organism hierarchy and other hierarchies, as well as the use of common names as Preferred Terms in specific categories or contexts should be specified in the national guidelines.

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(Biochemical) names, ingredients of medicinal products, enzyme and hormone names

A term that refers to a chemical substance in a medicinal product can be interpreted in two ways: Either it is the name of a specific component of the product (e.g. morphine, glycogen) or it is a general term for the chemical substance itself. Ingredients are listed in the SNOMED CT Pharmaceutical/biological product hierarchy, and chemical substances are listed under their generic name in the Substance hierarchy.

In the target language it may be common that different orthographic principles are used for products and substances. The specific spelling rules for chemicals and biochemical agents, ingredients, enzymes, and hormones should be defined in the national guidelines.

Whether substances and products that are not available in one's own country are translated, and if so, what principles apply in this case, should also be addressed in the national guidelines.

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Foreign (loan) words and abbreviations, acronyms and initials

National translation guidelines should include instructions on the extent to which **foreign words** are accepted in the target language. Examples are the English terms “cardiac output”, “Rift Valley fever”, “spindle cells”, “bias”, etc. or the French terms “tabatière”, “plaques”, “grand mal” that are used unchanged in different other languages. Accepted foreign-language terms should in any case comply with the orthographic rules of the source language. This means, for example, that the accents in French words such as “péan”, “tabatière” and “debridement” must be taken into account when they are used in another language.

Some (sub)hierarchies (e.g. Staging and scales) can contain a large number of concepts for which there is no official translation into other languages. Examples are the tumor staging system “tumor-node-metastasis (TNM)” or the “Bristol Language Assessment Scales (BLADES)” score. In these cases the term of the source language is preferred.

**Acronyms and initials** – both foreign and national – also play an important role in translation: "AIDS" (acquired immune deficiency syndrome) is an example of an abbreviation that is accepted as such in many languages, while in French and Spanish it is "SIDA", the abbreviation for the national expressions. It is recommended that only well-known and widely used foreign or national abbreviations should be included in national editions. As a rule, abbreviations should never be used in the FSN and only rarely be part of the Preferred Term (PT) as they tend to be highly ambiguous.

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Eponyms

Eponyms are an essential part of medical terminology and clinical language. While most eponyms are used internationally, there are some language-specific eponyms that can be difficult to translate. Examples include the disease names "Wegener's syndrome" and "Reiter's disease", which are controversial because they were associated with the Nazi regime. Therefore, an eponym can disappear from language use quite quickly, while a descriptive term retains its meaning, regardless of whether it is used frequently or not.

Another disadvantage of eponyms is that they do not meet the essential requirements of well-formed terms such as clarity, linguistic correctness and transparency. However, due to their frequent occurrence in clinical practice, eponyms are also used in SNOMED CT. The national guidelines should include rules to help the translator translate eponyms correctly (e.g. systematically check whether the eponym exists in the target language or whether another (language-specific) eponym or term is used instead).

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Case significance

The current version of SNOMED CT contains three case sensitive values (Table 3): initial case insensitive (cl - use if any other letter than the first is uppercase), entire sensitive (CS - use if first letter is case sensitive), and entire case insensitive (ci - default).

Case Sensitivity Indicator

Meaning

Examples

cl

First letter of the description may or may not be capitalized while the case of the rest of the description cannot be changed.

*   Family history of Prader-Willi syndrome (situation)
    
*   Born in Australia (finding)
    
*   Neonatal jaundice with Dubin-Johnson syndrome (disorder)
    

CS

Cannot change any case in the description

Changing case may change the meaning of the term or is not commonly used

*   Down syndrome
    
*   English as a second language (finding)
    
*   pH measurement (procedure)
    
*   mm (qualifier value)
    

ci

Entire description may be lower or upper case

Changing case does not change the meaning of the term

*   Fracture of tibia (disorder)
    
*   Blood compatibility test (procedure)
    
*   Bite of fish (event)
    
*   Floor mat (physical event)
    

**Table 3 - Case sensitivity rules**

If the case of the initial letter in a source or target language description is significant, i.e. the term must begin with an uppercase letter or a lowercase letter, this is taken into account in the SNOMED CT source and target language description files in the Case Sensitivity indicator metadata. When translating, it is important that the value of this description field is correctly chosen in the target language description considering the term used in that language description and regardless of the case sensitivity indicator value used in the English description.

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Punctuation, characters and numerals

The correct use of commas and hyphens, slashes, brackets and colons, typographical characters and special characters as well as numerals in the International Edition is described in more detail in the Editorial Guide.Recommendations for language-specific usage must be clearly elaborated in the national guidelines for each language.

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[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#translation-templates)

Translation templates

To improve the consistency of translation of concepts of the same type, the use of translation templates is of particular interest. Translation templates, similar to the SNOMED International Editorial templates ([https://confluence.ihtsdotools.org/display/SCTEMPLATESarrow-up-right](https://confluence.ihtsdotools.org/display/SCTEMPLATES)
 ), are recommendations for naming, word order, use of the noun or adjective form, etc., which together provide a framework for constructing the FSN and synonyms of certain subhierarchies (i.e. subhierarchies with common features) of the terminology.

An example of a translation template is the one described below, which was used in the Belgian-French translation process. The target concepts of this translation template were the concepts representing a bronchus of a specific (lobe of) lung. The FSN structure of these concepts is represented in the form of the English source template as follows: "Structure of bronchus of \[laterality\] \[localisation\] lobe".

When this English template is decomposed, it becomes clear that it is derived from the translation of two (subfamilies of) nested concepts: the concept 955009 |Bronchial structure (body structure)|, which represents a bronchus, and the concepts representing the lobes of the lung (for which a first template had already been created).

The notion of ‘nested concept’ is used to describe a word or phrase that is part of an FSN but is itself also a SNOMED CT concept. It is important to recognise nested concepts when translating SNOMED CT content, even if no templates are used, as the translation of the more pre-coordinated concepts should be coherent with the translation of these ‘parent’ nested concepts. This is especially true for disease and procedure concepts that refer to anatomical parts in their FSNs.

In the above example, the potential \[laterality\] values = (empty), right, left refer to the lung laterality and the potential \[localisation\] values = (empty), upper, middle, lower refer to the position of the lung lobe.

> For this family of concepts the following Belgian-French translation template is adopted:
> 
> PT: "bronche lobaire \[localization, new French anatomical nomenclature\] \[laterality, Fr\] "
> 
> Syn1: "structure de la bronche lobaire \[localization, new French anatomical nomenclature\] \[laterality, Fr\]"
> 
> Syn 2: "bronche lobaire \[localization, old French anatomical nomenclature\] \[laterality, Fr\] "
> 
> Syn 3**:** "bronche du lobe \[localization, new French anatomical nomenclature\] du poumon \[laterality, Fr\]"

The template is based on the Belgian-French translation of the concept 39582006 |Lobar bronchus structure (body structure)|, which, in turn, depends on the translation of the concepts 955009 |Bronchial structure (body structure)| and 31094006 |Structure of lobe of lung (body structure)|.

> Adopting this template to the concept 11339004 |Structure of bronchus of right upper lobe (body structure)|, the following translations are generated:
> 
> PT: "bronche lobaire supérieure droite"
> 
> Syn 1: "structure de la bronche lobaire supérieure droite"
> 
> Syn 2: "bronche lobaire crâniale droite"
> 
> Syn 3: "bronche du lobe supérieur du poumon droît"

The development of translation templates takes some time, but has the following advantages:

*   Translation templates force authors to consider families of concepts rather than isolated concepts in translation, which often leads to a better understanding of the medical reality represented or not represented by those concepts and reduces the risk of misinterpretation of concept meaning. This can be particularly useful for primitive concepts or hierarchies without a concept model.
    
*   They ensure that sibling concepts of the same "family" are translated in a consistent way, even if their translation is distributed among different translators ("horizontal homogeneity" of translation). This is very useful for large families with several hundred concepts such as "neoplasm of \[organ\]".
    
*   They ensure that the translation of more pre-coordinated concepts matches the translation of the "nested" concepts contained in their FSN ("vertical homogeneity" of translation). In reality, one has to work in such a way as to build a series of overlapping inverted pyramids, from simple concepts to the more pre-coordinated terms, and create a hierarchy of dependent templates.
    
*   The meaning of words that are not SNOMED CT concepts can, if possible, be set in context. This is interesting not only for translation, but also for improvement of the Core terminology, as it may lead to the inclusion of new SNOMED CT attributes or attribute values to further define primitive concepts.
    
*   The templates can be implemented in a dedicated computer programme to provide translators with automatic translation suggestions for concepts, thus reducing the translation time for batches with concept families.
    
*   Templates can also support quality assurance, as they can be used to retroactively align old translations with new templates.
    
*   When a link between the translation template and the concepts to which it has been applied is stored in a database, translation templates ensure that all dependent concepts to be reviewed can be traced back if the national translation of a nested concept needs to be corrected or if the FSN of a nested concept changes in SNOMED International and the change has an impact on the understanding of the concept in the target language.
    

Research is being conducted to investigate the possibility of storing the relationships between translation templates and their output descriptions in the local language in Refset format.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Translation+Guide&entry.670899847=Translating%20SNOMED%20CT)

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Last updated 5 months ago

*   [Basic approach](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#basic-approach)
    
*   [The principle of concept based translation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#the-principle-of-concept-based-translation)
    
*   [General linguistic principles](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#general-linguistic-principles)
    
*   [Language for Specific Purposes](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#language-for-specific-purposes)
    
*   [Ambiguities in the source language](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#ambiguities-in-the-source-language)
    
*   [Selection of the right term](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#selection-of-the-right-term)
    
*   [Translation of the Fully Specified Name](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#translation-of-the-fully-specified-name)
    
*   [Concept equivalence](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#concept-equivalence)
    
*   [Translation techniques](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#translation-techniques)
    
*   [Naming conventions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#naming-conventions)
    
*   [General conventions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#general-conventions)
    
*   [Naming conventions for specific hierarchies](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#naming-conventions-for-specific-hierarchies)
    
*   [Translation templates](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-translation-guide/4-translating-snomed-ct#translation-templates)
    

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# Solicitudes de cambios | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

SNOMED CT se ha desarrollado para su implementación y uso en sistemas informáticos sanitarios, por lo que es esencial para el éxito de su adopción que la terminología cumpla con los requisitos de los usuarios. Para facilitar el desarrollo y la mejora continuos de SNOMED CT, SNOMED International depende de los comentarios continuos de los usuarios. Una responsabilidad importante de un CNR es, por tanto, proporcionar a SNOMED International información de los usuarios de los Países Miembros sobre errores, limitaciones y sugerencias de cambios en el contenido de SNOMED CT. En cuanto a la gestión de las solicitudes de cambios, cada CNR debe:

1.  Mantener un registro de los problemas y otras cuestiones notificadas en el País Miembro, y
    
2.  Documentar, presentar y apoyar las solicitudes de propuestas de actualizaciones y mejoras de SNOMED CT.
    

Por lo tanto, un CNR debe proporcionar un mecanismo para apoyar las solicitudes de los usuarios, tanto relacionadas con la Edición Nacional (cuando exista) como con la Edición Internacional de SNOMED CT. Las solicitudes para la Edición Internacional deben comunicarse a SNOMED International, mientras que las solicitudes para la Edición Nacional deben gestionarse localmente.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/solicitudes-de-cambios#figura-9.-los-cnr-gestionan-las-solicitudes-de-los-usuarios-para-introducir-cambios-en-las-ediciones)

**Figura 9. Los CNR gestionan las solicitudes de los usuarios para introducir cambios en las Ediciones Nacionales e internacional de SNOMED CT.**

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2133369718-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FI7N0Q2Su8RGW5pAlIrWt%252Fuploads%252Fgit-blob-cc58900277ea81f9455eacd643c6d498d91a74e1%252F259854844.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=6a2bff96&sv=2)

\*\*

La forma de presentar las solicitudes de los usuarios depende de cada CNR. Un CNR puede optar por tener su propio sistema de presentación de solicitudes, pero la solución también podría ser un simple sistema de envío por correo o un sistema de transferencia de archivos. Esto depende del nivel de uso de SNOMED CT (y por tanto del número de solicitudes) en el País Miembro. Un CNR podría decidir tener un sistema sencillo en la fase de establecimiento del CNR y luego lanzar un sistema más sofisticado cuando aumente el número de solicitudes.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/solicitudes-de-cambios#servicio-internacional-de-solicitud-de-contenido-crs-de-snomed-ct)

Servicio internacional de solicitud de contenido (CRS) de SNOMED CT


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

El CRS es el sistema de presentación de solicitudes en línea de SNOMED International, que permite a los CNR de los Países Miembros y a otros usuarios autorizados presentar solicitudes de cambio o adición de nuevos contenidos a la Edición Internacional de SNOMED CT. Por lo tanto, todas las solicitudes de los usuarios para la Edición Internacional de SNOMED CT deben pasar por el CRN, y cada CRN debe tener acceso al CRS. Los conceptos de relevancia únicamente nacional no deben presentarse a SNOMED International. Es responsabilidad del CNR determinar qué solicitud es específica de su país y cuáles son de relevancia internacional. Los CNR deben conocer los principios editoriales de SNOMED CT y presentar únicamente solicitudes que cumplan dichos principios.

Las solicitudes enviadas a CRS son revisadas por los autores de SNOMED International, y las solicitudes que cumplen los criterios de inclusión a la Edición Internacional de SNOMED CT se añaden a la Edición Internacional. El CRS es una herramienta en línea que permite a los usuarios ver el estado actual de todas las solicitudes que se han realizado a través del sistema (véase la Figura 10).

**Figura 10 Captura de pantalla de CRS. Ejemplo de resumen de solicitudes enviadas al sistema.**

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2133369718-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FI7N0Q2Su8RGW5pAlIrWt%252Fuploads%252Fgit-blob-7200b4b01ddde1e1408ffdaf01324b82897f6470%252F259854845.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=7bedc86d&sv=2)

Los usuarios reciben una notificación por correo electrónico cuando una solicitud cambia de estado (aceptada, no aceptada, en trámite o solicitud de aclaración). Si una solicitud no es aceptada, se da una razón al solicitante. El solicitante que no esté satisfecho con el motivo de la no aceptación puede recurrir mediante un proceso formal de apelación.

Para obtener información actualizada sobre las disposiciones vigentes y acceder al CSR, consulte [la Guía del usuario del CRSarrow-up-right](https://confluence.ihtsdotools.org/display/SCTCR/CRS+User+Guide)

Para más información sobre cómo solicitar cambios en los contenidos o la adición de nuevos contenidos, consulte [https://www.snomed.org/change-or-addarrow-up-right](https://www.snomed.org/change-or-add)
. El documento "Customer Guidance For Requesting changes to SNOMED CT" puede descargarse desde esta página. El documento explica cómo presentar una solicitud y qué datos debe facilitar el solicitante en el proceso.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Spanish+NRC+Guide&entry.670899847=Solicitudes%20de%20cambios)

[PreviousDistribución de SNOMED CTchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-distribucin-de-snomed-ct)
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Last updated 5 months ago

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# Benefits to Vendors | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents

This section identifies key benefits for vendors arising from implementing SNOMED CT. It summarizes general benefits that encourage adoption, procurement and deployment of SNOMED CT enabled systems. It also notes direct benefits to vendors arising from use of a common global terminology that enables effective meaning-based retrieval, facilitates mapping to ICD-10 and other classifications, and supports localization and customization to meet specific national, regional or specialty requirements. Figure 1. below illustrates the benefits to hospitals and clinics who procure SNOMED CT enabled systems; it is also possible to sell SNOMED CT enabled systems to others in the figure such as governments, clinical research establishments, and health funders & providers who too can derive similar benefits.

Figure 1. Vendors benefit from the value of SNOMED CT in meeting requirements of a range of stakeholders

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-d1f7aac5ec610cbdb0881b7ddcf8c4b4d333d19e%252F29951596.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=e133c9b&sv=2)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#general-benefits-of-snomed-ct)

General Benefits of SNOMED CT


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SNOMED CT supports the consistent representation of comprehensive high-quality clinical content in health records. The value of SNOMED CT is strengthened by its solid clinical validation and a design that facilitates evolutionary growth to meet emerging requirements such as data analytics.

The use of an EHR improves communication and increases the availability of relevant information. If clinical information is stored in ways that allow meaning-based retrieval, the benefits are greatly increased. The added benefits range from increased opportunities for real-time decision support to more accurate retrospective reporting for research and management, as well as enhanced data quality and consistency at the point of data collection. As a result, use of SNOMED CT benefits individual patients and clinicians as well as populations and supports evidence-based care.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#snomed-ct-enabled-health-records-benefit-individuals)

SNOMED CT Enabled Health Records Benefit Individuals

SNOMED CT enabled clinical health records benefit clinicians care for individual patients by:

*   Enabling relevant clinical information to be recorded using consistent, common representations during a consultation.
    
*   Enabling guideline and decision support systems to check the record and provide real-time advice, for example, through clinical alerts.
    
*   Supporting the sharing of appropriate information with others involved in delivering care to a patient through data capture that allows understanding and interpretation of the information in a common way by all providers.
    
*   Allowing accurate and comprehensive searches that identify cohorts of patients for follow-up or changes of treatment based on revised guidelines.
    
*   Removing language barriers (SNOMED CT is multilingual).
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#snomed-ct-enabled-health-records-benefit-populations)

SNOMED CT Enabled Health Records Benefit Populations

SNOMED CT enabled clinical health records benefit policy makers interested in population health by:

*   Facilitating early identification of emerging health issues, monitoring of population health and responses to changing clinical practices.
    
*   Enabling accurate and targeted access to relevant information, reducing costly duplications and errors.
    
*   Enabling the delivery of relevant data to support clinical research and contribute evidence for future improvements in treatment.
    
*   Enhancing audits of care delivery by providing capability for detailed analysis of clinical records (e.g. to investigate outliers and exceptions).
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#snomed-ct-enabled-health-records-support-evidence-based-healthcare)

SNOMED CT Enabled Health Records Support Evidence-Based Healthcare

SNOMED CT enabled health records inform evidence-based healthcare decisions by:

*   Enabling links between clinical records and existing clinical guidelines or protocols.
    
*   Supporting the development of adequate evidence used in the development of clinical guidelines.
    

Consequently there can be:

*   Enhanced quality of care experienced by individuals.
    
*   Reduced costs from inappropriate and duplicative testing and treatment.
    
*   Reduced frequency and impact from adverse healthcare events.
    
*   Increased cost-effectiveness and quality of care delivered to populations.
    

These general benefits lead to SNOMED CT being increasingly included as part of clinical system procurements in Member countries and elsewhere. Population benefits arising from use of SNOMED CT may also motivate bodies responsible for governance, funding and management of healthcare provision to include it in their strategic plans. As a result, use of SNOMED CT is being increasingly recommended, incentivized or mandated to enable Members to gain the benefits of their investment in and ownership of SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#strategic-benefits-to-vendors)

Strategic Benefits to Vendors


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### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#staying-competitive-and-relevant-to-the-market)

Staying Competitive and Relevant to the Market

*   SNOMED CT is increasingly a stated requirement in EHR system procurements
    
*   Even when not explicitly mentioned, SNOMED CT can contribute to meeting procurement requirements related to:
    
    *   Clinical records
        
    *   Decision support
        
    *   Reporting
        
    *   Care quality measures
        
    *   Mapping to ICD-10 and other classifications
        
    *   Standard reference data e.g. allergen list
        
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#selling-into-international-markets)

Selling Into International Markets

*   SNOMED CT is designed as global terminology for healthcare
    
*   Products built to use SNOMED CT can be deployed in many different countries
    
*   SNOMED CT is available for free use in Member territories see [https://www.snomed.org/membersarrow-up-right](https://www.snomed.org/members)
    
*   Member countries welcome systems that make effective use of SNOMED CT
    
*   Several countries specify SNOMED CT as a required or preferred clinical terminology
    
*   SNOMED CT is used in more than eighty countries
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#meeting-clinician-expectations)

Meeting Clinician Expectations

*   SNOMED CT makes data collection by busy doctors easy, safe and reusable
    
*   SNOMED CT supports recording at a level of detail appropriate to clinical record keeping
    
    *   Greater detail than commonly available from classifications such as ICD
        
    *   Maps to classifications to support allocation of classification codes and avoiding double entry for clinical and classification/reporting purposes
        
    *   Level of clinical detail is aligned to the needs of clinical decision making and clinical decision support systems
        
    
*   SNOMED CT covers a broad range of clinical concepts required by different clinical specialties
    
*   Enhanced features enabled by SNOMED CT lead to better clinician acceptance which influences procurement decisions and is essential for deployment
    
*   Proven examples of effective clinical systems with innovative features which are enabled by SNOMED CT are key to winning new business
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#supporting-standards)

Supporting Standards

*   SNOMED CT is a terminology standard for unambiguous representation of clinical information
    
*   Standardization creates bridges for effective communication and reuse of EHR data
    
*   SNOMED CT forms a configurable foundation for national and local standards
    
*   SNOMED International is working with other standards bodies to meet the requirements for interoperability
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#retaining-existing-customers)

Retaining Existing Customers

*   SNOMED CT can be introduced in a staged manner minimizing disruption to existing customers
    
*   SNOMED CT readiness avoids loss of customers when SNOMED CT requirements are adopted
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#practical-benefits-to-vendors)

Practical Benefits to Vendors


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### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#common-terminology)

Common Terminology

*   A single internationally-maintained clinically-validated terminology minimizes the need to support local code systems that duplicate effort and create incompatible solutions
    
*   SNOMED CT covers the broad scope of clinical information represented in health records which can be used to meet the needs of most specialties
    
*   SNOMED CT is regularly updated to keep pace with changing patterns of health and emerging clinical knowledge
    
*   A managed request submission process supports quality-assured additions to SNOMED CT
    
*   The SNOMED CT extension mechanism enables the addition of concepts to meet national or local requirements within the framework of a common terminology
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#ease-of-adoption)

Ease of Adoption

*   While the section "[Choosing an Approach to Implementation](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation)
    " covers the different ways in which SNOMED CT can be used in an EHR system, the simplest of those can be done with minimal effort
    
*   Vendors can choose to implement SNOMED CT natively or choose to integrate with offerings from among the many specialists in terminology services
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#enhanced-user-interfaces)

Enhanced User Interfaces

*   SNOMED CT provides navigation hierarchies, and effective techniques to constrain searches
    
*   SNOMED CT provides interface designers with concepts that have an unambiguous meaning and synonyms which they can employ directly
    
*   SNOMED CT also allows searches to be performed over any synonym of a concept, thereby increasing the chances of finding the concept needed
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#enhanced-analytics)

Enhanced Analytics

*   SNOMED CT concept definitions enable flexible and powerful querying of clinical information
    
*   Analysis can be further enhanced by tools that exploit description logic inferencing i.e. computation which utilizes the defining relationships of concepts
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#using-clinical-data-to-meet-external-reporting-requirements)

Using Clinical Data to Meet External Reporting Requirements

*   SNOMED CT maps enable clinical data to be reused to report statistical and management data using other code systems and classifications
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#integration-of-third-party-products)

Integration of Third Party Products

*   Use of SNOMED CT enables systems to use common services that add functionality to an EHR system. For example:
    
    *   Integration with guideline and decision support services based on knowledge encoded using SNOMED CT
        
        *   A common example of this is the providers of medication knowledge bases to support prescribing decision support
            
        
    *   Integration with add-on products and services to facilitate the management of specific diseases or participation in clinical research projects
        
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#adapting-to-meet-requirements)

Adapting to Meet Requirements

*   SNOMED CT enables configuration to meet the various requirements of:
    
    *   Multi-lingual environments
        
    *   Different clinical specialties
        
    *   Different clinical settings
        
    *   Support for different types of implementation
        
    
*   Vendors can use the configurability of SNOMED CT to meet diverse user requirements, but from a common platform
    
*   Elements of a configuration can be reused to meet similar use cases
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Vendor+Introduction&entry.670899847=Benefits%20to%20Vendors)

[PreviousIntroductionchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/1-introduction)
[NextIntroduction to SNOMED CTchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/3-introduction-to-snomed-ct)

Last updated 7 months ago

*   [General Benefits of SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#general-benefits-of-snomed-ct)
    
*   [SNOMED CT Enabled Health Records Benefit Individuals](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#snomed-ct-enabled-health-records-benefit-individuals)
    
*   [SNOMED CT Enabled Health Records Benefit Populations](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#snomed-ct-enabled-health-records-benefit-populations)
    
*   [SNOMED CT Enabled Health Records Support Evidence-Based Healthcare](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#snomed-ct-enabled-health-records-support-evidence-based-healthcare)
    
*   [Strategic Benefits to Vendors](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#strategic-benefits-to-vendors)
    
*   [Staying Competitive and Relevant to the Market](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#staying-competitive-and-relevant-to-the-market)
    
*   [Selling Into International Markets](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#selling-into-international-markets)
    
*   [Meeting Clinician Expectations](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#meeting-clinician-expectations)
    
*   [Supporting Standards](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#supporting-standards)
    
*   [Retaining Existing Customers](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#retaining-existing-customers)
    
*   [Practical Benefits to Vendors](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#practical-benefits-to-vendors)
    
*   [Common Terminology](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#common-terminology)
    
*   [Ease of Adoption](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#ease-of-adoption)
    
*   [Enhanced User Interfaces](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#enhanced-user-interfaces)
    
*   [Enhanced Analytics](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#enhanced-analytics)
    
*   [Using Clinical Data to Meet External Reporting Requirements](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#using-clinical-data-to-meet-external-reporting-requirements)
    
*   [Integration of Third Party Products](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#integration-of-third-party-products)
    
*   [Adapting to Meet Requirements](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/2-benefits-to-vendors#adapting-to-meet-requirements)
    

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# Implementation Strategies and Considerations | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents

*   To what extent will the use of SNOMED CT differentiate this product from others?
    
*   What use cases can SNOMED CT be applied to?
    
*   What migration paths will be offered to customers to move from their current coding system(s) to SNOMED CT?
    
*   Will SNOMED CT be implemented into an existing EHR product or as a new product variant?
    
*   Will implementation be achieved in more than one stage and if so in what stages?
    
*   What, if any, parts of the system will be delivered by external providers?
    
*   To what degree, and for what period, will previous designs be maintained in parallel?
    
*   Will SNOMED CT be a design time terminology or a run time terminology?
    
*   Will SNOMED CT be the interface terminology or just the storage, interoperability and reporting terminology?
    

A variety of implementation approaches were outlined in Section 4. This section references the approaches summarized in Section 4, and discusses some potential SNOMED CT implementation strategies, factors influencing implementation success, and possible measures of success.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#staged-implementation)

Staged Implementation


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Numerous pathways exist for the incremental implementation of SNOMED CT. These allow control of the timing and degree to which the existing designs and terminology resources are superseded.

Some Vendors have chosen to introduce SNOMED CT as part of a distinct, new product in their line of products. Many Vendors have introduced SNOMED CT in increments, with minimal disruption to their customers or end users. If a Vendor builds a new product, it is likely that a single-stage implementation would be appropriate.

[Choosing an approach to implementation](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation)
 summarizes a range of implementation approaches that differ in the extent to which they utilize different features of SNOMED CT.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#single-vs-multi-stage-implementations)

Single vs Multi-stage Implementations

Single stage implementations can:

*   Minimize the impact from multiple cycles of customer training
    
*   Launch a significant variant of a product into the market
    

Multi-stage implementations can:

*   Minimize the impact of any single stage
    
*   Match the extent of change to the needs and desires of the customers
    

One possible example of a staged implementation could involve a sequence of:

*   Initially: Reworking the design of electronic messages used to interoperate with data in other systems, this would then feature SNOMED CT as part of the payload within these messages (Approach 1).
    
*   Subsequently: Reworking existing data extracts and reports, using SNOMED CT indexes, to ensure the successful transition to a reliance on SNOMED CT based reporting (Approach 3).
    
*   Subsequently: Retaining the existing terminology at the user interface but mapping that to a store in which SNOMED CT was recorded in addition to the existing code system (Approach 4)
    
*   Subsequently: Migrating to the use of SNOMED CT at the user interface for new record entries (Approach 5).
    
*   Subsequently: Adopting new analytics tools which exploit the meaning held in SNOMED CT (Approach 7).
    
*   Subsequently: Extending the use of SNOMED CT to capture more structured data as SNOMED CT expressions (Approach 9).
    
*   Finally: Using all SNOMED CT features throughout the EHR (Approach 10).
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#relationships-and-dependencies)

Relationships and Dependencies


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Commercial and technical concerns about dependence on third-party components may be a valid reason for in-house development of all the required 'terminology services'.

However, a range of off-the-shelf terminology resources, such as SNOMED CT subsets, may be available to reuse, for example, to improve the user's data entry experience. Some of these resources will be usable worldwide and free of charge, while others may be available under some type of license. A dependence on a third party to maintain derivatives, such as subsets, can be eliminated by taking that responsibility in-house. Three distinct options are therefore:

*   Adopt and use a third party terminology resource (e.g. a subset), relying on the owner to maintain them.
    
*   Adapt an existing terminology resource (e.g. a subset), and so take on responsibility for maintaining a separate version.
    
*   Enter into a collaborative relationship e.g. to jointly maintain the subset.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#language-and-dialect-strategies)

Language and Dialect strategies


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

SNOMED CT implementation can greatly simplify the configuration of an EHR product with terms expressed in the language or dialect required by the customer. A SNOMED CT implementation strategy should exploit the benefits of SNOMED CT for language and dialect localization. For example, using a SNOMED CT language reference set, which represents the preferred and acceptable terms in a given language or dialect, a subset used to populate a drop-down box can be simply re-configured to show terms in a different dialect. For other parts of a localization, such as the headings in a form, it is also possible to use SNOMED CT language reference sets as a reference source. The extent of use of language reference sets should be considered as part of a product strategy.

To exploit the language and dialect capabilities of SNOMED CT, a Vendor can use the localized content provided by a National Release Center.

A language or dialect variant needed by the customer can be used in any of the following scenarios:

*   The SNOMED CT International Edition is used and this reflects the language used in the healthcare records.
    
*   A specific dialect of a language is needed, such as Australian English, UK English, or US English.
    
*   There is a dominant local spoken language, but this is not used in healthcare or health records (which are recorded using a language or dialect already available in SNOMED CT).
    
*   Multiple languages are spoken, e.g. Canada, where any of those may be used.
    
*   A translation of SNOMED CT is intended only to be used as a reference terminology i.e. not for use at the user interface.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#measures-of-implementation-success)

Measures of Implementation Success


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The extent to which a SNOMED CT implementation is successful can be evaluated in many ways, including the evidence-based evaluation of:

*   Delivery of the planned benefits, along with continuity of existing value provided by the system
    
*   The ability of customers and users to accommodate the changes with minimal training or disruption
    
*   Extent and quality of interoperation with external systems and its value to customers: Electronic messages which retain the meaning of the clinical content, with effective reuse in the receiving system
    
*   Uninterrupted, undisturbed operation of the healthcare enterprise through the period of introduction and use of SNOMED CT
    
    *   Health outcomes of patients
        
    *   Staff satisfaction
        
    *   Enterprise remuneration and/or prestige
        
    
*   Peer-recognition for good work
    
*   Success in exploiting shared works such as off-the-shelf subsets or queries
    
*   Minimal cost and maximal benefit from successive releases of SNOMED CT
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#factors-which-influence-implementation-success)

Factors which Influence Implementation Success


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#vendor-perspective)

Vendor Perspective

The factors which may influence implementation success, from a vendor perspective, include:

*   Careful planning, understanding of key objectives and engagement with customers
    
*   Successful matching of the user needs to the relevant SNOMED CT features and setting realistic goals for the delivery of specific benefits
    
*   Selection of an appropriately staged implementation roadmap giving continuity of service plus an incrementally improved user experience
    
*   Judicious selection of techniques and tools
    
*   Consistent representation of stored clinical information
    
*   Optimization of information retrieval and analysis
    
*   Maximizing the reuse of existing configuration artifacts such as queries or subsets
    
*   Separation of the terminology: discrete configuration data and avoidance of hard coding of terminology directly into software code
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#customer-perspective)

Customer Perspective

The factors which may influence implementation success, from a customer perspective, include:

*   Ease and effectiveness of data entry and display of SNOMED CT. For example, speed of data entry, ease of search and navigation, limited search scope based on the context, aggregation of details, and highlighting of critical information are all important techniques for busy clinicians
    
*   Minimal additional configuration and training burden for the users
    
*   Adequate opportunities to adjust the product and its configuration for local needs, including exploitation of pre-existing, local designs
    
*   Significant value from their own preparatory work to deploy the product and associated services
    
*   Quality of the product, its flexibility and a future value sufficient to retain it beyond the current contract period
    

* * *

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*   [Staged Implementation](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#staged-implementation)
    
*   [Single vs Multi-stage Implementations](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#single-vs-multi-stage-implementations)
    
*   [Relationships and Dependencies](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#relationships-and-dependencies)
    
*   [Language and Dialect strategies](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#language-and-dialect-strategies)
    
*   [Measures of Implementation Success](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#measures-of-implementation-success)
    
*   [Factors which Influence Implementation Success](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#factors-which-influence-implementation-success)
    
*   [Vendor Perspective](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#vendor-perspective)
    
*   [Customer Perspective](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations#customer-perspective)
    

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# SNOMED CT Browsers | Practical Guides SNOMED NRC Guide | SNOMED International Documents

SNOMED CT Browsers are software applications or tools used for searching, navigating, viewing and reviewing terminology content. For NRCs that want users and potential users to increase and enhance their knowledge of SNOMED CT, it can be a good idea to make a SNOMED CT browser freely available.

A typical browser can locate concepts and descriptions by searching the text of descriptions (terms) or by entering SNOMED CT identifiers. Browsers may also provide a way to navigate the SNOMED CT hierarchies. Browsers may display views of various artifacts including the set of related descriptions, the hierarchical relationships and other defining relationships of a concept.

A variety of different SNOMED CT browsers are available online, as downloadable applications or as web-based applications. But a Member can also choose to develop its own SNOMED CT browser and make it available for national users. This is especially relevant if national customized SNOMED CT content is developed and should be browsable, such as translations, Reference sets, etc. An NRC may download and install for national use the SNOMED International open source browser. As this is open source, it is also possible to add functionality to it. If an NRC does this, its contribution of the components back into the open source repository may be highly beneficial for all Members.

On the SNOMED International webpage on SNOMED CT Browsers, SNOMED International provides a list of the different types of browsers available. It is possible to add items to this list if you are aware of other browsers that are not included. Browsers are eligible for inclusion in the list if they are freely accessible software applications that provide searchable access to SNOMED CT.

*   SNOMED International Browser can be found here: [**http://browser.ihtsdotools.org**arrow-up-right](http://browser.ihtsdotools.org/)
    **.**
    
*   An overview of some other SNOMED CT browsers can be found here: [https://www.implementation.snomed.org/browsersarrow-up-right](https://www.implementation.snomed.org/browsers)
    

* * *

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# SNOMED CT National Release Center Guide | Practical Guides SNOMED NRC Guide | SNOMED International Documents

The SNOMED CT National Release Center Guide provides an introduction to SNOMED International and SNOMED CT for those working in or planning to development a National Release Center. It is also applicable to countries considering joining SNOMED International and Members.

[Introduction](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/introduction)

[What is a National Release Center](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/what-is-a-national-release-center)

[NRC Responsibilities](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/nrc-responsibilities)

[NRC Organization Phases](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/nrc-organization-phases)

[The Role of NRCs related to SNOMED CT Licensing](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/the-role-of-nrcs-related-to-snomed-ct-licensing)

[Implementation Consultancy](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/implementation-consultancy)

[Engaging Stakeholders](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/engaging-stakeholders)

[Education and Training](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training)

[Tooling](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/tooling)

[SNOMED CT Browser](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-ct-browsers)

[Distribution of SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/distribution-of-snomed-ct)

[Change Requests](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/change-requests)

[Content Development and SNOMED CT Customization](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization)

[SNOMED International Governance, Advisory Groups and Events](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events)

[Further Information](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/further-information)

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© Copyright 2025 International Health Terminology Standards Development Organisation, all rights reserved.

This document is a publication of International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED International owns and maintains SNOMED CT®.

Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. This document may be subject to updates. Always use the latest version of this document published by SNOMED International. This can be viewed online and downloaded by following the links on the front page or cover of this document.

SNOMED®, SNOMED CT® and IHTSDO® are registered trademarks of International Health Terminology Standards Development Organisation. SNOMED CT® licensing information is available at [http://snomed.org/licensingarrow-up-right](http://snomed.org/licensing)
. For more information about SNOMED International and SNOMED International Membership, please refer to [http://www.snomed.orgarrow-up-right](http://www.ihtsdo.org/)
 or contact us at [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#d0b9beb6bf90b9b8a4a3b4bffebfa2b7)
.

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# NRC Organization Phases | Practical Guides SNOMED NRC Guide | SNOMED International Documents

Establishing a well-functioning NRC is not a trivial task, and awareness about the steps required to achieve an active and effective NRC is necessary in order to plan and recruit appropriately. The processes involved with setting up and running an NRC can be described in three phases: establishment, roll-out and maintenance.

Figure 3. Different stages of setting up and running NRCs

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3066103899-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FP1frmzZuNvoHsCrG7SKQ%252Fuploads%252Fgit-blob-f1f4f494e610157cea5ade1fdf2c1949aa327fd7%252F26837056.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=bab75ba5&sv=2)

Each NRC can undertake a variety of responsibilities in order to facilitate implementation and use of SNOMED CT in the Member country. These responsibilities range from development, distribution and maintenance of SNOMED CT to support of SNOMED CT implementation projects, as well as education of people involved with SNOMED CT use and implementation. In the stage of establishing an NRC, it is vital to make decisions about which services will be provided and what national developments the NRC will undertake. These decisions also include deciding on the organization of the NRC, the work processes, the timetable and so on. It is of course possible for the scope of activity of the NRC to be increased (or decreased) in the future, as the needs change.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/nrc-organization-phases#list-of-nrc-establishment-decisions)

List of NRC establishment decisions


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Prior to establishing an NRC, the following questions should be considered in order to be able to determine the best possible NRC organization and workflow, along with appropriate recruitment and training of staff to match the necessary NRC competencies for the planned national approach and goals. The list is not complete, but includes some core considerations that existing Members have found to be important.

**NRC management decisions** Regarding NRC management, decisions need to be made about work processes, timetables and resource allocation.

*   What is the planned timeline for the establishment and roll out of the NRC?
    
*   What is the purpose/strategy for SNOMED CT in my country?
    
*   What resources will be spent on tailoring the International Release to meet national requirements?
    
*   Who will be responsible for managing specific work tasks?
    

**Use of SNOMED CT with other terminologies, classifications and models** Typically a Member country also uses other terminologies, classifications systems or information models, and it is important for an NRC to have a clear strategy for how SNOMED CT is to align with the current or planned use of these other products in the Member country.

*   What set of standard terminologies (in addition to SNOMED CT) will be used in the country? Are these required or suggested?
    
*   Do you need mappings between SNOMED CT and other terminologies or classifications?
    
*   Are there any interdependencies with other products (classifications/coding systems/information model initiatives) that would affect SNOMED CT releases, content, etc.?
    

**National adjustment/extensions** An NRC should consider to what extent national SNOMED CT adjustments (translations, extensions, Reference sets, etc.) should be made to develop the SNOMED CT National Extension and conform this to the needs and desired use cases for the Member country.

*   Do you need a translation of SNOMED CT into the language and/or dialects applied of our country?
    
*   Do you need national Reference sets to constrain the amount of SNOMED CT concepts to be used within specific use cases, clinical domains, etc. and to support consistent use of SNOMED CT within these areas?
    
*   Do you need national content (extensions to the International Edition of SNOMED CT) in order to meet specific national needs?
    
*   Who will manage derivatives, for example Reference sets and mappings, in the longer term? The NRC or someone else?
    

**Implementation and use cases** An NRC can take on very different strategies for supporting implementation and use of SNOMED CT in the specific Member country, and therefore an NRC should consider if, or to what extent, it will support specific SNOMED CT implementations. It should also consider how collaboration with the related stakeholders will be carried out.

*   Who is responsible for what, for example in implementation projects?
    
    *   What will be done at the national level?
        
    *   What is the responsibility of the various stakeholders (NRC, clinicians, healthcare organizations, IT vendors, etc.)?
        
    
*   Which organizations are already using SNOMED CT in the country and how will you engage with them?
    
*   What level/type of support will you offer?
    
*   Are there any priority use cases that you want to communicate?
    
*   Do you intend to specify compliance standards for use of SNOMED CT in your country?
    

**Education** An NRC should have a clear plan for its role with respect to SNOMED CT education and training of the various stakeholder groups within the country.

*   Do you intend to offer any guidance documents over and above what SNOMED International provides?
    
*   Do you intend to deliver training on SNOMED CT? At different levels?
    
*   Will you translate all SNOMED International materials (beyond SNOMED CT terminology, e.g. education materials, translations guidelines, deployment guidelines) into your national language, or is use of English acceptable?
    

**Tooling** It is important for an NRC to explore and discuss what specific tools are required to undertake the work of the NRC and to determine which tools will be used by the NRC.

*   Will you use your own tooling or will you rely on SNOMED International's tools?
    
*   What existing systems/processes/tooling do you already have in place that can be leveraged to fulfill your activities as an NRC?
    
*   What tooling is required to support activities of your NRC? Where will these be obtained (from SNOMED International, vendors, in house development)?
    

Consideration of each of the above questions will lead to additional questions that need to be answered to obtain a realistic overview/estimate of the magnitude and types of resources required to achieve the identified goals. For example, it is not enough to decide that you want to make a translation of SNOMED CT into your national language. This decision also requires elaboration of when and how you plan to do this, who should undertake the work and availability of required funding.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/nrc-organization-phases#balance-ambitions-and-resources)

Balance ambitions and resources


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If an NRC decides to develop a wide range of services and products to support the use of SNOMED CT in the Member country, it will likely promote successful adoption of the terminology. However, it is important that the NRC set up ambitions and timelines realistic in relation to the resources available. Members should carefully consider and define the national visions for use of SNOMED CT in the Member country. Hence, Members should be clear about the way they expect SNOMED CT to be used, which again must align with the national strategy and infrastructure.

It can be useful to consider a stepwise development process, where the NRC prioritizes the initiatives that should be carried out immediately and sets aside initiatives could be scheduled later. This is better than setting the bar too high and initiating too many projects that are difficult to complete.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/nrc-organization-phases#communicate-with-fellow-nrcs)

Communicate with fellow NRCs


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For every stage of NRC development it is essential to get in contact with other NRCs in order to gain insight to existing ways of organizing and running an NRC and to learn from others' experiences. SNOMED International facilitates communication between Members in different ways, for example through workshops during the biannual face-to-face meetings or by participation in the [Member Forum](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#member-forum)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/nrc-organization-phases#nrc-governance)

NRC governance


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Every NRC needs a clear governance structure to ensure that the work of the NRC and the strategic decisions are continuously aligned with user needs, national strategic priorities, SNOMED International developments and initiatives, collaborators' work, etc. The NRC should therefore consider what governance structure would be suitable to fulfill the needs of the NRC, as the needs may vary depending on the extent of services and the National Extension the NRC decides to develop.

In the simplest form, NRC governance can be carried out as operational line management of the responsibility for directing the day-to-day work of the NRC. Alternatively, there may be a need for having formal committees to advise on the direction of the NRC. This could, for example, be necessary if a National Extension is developed, as this may entail the need of an editorial committee to define and maintain editorial policies and ensure that they are being followed.

* * *

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*   [List of NRC establishment decisions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/nrc-organization-phases#list-of-nrc-establishment-decisions)
    
*   [Balance ambitions and resources](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/nrc-organization-phases#balance-ambitions-and-resources)
    
*   [Communicate with fellow NRCs](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/nrc-organization-phases#communicate-with-fellow-nrcs)
    
*   [NRC governance](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/nrc-organization-phases#nrc-governance)
    

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# Introducción a SNOMED CT | Practical Guides Intro a SCT para proveedores | SNOMED International Documents

Esta sección proporciona una breve descripción de las características clave de SNOMED CT, cómo acceder a SNOMED CT, algunos de los otros servicios ofrecidos por SNOMED International y cómo SNOMED CT se puede utilizar con otras terminologías y estándares de informática de salud. Para una introducción detallada a SNOMED CT, el lector debe consultar la [Guía de inicio de SNOMED CT arrow-up-right](https://www.snomed.org/what-is-snomed-ct)
También consulte la página web de SNOMED International [https://www.snomed.org/what-issnomed-ct.arrow-up-right](https://www.snomed.org/what-is-snomed-ct)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin-a-snomed-ct#caracteristicas-clave)

Características clave


-------------------------------------------------------------------------------------------------------------------------------------------------------------------

**SNOMED CT:**

*   Es la terminología clínica multilingüe más completa del mundo.
    
*   Incluye, entre otros, conceptos relacionados con diagnósticos, signos, síntomas, procedimientos, estructuras corporales, organismos y sustancias
    
*   Es un recurso con contenido clínico completo y validado científicamente.
    
*   Garantiza la calidad del contenido clínico en el expediente clínico electrónico
    
*   Contiene mapas desde y hacia otros estándares internacionales
    

Los componentes de SNOMED CT incluyen:

*   Conceptos que representan ideas y frases clínicas organizados en jerarquías.
    
*   Descripciones que vinculan los términos legibles para humanos con los conceptos
    
*   Relaciones que vinculan cada concepto con otros conceptos relacionados
    

Cuando se implementa en aplicaciones de software, SNOMED CT puede representar información clínicamente relevante de manera consistente, confiable y completa como parte integral para la producción y el uso de información sanitaria electrónica.

**Componentes de SNOMED CT**

SNOMED CT es una terminología clínica básica de atención clínica que contiene conceptos con significados únicos, y definiciones basadas en una lógica formal organizadas en jerarquías.

**Conceptos**

Los conceptos de SNOMED CT representan pensamientos clínicos variados y profundos. Cada concepto tiene un identificador de concepto numérico único que utiliza hasta 18 dígitos. Dentro de cada jerarquía, los conceptos se organizan desde lo general hasta lo más detallado. Esto permite registrar datos clínicos detallados y luego acceder a ellos o agregarlos a un nivel más general.

**Descripciones**

Las descripciones de SNOMED CT vinculan los términos legibles por humanos a los conceptos. Existen varios tipos de descripciones, de las cuales las dos más importantes son la "Descripción Completa" (FSN) y los "Sinónimos". La Descripción Completa es una frase formalmente estructurada e inequívoca que especifica el significado del concepto. Los sinónimos son otros términos que se utilizan para referirse al mismo significado. Cada traducción de SNOMED CT incluye un conjunto adicional de descripciones, que vinculan términos en otro idioma con los mismos conceptos de SNOMED CT. La figura 2 muestra un concepto con el identificador (128601007), una Descripción Completa y tres sinónimos en idioma Español para este ejemplo:

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-d5e64f75d8452e0f1cf4197de0f112572c444e55%252F259854940.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=6ae3b0a9&sv=2)

**Figura 2. Los sinónimos de SNOMED CT permiten a los usuarios elegir qué términos quieren que representen un concepto.**

**Relaciones**

Las relaciones de SNOMED CT vinculan cada concepto con otros conceptos que tienen un significado relacionado. Estas relaciones establecen las definiciones formales y algunas otras características del concepto. Un tipo común de vínculo es la relación jerárquica que relaciona un concepto con conceptos más generales. Por ejemplo, el concepto de _neumonía viral_ es un descendiente del concepto más general de _neumonía_. Estas relaciones, que definen la jerarquía de los conceptos de SNOMED CT, se representan como relaciones |es un/una|.

Otros tipos de relaciones representan diferentes aspectos de la definición de un concepto. Por ejemplo, el concepto de _neumonía viral_ tiene una relación _de agente causal_ con el concepto _de virus_ y una relación _de sitio de hallazgo_ con el concepto de _pulmón_.

**Integral, escalable y flexible**

SNOMED CT tiene una amplia cobertura de temas relacionados con la salud. Se puede utilizar para describir el historial médico de un paciente, los detalles de un procedimiento ortopédico, la propagación de epidemias y mucho más. Al mismo tiempo, la terminología tiene una profundidad inigualable, lo que permite a los médicos registrar datos con el nivel de granularidad adecuado según sea el caso.

Las aplicaciones específicas (por ejemplo las que se utilizan en una especialidad) tienden a centrarse en un conjunto restringido de conceptos de SNOMED CT, como los conceptos relacionados con la oftalmología. Estos subconjuntos se pueden utilizar para representar partes relevantes de la terminología, dependiendo del contexto clínico y los requisitos locales.

Cuando las diferentes jurisdicciones tienen necesidades más allá de las que pueden reflejarse en una terminología global, quizás por ejemplo debido a requisitos en la legislación local, se pueden desarrollar extensiones locales o nacionales. Así, aunque SNOMED CT tiene un alcance global, puede adaptarse a las necesidades de cada país o zona. Los proveedores también pueden crear extensiones para conceptos específicos dentro de sus propios sistemas o para subconjuntos que respalden la implementación.

Los mapas de SNOMED CT funcionan proporcionando enlaces explícitos a clasificaciones relacionadas con la salud y a esquemas de codificación que se utilizan en todo el mundo. Estos mapas facilitan la reutilización de datos clínicos basados en SNOMED CT para otros fines, como reembolsos o informes estadísticos.

Los mapas incluidos en la Edición Internacional de SNOMED CT incluyen:

*   SNOMED CT a CIE-10
    
*   SNOMED CT a ICD-O (vinculación de las morfologías de SNOMED CT con los códigos ICD-O)
    
*   De SNOMED CT a MedDRA y de MedDRA a SNOMED CT
    
*   SNOMED CT a Orphanet
    
*   SNOMED CT a GMDN
    

Puede encontrar más información sobre estos mapas en [https://www.snomed.org/mapsarrow-up-right](https://www.snomed.org/maps)
.

**Compatibilidad con diferentes idiomas**

SNOMED CT es una terminología multinacional y multilingüe. Tiene un marco incorporado para administrar diferentes idiomas y dialectos. La versión internacional incluye un conjunto de conceptos y relaciones independientes del lenguaje. Actualmente, SNOMED CT está disponible en Inglés de EE. UU., Inglés del reino Unido y Español, así como en otros idiomas; consulte [https://www.implementation.snomed.org/member-translations.arrow-up-right](https://www.implementation.snomed.org/member-translations)

**Expresiones de SNOMED CT**

Se puede utilizar un único identificador de concepto para representar cualquiera de los más de 360.000 conceptos de SNOMED CT, por ejemplo, neumonía. En algunos casos, puede ser necesaria una granularidad de significado aún más fina para captar la verdadera intención de lo registrado por un médico.

Por ejemplo, neumonía causada por estreptobacilo. En estos casos, SNOMED CT proporciona un mecanismo formal para utilizar dos o más identificadores de conceptos vinculados entre sí de manera lógica para representar refinamientos del significado de un concepto. Estas se conocen como expresiones poscoordinadas. Por ejemplo, 'neumonía causada por estreptobacilo' puede expresarse mediante:

53084003| neumonía bacteriana |:246075003| agente causal |=29295005| Estreptobacilo |

No es esencial que los proveedores implementen la poscoordinación a menos que existan requisitos para representar significados que no se puedan capturar utilizando un único identificador de concepto. Incluso en los casos en que se necesita información más específica, existen otras opciones que se pueden utilizar. Esto incluye el uso de campos específicos en la interfaz de usuario o mensajes para capturar patrones de refinamiento específicos, como la lateralidad. Sin embargo, las expresiones poscoordinadas proporcionan una forma flexible de representar detalles adicionales, cuando esto es necesario.

*   Las expresiones que identifican un concepto utilizando un único identificador de concepto se denominan "precoordinadas".
    
*   Las expresiones que se basan en la composición de múltiples identificadores de conceptos, como se ilustra arriba, se denominan "poscoordinadas".
    

**Representación lógica del significado**

Además de la representación legible por humanos del significado (proporcionada por las descripciones), SNOMED CT incluye relaciones entre conceptos que proporcionan una representación del significado de cada concepto que es procesable por la máquina. Estas relaciones definitorias proporcionan la base para la recuperación de información basada en el significado.

Cada concepto de SNOMED CT (excepto el concepto raíz) tiene una relación con uno o más conceptos padre. Cada uno de estos conceptos padres representa un significado clínico más general (conocido como supertipo). La red de relaciones resultante es más que un simple árbol y forma una estructura lógica conocida como polijerarquía . Esta estructura permite representar el significado de una manera más completa que lo que es posible en una jerarquía simple.

Por ejemplo, una jerarquía simple solo podría representar |celulitis del pie| como un tipo de |trastorno del pie| o, por otro lado, un tipo de |celulitis|. Como se muestra en la Figura 3, la polijerarquía de subtipos SNOMED CT captura ambas relaciones de supertipos.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-06e165b855b0ce3c30e799de96de1ded5a6403a6%252F259854939.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=6fc328c6&sv=2)

**Figura 3. Fragmento de la polijerarquía del subtipo SNOMED CT que muestra un concepto con dos supertipos padres**

Además de las relaciones que forman la polijerarquía de subtipos, SNOMED CT también incluye otras relaciones que representan características de un concepto que lo distinguen de sus supertipos. Por ejemplo, como se muestra en la Figura 4, las relaciones definitorias del concepto |celulitis del pie| también incluyen valores para los atributos |morfología asociada| y |sitio del hallazgo|.\*\*\*\*

**Figura 4. Definición de relaciones de la celulitis del pie**

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-a434001ae95aaa9b842579aef7fc50075727d509%252F259854938.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=b7ba04bf&sv=2)

\*\*

Los conceptos, sus descripciones y relaciones se pueden explorar utilizando el navegador de SNOMED International ([http://browser.ihtsdotools.org).arrow-up-right](http://browser.ihtsdotools.org/)

**Formato de publicación estándar con control de versiones integrado**

SNOMED CT ha estandarizado métodos para el empaquetado y distribución de contenidos y derivados. Los archivos de distribución siguen una convención formal de nombres y tienen un formato de publicación estandarizado delimitado por tabulaciones que incluye el seguimiento completo de las diferentes versiones de cada componente desde el lanzamiento de SNOMED CT en 2002 hasta hoy. Los archivos de distribución incluyen archivos para conceptos, descripciones, relaciones y una estructura de archivo de Conjuntos de Referencia extensible que se utiliza para representar mapas, subconjuntos y preferencias de idioma.

El mecanismo de versiones admite la distribución de representaciones distintas de los datos.

Con cada publicación de SNOMED CT se ponen a disposición dos tipos de archivos de publicación:

*   Versión completa: contiene el historial completo de cada componente
    
*   Versión de instantánea: contiene el estado actual de cada componente
    

Nota sobre la versión Delta (incluye cambios realizados entre una versión y la siguiente) : _Los archivos delta se han eliminado del Paquete de Publicación de SNOMED International, de las Extensiones del Servicio Gestionado y de los Paquetes de Derivados. Sin embargo, hay una Herramienta de Generación Delta disponible para aquellos que la_ _necesitan. La Herramienta de Generación Delta permite a los usuarios crear su propio Delta entre dos fechas de lanzamiento fijas; puede encontrarla aquí:_ [https://github.com/IHTSDO/delta-generator-tool/releases.arrow-up-right](https://github.com/IHTSDO/delta-generator-tool/releases)

La Edición Internacional se ofrece en ambos tipos de publicación. Sin embargo, como la instantánea se puede generar a partir de la versión completa, la especificación sólo requiere que las organizaciones que mantienen Extensiones proporcionen una versión completa de su extensión.

**Mejora continua**

SNOMED CT es objeto de mejoras continuas, como la adición de nuevos conceptos cuando es necesario o el refinamiento de las definiciones actuales de los conceptos. SNOMED CT tiene un control de versiones sólido de todos los componentes basado en un mecanismo de "fecha de vigencia". Los datos incluyen el historial completo y explícito de todas las versiones de todos los componentes, sin importar que estén o no activos actualmente.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin-a-snomed-ct#acceso-a-snomed-ct)

Acceso a SNOMED CT

Navegación del contenido de SNOMED CT

SNOMED International ofrece un navegador terminológico para permitir la revisión en línea de la Edición Internacional de SNOMED CT ([http://browser.ihtsdotools.orgarrow-up-right](http://browser.ihtsdotools.org/)
). Este navegador también proporciona acceso a varias Ediciones Nacionales de SNOMED CT. Se pueden encontrar otros navegadores SNOMED CT en [http://snomed.org/browsersarrow-up-right](http://snomed.org/browsers)
.

**Obtención de los Archivos de Publicación de SNOMED CT**

**Licencias y acceso a los archivos de publicación**

Todos los proveedores, desarrolladores y distribuidores de productos y servicios habilitados con SNOMED CT deben registrar la aceptación del Acuerdo de Licencia de Afiliado de SNOMED CT. Al hacer esto, se convierten en afiliados de SNOMED International y obtienen acceso a las descargas de la Edición Internacional de SNOMED CT y sus derivados. Algunos Países Miembros tienen como requisito que se use su Edición Nacional de SNOMED CT y el acceso a ésta puede estar sujeto a un acuerdo de licencia adicional. En la Sección 7 se proporciona más información sobre las licencias, incluidas las sublicencias para usuarios finales y las tarifas por su uso en Países No Miembros.

**Descarga de la Edición Internacional**

Los Centros Nacionales de Referencia (CNR) de algunos Países Miembros tienen sus propios sitios de distribución que permiten a los Afiliados de SNOMED International que estén registrados con ellos que descarguen la Edición Internacional de SNOMED CT. SNOMED International ofrece un servicio centralizado para que los afiliados de SNOMED International descarguen la Edición Internacional. Este servicio también lo utilizan algunos Países Miembros.

**Descarga de Extensiones o Ediciones nacionales**

Los Centros Nacionales de Referencia (CNR) que mantienen Extensiones Nacionales en los Países Miembros proporcionan estas Extensiones a los Afiliados Internacionales de SNOMED registrados por ellos. En algunos casos, la Extensión Nacional y la Edición Internacional pueden distribuirse en una forma pre-fusionada que representa la Edición Nacional completa. Para obtener más detalles, consulte los enlaces a “Miembros de SNOMED International” en [http://snomed.org/membersarrow-up-right](http://snomed.org/members)
.

**Fechas de publicación**

SNOMED International publica actualizaciones periódicas de la Edición Internacional de SNOMED CT. SNOMED CT se publica mensualmente el primer día de cada mes. Puede encontrar más detalles en [https://www.snomed.org/releasesarrow-up-right](https://www.snomed.org/releases)
.

De manera similar, los Miembros y Afiliados que mantienen Extensiones publican las versiones actualizadas de sus Extensiones para alinearse con la Edición Internacional de SNOMED CT, esto sucede siempre después del lanzamiento internacional correspondiente.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin-a-snomed-ct#otros-productos-de-snomed)

Otros productos de SNOMED

SNOMED International mantiene una gama de otros productos y los distribuye a sus miembros, licenciatarios y otros usuarios.

Estos productos incluyen extensiones y productos derivados de SNOMED CT. Otros son productos globales disponibles fuera del modelo de licencia tradicional de SNOMED CT. Por ejemplo, la Terminología del Resumen Internacional de Pacientes (IPS) y el Conjunto Global de Pacientes. Para más información consulte [https://www.snomed.org/other-snomed-productsarrow-up-right](https://www.snomed.org/other-snomed-products)
 para más detalles.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin-a-snomed-ct#otros-servicios-de-snomed-international)

Otros servicios de SNOMED International

**Documentación**

La Biblioteca de Documentos de SNOMED CT se puede consultar en [docarrow-up-right](http://snomed.org/doc)
 y proporciona acceso a las especificaciones de diseño detalladas de SNOMED CT y a los formatos de los archivos de publicación. La biblioteca también proporciona acceso a otras normas y directrices relacionadas. Estos documentos están disponibles como páginas web navegables en línea y/o como archivos PDF descargables.

**Educación**

¿Por dónde empezar?

*   El [Tutorial de Inicio de SNOMED CTarrow-up-right](https://elearning.ihtsdotools.org/course/view.php?id=5&section=1)
     proporciona una descripción general de los conceptos básicos de SNOMED CT.
    
*   La [Guía de Recursos Educativosarrow-up-right](https://elearning.ihtsdotools.org/course/view.php?id=5&section=1)
     proporciona detalles sobre el material educativo disponible que cubre una variedad de temas relacionados con SNOMED CT.
    

SNOMED International ofrece una variedad de ofertas educativas. A continuación se muestra el conjunto de cursos, rutas de aprendizaje y exámenes de certificación disponibles.

**Catálogo de cursos y plataforma de aprendizaje electrónico** Inscríbase en todos los cursos y exámenes de certificación de SNOMED CT a través del catálogo de cursos de SNOMED CT en [https://courses.ihtsdotools.org/arrow-up-right](https://courses.ihtsdotools.org/)
. Seleccione el producto educativo correspondiente.Se puede acceder a nuestra plataforma de aprendizaje electrónico, que alberga la mayoría de nuestras ofertas educativas en [https://elearning.ihtsdotools.org/.arrow-up-right](https://elearning.ihtsdotools.org/)

**Cursos**

[Curso de Fundamentosarrow-up-right](https://ourses.ihtsdotools.org/product?catalog=FCS)
, [Curso de implementaciónarrow-up-right](https://courses.ihtsdotools.org/product?catalog=ICE)
, [Curso de autoría nivel 1arrow-up-right](https://courses.ihtsdotools.org/product?catalog=AL1)
, [Curso de autoría nivel 2arrow-up-right](https://courses.ihtsdotools.org/product?catalog=AL2)
.

**Rutas de aprendizaje**

[SNOMED CT para desarrolladoresarrow-up-right](https://courses.ihtsdotools.org/product?catalog=DEV)
, [SNOMED CT para analistas de datosarrow-up-right](https://courses.ihtsdotools.org/product?catalog=DAN)
, [**SNOMED CT para clínicos**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=CLI)
 , [SNOMED CT para traductoresarrow-up-right](https://courses.ihtsdotools.org/product?catalog=TRA)
.

**Exámenes de certificación**

[Certificación de autoría de SNOMED CT nivel 1arrow-up-right](https://courses.ihtsdotools.org/product?catalog=AC1)
, [Certificación de autoría de SNOMED CT nivel 2arrow-up-right](https://courses.ihtsdotools.org/product?catalog=AC2)
.

Algunos Centros Nacionales de Referencia también proporcionan una variedad de materiales y servicios en apoyo a la implementación y varios albergan comunidades de implementación locales. Para obtener más información, consulte al Miembro correspondiente siguiendo los enlaces [http://snomed.org/membersarrow-up-right](http://snomed.org/members)
.

**Herramientas y servicios**

SNOMED International está desarrollando una gama de herramientas destinadas principalmente a apoyar el desarrollo y la distribución de la terminología a nivel centralizada por parte de SNOMED International y a nivel nacional por parte de los CNR en los Países Miembros. Estas herramientas se desarrollan siguiendo principios de código abierto y pueden otorgar valor práctico y/o ilustrativo para los proveedores. Consulte los detalles en [https://www.snomed.org/software-toolsarrow-up-right](https://www.snomed.org/software-tools)
.

También hay otros proveedores de herramientas y servicios que apoyan la implementación de SNOMED CT: [https:// arrow-up-right](https://www.implementation.snomed.org/implementation-tooling)
[www.implementation.snomed.org/implementation-toolingarrow-up-right](http://www.implementation.snomed.org/implementation-tooling)
, como algunos desarrollos realizados por miembros de SNOMED International y siguiendo un modelo de código abierto.

**Solicitudes de cambios y adiciones**

SNOMED International ofrece un servicio de envío de solicitudes para recopilar y procesar solicitudes de adiciones y cambios al contenido de la Edición Internacional de SNOMED CT. Se puede acceder a este servicio directamente a través de los Centros Nacionales de Referencia (CNR) de los Países Miembros y a través de las Autoridades Terminológicas reconocidas que representan a las organizaciones de desarrollo de estándares con las que SNOMED International está colaborando.

Los proveedores de los Países Miembros deben presentar sus solicitudes inicialmente al CNR del país en el que tienen su sede o del país en el que se ha originó la solicitud de adición o cambio. Las solicitudes con particular relevancia local pueden agregarse a una Extensión Nacional, pero aquellas que el CNR considere que tienen relevancia internacional pueden enviarse a SNOMED Internacional para tomar una decisión sobre la pertinencia de su adición a la Edición Internacional. Si se considera que una solicitud tiene alta prioridad, se realizará una acción en el siguiente ciclo de lanzamiento. Sin embargo, las solicitudes que requieren cambios significativos que podrían afectar otros contenidos pueden demorar más.

### 

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Uso de SNOMED CT con otros estándares

SNOMED CT es sólo una parte de la solución a los desafíos para el uso efectivo de la información clínica. Por lo tanto, SNOMED International coopera con muchas organizaciones para optimizar los beneficios prácticos y minimizar la duplicación de esfuerzos. En esta sección se describen algunas áreas clave en las que este enfoque colaborativo está impulsando desarrollos que abordan las necesidades de los proveedores de atención médica, los proveedores y usuarios del expediente clínico electrónico y otras partes interesadas con interés en la representación consistente de la información relacionada con la salud.

SNOMED International tiene un programa de asociación activo con organizaciones de desarrollo de estándares internacionales, organismos clínicos profesionales y organizaciones comerciales. El objetivo es facilitar el uso de

SNOMED CT con otros estándares y perfiles internacionales, consulte [https://www.snomed.org/our-partnershipsarrow-up-right](https://www.snomed.org/our-partnerships)
.

**Clasificaciones de la Organización Mundial de la Salud**

SNOMED International tiene un acuerdo de trabajo formal con la Organización Mundial de la Salud (OMS) para desarrollar y garantizar mapas y vínculos entre SNOMED CT y las clasificaciones de la OMS, para mas información consulte [https://www.snomed.org/standardspartnerships/world-health-organization.arrow-up-right](https://www.snomed.org/standards-partnerships/world-health-organization)

Los mapas de SNOMED CT a CIE-10 y de SNOMED CT a CIE-11 son distribuidos por SNOMED International, para mas información consulte [https://www.snomed.org/maps.arrow-up-right](https://www.snomed.org/maps)

**LOINC (Nombres y Códigos de Identificadores de Observación Lógica)**

En julio de 2013, SNOMED International firmó un acuerdo a largo plazo con el Regenstrief Institute Inc. (RII) propietarios de LOINC (Identificadores de observación lógica, nombres y códigos). Este acuerdo marcó el inicio del trabajo cooperativo que vinculará a LOINC y SNOMED CT.

El trabajo colaborativo produjo un archivo de asociación de expresiones y conjuntos de mapas LOINC®/SNOMED CT basado en la versión internacional de SNOMED CT de julio de 2017, y la versión 2.58 de LOINC, publicada en diciembre de 2016.

En 2022, las dos organizaciones firmaron un [nuevo acuerdo de colaboraciónarrow-up-right](https://www.snomed.org/standards-partnerships/loinc%C2%AE)
 que facilita la adopción de terminología estandarizada para respaldar la interoperabilidad para el intercambio de datos de salud en todo el mundo, con el objetivo de mejorar y optimizar la prestación de servicios de atención médica.

El nuevo acuerdo sienta las bases para el desarrollo de una extensión de LOINC® que se alinea con el modelo de SNOMED CT, permitiendo a SNOMED International y Regenstrief distribuir el contenido de LOINC® y de SNOMED CT en conjunto para sus respectivos usuarios. La extensión creará códigos de SNOMED CT y de LOINC® para todos los conceptos que se comparten entre las terminologías, lo que facilitará que los implementadores tengan un enfoque unificado para implementar ambos estándares y cumplir con los requisitos clínicos y regulatorios a nivel mundial.

En Octubre de 2023 y en el marco del acuerdo del 2022, los equipos produjeron [La ontología LOINC: Una solución de interoperabilidad de LOINC y SNOMEDarrow-up-right](https://loincsnomed.org/)
. La ontología LOINC apoya a los proveedores y usuarios que implementan diferentes combinaciones de SNOMED CT y LOINC en los sistemas de información de salud y les permite cumplir con los requisitos clínicos y regulatorios usando una sola solución. Vinculados entre sí de manera complementaria, SNOMED CT proporciona el marco computable y LOINC proporciona el contenido de laboratorio y patología en un formato comprensible para los países que actualmente no utilizan LOINC.

**HL7**

En julio de 2021, [HL7arrow-up-right](https://www.hl7.org/)
 y SNOMED International anunciaron otro acuerdo de colaboración de 2 años, basándose en los acuerdos anteriores de 2009, 2014, 2016 y 2019. El acuerdo apunta nuevamente a mejorar la interoperabilidad centrándose en la adopción de prácticas de trabajo que faciliten el uso de SNOMED CT con los estándares HL7 a nivel mundial. Como anteriormente, ambas organizaciones están trabajando para evitar la duplicación de esfuerzos y resolver problemas relacionados con brechas y superposiciones. Para obtener más detalles, consulte [https://www.snomed.org/standards-partnerships/hl7-internationalarrow-up-right](https://www.snomed.org/our-partnerships/hl7-international)
.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Spanish-Vendor-Guide&entry.670899847=Introducci%C3%B3n%20a%20SNOMED%20CT)

[PreviousBeneficios para los proveedoreschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/beneficios-para-los-proveedores)
[NextElección de un enfoque de implementaciónchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin)

Last updated 5 months ago

*   [Características clave](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin-a-snomed-ct#caracteristicas-clave)
    
*   [Acceso a SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin-a-snomed-ct#acceso-a-snomed-ct)
    
*   [Otros productos de SNOMED](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin-a-snomed-ct#otros-productos-de-snomed)
    
*   [Otros servicios de SNOMED International](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin-a-snomed-ct#otros-servicios-de-snomed-international)
    
*   [Uso de SNOMED CT con otros estándares](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin-a-snomed-ct#uso-de-snomed-ct-con-otros-estandares)
    

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# Herramientas | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

Existen numerosas herramientas que los CNR pueden necesitar, dependiendo de la medida en que personalicen o amplíen la Edición Internacional de SNOMED CT.

Las herramientas necesarias para un CNR dependen de los servicios que vaya a prestar y del enfoque que adopte para prestar sus servicios. Sin embargo, como mínimo, un CNR necesita una plataforma en la que SNOMED CT pueda ponerse a disposición de los usuarios, es decir, una herramienta que apoye la distribución a los usuarios de la Edición Internacional (recibida desde SNOMED International) y las posibles Extensiones Nacionales. Además, si la CNR decide desarrollar Extensiones Nacionales, incluida una traducción nacional o Conjuntos de Referencia nacionales, también se necesitan herramientas para apoyar estas tareas. La Figura 8 muestra varios tipos de herramientas que un CNR puede utilizar para apoyar su trabajo con SNOMED CT.

**Figura 8 Herramientas útiles para un CNR.**

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2133369718-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FI7N0Q2Su8RGW5pAlIrWt%252Fuploads%252Fgit-blob-3be5e4210c7b1563579ed9a8e5989bc7971f64a8%252F259854840.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=9f90c0d6&sv=2)

\*\*

En secciones posteriores de este documento se presentan las prácticas y herramientas típicas relacionadas con cada una de las tareas de trabajo mencionadas .

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/herramientas#servicio-de-herramientas-de-snomed-international)

Servicio de herramientas de SNOMED International


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Los CNR son libres de elegir o desarrollar herramientas que permitan la distribución y gestión de SNOMED CT y sus derivados nacionales en sus países. Sin embargo, SNOMED International realiza un gran esfuerzo en el desarrollo de los servicios de herramientas de SNOMED International, que representan una gama de servicios y herramientas que se han puesto a disposición para apoyar a SNOMED International, a los Miembros y a la Comunidad de Práctica. Con el tiempo, SNOMED International pretende incluir en sus servicios de herramientas las herramientas necesarias para apoyar toda la gama de funciones esenciales del CNR.

Los desarrollos de los servicios de herramientas se basan ahora en el Open Tooling Framework (OTF) de SNOMED International y el código fuente está disponible bajo una licencia de código abierto Apache v2 (siempre que sea posible). Este marco es un conjunto de interfaces de programación de aplicaciones (API) normalizadas, sujetas a una serie de principios que definen los servicios de software fundamentales. Estos servicios son consumidos por aplicaciones empresariales, que se están desarrollando para satisfacer los requisitos de herramientas de SNOMED International y sus Miembros.

Los servicios de herramientas de SNOMED International figuran en [https://www.snomed.org/software-tools.arrow-up-right](https://www.snomed.org/software-tools)

En el portal de apoyo a la implementación de SNOMED CT también se ofrecen detalles sobre [las herramientas de implementaciónarrow-up-right](https://www.implementation.snomed.org/implementation-tooling)
.

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[PreviousEducación y capacitaciónchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-educacin-y-capacitacin)
[NextNavegadores de SNOMED CTchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/navegadores-de-snomed-ct)

Last updated 5 months ago

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# Implementation Consultancy | Practical Guides SNOMED NRC Guide | SNOMED International Documents

A desirable function of an NRC is to act as a resource and advisory body for Affiliates. It is crucial for successful national adoption of SNOMED CT that Affiliates are able to obtain the required education, training and guidance. SNOMED International delivers a range of education and training resources, which are described in later sections. However, Affiliates may require further guidance on implementation aspects, on customization, or on SNOMED CT education for specific user groups. An NRC should clarify how it will support requests for education and implementation consultancy.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/implementation-consultancy#snomed-ct-users)

SNOMED CT users


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In order to provide the most efficient support to national SNOMED CT users, the NRC should ensure that the available implementation and training resources are focused on the specific types of SNOMED CT users. The NRC must therefore have insight into the different aspects related to SNOMED CT implementation and use, know about the different types of SNOMED CT users, and understand the role and needs each of these groups of users with respect to SNOMED CT knowledge and skills.

Figure 7 illustrates three types of SNOMED CT users who have different needs with respect to learning about SNOMED CT. The knowledge required for users and professionals related to clinical data entry differ from the knowledge required for designers and developers. Moreover, users responsible for information management require more cross-disciplinary knowledge than healthcare professionals, being responsible for reconciling user needs, the terminological framework and system setup. Within the different types of SNOMED CT users there are various user roles, and the individuals in those user roles need to learn about SNOMED CT at various levels of detail and with different points of departure. These generic user types are intentionally broad. Individual Members may identify other user categories and subdivisions relevant to national circumstances taking account of different approaches to eHealth strategy and SNOMED CT implementation.

Figure 7. Three broad groups of SNOMED CT Users

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3066103899-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FP1frmzZuNvoHsCrG7SKQ%252Fuploads%252Fp825ZcztBcuK2rDD4alM%252FImage%252009-07-2025%2520at%252016.55.jpg%3Falt%3Dmedia%26token%3D3535b2e1-eb7c-45c3-9c0a-0b50ec1f5e86&width=768&dpr=3&quality=100&sign=23299259&sv=2)

A description and examples of the different user groups can be found below:

**Users** are those engaged in entry, storage, retrieval and/or reuse of clinical information.

_Examples_

*   Healthcare practitioners (clinicians, nurses, therapists, etc.)
    
*   Medical coders and secretaries engaged in clinical data entry
    
*   Clinical knowledge providers and publishers
    
*   Clinical researchers
    
*   Information analysts
    
*   Managers of migration from pre-existing data to SNOMED CT representation
    

**Designers and Developers** are those designing, developing, configuring or deploying software systems that use SNOMED CT. SNOMED International has developed a [Vendor Guide](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/)
 to support vendors understanding SNOMED CT implementation.

_Examples_

*   Healthcare solution providers – designers and software developers
    
*   System integrators
    
*   Researchers and innovators
    
*   Clinical experts and others involved in customizing user interfaces and data entry protocols
    

**Terminology Developers** are organizations developing and distributing content and other artifacts such as subsets, maps, etc.

_Examples_

*   SNOMED International
    
*   National Release Centers
    
*   Other institutions working with terminologies
    
*   Researchers and innovators
    

**Educators and trainers** are those people involved with education and training of people involved with implementation and use of SNOMED CT.

_Examples_

*   People with the sufficient knowledge to educate and train people within a specific user group and at the level required for the actual user.
    

* * *

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=NRC+Guide&entry.670899847=Implementation%20Consultancy)

[PreviousThe Role of NRCs related to SNOMED CT Licensingchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/the-role-of-nrcs-related-to-snomed-ct-licensing)
[NextEngaging stakeholderschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/engaging-stakeholders)

Last updated 7 months ago

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# Introduction | Practical Guides SNOMED NRC Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/introduction#background)

Background


----------------------------------------------------------------------------------------------------------------------

When a country joins SNOMED International it gains a number of rights and obligations related to SNOMED International products, including SNOMED Clinical Terms (SNOMED CT). All Member countries[1arrow-up-right](https://confluence.ihtsdotools.org/display/DOCNRCG/Introduction#Footnote1)
 also play a key role within the governance and advisory bodies of SNOMED International. Therefore, joining SNOMED International brings with it a need to learn how SNOMED International works, the roles of SNOMED International Members and practical ways to maximize the benefits of membership.

An important first step is to designate an organization as a National Release Center (NRC) to fulfill the operational requirements of membership, including managing the national distribution of SNOMED CT. This guide is a high-level introductory document for National Release Centers.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/introduction#objective)

Objective


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The objective of the "SNOMED International National Release Center Guide" (NRC Guide) is to offer a practical and useful starting point for Member countries. It provides guidance on NRC responsibilities and the relationships between NRCs, SNOMED International, and implementers and users within a Member country.

This document is also intended to provide guidance on how NRCs can support an effective and efficient introduction of SNOMED CT in their countries. However, it does not provide a general introduction to SNOMED CT. Readers interested in learning more about SNOMED International's terminology should refer instead to the SNOMED CT Starter Guide.

The SNOMED CT Starter Guide can be found here: [http://snomed.org/starterguide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/introduction#target-audience)

Target Audience


--------------------------------------------------------------------------------------------------------------------------------

The target audience of the NRC Guide is those people responsible for establishing, managing and working within a National Release Center. While primarily designed for new Members, this guide also provides a useful reference for NRC staff in existing Member countries.

Readers of this guide should already have an understanding of what a Member and an Affiliate are. [SNOMED International Glossary](https://docs.snomed.org/snomed-international-documents/snomed-ct-glossary/)
 can be used to clarify specific words and phrases used.

circle-info

This document uses the term "Member country" as this is considered easier to understand than the more formal term "Member territory." In most cases Members are countries or states recognized by the United Nations, but in exceptional circumstances entities that are not strictly "countries" may be permitted to join SNOMED International as Members.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=NRC+Guide&entry.670899847=Introduction)

[PreviousSNOMED CT National Release Center Guidechevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide)
[NextWhat Is a National Release Center?chevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/what-is-a-national-release-center)

Last updated 7 months ago

*   [Background](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/introduction#background)
    
*   [Objective](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/introduction#objective)
    
*   [Target Audience](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/introduction#target-audience)
    

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# Apéndice 1. - Experiencia del usuario de SNOMED CT | Practical Guides Intro a SCT para proveedores | SNOMED International Documents

Independientemente del diseño del expediente clínico electrónico que se utilice para implementar SNOMED CT, cada diseño incorporará alguna forma de interacción entre los usuarios finales y SNOMED CT. La forma en que se implementa SNOMED CT hace una diferencia significativa en la experiencia del usuario. Se pueden utilizar varias técnicas simples para integrar sin problemas SNOMED CT con interfaces de usuario que se adapten a las necesidades de los usuarios clínicos.

Esta sección ofrece orientación de alto nivel sobre formas de brindar una experiencia de usuario positiva de SNOMED CT como parte de un sistema de expediente clínico electrónico. Se pueden encontrar más detalles sobre los temas tratados en esta sección en la Biblioteca de Documentos de SNOMED CT y en la [Guía de búsqueda y registro de datos.arrow-up-right](https://confluence.ihtsdotools.org/display/DOCSEARCH)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#identificadores-de-conceptos-de-snomed-ct)

Identificadores de conceptos de SNOMED CT


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

A diferencia de algunos esquemas de clasificación en los que los caracteres utilizados en cada código transmiten algún significado, los identificadores de conceptos de SNOMED CT son una secuencia de dígitos que de ninguna manera reflejan el significado del concepto. Por este motivo, normalmente no se obtiene ningún valor mostrando el identificador al usuario y, en la mayoría de los casos, debería ocultarse para simplificar la interfaz de usuario. En lugar de ello, los usuarios deberían ver e interactuar con los términos utilizados para representar los conceptos, y el identificador de concepto SNOMED CT debería utilizarse únicamente en el registro almacenado.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#termino-preferido-y-sinonimos)

Término preferido y sinónimos


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Cuando se utiliza SNOMED CT como terminología de interfaz, el término preferido para cada concepto debe usarse como predeterminado para ser mostrado en la interfaz de usuario. Cada concepto puede tener un término preferido diferente en diferentes idiomas, dialectos, especialidades o entornos de atención, por lo que pueden configurarse para un entorno clínico específico. Para facilitar a los usuarios la búsqueda de un concepto determinado, las interfaces de usuario pueden admitir la búsqueda de cualquier sinónimo aceptable para cada concepto. Los términos preferidos y los sinónimos aceptables se definen en SNOMED CT utilizando un Conjunto de Referencia de Lenguaje, que hace referencia al subconjunto de descripciones utilizadas en un idioma, dialecto, especialidad o entorno de atención determinados. SNOMED International distribuye dos Conjuntos de Referencia de Lenguajes (para Inglés de EE. UU. y para Inglés del Reino Unido) y varios Países Miembros distribuyen sus propios conjuntos de referencia de idiomas nacionales. Se pueden crear Conjuntos de Referencia de Lenguajes adicionales a nivel regional, de especialidad, de instituto o de producto de software para personalizar verdaderamente la experiencia del usuario local.

Cuando se utiliza una terminología de interfaz independiente, cada término puede estar vinculado (o asignado) a un concepto de SNOMED CT apropiado. Cuando se selecciona el término en la interfaz, el identificador del concepto de SNOMED CT vinculado se almacena en el registro. Es importante que cuando se utiliza una terminología de interfaz la asignación a SNOMED CT sea de calidad suficiente (idealmente equivalente) para soportar los casos de uso para los cuales se utilizarán los datos. El uso de una terminología de interfaz, por ejemplo, puede ser útil para el registro de datos estructurados, donde solo una parte del significado está representado por el término seleccionado y el resto por el contexto de la interfaz circundante. Un ejemplo de esto se ilustra en la Figura 18. En este ejemplo, cuando se selecciona el botón de opción junto al término 'Completa' (de la sección 'Movilidad' en la interfaz de usuario), el concepto 160680006 |completamente móvil (hallazgo)| se registra en el registro de salud para representar completamente el significado de la selección y hacer que las consultas futuras sobre estos datos sean más confiables.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-988e82140ea9c422abdc6db726ec608af74992a3%252F259854961.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=253608e8&sv=2)

**Figura 18. Ejemplo de terminología de interfaz utilizada como parte del registro de datos estructurados**

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#descripcion-completa-fsn)

Descripción completa (FSN)


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

A veces, las palabras o frases idénticas pueden tener múltiples significados. En estos casos, puede ser útil mostrar la Descripción Completa (FSN) de un concepto para eliminar la ambigüedad de cada término idéntico.

Por ejemplo, la Figura 19 ilustra tres términos que coinciden con la búsqueda de "frío" y que tienen significados muy diferentes. En la práctica, estas ambigüedades también se pueden minimizar con restricciones de búsqueda adecuadas (por ejemplo, sólo dos de estos resultados se refieren a trastornos). El gráfico contiene conceptos en idioma Inglés para ejemplificar el caso de uso de manera explícita.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-d20fcc339f233dbeb540e191507e2f831ae75ebb%252F259854960.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=4a9d8c92&sv=2)

**Figura 19. Resultados de búsqueda que coinciden con "cold" con sus FSN que se muestran a la derecha**

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#restriccion-de-los-resultados-de-busqueda)

Restricción de los resultados de búsqueda


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

SNOMED CT es una terminología con una amplia cobertura. En consecuencia, las búsquedas sin restricciones pueden generar listas largas e inútiles de términos coincidentes. Lo ideal sería que a los usuarios sólo se les presente contenido relevante para su tarea. Hay varias formas de restringir los resultados de búsqueda para ofrecer una lista de resultados más corta y relevante, incluida la restricción de los conceptos:

*   A una jerarquía particular
    
    *   Por ejemplo, sólo conceptos de la jerarquía de procedimientos
        
    
*   A los subtipos de un concepto de agrupador dado
    
    *   Por ejemplo, solo los conceptos que son subtipos del concepto |forma de dosis farmacéutica|
        
    
*   Basado en la pertenencia a un subconjunto definido de conceptos o descripciones
    
    *   Por ejemplo, solo los conceptos de estructura corporal a los que hace referencia el |conjunto de referencia de estructura corporal lateralizable|
        
    
*   Basado en atributos particulares del concepto
    
    *   Por ejemplo, solo los conceptos de trastorno definidos con una |morfología asociada| de |inflamación|
        
    

Si las búsquedas no están restringidas, el resultado puede incluir una larga lista de conceptos irrelevantes, entre los cuales es difícil para un usuario encontrar el término apropiado. Las búsquedas sin restricciones también conducen a errores de codificación cuando términos similares se asocian con conceptos de diferentes jerarquías. Por ejemplo, el término "enfisema" puede referirse a una anomalía morfológica en el pulmón o a la enfermedad causada por esta anomalía. Si bien estos conceptos están relacionados, utilizar una anomalía morfológica como diagnóstico del paciente conducirá a resultados de recuperación incorrectos.

En la Figura 20 se muestra un ejemplo de restricción a una jerarquía particular. Este ejemplo ilustra una búsqueda que se realiza con dos restricciones diferentes. A la izquierda, los resultados se limitan a la jerarquía de "hallazgo clínico", y a la derecha, a la jerarquía de "procedimiento".

Cabe señalar que algunas jerarquías de SNOMED CT nunca son relevantes para el registro de datos clínicos. En particular, los conceptos de la jerarquía del Componente del Modelo SNOMED CT son artefactos técnicos que deben excluirse de las búsquedas utilizadas para el ingreso de datos clínicos.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-c431088fd19b218426126e2c8da34e67104d8cef%252F259854959.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=4c3adc9&sv=2)

**Figura 20. Una búsqueda restringida a la jerarquía de procedimientos (a la izquierda) y a la jerarquía de trastornos (a la derecha)**

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#ordenar-los-resultados-de-la-busqueda)

Ordenar los resultados de la búsqueda


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Para muchos propósitos es útil ordenar los resultados de búsqueda por longitud ascendente del término. Esto garantiza que los términos que coinciden con la cadena de búsqueda sin otras adiciones se vean primero. Otras secuencias de listas pueden tener sus propios méritos, pero el orden alfabético a menudo no es útil, excepto en una lista muy corta de resultados de búsqueda.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#navegacion-por-el-arbol)

Navegación por el árbol


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Una interfaz de usuario puede incluir el uso de navegación en árbol para permitir al usuario navegar hacia arriba o hacia abajo en el contenido organizado en una estructura de árbol, expandiendo y contrayendo nodos según sea necesario. También se puede utilizar una jerarquía de árbol para organizar los resultados de búsqueda en una lista anidada que muestra primero las coincidencias más generales, con subtipos de coincidencias más específicas anidados debajo de ellas.

La jerarquía de subtipos de SNOMED CT puede, en algunos casos, utilizarse para estos fines. También se pueden desarrollar estructuras de navegación alternativas utilizando un Conjunto de Referencia ordenado, que se personaliza para un caso de uso específico. Por ejemplo, los usuarios pueden desear navegar al contenido de diagnósticos utilizando agrupaciones personalizadas relevantes solo para la región local.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#formularios-de-registro-de-datos)

Formularios de registro de datos


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Para el registro de datos estructurados, a menudo se utilizan formularios con plantillas. En estos casos, los conceptos o expresiones de SNOMED CT se pueden vincular a cada campo, opción o elemento de una lista. La preparación de estos enlaces es parte de la personalización de una implementación para utilizar SNOMED CT.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Spanish-Vendor-Guide&entry.670899847=Ap%C3%A9ndice%201.%20-%20Experiencia%20del%20usuario%20de%20SNOMED%20CT)

[PreviousReferenciaschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/referencias)

Last updated 5 months ago

*   [Identificadores de conceptos de SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#identificadores-de-conceptos-de-snomed-ct)
    
*   [Término preferido y sinónimos](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#termino-preferido-y-sinonimos)
    
*   [Descripción completa (FSN)](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#descripcion-completa-fsn)
    
*   [Restricción de los resultados de búsqueda](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#restriccion-de-los-resultados-de-busqueda)
    
*   [Ordenar los resultados de la búsqueda](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#ordenar-los-resultados-de-la-busqueda)
    
*   [Navegación por el árbol](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#navegacion-por-el-arbol)
    
*   [Formularios de registro de datos](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/apndice-1-experiencia-del-usuario-de-snomed-ct#formularios-de-registro-de-datos)
    

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# SNOMED International Governance, Advisory Groups and Events | Practical Guides SNOMED NRC Guide | SNOMED International Documents

It is important that all Members are familiar with the existence and responsibilities of the different bodies and forums of SNOMED International in order for the them to know what roles and responsibilities the Member and, more specifically, the NRC plays (or can play) within these, but also to be acquainted with the support and benefit each Member can get by engaging in the different forums.

The bodies and forums of SNOMED International are the foundation for the continuous maintenance, development and distribution of SNOMED CT, and they provide the organizational framework for communication and collaboration between the different parts of the SNOMED CT community.

An overview of the different Bodies and Forums is shown below

Figure 13. SNOMED International Governance and Advisory Structures.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3066103899-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FP1frmzZuNvoHsCrG7SKQ%252Fuploads%252Fgit-blob-5de71cc944f6307daad4c1a1ebf0d0bf185556c9%252F254968133.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=5aacb408&sv=2)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#general-assembly)

General Assembly


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The General Assembly is the highest authority in SNOMED International and contains one representative from each of its national Members. The General Assembly is collectively responsible for assuring that the Purpose, Objects and Principles of the Association are pursued and that the interests of SNOMED International are safeguarded. It can make binding decisions regarding all matters relating to SNOMED International, subject to and in accordance with the provisions of the Articles of Association, such as budget, work plan and strategic goals. It is recommended though not required that General Assembly representatives attend all meetings. Face-to-face meetings occur usually twice per year with occasional teleconferences and electronic voting.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#management-board)

Management Board


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The Management Board is appointed by the General Assembly. The Management Board directs the Association and has the responsibility for key business decisions. It has at least four face-to-face meetings per year with occasional teleconferences between these meetings.

The Management Board also appoints the Chief Executive Officer (CEO), who has day-to-day responsibility for running the organization. A Senior Management Team, with members each responsible for a particular line of business, supports the CEO and directs the work of employees.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#advisory-bodies)

Advisory bodies


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#member-forum)

Member Forum

Each Member is entitled to nominate two representatives to the Member Forum (MF). The MF acts as a non-voting advisory body to the CEO and Senior Management Team.

The MF is also a means for optimizing the collaboration and coordination among SNOMED International Member countries provides a means for Members to have discussions on specific Member issues. Moreover, the MF facilitates contact and communication between countries with similar foundations, needs, priorities, etc. It is recommended that each Member gets involved in the MF.

The MF can raise issues of concern to the CEO and Senior Management Team and is also requested to provide specific feedback on national priorities and other matters. The MF is the conduit for communicating widely on consultations that SNOMED International may undertake. These consultations may include specific issues related to SNOMED CT content or SNOMED International documents, products and services. The MF is also a key player in determining which SNOMED International work items should be undertaken and prioritized.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#advisory-groups)

Advisory Groups

Advisory Groups were established in June 2015 to conduct specific activities that contribute to the fulfillment of the Senior Management Team's responsibilities or the organization's mandate. They are meant to be agile, given the changing needs and direction of the organization, therefore, each group is reviewed on an annual basis to determine if it is still required or if changes in the Terms of Reference are needed. Generally, Advisory Group members have specific skills and abilities related to that particular group.

The role of each Advisory Group is to provide advice to the applicable Senior Management Team member(s) on specific areas that are included in the Terms of Reference to further the knowledge and direction of the organization. At the beginning of each year, each Advisory Group develops a group work plan outline, determines whether Task and Finish sub-groups are required, outlines any resource requirements needed, and lays out a set of measures in order to monitor the progress of the applicable group work plan. The organization, with the approval of the Management Board, may elect to seek approval for separate budget items in the annual budget to assist the Advisory Groups in the completion of their approved work plans. All work plans are to be submitted to the CEO annually for review and approval.

NRCs should note that Advisory Group members are selected by two different nomination processes. The Terms of Reference of each Advisory Group describes which of the two is relevant (or if a combination of the two is used).

**Member-based nominations**

Member-based nominations are used when SNOMED International seeks to create a forum for SNOMED International staff to work closely with Members. Under this system, Members nominate representatives to serve on an Advisory Group, so the Advisory Group members represent their countries. Typically the Senior Management Team member who chairs the Advisory Group contacts the General Assembly and Member Forum representatives in May or June and invites them to nominate representatives with a particular skill set. SNOMED International then accepts all of those nominees or a subset of them. Any travel expenses of the Advisory Group members to attend approved face-to-face events are then assumed to be the responsibility of the Member. A Member's refusal or inability to pay these expenses does not invalidate or prejudice the nomination in any way, and teleconferencing for those who cannot attend in person is a typical option.

**Standard nominations**

Other Advisory Groups rely on a standard, open, skills-based nomination process. Advisory Group members selected through this process may submit to SNOMED International any approved travel expenses for reimbursement to attend approved face-to-face Advisory Group events (the SNOMED International Travel Policy has more information about approved expenses and means of submission).

Can Members nominate individuals to serve on Advisory Groups that utilize the standard nomination process? Yes. For example, a Member may nominate its NRC IT expert to serve on the Modeling Advisory Group, which uses the standard nomination process. SNOMED International may select them based on their skills. Who then pays for the travel expenses to attend an Advisory Group face-to-face meeting? The elected person would be entitled (but not required) to submit their expenses for reimbursement from SNOMED International, on the basis that they are serving on the Advisory Group as an expert, and not as a Member representative.

Table 1: Advisory Groups and their Nomination Processes

Group name

Nomination process

[**Content Managers AG**arrow-up-right](https://conf.spaces.snomed.org/wiki/spaces/cmag/overview)

Member-based

[**E-Learning AG**arrow-up-right](https://conf.spaces.snomed.org/wiki/spaces/ELAG/overview)

Member-based

[**Modeling AG**arrow-up-right](https://conf.spaces.snomed.org/wiki/spaces/mag/overview)

Standard

[**SNOMED CT Editorial AG**arrow-up-right](https://conf.spaces.snomed.org/wiki/spaces/editorialag/overview)

Standard

[**Terminology Release AG**arrow-up-right](https://conf.spaces.snomed.org/wiki/spaces/TRAG/overview)

Standard

[**Manage Service User Group**arrow-up-right](https://conf.spaces.snomed.org/wiki/spaces/TUAG/overview)

Member-based

More information about Advisory Groups can be found at [http://snomed.org/advisoryarrow-up-right](http://snomed.org/advisory)
.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#clinical-reference-groups)

Clinical Reference Groups

Clinical input to support the development of SNOMED CT is delivered through Clinical Reference Groups. These groups are focused on clinical specialities, with each specialty are having its own Confluence based site. Each site supports discussion and knowledge sharing. Access to the Clinical Reference Groups is though a central Confluence portal focused on clinical engagement activities at [http://snomed.org/crgarrow-up-right](http://snomed.org/crg)
.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#snomed-international-collaborative-space-snomed-spaces)

SNOMED International Collaborative Space – SNOMED Spaces

[SNOMED Spacesarrow-up-right](https://conf.spaces.snomed.org/wiki/spaces)
 is a space where the people within SNOMED International Governance and Advisory Bodies can view information.

Members, Affiliates, or other interested parties can access the space to learn more about SNOMED International and SNOMED CT. The space also enables viewing information about Advisory Groups, Clinical Reference Groups and Project Groups.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#snomed-forums)

SNOMED Forums

[SNOMED Forumsarrow-up-right](https://forums.snomed.org/)
 is used for announcements, colloboration and discussion. It is used for connecting the SNOMED CT Community through open discussion and knowledge sharing.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#snomed-international-meetings-and-events)

SNOMED International Meetings and Events


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

SNOMED International arranges two events a year. In April it holds a Business Meeting and in October a second Business Meeting is combined with the annual SNOMED CT EXPO. The venue of the October event varies each year and Members encouraged to submit proposals for hosting the event in their country.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#business-meetings)

Business Meetings

SNOMED International Business Meetings include face-to-face meetings of SNOMED International Governance Bodies and Advisory Groups. Business Meetings may also include face-to-face meetings of some Project Groups and Clinical Reference Groups.

While meetings of Advisory Groups are open to observers, some sessions of other groups are closed and may only be attended by members of the relevant bodies.

A key part of each Business Meeting is the open meeting of the General Assembly, where the key strategic decisions, plans and achievements are made and announced.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#snomed-ct-expo)

SNOMED CT EXPO

The [SNOMED CT EXPOarrow-up-right](https://www.snomed.org/snomedct-expo)
 is an open event for anyone interested in SNOMED CT and practical applications of the terminology. The event includes invited keynote speakers and several tracks of peer-reviewed presentations about SNOMED CT in general with a focus on implementation experiences and developments that facilitate more effective use of the terminology.

The EXPO also includes tutorials and workshops for those seeking greater understanding of SNOMED CT, an exhibition of vendor products that use SNOMED CT and a range of poster presentations on related topics.

The EXPO is the main annual event in SNOMED International calendar for anyone interested in the use and development of the global healthcare terminology. In addition to the scheduled sessions, it provides an excellent opportunity to network with others with a shared interest in SNOMED CT.

* * *

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=NRC+Guide&entry.670899847=SNOMED%20International%20Governance%2C%20Advisory%20Groups%20and%20Events)

[PreviousContent Development and SNOMED CT customizationchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization)
[NextFurther informationchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/further-information)

Last updated 5 months ago

*   [General Assembly](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#general-assembly)
    
*   [Management Board](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#management-board)
    
*   [Advisory bodies](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#advisory-bodies)
    
*   [Member Forum](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#member-forum)
    
*   [Advisory Groups](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#advisory-groups)
    
*   [Clinical Reference Groups](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#clinical-reference-groups)
    
*   [SNOMED International Collaborative Space – SNOMED Spaces](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#snomed-international-collaborative-space-snomed-spaces)
    
*   [SNOMED Forums](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#snomed-forums)
    
*   [SNOMED International Meetings and Events](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#snomed-international-meetings-and-events)
    
*   [Business Meetings](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#business-meetings)
    
*   [SNOMED CT EXPO](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events#snomed-ct-expo)
    

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# Further information | Practical Guides SNOMED NRC Guide | SNOMED International Documents

The NRC Guide is intended as a useful starting point for National Release Centers. More detailed information and a range of informative documents and training materials can be accessed from the SNOMED International web site [http://www.snomed.orgarrow-up-right](http://www.snomed.org/)
. The table below provides links to many of the key resources for further learning about SNOMED CT.

**Topic**

**Key reference**

**General information about SNOMED CT**

Materials include what is SNOMED CT?, value and benefits, and information about licensing.

[https://www.snomed.org/what-is-snomed-ctarrow-up-right](https://www.snomed.org/what-is-snomed-ct)
[https://www.snomed.org/value-of-snomedctarrow-up-right](https://www.snomed.org/value-of-snomedct)
 [https://www.snomed.org/licensingarrow-up-right](https://www.snomed.org/licensing)

**SNOMED CT Document Library**

Access to a wide range of documents about SNOMED CT

[http://snomed.org/docarrow-up-right](http://snomed.org/doc)

**SNOMED CT Browsers**

The SNOMED International Browser and a list of other tools for exploring SNOMED CT content

[http://browser.ihtsdotools.orgarrow-up-right](http://browser.ihtsdotools.org/)
 [https://www.implementation.snomed.org/browsersarrow-up-right](https://www.implementation.snomed.org/browsers)

**SNOMED CT In Action**

Examples of how SNOMED CT is being used around the world.

[https://www.snomed.org/snomed-in-actionarrow-up-right](https://www.snomed.org/snomed-in-action)

**SNOMED CT Starter Guide**

A general purpose introduction to SNOMED CT which complements this guide.

[http://snomed.org/starterguide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/)

**Vendor Guide**

The Vendor Introduction to SNOMED CT provides an informative practical introduction to SNOMED CT focused primarily on the needs of vendors and developers of EHRs.

[http://snomed.org/vendorintro](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/)

**SNOMED CT E-Learning Server**

Access to a growing range of online training resources about SNOMED CT. Including formal courses and open-access materials.

[http://snomed.org/elearningarrow-up-right](http://snomed.org/elearning)

**SNOMED CT Expo Presentations**

Presentation materials

[https://www.youtube.com/@snomedct/playlistsarrow-up-right](https://www.youtube.com/@snomedct/playlists)

**About SNOMED International**

More information about the organization that owns and maintains SNOMED CT

[https://www.snomed.org/about-usarrow-up-right](https://www.snomed.org/about-us)
[https://www.snomed.org/get-involvedarrow-up-right](https://www.snomed.org/get-involved)
[http://snomed.org/membersarrow-up-right](http://snomed.org/members)
[https://www.snomed.org/our-partnershipsarrow-up-right](https://www.snomed.org/our-partnerships)
[https://www.snomed.org/snomed-ct-marketplacearrow-up-right](https://www.snomed.org/snomed-ct-marketplace)

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=NRC+Guide&entry.670899847=Further%20information)

[PreviousSNOMED International Governance, Advisory Groups and Eventschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/snomed-international-governance-advisory-groups-and-events)

Last updated 5 days ago

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# SNOMED CT Starter Guide | Practical Guides | SNOMED International Documents

The SNOMED CT Starter Guide is designed as a practical introduction for anyone interested in understanding SNOMED CT, the global standard for clinical terminology. Its goal is to provide a high-level, accessible overview that helps readers begin exploring how SNOMED CT supports effective healthcare information management.

[Introduction](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/readme-1)

[SNOMED CT Benefits](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits)

[Using SNOMED CT in Clinical Information](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information)

[SNOMED CT Basics](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics)

[SNOMED CT Logical Model](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/5-snomed-ct-logical-model)

[SNOMED CT Concept Model](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model)

[SNOMED CT Expressions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/7-snomed-ct-expressions)

[SNOMED CT Implementation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation)

[Content Development](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/9-content-development)

[Extension and Customization](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/10-extension-and-customization)

[Translations and Language Preferences](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/11-translations-and-language-preferences)

[Mapping](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping)

[Release Schedule and File Formats](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/13-release-schedule-and-file-formats)

[The Organization Behind SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct)

[Learning More About SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/15-learning-more-about-snomed-ct)

circle-info

© Copyright 2026 International Health Terminology Standards Development Organisation, all rights reserved.

This document is a publication of International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED International owns and maintains SNOMED CT®.

Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. This document may be subject to updates. Always use the latest version of this document published by SNOMED International. This can be viewed online and downloaded by following the links on the front page or cover of this document.

SNOMED®, SNOMED CT® and IHTSDO® are registered trademarks of International Health Terminology Standards Development Organisation. SNOMED CT® licensing information is available at [http://snomed.org/licensingarrow-up-right](http://snomed.org/licensing)
. For more information about SNOMED International and SNOMED International Membership, please refer to [http://www.snomed.orgarrow-up-right](http://www.ihtsdo.org/)
 or contact us at [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#1b72757d745b72736f687f743574697c)
.

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Last updated 7 months ago

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# Navegadores de SNOMED CT | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

Los Navegadores SNOMED CT son aplicaciones o herramientas de software utilizadas para buscar, navegar, visualizar y revisar contenidos terminológicos. Para los CNR que deseen que los usuarios y usuarios potenciales aumenten y mejoren sus conocimientos de SNOMED CT, puede ser una buena idea poner a su disposición un navegador gratuito de SNOMED CT.

Un navegador típico puede localizar conceptos y descripciones haciendo búsquedas basadas en el texto de las descripciones (términos) o introduciendo identificadores de SNOMED CT. Los navegadores también pueden proporcionar una forma de navegar por las jerarquías de SNOMED CT. Los navegadores pueden mostrar vistas de varios artefactos, incluido el conjunto de descripciones relacionadas, las relaciones jerárquicas y otras relaciones definitorias de un concepto.

Existe una gran variedad de navegadores de SNOMED CT disponibles en línea, como aplicaciones descargables o como aplicaciones basadas en web. Pero un Miembro también puede optar por desarrollar su propio navegador de SNOMED CT y ponerlo a disposición de los usuarios nacionales. Esto es especialmente importante si se desarrollan contenidos de SNOMED CT personalizados a nivel nacional que deban ser navegables, como traducciones, conjuntos de referencia, etc. Un CNR puede descargar e instalar el navegador de código abierto de SNOMED International para uso nacional. Al ser de código abierto, también es posible añadirle funcionalidades. Si un CNR hace esto, su contribución con nuevos componentes al repositorio de código abierto puede ser muy beneficiosa para todos los Miembros.

En la página web de SNOMED International sobre Navegadores de SNOMED CT, SNOMED International proporciona una lista de los diferentes tipos de navegadores disponibles. Es posible añadir elementos a esta lista si conoce otros navegadores que no estén incluidos. Los navegadores pueden incluirse en la lista si son aplicaciones informáticas de libre acceso que proporcionan acceso a SNOMED CT.

*   El Navegador de SNOMED International puede encontrarse aquí: [http://browser.ihtsdotools.orgarrow-up-right](http://browser.ihtsdotools.org/)
    .
    
*   En esta liga encontrará una descripción general de otros navegadores de SNOMED CT: [http://snomed.org/browsersarrow-up-right](http://snomed.org/browsers)
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Spanish+NRC+Guide&entry.670899847=Spanish%20%3A%20Navegadores%20de%20SNOMED%20CT)

[PreviousHerramientaschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/herramientas)
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Last updated 5 months ago

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# What Is a National Release Center? | Practical Guides SNOMED NRC Guide | SNOMED International Documents

A National Release Center (NRC) is an official point of contact within a Member's jurisdiction that has the responsibility to serve as the interface between SNOMED International, the national users and Affiliates, and other Members.

Figure 1. A National Release Center is the primary contact point for SNOMED International, users and other Members.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3066103899-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FP1frmzZuNvoHsCrG7SKQ%252Fuploads%252Fgit-blob-2ddfd06928dac1edb1e3372e8f01d47c6d5585a7%252F254968138.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=f659d0e&sv=2)

SNOMED International requires each Member to have a nominated organization that fulfills a small set of core NRC responsibilities. These responsibilities include receiving the International Release of SNOMED CT from SNOMED International, making it available to licensees in the Member country, and promoting and supporting adoption and deployment of SNOMED CT in the Member country. Some NRCs also provide additional products and services to support national use of SNOMED CT. Provided that the core responsibilities are fulfilled, each Member is free to decide whether or not their NRC should provide other related services or products.

For Members that choose only to distribute the International Release of SNOMED CT, the NRC can be limited to only one or two people to undertake the minimal required services. NRCs of other Members are larger organizations that have many other responsibilities related to SNOMED CT and also manage the use of other health informatics standards within that country. An NRC can be established as a new body or organization within the Member country, or it can be folded into an existing body or organization.

As the primary contact point for both national Affiliates and SNOMED International, the NRC plays a central role in effective and efficient collaboration with the various partners. The term "National Release Center" is used by SNOMED International, but a Member may give the organization that fulfills this role in their country a different name.

* * *

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[PreviousIntroductionchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/introduction)
[NextNRC Responsibilitieschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/nrc-responsibilities)

Last updated 7 months ago

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# El papel del CNR en relación con el licenciamiento de SNOMED CT | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-el-papel-del-cnr-en-relacin-con-el-licenciamiento-de-snomed-ct#licencias-de-afiliado)

Licencias de Afiliado


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Las organizaciones que desarrollen o distribuyan productos o servicios que incluyan o proporcionen acceso a SNOMED CT deben ser Afiliados de SNOMED International. Las organizaciones que utilizan SNOMED CT deben ser Afiliadas de SNOMED International o sublicenciatarias de una Afiliada de SNOMED International. Convertirse en Afiliado de SNOMED International requiere una licencia de afiliación, que es un acuerdo contractual entre SNOMED International y los Afiliados.

Aunque las Licencias de Afiliación son acuerdos entre SNOMED International y los Afiliados, los Miembros a menudo actúan como agentes intermediarios entre SNOMED International y los Afiliados al emitir las licencias. En este caso, el CNR necesita proporcionar información a SNOMED International sobre las Licencias de Afiliación emitidas por ellos. El Acuerdo de Licencia de Afiliación a SNOMED CT es una licencia mundial para el uso de la Edición Internacional de SNOMED CT. La aceptación del Acuerdo de Licencia da derecho al Afiliado a descargar las publicaciones de la Edición Internacional de SNOMED CT.

**Figura 4 Todos los acuerdos de licencia de afiliación son con SNOMED International. Sin embargo, los Miembros, como agentes de SNOMED International, pueden emitir licencias de Afiliado.**

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2133369718-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FI7N0Q2Su8RGW5pAlIrWt%252Fuploads%252Fgit-blob-a6acbc98198d600f79b5fc297d00ecca3850cd0a%252F259854833.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=ca915c87&sv=2)

\*\*

Las condiciones de uso de SNOMED CT se detallan en el [acuerdo de licencia de afiliación de SNOMED CTarrow-up-right](https://www.snomed.org/get-snomed)
. Las notas que figuran a continuación destacan algunos puntos clave sobre la disponibilidad de licencias de afiliación, las condiciones de uso y las circunstancias en las que se aplican cuotas por el uso de SNOMED CT.

Obtención de una Licencia de Afiliado a SNOMED International

*   Se le pide a los solicitantes que se encuentren en los Países Miembros que consulten la página web correspondiente para saber cómo solicitar una licencia de Afiliado en su país: [Miembrosarrow-up-right](http://www.snomed.org/members)
    .
    
*   Los solicitantes que no se encuentren en un País Miembro, o que estén en un País Miembro que no ofrezca actualmente un servicio de registro, pueden solicitar una licencia utilizando el [Servicio de Licencias y Distribución para Miembrosarrow-up-right](https://www.snomed.org/licensing)
     (MLDS).
    

**Uso de SNOMED CT en los Países Miembros** SNOMED International no cobra por el uso de la Edición Internacional de SNOMED CT en los Países Miembros. Sin embargo, un Miembro puede imponer algunas condiciones para el uso de SNOMED CT dentro de su país. **Uso de SNOMED CT fuera de los Países Miembros** Los Afiliados deben pagar [una cuota anualarrow-up-right](https://www.snomed.org/licensing)
 a SNOMED International por su uso en cada hospital, clínica u otra institución de un país que no sea Miembro de SNOMED International. Las tarifas varían en función de la riqueza del país. Los Afiliados también deberán pagar [cuotasarrow-up-right](https://www.snomed.org/licensing)
 si exponen contenidos de SNOMED CT de forma que puedan utilizarse en MiembroPaíses No Miembros. Esto incluye proporcionar acceso a SNOMED CT a través de Internet, en una aplicación web, una aplicación para teléfonos móviles o como parte de una especificación o norma publicada. **Prestación de servicios que permitan el acceso a SNOMED CT en MiembroPaíses No Miembros** Las empresas u organizaciones que proporcionen aplicaciones, portales web y otro software que incorpore todo o parte de SNOMED CT, o que publiquen mapeos u otros materiales que incluyan todo o parte de SNOMED CT necesitan el permiso de SNOMED International y una licencia para estas actividades. Aquellos que proporcionen dicho acceso a estos servicios o materiales a otra empresa u organización para su uso en un país no Miembro deben confirmar primero que dicha empresa u organización es un Licenciatario Afiliado. Además, deben asegurarse de que el receptor de los servicios o materiales comprende su obligación de informar y pagar cuotas a SNOMED International por el uso en MiembroPaíses No Miembros. **Navegadores web de SNOMED CT** Los navegadores SNOMED CT basados en la web que permiten visualizar contenidos de SNOMED CT se consideran actualmente un caso especial sobre el que SNOMED International ha publicado directrices (véase la [guía de licencias de navegadoresarrow-up-right](https://confluence.ihtsdotools.org/download/attachments/73368648/Ihtsdo_Guidance_PublicAccessBrowserAndTools_20141211.pdf)
). Sin embargo, tenga en cuenta que estas directrices sólo cubren el uso para explorar el contenido de SNOMED CT. No eximen a quienes utilizan SNOMED CT en MiembroPaíses No Miembros de la obligación de pagar cuotas por su uso.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-el-papel-del-cnr-en-relacin-con-el-licenciamiento-de-snomed-ct#licencias-nacionales)

Licencias nacionales


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Un Miembro podrá conceder a sus Afiliados licencias para el uso de su Extensión Nacional de SNOMED CT (incluidas traducciones, adiciones de contenido y conjuntos de Referencia). Estas licencias deben incluir el requisito de que el licenciatario sea titular de una licencia de Afiliado a SNOMED CT para la Edición Internacional. Una forma de conseguirlo es incluir una copia del Acuerdo de Licencia de Afiliación a SNOMED CT dentro de la Licencia Nacional. En este caso, deberá asegurarse de que la copia de este acuerdo se actualiza periódicamente con los cambios aprobados por SNOMED International.

Los términos de la Licencia Nacional podrían ser similares a los de la Licencia de Afiliación a SNOMED CT, pero con el Miembro como licenciante y la Extensión Nacional como obra licenciada. Otra posibilidad es que la Licencia Nacional forme parte de una política más general de concesión de licencias para obras de titularidad nacional. Sin embargo, SNOMED International exige que el Licenciatario de una Extensión Nacional sea también Licenciatario Afiliado de SNOMED CT (es decir, Licenciatario de SNOMED International). Un Miembro puede cumplir este requisito registrando la aceptación del Acuerdo de Licencia de Afiliación a SNOMED CT por parte del Licenciatario.

Los Miembros también pueden imponer requisitos adicionales relacionados con el uso de la Edición Internacional de SNOMED CT en sus países. Por ejemplo, un Miembro puede exigir a los Licenciatarios que utilicen la Extensión Nacional cuando desplieguen SNOMED CT en su país.

La responsabilidad formal del CNR es mantener un registro de todas las licencias concedidas por el Miembro a los Afiliados dentro del País Miembro. Este registro debe incluir información sobre:

1.  La identidad del Afiliado
    
2.  Los productos suministrados bajo licencia
    
3.  Las condiciones de pago de la licencia
    
4.  Utilización del producto en un País No Miembro
    

Si un Afiliado proporciona información sobre el uso en un país no Miembro, el Miembro está obligado a informar de ello a SNOMED International para que puedan cobrarse las cuotas correctas. En caso del cese de la afiliación, el antiguo Miembro deberá presentar a SNOMED International, en un plazo de 30 días, el registro completo de todas las licencias que haya concedido.

Se anima a los Miembros a compartir información sobre los Afiliados que hayan registrado y que tengan su sede u operen en otros Países Miembros. También deben informar a los Afiliados sobre la obtención de una Licencia Nacional en su país de origen.

**Figura 5 Los Miembros gestionan las licencias concedidas a los Afiliados para el uso nacional de SNOMED CT**

\*\*

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2133369718-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FI7N0Q2Su8RGW5pAlIrWt%252Fuploads%252Fgit-blob-24e56060c5a7e341ddfc9ba136442006b812ab74%252F259854834.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=2f3fbe1c&sv=2)

\*\*

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-el-papel-del-cnr-en-relacin-con-el-licenciamiento-de-snomed-ct#sublicencias)

Sublicencias


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Los Afiliados de SNOMED International pueden conceder sublicencias que permitan a las organizaciones/usuarios utilizar SNOMED CT como parte de una aplicación informática o un sistema de información. Una organización que no sea afiliada de SNOMED International sólo puede utilizar SNOMED CT de acuerdo con los términos de una sublicencia emitida por un Afiliado de SNOMED International.

Es responsabilidad del Afiliado gestionar estas sublicencias y poner la información sobre las mismas a disposición de SNOMED International. Los Afiliados también están obligados a informar y efectuar los pagos correspondientes cuando se utilice SNOMED CT en Países No Miembros.

La concesión de sublicencias no es una función del CNR, pero los CNR necesitan:

*   Comprender que los Afiliados están obligados a conceder sublicencias a las organizaciones que utilicen sistemas y servicios habilitados con SNOMED CT que ellos proporcionan;
    
*   Asegurarse de que los Afiliados y usuarios de su país conozcan este requisito.
    

**Figura 6 Los Afiliados otorgan sublicencias.**

\*\*

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2133369718-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FI7N0Q2Su8RGW5pAlIrWt%252Fuploads%252Fgit-blob-b0114c60fa2dbbfb4d4e6014d3ec2c0de4f90fff%252F259854835.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=e5c8efe&sv=2)

\*\*

Los Miembros no están obligados a facilitar o gestionar sublicencias. Sin embargo, como principal punto de contacto para los Afiliados nacionales, un CNR debe ser capaz de apoyar y orientar a los Afiliados en asuntos relacionados con la gestión de sublicencias y de indicar a los Afiliados la fuente de información adecuada dentro de SNOMED International.

Licencia y distribución de SNOMED CT - Herramientas

SNOMED International proporciona una plataforma para la concesión de licencias y la distribución de SNOMED CT para sus Países Miembros. Este servicio se denomina [Servicios de Licenciamiento y Distribución para Miembrosarrow-up-right](https://mlds.ihtsdotools.org/)
 (MLDS) y permite al CNR disponer de un portal web en el idioma preferido en el que los Afiliados pueden registrarse y actualizar su información de licencia, así como descargar SNOMED CT y otros productos relacionados. El CNR es responsable de traducir la terminología de la interfaz, etc., pero SNOMED International ayuda al CNR a empezar. Una vez registrado en el MLDS, un Afiliado puede acceder a la distribución nacional del CNR, así como a otros productos del CNR, siempre que el País Miembro utilice MLDS. Para más información sobre el uso del MLDS en su país, póngase en contacto con su Ejecutivo de Relaciones con el Cliente. (para Latinoamérica: [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#61170c0421120f0e0c04054f0e1306)
).

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Spanish+NRC+Guide&entry.670899847=El%20papel%20del%20CNR%20en%20relaci%C3%B3n%20con%20el%20licenciamiento%20de%20SNOMED%20CT)

[PreviousFases de la organización del CNRchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-fases-de-la-organizacin-del-cnr)
[NextAsesoramiento para la implementaciónchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-asesoramiento-para-la-implementacin)

Last updated 5 months ago

*   [Licencias de Afiliado](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-el-papel-del-cnr-en-relacin-con-el-licenciamiento-de-snomed-ct#licencias-de-afiliado)
    
*   [Licencias nacionales](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-el-papel-del-cnr-en-relacin-con-el-licenciamiento-de-snomed-ct#licencias-nacionales)
    
*   [Sublicencias](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-el-papel-del-cnr-en-relacin-con-el-licenciamiento-de-snomed-ct#sublicencias)
    

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# Educación y capacitación | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

Los usuarios deben estar dotados de los conocimientos y habilidades adecuados que les permitan practicar las tareas asignadas a un grupo de usuarios específico. Además, es importante capacitar a los usuarios para que comprendan y apliquen SNOMED CT de acuerdo con la visión, la estrategia y la infraestructura de cada País Miembro. En las siguientes secciones se consideran las funciones de SNOMED International y los CNR en la educación y capacitación relacionadas con SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-educacin-y-capacitacin#el-papel-de-snomed-international-en-la-educacion-sobre-snomed-ct)

El papel de SNOMED International en la educación sobre SNOMED CT


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

La función general de SNOMED International en la educación y capacitación sobre SNOMED CT es proporcionar información coherente sobre SNOMED CT, asesoramiento sobre sus ventajas y orientación sobre formas eficaces de utilizar SNOMED CT para obtener dichas ventajas. Además, siempre que es posible, SNOMED International comparte sus documentos y servicios de educación de forma que los CNR puedan reutilizarlos, traducirlos y personalizarlos para cumplir los requisitos nacionales. A continuación se describen los documentos, recursos educativos y servicios que SNOMED International ofrece para ayudar en el proceso de aprendizaje de SNOMED CT.

**Biblioteca de documentos de SNOMED CT**

La Biblioteca de documentos de SNOMED CT proporciona acceso en línea a una amplia gama de documentos relacionados con SNOMED CT. Estos documentos abarcan desde introducciones a SNOMED CT dirigidas a públicos concretos, hasta especificaciones detalladas, guías especializadas e informes. En las páginas web de la Biblioteca de documentos encontrará una breve introducción a cada uno de los documentos y un enlace que le permitirá acceder libremente a ellos. Estos documentos pueden consultarse en línea o descargarse en formato PDF, y en muchos casos en ambos formatos. Algunos documentos incluyen borradores, por lo que los lectores deben conocer el estado del documento o de la sección, que se indica mediante notas de estado textuales en páginas individuales o en el prefacio del documento.

La Biblioteca de documentos[(http://snomed.org/docarrow-up-right](http://snomed.org/doc)
) proporciona acceso a los documentos clave sobre SNOMED CT.

Documentos clave

*   La [Guía de Inicioarrow-up-right](https://confluence.ihtsdotools.org/display/DOCSTART)
     de SNOMED CT es un punto de partida práctico y útil desde el que cualquier persona con un interés general en la información en salud puede empezar a aprender sobre SNOMED CT.
    
*   La [Guía Práctica de Extensionesarrow-up-right](https://confluence.ihtsdotools.org/display/DOCEXTPG/Extensions+Practical+Guide)
     presenta la finalidad, el proceso y los principios de la creación, distribución y gestión de extensiones de SNOMED CT. Los productores de extensiones deben familiarizarse con esta guía para garantizar la calidad e integridad de las ediciones de SNOMED CT que publican.
    
*   La [Especificación de Archivos de Publicación de SNOMED CTarrow-up-right](https://confluence.ihtsdotools.org/display/DOCRELFMT)
    , que define formalmente los formatos de archivo en los que SNOMED CT se distribuye a los Miembros y Afiliados de SNOMED International.
    

Los comentarios de los Miembros sobre la documentación son importantes para que SNOMED International garantice que los lectores dispongan del mejor material posible para aprender sobre SNOMED CT. Se ruega a los Miembros/usuarios/lectores que envíen cualquier tipo de comentario sobre la documentación, por ejemplo si se detectan fallos claros o falta de contenido, o si hay partes que necesitan aclaración.

Los comentarios sobre los documentos en línea pueden enviarse como comentarios en las páginas del documento publicado. Para los documentos que no están disponibles en línea, busque en el documento los detalles sobre cómo hacer comentarios.

**Guía de Inicio de SNOMED CT y Guía de Recursos Educativos**

La Guía de Inicio de SNOMED CT ofrece una visión general de los fundamentos de SNOMED CT. La Guía de Recursos Educativos ofrece información detallada sobre material educativo que abarca una serie de temas relacionados con SNOMED CT. Ambos pueden encontrarse [aquíarrow-up-right](https://elearning.ihtsdotools.org/course/view.php?id=5&section=1)
.

**Cursos de aprendizaje electrónico de SNOMED CT**

SNOMED International ofrece una amplia gama de ofertas educativas. A continuación se presenta el conjunto de cursos, itinerarios de aprendizaje y exámenes de certificación.

![(info)](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2133369718-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FI7N0Q2Su8RGW5pAlIrWt%252Fuploads%252Fgit-blob-b7f92e05f893b45ac6d7189bc175343326b2ad98%252Finformation.svg%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=30970571&sv=2)

Catálogo de cursos y plataforma de aprendizaje electrónicoPara inscribirse en todos los cursos y exámenes de certificación SNOMED CT, visite nuestro catálogo de cursos SNOMED CT en y seleccione el producto educativo correspondiente. Puede acceder a nuestra plataforma de aprendizaje electrónico, que alberga la mayor parte de nuestra oferta educativa en\[ https:// elearning.ihtsdotools.org\](https://elearning.ihtsdotools.org/)

**Cursos**

*   [**Curso de Fundamentos**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=FCE)
    
    *   El objetivo del curso es proporcionar la cobertura de una amplia gama de temas relacionados con SNOMED CT a un nivel relativamente básico. También permite avanzar a una una comprensión más detallada de SNOMED CT al permitir a aquellos que completen este curso unirse a cursos de aprendizaje electrónico de SNOMED CT más avanzados en el futuro.
        
    
*   [**Curso de Implementación**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=ICE)
    
    *   Este curso se basa en los conocimientos adquiridos durante el Curso de Fundamentos de SNOMED CT. Proporciona una comprensión de SNOMED CT suficiente para quienes participan en las distintas partes del proceso de implementación: desde la decisión de adoptar SNOMED CT, pasando por la especificación y adquisición y/o diseño y desarrollo de soluciones habilitadas con SNOMED CT, hasta el despliegue y su uso práctico.
        
    
*   [**Curso de Autoría Nivel 1**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=AL1)
    
    *   Este curso le enseña los conocimientos y habilidades necesarios para realizar tareas básicas de autoría de SNOMED CT. Los estudiantes tendrán la oportunidad de aprender y practicar tareas de autoría utilizando una versión educativa de la plataforma de autoría de SNOMED International. Los ejercicios de autoría se realizarán en una extensión ficticia.
        
    
*   [**Curso de Autoría Nivel 2**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=AL2)
    
    *   Este curso enseña a los autores experimentados de SNOMED CT a ampliar y desarrollar sus habilidades de autoría. El curso se centra principalmente en el aprendizaje de los alumnos a través de ejercicios prácticos de autoría realizados en nuestra plataforma de autoría educativa y a través de seminarios web interactivos con autores experimentados. Este curso es un pre-requisito para el examen de certificación de Autoría Nivel 2 de SNOMED CT.
        
    

**Rutas de aprendizaje**

Las rutas de aprendizaje de SNOMED International contienen una colección de recursos de e-Learning diseñados para enseñar de forma flexible un conjunto de habilidades específicas de SNOMED CT. Las rutas de aprendizaje actualmente disponibles incluyen:

*   [**SNOMED CT para Desarrolladores**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=DEV)
    \- El objetivo de esta ruta de aprendizaje es enseñarle lo suficiente sobre SNOMED CT en el menor tiempo posible para que pueda desarrollar aplicaciones de software que aprovechen sus capacidades.
    
*   [**SNOMED CT para Analistas de Datos**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=DAN)
     - El objetivo de esta ruta de aprendizaje es proporcionar una sólida comprensión de cómo SNOMED CT puede utilizarse para apoyar sus requisitos de análisis de datos clínicos.
    
*   [**SNOMED CT para Clínicos**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=CLI)
     - El objetivo de esta ruta de aprendizaje es proporcionar una introducción al por qué, el qué y el cómo de SNOMED CT desde una perspectiva clínica.
    
*   [SNOMED CT para Traductoresarrow-up-right](https://courses.ihtsdotools.org/product?catalog=TRA)
     - Esta breve ruta de aprendizaje presenta SNOMED CT a los traductores y cubre los requisitos comunes para comprender SNOMED CT. Incorpora contenidos de e-Learning de cursos preexistentes. Al completar este itinerario, el alumno tendrá los conocimientos básicos de SNOMED CT que un traductor puede necesitar para realizar una traducción.
    

**Exámenes de certificación**

Los exámenes de certificación de SNOMED International permiten a las personas ser reconocidas por sus capacidades en áreas de habilidades específicas. Actualmente, SNOMED International ofrece tres exámenes de certificación:

*   [**Certificación de Autoría Nivel 1 de SNOMED CT**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=AC1)
     - Esta certificación reconoce su competencia en la realización de tareas básicas de autoría de SNOMED CT.
    
*   [**Certificación de Autoría Nivel 2 de SNOMED CT**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=AC2)
     - Esta certificación reconoce su competencia en la realización de tareas básicas de autoría de SNOMED CT.
    

**Ventajas educativas para los Afiliados**

Como parte de los "Beneficios de Afiliación Mejorados", cada Afiliado tiene derecho a los siguientes beneficios educativos:

*   Cursos gratuitos de SNOMED CT
    
*   Descuento de afiliación para todas las certificaciones ofrecidas
    
*   Acceso a un examen de certificación gratuito al año
    

A los participantes se les ofrecerá **automáticamente un descuento de afiliación** cuando accedan a su cuenta de e-Learning durante el proceso de inscripción.

Los Centros Nacionales de Referencia de SNOMED (CNR) pueden solicitar su **inscripción gratuita** en cualquiera de nuestros exámenes de certificación enviando un correo electrónico a [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#2c4940494d5e4245424b6c5f424341494802435e4b)
 para solicitar un cupón de "Miembro gratuito". Este vale puede utilizarse para matricularse gratuitamente a través de nuestro [Catálogo de cursosarrow-up-right](https://courses.ihtsdotools.org/)
. Por favor, incluya el nombre y el correo electrónico de la persona que se inscribirá, y la ruta de certificación en la que le gustaría participar. A continuación, enviaremos el vale al participante seleccionado. Todas las asignaciones de vales "Miembro gratis" deben ser aprobadas por el representante del Foro de Miembros en el respectivo País/territorio Miembro.

Tenga en cuenta que los CNR pueden reclamar sus inscripciones gratuitas en cada una de nuestras certificaciones anualmente, así que aproveche esta oferta para educar a su equipo local.

**Asociaciones educativas**

SNOMED International busca establecer asociaciones con organizaciones de nuestros países y territorios Miembros que estén interesadas en traducir una o más de nuestras ofertas educativas a su lengua materna. Para más información, envíe una solicitud a nuestro servicio de apoyo a la educación ([\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#52373e3733203c3b3c3512213c3d3f37367c3d2035)
).

**SNOMED en acción**

SNOMED International tiene un sitio web llamado SNOMED In Action, que ofrece a los Miembros y a otros usuarios la oportunidad de registrar implementaciones de SNOMED CT y proporcionar diversos detalles sobre implementaciones y usos específicos de SNOMED CT. Otros Miembros y usuarios pueden inspirarse para seguir estos ejemplos, o ponerse en contacto con personas e instituciones que hayan participado en implementaciones específicas de SNOMED CT.

SNOMED International anima a sus Miembros y a otras partes interesadas y usuarios a registrar sus implementaciones de SNOMED CT en este sitio para facilitar el intercambio de conocimientos y la concientización sobre cómo puede aplicarse SNOMED CT y cómo aprovechar sus ventajas.

En esta página web encontrará una visión general de diferentes ejemplos de SNOMED CT en uso, y también tiene la oportunidad de registrar su propia implementación de SNOMED: [https://www.snomed.org/snomed-in-action.arrow-up-right](https://www.snomed.org/snomed-in-action)

**Portal de apoyo a la implementación de SNOMED CT**

Implementar con éxito SNOMED CT es crucial para aprovechar sus ventajas para los usuarios. El [**Portal de apoyo a la implementación**arrow-up-right](https://www.implementation.snomed.org/)
 es un recurso completo para las personas y organizaciones interesadas en implementar SNOMED CT en sus sistemas sanitarios. Proporciona acceso a una amplia gama de recursos y herramientas, así como orientación y apoyo, para ayudar a los usuarios a aplicarlos con éxito.

**Catálogo de productos y servicios**

Esta es una [guía arrow-up-right](https://www.snomed.org/resources)
completa de nuestros productos y servicios, con descripciones y enlaces. Sugiere grupos de productos y servicios para distintos grupos de clientes.

**Valor de SNOMED CT**

La página web sobre [el valor de SNOMED CTarrow-up-right](https://www.snomed.org/value-of-snomedct)
 es un recurso útil que incluye los argumentos a favor de la inversión y las ventajas de SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-educacin-y-capacitacin#funciones-del-cnr-en-la-educacion-sobre-snomed-ct)

Funciones del CNR en la educación sobre SNOMED CT


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Para abordar los requisitos nacionales de implementación, se anima a los CNR a complementar o personalizar los recursos de educación publicados por SNOMED International. Esto incluye la traducción de documentos y recursos de educación cuando sea necesario. La educación relacionada con algunos aspectos específicos de las estrategias nacionales puede ser satisfecha con materiales desarrollados desde cero por el CNR. Por ejemplo, si se van a utilizar conjuntos de referencia específicos dentro de ámbitos clínicos concretos para cumplir requisitos de reporteo específicos, podrían necesitarse orientaciones sobre el uso de estos conjuntos de referencia junto con información sobre los procedimientos de reporteo.

Tanto si un CNR elabora sus propios materiales de formación como si modifica los recursos proporcionados por SNOMED International, es importante que cualquier explicación de SNOMED CT sea precisa y conforme a las especificaciones formales de SNOMED CT. Por lo tanto, el CNR debe revisar periódicamente sus materiales de educación relacionados con SNOMED CT para garantizar la alineación con las actualizaciones de los materiales internacionales.

Si un CNR asume la educación de los Afiliados y usuarios nacionales, es importante que el personal del CNR tenga un conocimiento amplio y profundo de los diferentes niveles y posibilidades de aplicación y pueda ayudar con las peticiones de los diferentes grupos de usuarios. Alternativamente, el CNR puede aconsejar o dirigir a los Afiliados a espacios y personas donde puedan obtener la orientación adecuada. Por lo tanto, el CNR debe estar al tanto de las personas, a nivel nacional o internacional, que tienen las competencias adecuadas para educar y orientar a los usuarios sobre temas específicos. Una combinación de recursos internos y externos para proporcionar formación y educación es una solución razonable para muchos CNR.

Cada persona aprende de una forma diferente. El CNR podría considerar la posibilidad de impartir formación presencial o en línea para que las personas tengan la oportunidad de hacer preguntas y desarrollar sus ideas. Unas breves sesiones introductorias sobre los principios de SNOMED CT y un recorrido por la versión son buenas formas de iniciar a los usuarios. De este modo, los materiales de referencia les resultarán mucho más accesibles.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Spanish+NRC+Guide&entry.670899847=Educaci%C3%B3n%20y%20capacitaci%C3%B3n)

[PreviousParticipación de las partes interesadaschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-participacin-de-las-partes-interesadas)
[NextHerramientaschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/herramientas)

Last updated 5 months ago

*   [El papel de SNOMED International en la educación sobre SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-educacin-y-capacitacin#el-papel-de-snomed-international-en-la-educacion-sobre-snomed-ct)
    
*   [Funciones del CNR en la educación sobre SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-educacin-y-capacitacin#funciones-del-cnr-en-la-educacion-sobre-snomed-ct)
    

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# Introduction | Practical Guides | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/readme-1#goals-and-objectives)

Goals and Objectives


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The vision for the SNOMED CT Starter Guide is for it to be a practical and useful starting point from which anyone with a general interest in healthcare information can begin learning about SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/readme-1#target-audience)

Target Audience


-----------------------------------------------------------------------------------------------------------------------------------

The target audience for this Starter Guide includes people from various disciplines who may be involved at any point in the SNOMED CT information management cycle – from initial planning, clinical content definition and implementation through to use of the resulting clinical information. This spans people involved with planning and deciding to proceed and resource a SNOMED CT implementation, people involved in reference set development, terminology management, technical implementation and all aspects of deployment and use. It also includes people involved in clinical information retrieval, analyses, decision support and other aspects of knowledge representation. The characteristics common to all members of the target audience are that they have a reason for wanting to understand SNOMED CT and are seeking a high-level initial overview of topics of which they need to be aware. The Starter Guide does not provide in depth knowledge but does provide an informative and authoritative foundation on which to build.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/readme-1#topics)

Topics


-----------------------------------------------------------------------------------------------------------------

The topics covered in this SNOMED CT Starter Guide include:

*   SNOMED CT Benefits
    
*   Using SNOMED CT in Clinical Information
    
*   SNOMED CT Basics
    
*   SNOMED CT Logical Model
    
*   SNOMED CT Concept Model
    
*   Expressions SNOMED CT Expressions
    
*   Content Development
    
*   Extension and Customization
    
*   Translation and Language Preferences
    
*   Mapping
    
*   Release Schedule and File Formats
    
*   Implementation
    
*   SNOMED International
    
*   Learning More
    

For each topic the questions addressed include:

*   Why is this important?
    
*   What is this?
    

Supporting references are included in the final chapter of the guide.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Starter+Guide&entry.670899847=1.%20Introduction)

[PreviousSNOMED CT Starter Guidechevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide)
[NextSNOMED CT Benefitschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits)

Last updated 7 months ago

*   [Goals and Objectives](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/readme-1#goals-and-objectives)
    
*   [Target Audience](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/readme-1#target-audience)
    
*   [Topics](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/readme-1#topics)
    

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# SNOMED CT Benefits | Practical Guides | SNOMED International Documents

This section provides an overview of how effective use of SNOMED CT:

*   Benefits populations
    
*   Benefits individual patients and clinicians
    
*   Supports evidence based healthcare
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits#why-is-this-important)

Why is this important?


------------------------------------------------------------------------------------------------------------------------------------------------------------

Understanding the benefits of SNOMED CT will inform key decisions and the development of strategies for adoption, implementation and use of this clinical terminology.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits#what-is-this)

What is this?


------------------------------------------------------------------------------------------------------------------------------------------

SNOMED CT supports the development of comprehensive high-quality clinical content in health records. It provides a standardized way to represent clinical phrases captured by the clinician and enables automatic interpretation of these. SNOMED CT is a clinically validated, semantically rich, controlled vocabulary that facilitates evolutionary growth in expressivity to meet emerging requirements.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F19067948-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FUmSUeu96fIQZWDm7RISx%252Fuploads%252Fgit-blob-9f04134a6f6cc23eb0b751188742aa71151ff319%252F29952939.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=faa3ac94&sv=2)

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits#electronic-health-records)

Electronic Health Records

SNOMED CT based clinical information benefits individual patients and clinicians as well as populations and it supports evidence based care.

The use of an Electronic Health Record (EHR) improves communication and increases the availability of relevant information. If clinical information is stored in ways that allow meaning-based retrieval, the benefits are greatly increased. The added benefits range from increased opportunities for real time decision support to more accurate retrospective reporting for research and management.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits#snomed-ct-enabled-health-records-benefit-individuals)

SNOMED CT Enabled Health Records Benefit Individuals

SNOMED CT enabled clinical health records benefit individuals by:

*   Enabling relevant clinical information to be recorded using consistent, common representations during a consultation.
    
*   Enabling guideline and decision support systems to check the record and provide real-time advice, for example, through clinical alerts.
    
*   Supporting the sharing of appropriate information with others involved in delivering care to a patient through data capture that allows understanding and interpretation of the information in a common way by all providers.
    
*   Allowing accurate and comprehensive searches that identify patients who require follow-up or changes of treatment based on revised guidelines.
    
*   Removing language barriers (SNOMED CT enables multilingual use).
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits#snomed-ct-enabled-health-records-benefit-populations)

SNOMED CT Enabled Health Records Benefit Populations

SNOMED CT enabled clinical health records benefit populations by:

*   Facilitating early identification of emerging health issues, monitoring of population health and responses to changing clinical practices.
    
*   Enabling accurate and targeted access to relevant information, reducing costly duplications and errors.
    
*   Enabling the delivery of relevant data to support clinical research and contribute evidence for future improvements in treatment.
    
*   Enhancing audits of care delivery with options for detailed analysis of clinical records to investigate outliers and exceptions.
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits#snomed-ct-enabled-health-records-support-evidence-based-healthcare)

SNOMED CT Enabled Health Records Support Evidence-Based Healthcare

SNOMED CT enabled health records inform evidence based health care decisions by:

*   Enabling links between clinical records and enhanced clinical guidelines and protocols.
    
*   Enhancing the quality of care experienced by individuals.
    
*   Reducing costs of inappropriate and duplicative testing and treatment.
    
*   Limiting the frequency and impact of adverse healthcare events.
    
*   Raising the cost-effectiveness and quality of care delivered to populations.
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Starter+Guide&entry.670899847=SNOMED%20CT%20Benefits)

[PreviousIntroductionchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/readme-1)
[NextUsing SNOMED CT in Clinical Informationchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information)

Last updated 7 months ago

*   [Why is this important?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits#why-is-this-important)
    
*   [What is this?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits#what-is-this)
    
*   [Electronic Health Records](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits#electronic-health-records)
    
*   [SNOMED CT Enabled Health Records Benefit Individuals](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits#snomed-ct-enabled-health-records-benefit-individuals)
    
*   [SNOMED CT Enabled Health Records Benefit Populations](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits#snomed-ct-enabled-health-records-benefit-populations)
    
*   [SNOMED CT Enabled Health Records Support Evidence-Based Healthcare](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits#snomed-ct-enabled-health-records-support-evidence-based-healthcare)
    

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# Knowledge Base | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

The knowledge base can be thought of as the brains of a clinical decision support system. Clinical knowledge is what fuels the knowledge base. This knowledge is documented by the clinical experts in their respective domains. The knowledge is then loaded into the KB as knowledge artifacts and stored in a machine processable format. These artifacts are then made available to the [inference engine](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/4-inference-engine)
 to execute the decision support logic. Knowledge artifacts may be updated when new clinical knowledge becomes available. In some CDSSs this is done using a specialized knowledge artifact management interface, which may support tasks such as rule creation, customization, and updating. In other cases, clinical knowledge artifacts are used from third party providers, who specialize in supporting CDSSs.

Types of CDS knowledge artifacts include:

*   Decision support rules
    
*   Clinical guidelines and care pathways
    
*   Documentation templates
    
*   Order sets
    

The characteristics of these knowledge artifacts are described in the section [Functional Areas](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#functional-areas)
.

The diagram below illustrates the key interactions with the knowledge base, as described above.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-0360503f209e3b2fb3d1fd03ce3d52586be1547d%252F123897476.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=5dfe289b&sv=2)

Knowledge base interactions

The topics below are presented in more detail in the following sections:

*   [Rules](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.1-rules)
    
*   [Guidelines](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines)
    
*   [Substrate](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.3-substrate)
    

* * *

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[NextRuleschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.1-rules)

Last updated 5 months ago

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# Desarrollo de contenidos y personalización de SNOMED CT | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

Para que la adopción de SNOMED CT tenga éxito, es importante que la terminología se ajuste a los requisitos de los casos de uso específicos en un país determinado o dentro de una organización determinada. En la mayoría de las situaciones, esto requiere ajustar o ampliar la terminología, lo que puede hacerse de varias maneras. SNOMED International autoriza a los Miembros y Afiliados a mantener y suministrar componentes y derivados adicionales conocidos como Extensiones de SNOMED CT. Estas extensiones son la manera formal de adaptar SNOMED CT a las necesidades específicas de los usuarios.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-desarrollo-de-contenidos-y-personalizacin-de-snomed-ct#extensiones)

Extensiones


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Los Miembros podrán mantener y suministrar componentes terminológicos adicionales y derivados que adapten la terminología a los requisitos nacionales específicos. Además, los Afiliados de SNOMED International también pueden mantener y suministrar componentes terminológicos adicionales y derivados que adapten la terminología para satisfacer las necesidades de una organización, cliente o solución de software concretos. Por tanto, las extensiones pueden distinguirse como Extensiones Nacionales o Extensiones de Afiliados.

*   La [Guía práctica de extensionesarrow-up-right](https://confluence.ihtsdotools.org/display/DOCEXTPG/Extensions+Practical+Guide)
     presenta la finalidad, el proceso y los principios de la creación, distribución y gestión de extensiones de SNOMED CT. Los desarrolladores de una extensión deben familiarizarse con esta guía para garantizar la calidad e integridad de las ediciones de SNOMED CT que publiquen.
    

**Una Extensión Nacional puede incluir:**

*   Traducción a la lengua nacional o adaptación a un dialecto nacional;
    
*   Contenido adicional en apoyo de los objetivos políticos nacionales, un diccionario nacional de drogas u otros requisitos específicos;
    
*   Derivados que configuran el uso del contenido de SNOMED CT especificando subconjuntos de contenido que se utilizarán para fines concretos;
    
*   Derivados que mapean otros sistemas de códigos utilizados en ese país hacia o desde SNOMED CT.
    

**Una Extensión de Afiliado puede incluir:**

*   Contenido adicional que permita a una organización de proveedores de servicios sanitarios o a un grupo de especialidades clínicas abordar sus casos de uso prioritarios;
    
*   Derivados que configuran el uso de SNOMED CT de forma que refleje las necesidades de una organización o especialidad de proveedores sanitarios;
    
*   Derivados que configuran la forma en que SNOMED CT se utiliza o se presenta a diferentes clientes que utilizan aplicaciones informáticas concretas;
    
*   Derivados que mapean sistemas de códigos locales o propietarios hacia o desde SNOMED CT.
    

El desarrollo de Extensiones Nacionales o de Afiliados requiere que el CNR o el Afiliado tengan un Identificador de Espacio de Nombres, que es asignado por SNOMED International. Se utiliza un identificador de espacio de nombres para identificar el origen y la afiliación de cada componente de extensión. Un CNR tiene la responsabilidad de garantizar que cualquier despliegue de SNOMED CT y otros productos terminológicos de SNOMED International se ajuste a las normas de SNOMED International. Por lo tanto, un CNR sirve de punto de contacto para que los Afiliados obtengan orientación y asesoramiento en el desarrollo y mantenimiento de las extensiones de afiliación.

**Extensiones y ediciones**

La Edición Internacional de SNOMED CT puede utilizarse sin ninguna Extensión. Sin embargo, una Extensión de SNOMED CT no puede utilizarse por sí sola porque todas las Extensiones dependen de la Edición Internacional, y algunas Extensiones dependen también de otras Extensiones. Por lo tanto, para cada Extensión existe una Edición correspondiente que incluye la Extensión, la Edición Internacional y cualquier otra Extensión de la que dependa.

**Figura 11 Una Edición Nacional incluye tanto la Extensión Nacional como la Edición Internacional.**

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2133369718-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FI7N0Q2Su8RGW5pAlIrWt%252Fuploads%252Fgit-blob-ae7c3d820ae9f9c8e5ef6a201d5b219e6f4877d1%252F259854847.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=b9e71aad&sv=2)

| Todas las organizaciones que mantengan Extensiones deben hacer que su Extensión esté disponible como un conjunto separado de archivos, incluso si también proporcionan una Edición pre-fusionada. Esto permite validar las partes constituyentes de la edición y también admite fusiones para producir Ediciones a medida que combinen varias Extensiones.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-desarrollo-de-contenidos-y-personalizacin-de-snomed-ct#traduccion)

Traducción


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La Edición Internacional de SNOMED CT contiene términos en Inglés Estadounidense, Inglés Británico y Español. Sin embargo, SNOMED CT está diseñado para soportar el uso multilingüe al permitir que los términos en cualquier idioma se vinculen a los mismos conceptos. Muchos de los Miembros actuales no utilizan el Inglés como lengua materna en la prestación de asistencia sanitaria, por lo que es posible que necesiten una traducción de SNOMED CT para conseguir un recurso terminológico nacional y ayudar a los usuarios a interpretar correctamente el contenido de SNOMED CT. La responsabilidad de la traducción recae en los Miembros que utilizan una lengua concreta en el País Miembro específico. Sin embargo, aunque se permite y anima a los Miembros a traducir SNOMED CT, no es una obligación de la afiliación. Cada Miembro debe considerar si traduce o no SNOMED CT a su lengua materna y/o dialecto, dados los objetivos reales de uso de SNOMED CT dentro de ese País Miembro.

Varios Miembros ya han traducido SNOMED CT a sus lenguas maternas. Estas traducciones se gestionan dentro de cada uno de los Países Miembros específicos como Extensiones Nacionales y se han creado basándose en la normativa de SNOMED International, pero de acuerdo con los requisitos particulares de cada País Miembro. Cada traducción puede compartirse con otros Miembros, y todos los Miembros tienen la obligación, de acuerdo con los Estatutos, de compartir sus traducciones si así se les solicita.

**Enfoques de traducción**

Traducir SNOMED CT no significa necesariamente traducir la versión completa de la Edición Internacional de SNOMED CT. Un Miembro puede decidir traducir partes de SNOMED CT para obtener un conjunto básico de componentes que se utilizarán en el país. Otro enfoque consiste en traducir conceptos que vayan a aplicarse dentro de una organización específica, un ámbito clínico, etc., lo que supone una traducción más orientada al caso de uso.

**Figura 12. Diferentes niveles de traducción de SNOMED CT**

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2133369718-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FI7N0Q2Su8RGW5pAlIrWt%252Fuploads%252Fgit-blob-2641158bfe709b497bca533a7c0ec119534d9ac2%252F259854848.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=ea3594b6&sv=2)

**Política de traducción**

SNOMED International cree que las traducciones de SNOMED CT son muy importantes porque una traducción puede apoyar la adopción de SNOMED CT debido a una mejor comprensión del contenido de SNOMED CT entre los usuarios finales. Por lo tanto, SNOMED International ha iniciado una política de traducción que reembolsa a los países Miembros:

1.  100% del coste de la traducción de conceptos, que se considerará el "núcleo" o conjunto incial;
    
2.  El coste de traducción de un documento de implementación; y
    
3.  El coste de un curso SNOMED CT.
    

(El pago máximo por cada Miembro será de 150.000 USD).

Para más información sobre Traducción, [visite: https://www.snomed.org/use-snomed-ctarrow-up-right](https://www.snomed.org/use-snomed-ct)

**Guía de traducción**

Junto con los Miembros, SNOMED International ha elaborado documentación que ayuda a los Miembros que deciden traducir SNOMED CT. La documentación debe apoyar procesos de traducción eficaces y permitir a los Miembros aprender de los éxitos de quienes ya se han lanzado a esta tarea. La documentación puede consultarse en el sitio web de SNOMED International e incluye lo siguiente:

[Directrices para la traducción de SNOMED CTarrow-up-right](https://www.snomed.org/_files/ugd/49d95c_bd5eb3c589e24e1983d4b0c07b451549.pdf)
 Este documento describe cuestiones importantes relacionadas con la traducción de SNOMED CT, formula recomendaciones y establece directrices. Las directrices generales pueden utilizarse como modelo para elaborar directrices nacionales. Además de directrices lingüísticas y terminológicas, el documento incluye recomendaciones generales sobre los pasos que hay que dar en un proceso de traducción e información sobre los documentos de origen o referencias que deben ponerse a disposición de quienes participan en el proceso de traducción [**Directrices para la gestión de traducciones de SNOMED CT**arrow-up-right](https://www.snomed.org/_files/ugd/49d95c_a511ae93cd164e749605ea6cb930e3f7.pdf)
 Este documento es una directriz complementaria que debe utilizarse con las "Directrices para la traducción de SNOMED CT" y ofrece recomendaciones sobre la gestión de un proyecto de traducción. El objetivo es ayudar a los nuevos Miembros que emprendan traducciones a evitar errores y permitirles aprovechar la experiencia adquirida. [**Metodología y herramientas para evaluar la calidad de la traducción de SNOMED CT**arrow-up-right](https://www.snomed.org/_files/ugd/49d95c_7eb6e2ac75604e79914f0734e33a3042.pdf)
 Este documento describe el uso de la metodología y el conjunto de herramientas de SNOMED International para evaluar la calidad de la traducción de SNOMED CT y ha sido desarrollado para ajustarse al Marco de Garantía de Calidad de SNOMED International. El documento incluye también el conjunto de herramientas propiamente dicho, por lo que resulta útil para cualquier Miembro que busque material de apoyo a la traducción. [**Marco de garantía de calidad de SNOMED International**arrow-up-right](https://confluence.ihtsdotools.org/pl/files/28737644/28737640/1/1468308174000/IHTSDO_Quality-Assurance_Framework_20100517_v2.0.pdf)
 El Marco de Garantía de Calidad de SNOMED International, junto con las Herramientas de Garantía de Calidad de SNOMED International, fue desarrollado por el SNOMED International Quality Assurance Committee y tiene como objetivo apoyar el desarrollo y la presentación de informes de métricas de calidad en todas las áreas de actividad de SNOMED International, incluidos los procesos organizativos y de apoyo, productos de datos (por ejemplo, datos de referencia terminológica, mapeos, traducciones, subconjuntos), documentación y servicios responsables de SNOMED International y provisiones de herramientas.También existen otros recursos, en su mayoría relativos a las experiencias prácticas de quienes han emprendido el desarrollo de la traducción.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-desarrollo-de-contenidos-y-personalizacin-de-snomed-ct#desarrollo-de-conjuntos-de-referencia)

Desarrollo de Conjuntos de Referencia


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Muchas implementaciones de SNOMED CT no requieren que los usuarios tengan acceso al conjunto completo de contenidos. A menudo sólo se necesitará una parte de los datos relacionados con una disciplina u organización concreta. Es posible restringir el contenido requerido mediante el uso de subconjuntos o Conjuntos de referencia.

Los Conjuntos de referencia son conjuntos de referencias a componentes de SNOMED CT. Los conjuntos de referencia simples sólo contienen la información necesaria para definir un subconjunto. Sin embargo, los conjuntos de referencia pueden ser más ricos que los subconjuntos, ya que también pueden incluir más información sobre los componentes y se han definido con otros fines, como los mapas con otros vocabularios o el suministro de estructuras jerárquicas alternativas.

Los Conjuntos de referencia se distribuyen como archivos de texto delimitados por tabuladores en los que cada fila incluye un identificador de componente de SNOMED CT para el Miembro del Conjunto de referencia. También hay varios campos estándar que admiten el control de versiones y campos adicionales definidos para cumplir los requisitos de tipos específicos de Conjuntos de referencia.

Para más información sobre los conjuntos de referencia y su formato, consulte la [Guía de Conjuntos de Referenciaarrow-up-right](https://confluence.ihtsdotools.org/display/DOCRFSPG)
.

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Last updated 5 months ago

*   [Extensiones](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-desarrollo-de-contenidos-y-personalizacin-de-snomed-ct#extensiones)
    
*   [Traducción](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-desarrollo-de-contenidos-y-personalizacin-de-snomed-ct#traduccion)
    
*   [Desarrollo de Conjuntos de Referencia](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-desarrollo-de-contenidos-y-personalizacin-de-snomed-ct#desarrollo-de-conjuntos-de-referencia)
    

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# Introduction | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction#background)

Background


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SNOMED CT is a standardized and multilingual clinical terminology used by clinicians and other health care providers to record and share health information. As the most comprehensive terminology in the world, SNOMED CT contains over 300,000 active clinical concepts, each representing a unique clinical meaning. These concepts are organized into hierarchies such as 404684003 | Clinical finding|, 71388002 | Procedure|, 123037004 | Body structure| and 373873005 | Pharmaceutical / biologic product|.

SNOMED CT is increasingly being used in clinical decision support (CDS) systems to support healthcare providers in making well informed clinical decisions. SNOMED CT's polyhierarchy, defining relationships and concept model are just some of the terminology's features that help to link patient records to the appropriate guidance, clinical knowledge and decision support rules.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction#purpose)

Purpose


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The guide [Data Analytics with SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-data-analytics-guide/)
 explains how SNOMED CT may be used to support data analytics, and how integrating clinical records with decision support tools can improve the care provided to individual patients by guiding safe, appropriate and effective patient care.

The purpose of this guide is to review the approaches, tools and techniques used to implement clinical decision support with SNOMED CT, and to share developing practice in this area. It is anticipated that this guide will benefit Members, vendors and users of SNOMED CT by promoting a greater awareness of how SNOMED CT has been and can be used to enhance clinical decision support implementations.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction#scope)

Scope


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This guide introduces the key components of clinical decision support systems, explores ways in which SNOMED CT can be used to enhance the capabilities within each of these components, and presents some case studies in which SNOMED CT has been used to support clinical decision support. The guide focuses on CDS systems that use a combination of SNOMED CT encoded knowledge artifacts (e.g. CDS rules and guidelines) and SNOMED CT encoded electronic health records. However, using SNOMED CT to enhance non-SNOMED CT enabled CDS and EHR systems is also considered.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction#audience)

Audience


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The target audience of this guide includes:

*   Members who wish to learn about using SNOMED CT for clinical decision support
    
*   Clinicians, informatics specialists and technical staff involved in the planning, management, design or implementation of clinical record applications or clinical decision support systems
    
*   Software vendors, data analysts, epidemiologists and others designing SNOMED CT based solutions
    

This guide assumes a basic level of understanding of SNOMED CT. For background information it is recommended that the reader refers to the [SNOMED CT Starter Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction#guide-overview)

Guide Overview


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The guide presents an introduction to clinical decision support using SNOMED CT and is structured as follows:

*   [Introduction](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction)
    : Provides an introduction to the guide, and defines clinical decision support (CDS) and clinical decision support systems (CDSS). It then presents an overview of CDS (including its scope, history and the 'five rights'), it explores the functional and clinical areas in which CDS is used, the features of SNOMED CT that support CDS, and a table of abbreviations used in this guide.
    
*   [Logical Architecture](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture)
    : Presents an overview of the logical architecture of an electronic health records system that uses CDS, and the internal components of a CDSS system.
    
*   [Knowledge Base](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base)
    : Describes the knowledge base of a CDSS, in which the knowledge artifacts that drive the CDS are stored, and how SNOMED CT may be used within these artifacts.
    
*   [Inference Engine](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/4-inference-engine)
    : Explains how the inference engine of a CDSS can use SNOMED CT to execute the knowledge artifacts in the knowledge base.
    
*   [Communications](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications)
    : Explores some of the considerations around implementing the communication mechanisms in a CDSS.
    

* * *

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Last updated 4 months ago

*   [Background](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction#background)
    
*   [Purpose](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction#purpose)
    
*   [Scope](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction#scope)
    
*   [Audience](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction#audience)
    
*   [Guide Overview](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction#guide-overview)
    

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# Content Development | Practical Guides | SNOMED International Documents

This section provides an overview of:

*   SNOMED CT International Release Content Development
    
*   Request Submission
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/9-content-development#why-is-this-important)

Why is this important?


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Understanding the quality and rigor of the approach to SNOMED CT content development ensures user confidence in the quality of the content when implementing or using SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/9-content-development#what-is-this)

What is this?


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### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/9-content-development#snomed-ct-international-release-content-development)

SNOMED CT International Release Content Development

SNOMED CT's content development is based on four basic principles that have and continue to guide development of its clinical content and technical design including:

*   Development efforts must encompass broad, inclusive involvement of diverse clinical groups and medical informatics experts.
    
*   The clinical content must be quality focused and adhere to strict editorial rules.
    
*   The quality improvement process must be open to public scrutiny and vendor input, to ensure that the terminology is truly useful within health care applications.
    
*   There must be minimal barriers to adoption and use.
    

The content of SNOMED CT evolves with each release. The types of changes made include new concepts, new descriptions, new relationships between concepts, and new reference sets, as well as updates and retirement of any of these components. Drivers of these changes include changes in understanding of health and disease processes; introduction of new drugs, investigations, therapies and procedures; and new threats to health, as well as proposals and work provided by SNOMED CT users.

The three basic operational criteria that help determine whether new content is following the principle of creating and sustaining semantic interoperability are that SNOMED CT must be:

*   Understandable: The meaning must be able to be communicated, to be understood by an average health care provider without reference to inaccessible, hidden or private meanings.
    
*   Reproducible: It is not enough for one individual to say they think they understand the meaning. It must be shown that multiple people understand the meaning in the same way.
    
*   Useful: The meaning must have some demonstrable use or applicability to health or health care.
    

Recognizing the goal that SNOMED CT should become the accepted international terminological resource for health care, it must therefore be capable of supporting multilingual terminological renderings of common concepts. For the terminology to be acceptable to the widest possible range of users it must include translations as well as alternative spellings and other variations that arise from a national and regional dialect. Furthermore it must be capable of representing differences between the underlying concepts that arise from cultural, ethnic or linguistic variations.

Clinical terminology development is challenging for a variety of reasons. Even in a single country or language people often use the same words to mean different things, as well as using different words for the same thing. The names assigned to some clinical conditions are sometimes based on an earlier incomplete or erroneous understanding and often these misleading names remain in use long after knowledge has moved on. Progress of medical knowledge and evolution of pathogenic organisms creates a continual, growing requirement to add new content and revise definitions. Efforts by specialty bodies to establish diagnostic criteria and staging scales also lead to changes, and sometimes to divergence between different or overlapping sources of authority. In the face of these challenges, content development is directed to address current and emerging priorities identified by Members and other stakeholders.

Continuous quality improvement is the aim of SNOMED International. Quality processes are included as part of the work completed by the team of modeler's involved in SNOMED CT development. A documented scientific process is followed and content is defined and reviewed by multiple clinician editors. Conflicts between editors are resolved through an iterative process, based on achieving agreement and consensus, before being entered into the terminology. As necessary, the authoring team consult with additional experts to review the scientific integrity of the content.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/9-content-development#requesting-content-additions-and-changes)

Requesting Content Additions and Changes

SNOMED International provides a request submission service to gather and process requests for additions and changes to the content of the SNOMED CT International Edition. This service is directly accessible by National Release Centers (NRC) in Member countries and recognized Terminology Authorities within organizations with whom SNOMED International is actively collaborating. Organizations within Member countries can submit their requests for additions and changes to the National Release Centre. In some cases, requests with particular local relevance may be added to a National Extension. The NRC forwards requests that it considers have international relevance to SNOMED International for a decision. If a request is deemed to have high priority it should result in action in the next release cycle. However, requests that require significant changes that would impact on other content may take longer.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Starter+Guide&entry.670899847=9.%20Content%20Development)

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Last updated 7 months ago

*   [Why is this important?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/9-content-development#why-is-this-important)
    
*   [What is this?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/9-content-development#what-is-this)
    
*   [SNOMED CT International Release Content Development](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/9-content-development#snomed-ct-international-release-content-development)
    
*   [Requesting Content Additions and Changes](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/9-content-development#requesting-content-additions-and-changes)
    

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# Responsabilidades del CNR | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

La mejor forma de organizar un CNR depende de un amplio abanico de factores, como el número de Afiliados potenciales, la visión y estrategia de uso de SNOMED CT en el país, la infraestructura nacional de eSalud, el grado de personalización, etc. Sin embargo, los Miembros de SNOMED International están obligados, como mínimo, a cumplir una serie de responsabilidades básicas dentro de su territorio, tal y como se muestra en la Figura 2 y se especifica en los Estatutos. Normalmente, el CNR cumple la mayoría de estas obligaciones, pero un Miembro puede tomar otras medidas para cumplir algunas de ellas. Los Estatutos de SNOMED International pueden consultarse aquí: [http:// snomed.org/articles.arrow-up-right](http://snomed.org/articles)

**Figura 2. Obligaciones de los Miembros.**

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2133369718-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FI7N0Q2Su8RGW5pAlIrWt%252Fuploads%252Fgit-blob-0e648c18bcc310b583117a67c99bafb35eb8cc89%252F259854829.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=cd5e2477&sv=2)

*   **Los CNR deben actuar como puntos de contacto principales para SNOMED International en relación con todos los aspectos de la gestión de los productos terminológicos.**
    
*   **Los CRN son los principales puntos de contacto para los Afiliados de un País Miembro.**
    
    *   Los Afiliados deben poder ponerse en contacto con el CNR para obtener orientación y directrices con respecto a la implementación y el uso de SNOMED CT en el País Miembro.
        
    *   Los CNR deben servir de intermediarios entre los Afiliados y la comunidad de SNOMED CT, por ejemplo:
        
        *   Animar a los expertos y a otras personas adecuadas a contribuir al trabajo de SNOMED International;
            
        *   Ayudar a SNOMED International a comunicarse con los Afiliados y expertos reconocidos o que deseen inscribirse como Afiliados de SNOMED International.
            
        
    
*   **Los CNR deben establecer y mantener los procesos necesarios para la distribución y autorización de SNOMED CT y los demás productos terminológicos.**
    
    *   Esto incluye el desarrollo de los mecanismos adecuados para que los usuarios obtengan acceso a las Ediciones Nacionales (cuando proceda) e Internacionales de SNOMED CT y los productos relacionados, así como mecanismos para recuperar y gestionar las licencias de afiliación. (Véase el apartado 9 sobre el apoyo al proceso).
        
    *   Esto incluye la gestión de los informes anuales sobre licencias y la notificación a SNOMED International de las actividades de los Afiliados en Países No Miembros.
        
    
*   **Los CNR deben garantizar que cualquier despliegue de un producto terminológico propiedad de SNOMED International se ajuste a las normas de SNOMED International.**
    
*   **Los CNR deben facilitar los comentarios de los usuarios sobre SNOMED CT, incluida la gestión de las solicitudes de cambio.**
    

Además de estas áreas, hay una serie de otras responsabilidades que el CNR puede decidir asumir. La tabla siguiente enumera una serie de posibles áreas de responsabilidad. La lista no es exhaustiva, pero incluye los principales ámbitos que cubren actualmente los CNR. Algunas de las áreas están marcadas como "Obligatorias", ya que forman parte de las principales áreas de responsabilidad.

**Cuadro 1. Ámbitos de responsabilidad del CNR**

Áreas de responsabilidad

Requerido

Opcion

Gestión de licencias (manual o automática)

✅

Distribución de la Edición Internacional|

✅

Gestionar extensiones

(Creación, publicación, distribución y mantenimiento)|

✅

Gestionar mapeos

(Creación, publicación, distribución y mantenimiento)|

✅

Gestionar conjuntos de referencia (RefSets)

(Creación, publicación, distribución y mantenimiento)|

✅

Gestionar traducciones

(Creación, publicación, distribución y mantenimiento)

✅

Ofrecer herramientas

Como servicio al usuario: Permitir a los usuarios el acceso a SNOMED CT

✅

Como herramientas del CNR: Gestión de SNOMED CT|

✅

Gestionar las solicitudes de cambios hechas por organizaciones en el país|

✅

Ofrecer educación, promoción y capacitación

✅

Vincular a las partes interesadas

✅

Ofrecer asesoramiento para la implementación

✅

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/responsabilidades-del-cnr#competencias-del-cnr)

Competencias del CNR

Las competencias requeridas para un CNR dependen de los servicios que el CNR decida prestar. Sin embargo, la mayor parte del personal del CNR debería tener un conocimiento general de SNOMED CT y de SNOMED International.

Si un CNR no puede prestar un tipo específico de servicio, debe tratar de identificar otros recursos que puedan satisfacer las necesidades de los ejecutores y usuarios del País Miembro.

Las siguientes competencias básicas son típicas del trabajo de un CNR. Algunas de estas áreas de competencia pueden considerarse específicas de una tarea, ya que no se exigirán como competencia constante dentro del CNR, sino que son necesarias para cumplir tareas específicas, como la traducción, el mapeo y el desarrollo de conjuntos de referencia.

**Competencias generales requeridas**

*   Terminología
    
*   Técnico y TI
    
*   Comunicación
    
*   Implementación
    
*   Educación
    

**Competencias para tareas específicas**

*   Conocimientos clínicos y científicos especializados
    
*   Lingüistica y traducción
    

En la Tabla 2 se describen las competencias específicas necesarias para llevar a cabo determinadas tareas relacionadas con el CNR.

Tareas

Competencias principales

Áreas de conocimiento / habilidades

Distribución de la Edición Internacional y la Extensión Nacional

*   Comunicación
    
*   Técnicas / TI
    

*   Comunicación con los afiliados Ejemplo: noticias actualizaciones
    
*   Soporte de herramientas para acceder a la Edición Internacional y a la Extensión Nacional
    

**Administración de extensiones**

​

​

*   Contenido
    

*   Terminología
    
*   Especialidades por dominio
    
*   Traducción
    

*   Desarrollo de contenido
    
*   Terminologías, descripción lógica
    

*   Técnico
    

*   Técnico/TI
    

*   Soporte de herramientas para el desarrollo y administración de la extensión
    

**Gestión de conjuntos de referencia**

​

​

*   Contenido
    

*   Terminología
    
*   Especialidades por dominio (expertos clínicos, etc.)
    

*   Desarrollo y gestión de conjuntos de referencia
    
*   Conocimiento por dominios, dependiendo del propósito del conjunto de referencia
    
*   Selección de conceptos
    
    *   Modelos lógico y conceptual
        
    
*   Técnicas de búsqueda
    

*   Técnico
    

*   Técnico/TI
    

*   Soporte de herramientas para desarrollo y gestión de conjuntos de referencia
    

**Gestión de mapeos**

​

​

*   Contenido
    

*   Terminología
    
*   Especialidades por dominio
    

*   Desarrollo y mantenimiento de mapeos
    
*   Conocimiento de las prácticas actuales para el uso de terminologías y clasificaciones en el territorio miembro
    

*   Técnico
    

*   Técnico/TI
    

*   Soporte de herramientas para desarrollo y gestión de mapeos
    

**Desarrollo de herramientas**

*   Navegación
    
*   Desarrollo de contenido
    
*   Conjuntos de referencia
    
*   Aseguramiento de la calidad
    
*   Distribución
    

*   Técnico/TI
    

*   Especificaciones técnicas y formatos de archivos de SNOMED CT
    
*   Diseño y desarrollo de software and bases de datos
    
*   Modelado de la información/estándares de modelado de la información
    
*   Técnicas y software para la búsqueda y registro de datos en SNOMED CT
    
*   Requerimientos y distribución de la autoría
    
*   Técnicas de aseguramiento de la calidad
    

**Gestión de traducciones**

*   Terminología
    
*   Linguística
    
*   Especialidades por dominio
    

*   Procesos de traducción
    
*   Definición de conceptos
    
*   Aseguramiento de la calidad
    
*   Tecnología para la autoría de terminologías
    

**Solicitud de cambios**

​

​

*   Contenido
    

*   Comunicación
    
*   Terminología
    
*   Traducciones
    

*   Desarrollo de contenido
    
*   Terminologías, descripción lógica
    

*   Técnico
    

*   Técnico/TI
    

*   Herramienta de autoría de terminologías
    
*   Herramientas de soporte para el envío de solicitudes de cambio y gestión de las solicitudes de cambios
    

**Educación, Promoción y vinculación de las partes interesadas**

*   Comunicación
    
*   Implementación
    
*   Educación
    

*   Competencias de difusión
    
*   Usuarios y necesidades de los usuarios
    
*   Conocimiento amplio y profundo de SNOMED CT, usuarios y aspectos de implementación
    
*   Ejemplos, casos de uso
    
*   Infraestructura nacional de TI sanitaria, prácticas actuales y normativa
    

Consultor+ía de implementación

*   Implementación
    
*   Técnico/TI
    
*   Análisis de negocios
    

*   Conocimiento amplio y profundo de SNOMED CT, usuarios y aspectos de implementación
    
*   Ejemplos, casos de uso
    
*   Niveles de implementación y oportunidades técnicas
    
*   Habilidades para entender los requisitos y relacionarlos con la terminología
    

**Gestión de licencias**

*   manual o automática
    

*   Comunicación
    
*   Técnico/TI
    

*   Comunicación con los Afiliados
    
*   Herramientas de apoyo, Ejemplo: repositorio de licencias
    

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# Substrate | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

An important consideration in the development of a Clinical Decision Support System (CDSS) is the _substrate_ over which the knowledge artifacts are authored and executed. When using SNOMED CT in a CDSS, the _substrate_ is the SNOMED CT content over which the CDS rules are authored or executed. Because medical knowledge is constantly changing, it is important that the substrate over which CDS is applied is kept current. To support this requirement, SNOMED CT releases regular new versions of the terminology, and retains a history of changes using its strong versioning mechanism. With this in mind, both the SNOMED CT edition and the specific version of that edition (released on a given date) need to be considered in determining the SNOMED CT substrate. For more information on the topic of versioning, please refer to section [Versioning](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-data-analytics-guide/11-challenges/11.4-versioning)
 in the guide [SNOMED CT Data Analytics Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-data-analytics-guide/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.3-substrate#knowledge-artifact-substrate)

Knowledge Artifact Substrate


-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

When publishing CDS knowledge artifacts, such as rules or guidelines, it is important to clearly indicate the substrate over which the artifacts were authored. The substrate used to author a CDS artifact needs to be considered when determining the appropriate substrate to use in the execution of that artifact.

For example a CDS rule, using the SNOMED CT US edition, dated 20160901 (September 1st 2016), may refer to the concept 5281000124103 | Persistent asthma|. If this rule was executed against the SNOMED CT International Edition (20170131), then this extension concept would not be found, and the rule could not be executed.

Similarly, a CDS rule using the International edition (20170131) may refer to the concept 721039003 | Dual energy computed tomography|. If the rule was executed against the 20160731 International edition (or an older version), then this concept (created in the 20170131 version) would not be found, and the rule could not be executed. This would also be true if the same CDS rule was executed against the US edition (20160901), because this edition is dependent on the 20160731 International edition.

Therefore, CDS knowledge artifacts referencing SNOMED CT concepts must be executed (by the inference engine) using a SNOMED CT substrate that includes the same modules, or a superset of the modules included in the SNOMED CT substrate used to author the artifact. In addition, the SNOMED CT substrate used to execute the CDS artifacts must use the same version, or a more recent version of these SNOMED CT modules, to ensure that all the referenced concepts are present. Please note that if a newer version of the substrate is used to execute the rules, then it is possible that a concept or relationship used at the time of artifact authoring may have become inactive. Edition and version dependencies such as these should be checked when adopting new CDS artifacts or updating a CDS system to use a newer version of SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.3-substrate#electronic-health-record-substrate)

Electronic Health Record Substrate


-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Another consideration when selecting the SNOMED CT substrate on which to execute CDS artifacts, is the substrate used to record data in the Electronic Health Record (EHR).

For example, if a CDS rule is triggered when the diagnosis recorded in the EHR is a descendant of 195967001 | Asthma|, that is: IF < 195967001 | Asthma| THEN ... and this rule is executed over the SNOMED CT International edition, dated 20170131 (January 31st 2017), then EHR records which capture a diagnosis of 5281000124103 | Persistent asthma| from the SNOMED CT US edition (20160901) will be unsuccessful in triggering the CDS rule.

Similarly, if a CDS rule is triggered when the diagnosis recorded in the EHR is a descendant of 19829001 | Pulmonary disease|, that is: IF < 19829001 | Pulmonary disease| THEN ... and this rule is executed over the US edition (20160901), then EHR records which capture a diagnosis of 12240951000119107 | Squamous cell carcinoma of left lung| will be unsuccessful in triggering the CDS rule. This is because the US edition (20160901) is dependent on the International edition (20160731), and the concept referenced above was added to the International edition (20170131).

Therefore, CDS knowledge artifacts must be executed (by the inference engine) using a SNOMED CT substrate that includes the same modules, or a superset of the modules used by the EHR system to record patient data. In addition, the SNOMED CT substrate used to execute the CDS knowledge artifacts must use the same or a more recent version of these SNOMED CT modules, to ensure that all the referenced concepts are present. Please note that if a newer version of the substrate is used to execute the rules, then it is possible that a concept recorded in the EHR may have become inactive. Edition and version dependencies such as these should be checked when implementing new CDS rules over existing EHR data or updating a CDS system to use a newer version of SNOMED CT.

* * *

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*   [Knowledge Artifact Substrate](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.3-substrate#knowledge-artifact-substrate)
    
*   [Electronic Health Record Substrate](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.3-substrate#electronic-health-record-substrate)
    

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# SNOMED CT Implementation | Practical Guides | SNOMED International Documents

This section provides an overview of:

*   How is SNOMED CT used?
    
*   Implementation Examples
    
    *   Clinical Record Applications
        
    *   Clinical Decision Support
        
    *   Enabling Interoperability
        
    *   Reporting
        
    
*   SNOMED CT in action
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#why-is-this-important)

Why is this important?


------------------------------------------------------------------------------------------------------------------------------------------------------------------

Realization of the benefits described in [SNOMED CT Benefits](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/2-snomed-ct-benefits)
, depends on using the terminology in software applications. The extent of benefits realization depends on the effectiveness of implementation and the way SNOMED CT is used within the system and by users and organizations.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#what-is-this)

What is this?


------------------------------------------------------------------------------------------------------------------------------------------------

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#how-is-snomed-ct-used)

How is SNOMED CT Used?

SNOMED CT itself is only a part of the solution to addressing the requirements for effective electronic clinical records. A terminology on its own 'does nothing'. To benefit from a terminology, it must be implemented and used as part of an application. The design of the software application in which it is used, and the objectives and motivation of its users, are key factors in determining success.

SNOMED CT is useful for clinical documentation, as it supports the representation of detailed clinical information, in a way that can be processed automatically. Realization of the capability of SNOMED CT to support clinical information and meaning based retrieval requires careful consideration of the actual setting, in terms of scope of use, record structure, data entry, data retrieval and communication.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F19067948-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FUmSUeu96fIQZWDm7RISx%252Fuploads%252Fgit-blob-df0d5ae45cfa146fc8c66e0407097583ba5e0cb7%252F29952970.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=388efd1c&sv=2)

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#implementation-examples)

Implementation Examples

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#clinical-record-applications)

Clinical Record Applications

SNOMED CT can be implemented in a wide range of clinical record applications. These include systems developed for use with other code systems that have been adapted to support SNOMED CT as well as systems designed with the assumption that SNOMED CT would serve as the primary terminology. The SNOMED CT features that applications support and use may vary, partly due to differences in user requirements and partly due to development priorities.

A terminological resource is only one part of a software application. The functions required to implement a terminology can be divided into:

*   Terminology services: Functions that can be performed without reference to data stored in a particular application record structure.
    
*   Record services: Functions that involve storing, retrieving or processing application data (e.g. patient health records).
    

Different applications may make use of different aspects of SNOMED CT. Applications that only require SNOMED CT for a very limited range of uses and may not require all the features of SNOMED CT. However, by using SNOMED CT, these applications benefit from an enhanced ability to exchange data with other more terminology rich applications. These applications can also evolve to meet emergent requirements by making increasing use of the power of SNOMED CT.

Most users only require a small subset of the content of SNOMED CT. However, use of a terminology that spans a wide range of specialties delivers the benefits that arise from consistency, and interoperability.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#clinical-decision-support)

Clinical Decision Support

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#how-can-the-use-of-snomed-ct-assist-in-clinical-decision-support)

_How can the use of SNOMED CT assist in clinical decision support?_

Clinical decision support is defined broadly as a clinical system application or process that helps health professionals make clinical decisions to enhance patient care. An example of clinical decision support would be the use of alerts to identify specific clinical contraindications in the administration of thrombocytopenia therapy after a stroke.

The use of SNOMED CT makes clinical information available in a computable form which can be queried and used to trigger decision support rules and prompts. The hierarchies of SNOMED CT enable complex reasoning to support decision support rules. For example, in SNOMED CT the concept |stroke| is synonymous with |cerebrovascular accident| and subsumes all lower level concepts including |paralytic stroke|, |thrombotic stroke| etc. This means that decision support queries are easier to develop and implement because they do not need to identify all the individual terms and codes which may be relevant.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#has-it-been-implemented)

_Has it been implemented?_

Yes. SNOMED CT is known to be used for Clinical Decision Support in a number of organizations including Kaiser Permanente, Duke University Medical Hospital in the US; National Health Service Hospitals in the UK and Hospital Italiano in Buenos Aries, Argentina.

Kaiser Permanente has a central terminology service which develops and maintains clinical decision support rules and prompts. These can be quickly distributed for implementation throughout the organization. In addition to using this type of approach for clinical decision support, Kaiser Permanente also use it to identify potential cohorts for clinical trials etc.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#enabling-interoperability)

Enabling Interoperability

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#how-can-you-ensure-that-clinical-information-entered-in-one-context-can-be-safely-and-accurately-tra)

_How can you ensure that clinical information entered in one context can be safely and accurately transmitted to another system in another context?_

Information can be recorded using SNOMED CT concepts and descriptions that are independent of the clinical information system being used and either independent of or tied to the context of use, depending on the user requirements. SNOMED CT is a common clinical terminology covering a wide range of requirements and its use. SNOMED CT allows meaning-based computation to be applied to information in messages sent between systems, and provides a foundation for interoperable interpretation of clinical information.

For example, subtype descendant concepts that may be relevant to prescribing decisions (e.g. |allergic disposition|, |kidney disease|) can be used to trigger alerts and reminders in the recipient system, such as medication allergy alerts and drug level investigation warnings. These preventative health care reminders, enable the quality of care to be improved.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#has-it-been-implemented-1)

_Has it been implemented?_

Yes. In the United States, Kaiser Permanente (KP), The Veterans Health Administration (VHA), and the Department of Defense (DoD) health systems interoperate using SNOMED CT. A consortium comprised of Kaiser Permanente, the Mayo Clinic, Intermountain Health Care, Geisinger Health System, and Group Health Cooperative of Puget Sound has announced they will interoperate using SNOMED CT and techniques established by KP, the VHA and DoD.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#reporting)

Reporting

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#how-can-clinical-information-encoded-as-snomed-ct-concepts-be-used-for-reporting-purposes)

_How can clinical information encoded as SNOMED CT concepts be used for reporting purposes?_

Information encoded as SNOMED CT concepts is semantically consistent. In other words, there is one unique SNOMED CT identifier representing each separate meaning. This lends itself to reporting through specifying the SNOMED CT identifiers of interest. SNOMED CT supports recording at appropriate levels of detail and using relevant terms. This also means that reports can be generated at the appropriate levels of detail using relevant terms for display in the report.

The hierarchical nature of SNOMED CT means that information can be aggregated at the appropriate levels of generalization. That same information can also be used in reporting to provide the same level of detail. SNOMED CT is a common clinical terminology covering a wide range of requirements and supporting a wide variety of use cases for reporting, including patient care, clinical audit, quality improvement, outcomes, epidemiology, patient safety, etc. As SNOMED CT is a clinical terminology with a global scope, reports using SNOMED CT can be compared across boundaries.

Where required, SNOMED CT may also be mapped to other code systems and classifications to support existing reporting requirements.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#has-it-been-implemented-2)

_Has it been implemented?_

Yes, many clinical information systems use SNOMED CT to varying degrees and many standards mandate or recommend that SNOMED CT be used. Such cases include reports sent using HL7 messages, microbiology results reporting, and genetic database reports.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#other-examples-of-snomed-ct-in-action)

Other examples of SNOMED CT in action

You can see other examples of implementations using SNOMED CT in a dynamically maintained list at [https://www.snomed.org/snomed-in-actionarrow-up-right](https://www.snomed.org/snomed-in-action)
. This site also allows you to add summaries of implementations that you are involved in.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Starter+Guide&entry.670899847=SNOMED%20CT%20Implementation)

[PreviousSNOMED CT Expressionschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/7-snomed-ct-expressions)
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Last updated 7 months ago

*   [Why is this important?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#why-is-this-important)
    
*   [What is this?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#what-is-this)
    
*   [How is SNOMED CT Used?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#how-is-snomed-ct-used)
    
*   [Implementation Examples](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/8-snomed-ct-implementation#implementation-examples)
    

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# References | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents

The Vendor Introduction is intended as a useful starting point for Vendors. More detailed information and a range of informative documents and training materials can be accessed from the SNOMED International web site [www.snomed.orgarrow-up-right](http://www.snomed.org/)
 and the [SNOMED CT Document Library](https://docs.snomed.org/)
.

The table below provides links to many of the key resources for further learning about SNOMED CT.

**Topic**

**Key reference**

**General information about SNOMED CT** Materials include what is SNOMED CT?, value and benefits, and information about licensing, software and tools, other SNOMED products.Also focused sites for vendors, members and implementers.

[https://www.snomed.org/what-is-snomed-ctarrow-up-right](https://www.snomed.org/what-is-snomed-ct)
[https://www.snomed.org/value-of-snomedctarrow-up-right](https://www.snomed.org/value-of-snomedct)
[http://snomed.org/licensearrow-up-right](http://snomed.org/license)
[https://www.snomed.org/software-toolsarrow-up-right](https://www.snomed.org/software-tools)
[https://www.snomed.org/other-snomed-productsarrow-up-right](https://www.snomed.org/other-snomed-products)

[https://www.snomed.org/vendorsarrow-up-right](https://www.snomed.org/vendors)
[https://www.snomed.org/membersarrow-up-right](https://www.snomed.org/members)
[https://www.snomed.org/implementersarrow-up-right](https://www.snomed.org/implementers)

**SNOMED CT Document Library**

Access to a wide range of documents about SNOMED CT

[http://snomed.org/doc](https://docs.snomed.org/)

**SNOMED CT Browsers**

The SNOMED International Browser and a list of other tools for exploring SNOMED CT content

[http://browser.ihtsdotools.orgarrow-up-right](http://browser.ihtsdotools.org/)

**SNOMED CT in Action**

Examples of how SNOMED CT is being used around the world.

[https://www.snomed.org/snomed-in-actionarrow-up-right](https://www.snomed.org/snomed-in-action)

**SNOMED CT Starter Guide**

A general purpose introduction to SNOMED CT which complements this guide.

[http://snomed.org/starterguide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/)

**SNOMED CT E-Learning Server**

Access to a growing range of online training resources about SNOMED CT. Including formal courses and open-access materials.

[http://snomed.org/elearningarrow-up-right](https://www.snomed.org/education)
[https://www.snomed.org/educationarrow-up-right](https://www.snomed.org/education)

**SNOMED CT Expo Presentations**

Presentation materials

[https://www.youtube.com/@snomedct/playlistsarrow-up-right](https://www.youtube.com/@snomedct/playlists)

**About SNOMED International**

More information about the organization that owns and maintains SNOMED CT

[http://snomed.org/eventsarrow-up-right](http://snomed.org/events)
[https://www.snomed.org/about-usarrow-up-right](https://www.snomed.org/about-us)
[https://www.snomed.org/get-involvedarrow-up-right](https://www.snomed.org/get-involved)
[http://snomed.org/membersarrow-up-right](http://snomed.org/members)
[https://www.snomed.org/our-partnershipsarrow-up-right](https://www.snomed.org/our-partnerships)
[https://www.snomed.org/snomed-ct-marketplacearrow-up-right](https://www.snomed.org/snomed-ct-marketplace)

* * *

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Vendor+Introduction&entry.670899847=References)

[PreviousLicensingchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/7-licensing)
[NextAppendix : User Experience of SNOMED CTchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/appendix-1-user-experience-of-snomed-ct)

Last updated 7 months ago

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# The Role of NRCs related to SNOMED CT Licensing | Practical Guides SNOMED NRC Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/the-role-of-nrcs-related-to-snomed-ct-licensing#affiliate-licenses)

Affiliate Licenses


-------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Organizations that develop or distribute products or services that include or provide access to SNOMED CT must be SNOMED International Affiliates. Organizations that use SNOMED CT must be either an SNOMED International Affiliate or a sub-licensee of an SNOMED International Affiliate. Becoming an Affiliate of SNOMED International requires an Affiliate License, which is a contractual agreement between SNOMED International and Affiliates.

Even though Affiliate Licenses are agreements between SNOMED International and Affiliates, Members often act as intermediate agents between SNOMED International and Affiliates by issuing the licenses. In this case, the NRC needs to provide information to SNOMED International about Affiliate Licenses issued by them. The SNOMED CT Affiliate License Agreement is a worldwide license for the use of the SNOMED CT International Edition. Acceptance of the License Agreement entitles an Affiliate to download releases of the SNOMED CT International Edition.

Figure 4. All Affiliate License Agreements are with SNOMED International. However Members, as agents of SNOMED International, may issue Affiliate licenses**.**

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3066103899-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FP1frmzZuNvoHsCrG7SKQ%252Fuploads%252Fgit-blob-fadaa2aee64518daed1e94a5ba463fc359d01481%252F254968145.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=ad9d9758&sv=2)

Full details of the conditions of use of SNOMED CT are provided by the [SNOMED CT Affiliate License agreementarrow-up-right](https://www.snomed.org/get-snomed)
. The notes below highlight a few key points about the availability of Affiliate licenses, conditions of use and circumstances in which charges are applicable for use of SNOMED CT.

**Obtaining an SNOMED International Affiliate License**

*   Applicants in Member countries are asked to check the relevant Member webpage for advice on how to apply for an Affiliate License within their country : [Membersarrow-up-right](http://www.snomed.org/members)
    .
    
*   Applicants who are not in an Member country, or are in Member country that does not currently provide a registration service, can apply for a license using the [Member Licensing and Distribution Servicearrow-up-right](https://www.snomed.org/licensing)
     (MLDS).
    

**Use of SNOMED CT in Member countries** SNOMED International does not charge for use of the SNOMED CT International Edition in Member countries. However, a Member is permitted to impose some conditions on use of SNOMED CT within its country.

**Use of SNOMED CT outside Member countries** Affiliates are required to pay [annual feesarrow-up-right](https://www.snomed.org/licensing)
 to SNOMED International for use in each hospital, clinic and other institution in a country that is not a Member of SNOMED International. The charges for this vary according to the wealth of the country. Affiliates are also liable to pay [feesarrow-up-right](https://www.snomed.org/licensing)
 if they expose SNOMED CT content in ways that enable it to be used in non-Member countries. This includes providing access to SNOMED CT via the Internet, in web application, mobile phone application or as part of a published specification or standard.

**Provision of services that enable access to SNOMED CT in non-Member countries** Companies or organizations providing apps, web portals and other software that incorporates all or part of SNOMED CT, or publishing mappings or other materials that include all or part of SNOMED CT require the permission of SNOMED International and a license for these activities. Those providing such access to these service or materials to another company or organization for use in a non-Member country must first confirm that that company or organization is an Affiliate Licensee. Furthermore, they must ensure the recipient of the services or materials understands its obligation to report and pay fees to SNOMED International for use in Non-Member countries.\\

**Web-based SNOMED CT browsers** Web-based SNOMED CT browsers that allow SNOMED CT content to be viewed are currently regarded as a special case on which SNOMED International has published guidelines (see [browser license guidancearrow-up-right](https://confluence.ihtsdotools.org/download/attachments/73368648/Ihtsdo_Guidance_PublicAccessBrowserAndTools_20141211.pdf)
). However, note that these guidelines only cover use to explore the content of SNOMED CT. They do not exempt those using SNOMED CT in Non-Member countries from obligation to pay fees for use.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/the-role-of-nrcs-related-to-snomed-ct-licensing#national-licenses)

National licenses


-----------------------------------------------------------------------------------------------------------------------------------------------------------------------

A Member may issue Affiliates with licenses for use of its National Extension of SNOMED CT (including translations, content additions and Reference sets). These licenses must include a requirement for the licensee to hold a SNOMED CT Affiliate License for the International Release. One way to achieve this is to include a copy of the SNOMED CT Affiliate License Agreement within the National License. In this case, care must be taken to ensure that the copy of this agreement is regularly updated with changes approved by SNOMED International.

The terms of the National License could be similar to the SNOMED CT Affiliate License but with the Member as the licensor and the National Extension as the licensed work. Alternatively, the National License might be part of a more general licensing policy for nationally owned works. However, SNOMED International requires that a licensee of a National Extension must also be a SNOMED CT Affiliate Licensee (i.e. a licensee with SNOMED International). A Member can meet this requirement by registering the Licensee's acceptance of the SNOMED CT Affiliate License Agreement.

Members can also impose additional requirements related to the use of the SNOMED CT International Edition in their countries. For example, a Member may require licensees to use of the National Extension when deploying SNOMED CT in its country.

The formal responsibility of the NRC is to maintain a register of all licenses granted by the Member to Affiliates within the Member country. This register must include information about:

1.  The identity of the Affiliate
    
2.  The products provided under the license
    
3.  The payment terms under the license (if any)
    
4.  Product usage in a non-Member country
    

If an Affiliate provides information about non-Member country use, the Member is obliged to inform SNOMED International of this so that the correct fees can be charged. In the event of termination of Membership, the former Member must submit the full register of all licenses it has issued to SNOMED International within 30 days.

Members are encouraged to share information about Affiliates they have registered that are based in or operating in other Member countries. They should also inform Affiliates about obtaining a National License in their country of origin.

Figure 5. Members manage licenses issued to Affiliates for national use of SNOMED CT

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3066103899-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FP1frmzZuNvoHsCrG7SKQ%252Fuploads%252Fgit-blob-6b212245c1cb9a3f3695be9042be4e605a5d9bcd%252F254968144.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=6a3fc2ac&sv=2)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/the-role-of-nrcs-related-to-snomed-ct-licensing#sub-licenses)

Sub-licenses


-------------------------------------------------------------------------------------------------------------------------------------------------------------

SNOMED International Affiliates can issue sub-licenses, to allow organizations/users to use SNOMED CT, as part of a software application or information system. An organization that is not itself an SNOMED International Affiliate is only permitted to use SNOMED CT in accordance with the terms of a sub-license issued by an SNOMED International Affiliate.

It is the Affiliate's responsibility to manage these sublicenses and make information about them available to SNOMED International. Affiliates are also required to report and make appropriate payments when SNOMED CT is used in non-Member countries.

Sub-licensing is not an NRC function but NRCs need to:

*   Understand that Affiliates are required to issue sub-licenses to organizations that use SNOMED CT enabled systems and services that they provide;
    
*   Ensure that Affiliates and users in their country are aware of this requirement.
    

Figure 6. Sub-licenses are issued by Affiliates.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3066103899-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FP1frmzZuNvoHsCrG7SKQ%252Fuploads%252Fgit-blob-b7ddca8f9ef07ad0e80559844c863e0e3a917aac%252F254968143.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=f2654d44&sv=2)

Members are not required to facilitate or manage sub-licenses. However, as the primary point of contact for the national Affiliates, an NRC should be able to support and guide Affiliates in matters related to the management of sub-licenses and to point Affiliates to the appropriate source of information within SNOMED International.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/the-role-of-nrcs-related-to-snomed-ct-licensing#licensing-and-distribution-of-snomed-ct-tools)

**Licensing and Distribution of SNOMED CT - Tools**

SNOMED International provides a platform for licensing and distribution of SNOMED CT for its Member countries. This service is named the [Member Licensing and Distribution Servicesarrow-up-right](https://mlds.ihtsdotools.org/)
 (MLDS) and enables the NRC to have a web based portal in the preferred language where Affiliates register and update their licensing information as well as download SNOMED CT and other related products. The NRC is responsible for translating the interface terminology, etc., but SNOMED International helps the NRC get started. Once registered in MLDS, an Affiliate can access the national distribution from the NRC as well as other NRC products, so long as the Member country is using MLDS. For more information about using MLDS in your country contact your SNOMED International Customer Relations Executive.

circle-info

SNOMED International does not charge for use of SNOMED CT in Member countries. However, an Member country may charge Affiliates a small fee for cost recovery.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=NRC+Guide&entry.670899847=The%20Role%20of%20NRCs%20related%20to%20SNOMED%20CT%20Licensing)

[PreviousNRC Organization Phaseschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/nrc-organization-phases)
[NextImplementation Consultancychevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/implementation-consultancy)

Last updated 7 months ago

*   [Affiliate Licenses](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/the-role-of-nrcs-related-to-snomed-ct-licensing#affiliate-licenses)
    
*   [National licenses](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/the-role-of-nrcs-related-to-snomed-ct-licensing#national-licenses)
    
*   [Sub-licenses](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/the-role-of-nrcs-related-to-snomed-ct-licensing#sub-licenses)
    
*   [Licensing and Distribution of SNOMED CT - Tools](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/the-role-of-nrcs-related-to-snomed-ct-licensing#licensing-and-distribution-of-snomed-ct-tools)
    

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# Elección de un enfoque de implementación | Practical Guides Intro a SCT para proveedores | SNOMED International Documents

*   ¿Cuál es la configuración que se desea implementar en el expediente clínico electrónico donde se utilizará SNOMED CT?
    
*   ¿La configuración deseada debe lograrse en una sola etapa o en una secuencia de etapas y, de ser así, cuáles son las etapas?
    
*   ¿El contenido de SNOMED CT debe almacenarse junto con otros datos de referencia del sistema o por separado?
    
*   ¿La implementación de SNOMED CT debe realizarse de forma nativa dentro del sistema de expediente clínico electrónico o mediante la integración con un proveedor externo de servicios de terminología?
    

La naturaleza diversa de los sistemas de expediente clínico electrónico, así como el amplio alcance de SNOMED CT, significa que no puede haber un enfoque universal. Existen diferentes maneras de lograr resultados similares y variaciones entre las secuencias de desarrollo adoptadas para alcanzar el mismo resultado.

La estrategia y planificación de implementación se analiza aquí abordando:

*   Las diferentes ubicaciones para el uso de SNOMED CT dentro de los sistemas y subsistemas de expediente clínico electrónico
    
*   ¿Qué se hace comúnmente para cada uno?
    
*   Algunas etapas de implementación comunes: escalamiento hasta un uso más amplio o integrado
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#introduccion-a-las-configuraciones-de-implementacion)

Introducción a las configuraciones de implementación


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

La representación simplificada de un sistema de expediente clínico electrónico que se muestra en la Figura 5 se utiliza para ilustrar una variedad de configuraciones alternativas en las que SNOMED CT se implementa en uno o más de los componentes de un expediente clínico electrónico.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-222887e7d53294617fd960500c9a69db3ce44a1b%252F259854952.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=18f5be2d&sv=2)

**Figura 5. Ilustración esquemática de un sistema de expediente clínico electrónico**

La ilustración de arriba muestra como componentes separados la interfaz de usuario, el almacenamiento de datos y la comunicación de datos externos para la operatividad entre sistemas. En la documentación de SNOMED CT, estos se consideran colectivamente como parte de una implementación de registros clínicos. Otros tipos de implementación incluyen la vinculación con recursos de conocimiento y la agregación y análisis. En el diagrama se hace una distinción entre los datos de referencia, como SNOMED CT o CIE-10, y los registros de datos clínicos guardados en el almacén de datos clínicos. Aparte de ambos se encuentra el almacén de datos, en el que se guardan por separado copias de partes de la totalidad de registros de datos clínicos para respaldar el análisis y la elaboración de informes de datos.

Una forma de categorizar los componentes ilustrados arriba es:

*   Los utilizados por médicos que atienden a pacientes individuales: registro, despliegue, uso de soporte de decisiones
    
*   Los utilizados por aquellos interesados en la gestión, estadística u otros datos de población/cohorte: recuperación, análisis, investigación, epidemiología.
    

Las convenciones diagramáticas utilizadas en esta sección se muestran en la Figura 6 a continuación.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-525d9bc8a003f0bede4dada018b69cc2437404ba%252F259854951.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=5d468a24&sv=2)

**Figura 6. Clave de colores para la Figura 7 a la Figura 16**

El resto de la sección presenta diez formas en las que SNOMED CT se puede implementar en los sistemas de expediente clínico electrónico. Como se mencionó anteriormente, estos no son exhaustivos ni totalmente excluyentes entre sí, sino simplemente ilustrativos. Los diez diferentes enfoques para utilizar SNOMED CT

son:

1.  Como terminología de referencia para la comunicación
    
2.  Como terminología de referencia para la integración de datos
    
3.  Como sistema de indexación para la recuperación de datos
    
4.  Como sistema de codificación para el almacenamiento de datos clínicos
    
5.  Como terminología de interfaz para la entrada de datos
    
6.  Para agregación y análisis simples
    
7.  Para análisis complejos utilizando lógica descriptiva
    
8.  Para la vinculación del conocimiento
    
9.  Como base extensible para representar datos clínicos
    
10.  Uso completo de todas las funciones de SNOMED CT
    

Con base en la categorización introducida anteriormente sobre el uso por parte de médicos o por parte de otros, los enfoques 1, 2, 4, 5, 8, 9 y 10 están dirigidos principalmente al uso por parte de médicos, mientras que los enfoques 3, 6 y 7 están dirigidos principalmente al uso por parte de otros. Sin embargo, los enfoques 6 y 7 incluyen elementos de interés para los médicos, y los enfoques 9 y 10 incluyen elementos de interés para otros.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-como-terminologia-de-referencia-para-la-integracion-de-datos)

SNOMED CT como terminología de referencia para la integración de datos

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-8075c51fec4d6690c719001880ba0f181da599aa%252F259854950.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=39e886c&sv=2)

**Figura 8. SNOMED CT como terminología de referencia para la integración de datos**

Este enfoque utiliza SNOMED CT como “Terminología de referencia” para la integración de datos, transformando los distintos códigos y textos libres recibidos de sistemas externos en códigos de SNOMED CT. Este enfoque generalmente se combina con uno de los enfoques que utilizan la integración de datos para que se puedan generar informes, consultas, soporte de decisiones o proporcionar una visualización consistente al usuario.

**Beneficios**

*   Los datos de los pacientes pueden integrarse desde una variedad de fuentes estructuradas y no estructuradas, incluidos los sistemas de registros médicos hospitalarios y los dispositivos móviles.
    
*   Los datos del paciente codificados de manera consistente se pueden utilizar para análisis, consultas, soporte de decisiones o visualización del usuario.
    
*   Se pueden realizar correlaciones entre datos de fuentes de diferentes tipos utilizando las relaciones definitorias de SNOMED CT.
    

**Consideraciones**

*   Es necesario mantener actualizado el mapeo entre el código fuente de los sistemas y SNOMED CT
    
*   El procesamiento del lenguaje natural para codificar registros no estructurados puede requerir la validación manual para garantizar una codificación de alta calidad
    
*   Deben tomarse en cuenta ciertas excepciones
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-como-sistema-de-indexacion-para-la-recuperacion-de-datos)

SNOMED CT como sistema de indexación para la recuperación de datos

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-decea66e1a400689dc46337dcfdbf972455ab9fd%252F259854949.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=eb4e70df&sv=2)

**Figura 9. SNOMED CT como sistema de indexación para la recuperación de datos**

Este enfoque tiene beneficios tanto para quienes realizan análisis de datos como para los usuarios clínicos de primera línea. No implica ningún cambio en el registro de datos ni en el almacenamiento de datos clínicos. Los registros almacenados como texto narrativo o que utilizan otros sistemas de códigos son procesados por una rutina que combina los códigos almacenados (y/o el texto narrativo) con los conceptos de SNOMED CT precoordinados apropiados. El resultado final es una representación de partes relevantes de la información del registro etiquetadas e indexadas mediante SNOMED CT. El índice resultante es luego utilizado por el subsistema de informes y análisis para respaldar la consulta, la recuperación y el análisis utilizando la terminología basada en SNOMED CT.

**Beneficios**

*   Admite la investigación y el análisis en un sistema local o en un almacén de datos compartido
    
*   Admite el uso de SNOMED CT para análisis e informes.
    
*   Para la identificación de cohortes de pacientes para estudios de investigación
    
*   Para la exploración de datos para apoyar la auditoría del proceso clínico
    
*   Para mejorar la experiencia del usuario en la revisión de registros longitudinales
    
*   Impacto nulo o mínimo en el tiempo de ejecución de los procesos
    

**Consideraciones**

*   No se aprovechan los beneficios derivados de un uso más amplio de SNOMED CT
    
*   Requiere que una proporción suficiente de elementos clínicos codificados existentes se puedan mapear con éxito hacia y desde SNOMED CT.
    
*   Los elementos codificados individuales pueden asignarse a más de un objetivo en SNOMED CT; en algunos cálculos, esto requerirá la selección de solo un objetivo del conjunto de candidatos en SNOMED CT, en otros no será necesario.
    
*   La calidad de los datos clínicos en sí puede ser el factor dominante en el valor de este enfoque, más que la existencia de excepciones, por ejemplo, cuando no existe un mapa único para un elemento codificado.
    
*   Deben tomarse en cuenta ciertas excepciones
    

### 

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SNOMED CT como sistema de codificación de datos clínicos en la HCE

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-f405d0cfdab879ac18e8a615e5f06172aa03fcb9%252F259854948.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=7ca9b4d6&sv=2)

**Figura 10. SNOMED CT como sistema de codificación de datos clínicos en la HCE**

Un implementador que quiera introducir los registros de SNOMED CT, pero que también esté interesado en mantener sin cambios la experiencia del usuario clínico al mínimo absoluto, puede elegir este enfoque. Puede ser un paso de bajo riesgo hacia un uso más amplio de SNOMED CT. La calidad del mapa entre la "terminología de interfaz existente" y los conceptos precoordinados de SNOMED CT deberá cumplir con una variedad de requisitos de gobernanza clínica, establecidos a nivel local. Como el contenido del almacén de datos utiliza SNOMED CT, los códigos de conceptos de SNOMED CT estarán disponibles para comunicarse con sistemas externos. Es probable que un enfoque de este tipo se reconozca como "almacenar e intercambiar registros utilizando SNOMED CT”

**Beneficios**

*   No hay cambios en los términos que los médicos están acostumbrados a ver en la interfaz de usuario
    
*   Almacenamiento de los datos de los pacientes mediante conceptos de SNOMED CT
    
*   Comunicación utilizando un significado compartido
    
*   Puede utilizar mapas desarrollados internacionalmente, como las mapas a CIE-9 y CIE-10
    
*   SNOMED CT está disponible para uso directo en comunicaciones electrónicas
    
*   Integración estandarizada con reglas de apoyo a la toma de decisiones
    

**Consideraciones**

*   Requiere que una proporción suficiente de la terminología de interfaz existente pueda asignarse con éxito a SNOMED CT
    
*   Un mapa ideal entre la terminología de la interfaz y SNOMED CT es un mapa uno a uno.
    
*   Será necesario manejar con cuidado las excepciones cuando no exista un mapa entre un elemento de la interfaz existente y SNOMED CT.
    
*   Puede ser apropiado ajustar los elementos de la interfaz para eliminar cualquier ambigüedad.
    
*   Es necesario mantener actualizado el mapeo entre la terminología de la interfaz y SNOMED CT.
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-como-terminologia-de-interfaz-para-el-registro-de-datos-de-expediente-clinico-electronico)

SNOMED CT como terminología de interfaz para el registro de datos de expediente clínico electrónico

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-2b08a281744a68a45d6eb092ef53aec436353ece%252F259854947.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=b76e9aa5&sv=2)

**Figura 11. SNOMED CT como terminología de interfaz para la entrada de datos de expediente clínico electrónico**

El uso de SNOMED CT en la interfaz de usuario es lo que distingue este enfoque respecto del anterior. Elimina la complejidad de crear y mantener un mapa desde la terminología de la interfaz hacia SNOMED CT. Dada la gran cantidad de términos disponibles en SNOMED CT, este enfoque puede respaldarse mediante el uso de subconjuntos de SNOMED CT para limitar la búsqueda del concepto de SNOMED CT apropiado. Como el contenido del almacén de datos utiliza SNOMED CT, hay códigos de concepto disponibles para comunicarse con sistemas externos. Además, SNOMED CT puede actuar como una fuente de datos de referencia maestros fácilmente disponible, por ejemplo, una lista de substancias con una misma característica o propiedad.

**Beneficios**

*   Descripciones estandarizadas disponibles en la interfaz de usuario
    
*   No se requiere mapeo entre los términos de la interfaz y los códigos almacenados en el registro del paciente
    
*   Admite técnicas mejoradas para el registro, búsqueda y visualización de datos, por ejemplo, búsqueda de sinónimos del mismo concepto.
    
*   Los datos de los pacientes se almacenan mediante conceptos de SNOMED CT
    
*   Datos de referencia maestros fácilmente disponibles, p. ej. lista de substancias con una misma característica o propiedad.
    

**Consideraciones**

*   Este enfoque puede requerir una transición de la experiencia del usuario. Sin embargo, se debe tener en cuenta que se pueden agregar nuevas descripciones a SNOMED CT para satisfacer sus expectativas.
    
*   Es necesario crear y mantener subconjuntos para ayudar a los usuarios a buscar y registrar adecuadamente los conceptos de SNOMED CT.
    

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[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-para-la-agregacion-y-el-analisis-sencillos-de-datos)

SNOMED CT para la agregación y el análisis sencillos de datos

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-b16878b17a2319b8220b2dd2792d404456ce555f%252F259854946.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=c1b27ea7&sv=2)

**Figura 12. SNOMED CT como diccionario para la agregación y análisis sencillos de dato s**

Basándose en el enfoque de implementación anterior, la adición de funciones de análisis mediante SNOMED CT, como se muestra en la Figura 12, proporciona capacidades mejoradas. Por ejemplo, este enfoque permite identificar cohortes de pacientes según criterios determinados, revisar el cumplimiento de los estándares de atención y responder a los requerimientos de informes obligatorios. Una ventaja clave de este enfoque es que no depende de ninguna asignación terminológica, ni de una terminología local ni de una terminología de interfaz. Utilizando las jerarquías de SNOMED CT y definiendo relaciones, este enfoque apoya la consulta y agregación de registros de salud. Tanto los analistas de datos como los médicos obtienen el poder analítico de SNOMED CT.

**Beneficios**

*   Admite el uso de SNOMED CT para fines de análisis e informes, como:
    
    *   Mejorar la experiencia del usuario en la revisión de registros longitudinales
        
    *   La exploración de datos para apoyar la auditoría del proceso clínico
        
    *   La identificación de cohortes de pacientes para estudios de investigación
        
    *   Cumplir con los requisitos para informes obligatorios
        
    
*   Puede utilizar mapas desarrollados internacionalmente, como los mapas a CIE-9 y CIE-10
    
*   Descripciones estandarizadas visibles en la interfaz de usuario
    
*   Los datos de los pacientes son almacenados mediante conceptos de SNOMED CT
    
*   Comunicación utilizando el significado compartido de conceptos
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-para-analisis-mediante-logica-descriptiva)

SNOMED CT para análisis mediante lógica descriptiva

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-0d8b2c86ad8379ca64590234e0e14b5ec9495017%252F259854945.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=bc97402d&sv=2)

**Figura 13. SNOMED CT como diccionario para análisis utilizando lógica descriptiva**

Este enfoque puede resultar adecuado para los usuarios que valoran la capacidad analítica adicional que se puede lograr con el uso computacional completo de las definiciones de los conceptos de SNOMED CT. Las capacidades analíticas mejoradas de este enfoque permiten una recuperación de registros más efectiva al minimizar la aparición de resultados falsos negativos, mejorando así la experiencia del usuario.

En las herramientas de informes y análisis, este enfoque utiliza técnicas de lógica descriptiva. No incluye el uso de expresiones poscoordinadas de SNOMED CT para el registro y el almacenamiento de datos, sin embargo sí explota las definiciones de cada concepto de SNOMED CT según la lógica descriptiva.

**Beneficios**

*   Informes y análisis más sofisticados y flexibles
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-para-la-vinculacion-del-conocimiento)

SNOMED CT para la vinculación del conocimiento

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-31122b4c272c955aa6f1676fb3c07bb76a3d61b8%252F259854944.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=d509ffcd&sv=2)

**Figura 14. SNOMED CT para la vinculación del conocimiento**

Una mejora del enfoque establecido anteriormente en la Figura 11 es la adición de uno o más recursos de conocimiento habilitados con SNOMED CT. Esta configuración incluye una colección de recursos de conocimiento (como guías clínicas o sistemas de apoyo a la toma de decisiones) que utilizan los códigos SNOMED CT que son almacenados en el registro de un paciente para determinar qué acciones se deben realizar durante la atención. Esto puede incluir la presentación de alertas al usuario, la visualización de guías clínicas y de protocolos de tratamiento relevantes o el llenado automático de una solicitud, mensaje o informe.

**Beneficios**

*   Permite la integración del expediente clínico electrónico con bases de conocimiento.
    
*   Las reglas pueden utilizar la jerarquía de SNOMED CT y definir relaciones para la agregación y la consulta.
    
*   Se puede utilizar para proporcionar alertas clínicas en tiempo real relevantes para el paciente en cuestión.
    
*   Se puede utilizar para sugerir guías y protocolos clínicos relevantes para el paciente en cuestión.
    

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[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-como-base-extensible-para-la-representacion-de-datos-clinicos)

SNOMED CT como base extensible para la representación de datos clínicos

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-be0204d7b13533308c00ff49563f811be1aedbfe%252F259854943.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=110ea459&sv=2)

**Figura 15. SNOMED CT como base extensible para la representación de datos clínicos**

La Figura 13 muestra la explotación de las definiciones de conceptos de SNOMED CT para el análisis, pero no presenta expresiones de SNOMED CT poscoordinadas en los registros de los pacientes. Por el contrario, el enfoque ilustrado en la Figura 15 apoya la creación, el almacenamiento, la recuperación y la visualización de registros que utilizan expresiones poscoordinadas de SNOMED CT. No necesariamente cuenta con herramientas de análisis dedicadas al contenido poscoordinado. Una razón para adoptar este enfoque es permitir que las combinaciones de contenido se almacenen juntas como un solo campo de datos, por ejemplo, para registrar la lateralidad de un procedimiento junto con el procedimiento en un solo campo, en lugar de utilizar campos separados.

Este enfoque permite realizar diversas mejoras en los conceptos existentes, por ejemplo, en el caso de "neumonía causada _por estreptobacilo_ " (como se ilustra más arriba). Una opción para este enfoque es utilizar un repositorio de expresiones de SNOMED CT para identificar, almacenar y compartir las expresiones poscoordinadas que se han utilizado.

**Beneficios**

*   Aumenta el nivel y el alcance del significado clínico que está respaldado mediante el uso de datos estructurados
    
*   Admite la construcción de los conceptos como expresiones de SNOMED CT, ya sea:
    
*   Por los propios usuarios finales
    
*   Durante el diseño y configuración del sistema
    

**Consideraciones**

*   Es posible que los sistemas externos a los que se envían datos del paciente no tengan la capacidad de procesar expresiones poscoordinadas de SNOMED CT.
    
*   Los campos de almacenamiento de datos y mensajes que deben incluir expresiones poscoordinadas de SNOMED CT, deben admitir una longitud de campo adecuada.
    
*   La recuperación de los registros de pacientes con contenido poscoordinado puede requerir un enfoque de consulta más sofisticado.
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#uso-completo-de-snomed-ct-para-ofrecer-todas-sus-potentes-funciones-en-un-expediente-clinico-electro)

Uso completo de SNOMED CT para ofrecer todas sus potentes funciones en un expediente clínico electrónico

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3869033221-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FgJUdYtsAnX415FsKishB%252Fuploads%252Fgit-blob-3eef687e098254d60d8a5a313a36c92b019dc4cb%252F259854942.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=3a75e3ee&sv=2)

**Figura 16. Uso completo de SNOMED CT para ofrecer todas sus potentes funciones en un expediente clínico electrónico**

Esta ilustración muestra un sistema en el que todos los componentes son capaces de utilizar y explotar todas las características de SNOMED CT. En todo el sistema es posible intercambiar, interpretar y utilizar información codificada como expresiones poscoordinadas de SNOMED CT y realizar análisis utilizando lógica descriptiva.

**Beneficios**

*   Este sistema combina todos los beneficios identificados para los enfoques anteriormente descritos.
    

**Resumen**

Los enfoques enumerados en esta sección ilustran que hay diversas maneras de alcanzar este "uso completo". Estos enfoques se pueden resumir considerando el conjunto de características de SNOMED CT que se utilizan en cada uno:

*   Conceptos y mapas (enfoques 1 y 4)
    
*   Conceptos, relaciones y mapas (enfoques 2 y 3)
    
*   Conceptos, descripciones y subconjuntos (enfoque 5)
    
*   Conceptos, descripciones, relaciones y subconjuntos (enfoques 6 y 8)
    
*   Conceptos, descripciones, relaciones, subconjuntos y lógica descriptiva (enfoque 7)
    
*   Conceptos, descripciones, relaciones, subconjuntos y expresiones (enfoque 9)
    
*   Conceptos, descripciones, relaciones, subconjuntos, lógica descriptiva, expresiones y mapas (enfoque 10)
    

Si bien el último enfoque (enfoque 10) podría considerarse como una posible configuración de destino o deseada, para la mayoría de los productos de expediente clínico electrónico lo más apropiado es una implementación por etapas hacia un diseño más integral.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Spanish-Vendor-Guide&entry.670899847=Elecci%C3%B3n%20de%20un%20enfoque%20de%20implementaci%C3%B3n)

[PreviousIntroducción a SNOMED CTchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/introduccin-a-snomed-ct)
[NextEstrategias y consideraciones de implementaciónchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/estrategias-y-consideraciones-de-implementacin)

Last updated 5 months ago

*   [Introducción a las configuraciones de implementación](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#introduccion-a-las-configuraciones-de-implementacion)
    
*   [SNOMED CT como terminología de referencia para la integración de datos](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-como-terminologia-de-referencia-para-la-integracion-de-datos)
    
*   [SNOMED CT como sistema de indexación para la recuperación de datos](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-como-sistema-de-indexacion-para-la-recuperacion-de-datos)
    
*   [SNOMED CT como sistema de codificación de datos clínicos en la HCE](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-como-sistema-de-codificacion-de-datos-clinicos-en-la-hce)
    
*   [SNOMED CT como terminología de interfaz para el registro de datos de expediente clínico electrónico](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-como-terminologia-de-interfaz-para-el-registro-de-datos-de-expediente-clinico-electronico)
    
*   [SNOMED CT para la agregación y el análisis sencillos de datos](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-para-la-agregacion-y-el-analisis-sencillos-de-datos)
    
*   [SNOMED CT para análisis mediante lógica descriptiva](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-para-analisis-mediante-logica-descriptiva)
    
*   [SNOMED CT para la vinculación del conocimiento](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-para-la-vinculacion-del-conocimiento)
    
*   [SNOMED CT como base extensible para la representación de datos clínicos](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#snomed-ct-como-base-extensible-para-la-representacion-de-datos-clinicos)
    
*   [Uso completo de SNOMED CT para ofrecer todas sus potentes funciones en un expediente clínico electrónico](https://docs.snomed.org/snomed-ct-practical-guides/intro-a-sct-para-proveedores/eleccin-de-un-enfoque-de-implementacin#uso-completo-de-snomed-ct-para-ofrecer-todas-sus-potentes-funciones-en-un-expediente-clinico-electro)
    

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# Release Schedule and File Formats | Practical Guides | SNOMED International Documents

This section provides an overview of:

*   Release schedule and process
    
*   Release files and formats
    
*   Release types
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/13-release-schedule-and-file-formats#why-is-this-important)

Why is this important?


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SNOMED CT is distributed to Members and Affiliate Licensees as a set of downloadable files. Those wishing to implement SNOMED CT in software applications should understand the release schedule and the structure and content of the release files. Users should be aware that regular updates of SNOMED CT are made available and should be used in their systems to benefit from continuous improvements to coverage and quality.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/13-release-schedule-and-file-formats#what-is-this)

What is this?


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### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/13-release-schedule-and-file-formats#release-schedule-and-process)

Release Schedule and Process

The SNOMED CT International Edition is currently released monthly on the last day of each month. The release files are made available to Members in advance of the formal release date and Affiliate Licensees gain access either through their National Member or via the SNOMED International Affiliate Licensing system. Many Members supplement the International Edition with releases of their national Extension. The Extensions may be released at the same time as the International Edition but in some cases are released on different dates and at different intervals.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/13-release-schedule-and-file-formats#release-files-and-formats)

Release Files and Formats

Release Format 2 (RF2) is the primary format used for SNOMED CT release files. This format includes valuable additional data that was not supported by the earlier format.

The SNOMED CT International Edition is released as a set of files:

*   The release files are:
    
    *   Tab-delimited text files
        
    *   Encoded in accordance with the Unicode UTF-8 specification (which supports a wide range of characters, symbols and accented characters)
        
    
*   There are individual files with specified columns for each of the core components of SNOMED CT:
    
    *   Concepts
        
    *   Descriptions
        
    *   Relationships
        
    

All components in the release files have permanent unique SNOMED CT Identifiers.

*   There are also individual files with specified columns for each type of Reference Set
    
    *   These files contain essential information about language preferences, subsets, maps and metadata to support technical implementations
        
    

The same file formats are also used for SNOMED CT Extensions.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/13-release-schedule-and-file-formats#release-types)

Release Types

The RF2 specification provides a history tracking mechanism within the distributed files. This enables different release types to be provided using the same file format and utilizing this mechanism to optimize installation and updating.

**Full Release:** A 'Full' release contains every version of every component that has ever been released prior to or in the specified Edition. This release provides a full historical record and can be used to obtain views of the state of any component at any point in time since its first release. The 'Full' release is the easiest way to install and initialize SNOMED CT. However the files are large and in each release only a small fraction of the content will have changed.

**Delta Release:** A 'Delta' release contains only those component versions created, inactivated or changed since the previous release. The 'Delta' release is much smaller than a 'Full' release and is ideal for updating a 'Full' release of the previous version. Adding a 'Delta' release to the previous version's 'Full' release will update the installation to a 'Full' release of the current Version. Note that a Delta release is not included as part of the International release but Delta release files can be generated. (See [https://github.com/IHTSDO/delta-generator-toolarrow-up-right](https://github.com/IHTSDO/delta-generator-tool)
 for details.)

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F19067948-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FUmSUeu96fIQZWDm7RISx%252Fuploads%252Fgit-blob-890918f1a334ab8136a5ba342421d62abca6d1a7%252F29952978.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=c1b296cd&sv=2)

**Snapshot Release:** A 'Snapshot' release contains the most recent version of every component released up to the time of the snapshot. The version of each component contained in a snapshot is the most recent version of that component at the release time. The 'Snapshot' release is useful for a simple installation but does not provide a history or retrospective view of the terminology.

There are valid use cases for each Release Type. Each International release will incorporate the Full and Snapshot Release Types, allowing users to choose the most appropriate format for their needs. Extensions should always be available as a full release and other Release Types may also be made available.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/13-release-schedule-and-file-formats#relationships-between-files)

Relationships Between Files

In Snapshot Release files

*   Each SNOMED CT concept is held as a single row in the concept file. Each row represents a clinical concept.
    
*   Each description is held as a single row in the description file, and is associated with a single concept.
    
*   Each relationship, from a source concept to a destination concept, is held as a single row in the relationship file. Each row also refers to the concept that represents the relationship type.
    

In Full Release files, concepts, descriptions and relationships may be represented by more than one row. In this case each row represents the state of the component at a stated point in time.

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*   [Why is this important?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/13-release-schedule-and-file-formats#why-is-this-important)
    
*   [What is this?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/13-release-schedule-and-file-formats#what-is-this)
    
*   [Release Schedule and Process](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/13-release-schedule-and-file-formats#release-schedule-and-process)
    
*   [Release Files and Formats](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/13-release-schedule-and-file-formats#release-files-and-formats)
    
*   [Release Types](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/13-release-schedule-and-file-formats#release-types)
    
*   [Relationships Between Files](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/13-release-schedule-and-file-formats#relationships-between-files)
    

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# Más información | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

La Guía del CNR pretende ser un punto de partida útil para los Centros Nacionales de Referencia. Se puede acceder a información más detallada y a una serie de documentos informativos y materiales educativos desde el sitio web de SNOMED International [http://www.snomed.org.arrow-up-right](http://www.snomed.org/)
 La tabla siguiente proporciona enlaces a muchos de los recursos clave para seguir aprendiendo sobre SNOMED CT.

Tópico

Referencia clave

**Información general sobre SNOMED CT** Los materiales incluyen: ¿qué es SNOMED CT?, valor y beneficios, e información sobre licencias.

[https://www.snomed.org/what-is-snomed-ctarrow-up-right](https://www.snomed.org/what-is-snomed-ct)
[https://www.snomed.org/value-of-snomedctarrow-up-right](https://www.snomed.org/value-of-snomedct)
 [https://www.snomed.org/licensingarrow-up-right](https://www.snomed.org/licensing)

**Biblioteca de documentos SNOMED CT** Acceso a una amplia gama de documentos sobre SNOMED CT

[http://snomed.org/docarrow-up-right](http://snomed.org/doc)

**Navegadores SNOMED CT** El Navegador Internacional de SNOMED y una lista de otras herramientas para explorar contenido de SNOMED CT

[http://browser.ihtsdotools.org/arrow-up-right](http://browser.ihtsdotools.org/)
 [https://www.implementation.snomed.org/browsersarrow-up-right](https://www.implementation.snomed.org/browsers)

**SNOMED CT en acción** Ejemplos del uso de SNOMED CT en todo el mundo.

[https://www.snomed.org/snomed-in-actionarrow-up-right](https://www.snomed.org/snomed-in-action)

**Guía de inicio de SNOMED CT** Una introducción general a SNOMED CT que complementa esta guía.

[http://snomed.org/starterguidearrow-up-right](http://snomed.org/starterguide)

**Guía de proveedores** La Introducción a SNOMED CT para proveedores proporciona una información práctica introductoria a SNOMED CT centrada principalmente en las necesidades de los proveedores y desarrolladores de HCE.

[http://snomed.org/vendorintroarrow-up-right](http://snomed.org/vendorintro)

**Servidor de e-Learning de SNOMED CT** Acceso a una creciente gama de recursos de educación en línea sobre SNOMED CT. Incluidos cursos formales y materiales de libre acceso

[http://snomed.org/elearningarrow-up-right](http://snomed.org/elearning)
[https://www.snomed.org/educationarrow-up-right](https://www.snomed.org/education)

**Presentaciones de la Expo SNOMED CT** Material de presentaciones

[https://www.youtube.com/@snomedct/playlistsarrow-up-right](https://www.youtube.com/@snomedct/playlists)

**Acerca de SNOMED International** Más información sobre la organización que posee y mantiene SNOMED CT

[https://www.snomed.org/about-usarrow-up-right](https://www.snomed.org/about-us)
[https://www.snomed.org/get-involvedarrow-up-right](https://www.snomed.org/get-involved)
[http://snomed.org/membersarrow-up-right](http://snomed.org/members)
[https://www.snomed.org/our-partnershipsarrow-up-right](https://www.snomed.org/our-partnerships)
[https://www.snomed.org/snomed-ct-marketplacearrow-up-right](https://www.snomed.org/snomed-ct-marketplace)

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[PreviousGobernanza, grupos consultivos y eventos de SNOMED Internationalchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-gobernanza-grupos-consultivos-y-eventos-de-snomed-international)

Last updated 5 days ago

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# Distribution of SNOMED CT | Practical Guides SNOMED NRC Guide | SNOMED International Documents

A core responsibility of an NRC is to make the International Edition of SNOMED CT and/or the National Extension of SNOMED CT available for Affiliates.

Every NRC must therefore be able to provide guidance on access to SNOMED CT, version control and management. Moreover, the NRC should be able to provide guidance to users on specific terminology services that are provided by the NRC, and in the use of national SNOMED CT developments, such as National Extensions, Reference sets, etc.

SNOMED International maintains and delivers shared content and derivatives that provide the foundation of SNOMED CT. This is known as the SNOMED CT International Edition.

SNOMED CT is distributed as sets of files containing terminology components and derivatives. These contain the basic data needed to implement SNOMED CT in various modes in a technology-neutral formats. The format, content and names of the files delivered conform to SNOMED CT specifications and guidelines published in [SNOMED CT Release File Specification](https://docs.snomed.org/snomed-ct-specifications/snomed-ct-release-file-specification/)
.

**Components represent the content of the terminology.**

The standard SNOMED CT representation for content is as three interrelated files. The Concept file contains unique identifiers for clinical ideas, the Description file links human readable terms with identified concepts, and the Relationship file represents associations between identified concepts.

**Derivatives facilitate the effective use of the terminology.**

The standard SNOMED CT representation for derivatives is a consistent but flexible file format, known as the Reference set format. Reference sets can be used for a wide range of purposes including subsets, language preferences, ordered lists, hierarchies, annotations and mappings to or from other terminologies, classifications and code systems.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/distribution-of-snomed-ct#access-to-snomed-ct-release-files)

Access to SNOMED CT release files:


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Members of SNOMED International and Affiliates outside of Member countries, both access the release files via SNOMED International's SNOMED CT Licensing and Distribution Services (MLDS).

All files distributed to Members are available from the [SNOMED CT International Editionarrow-up-right](https://mlds.ihtsdotools.org/#/viewReleases/viewRelease/167)
 product page on MLDS.

Access and information about MLDS can be found here: [https://mlds.ihtsdotools.orgarrow-up-right](https://mlds.ihtsdotools.org/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/distribution-of-snomed-ct#release-lifecycle)

Release Lifecycle


-------------------------------------------------------------------------------------------------------------------------------------------------

SNOMED International provides regular updates to the SNOMED CT International Edition. SNOMED CT is released monthly on the first day of each month. Further details can be found in [https://www.snomed.org/releasesarrow-up-right](https://www.snomed.org/releases)
.

Similarly, Members and Affiliates that maintain Extensions should release updated versions of their Extensions to align with the SNOMED CT International Edition.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/distribution-of-snomed-ct#members-release)

Members' Release

Regular changes to SNOMED CT are necessary in order to satisfy user needs and requirements and to improve the quality of SNOMED CT itself. An NRC must be aware that any change to SNOMED CT may have impact on National Extensions and guidance. Therefore, every release requires reconciliation to ensure that all National Extensions remain aligned with the International Edition.

If SNOMED CT components (concepts, descriptions or relationships) are added or inactivated, an assessment of how these changes affect a National Extension is be required, and adjustments to the national developments may be needed. For example:

*   Added concepts may require translation and may also be candidates for addition to national Reference sets.
    
*   Inactivated concepts that members of a National Reference set may need to be replaced with an appropriate active concept.
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/distribution-of-snomed-ct#release-files)

Release files

With every SNOMED CT release two different release file types are made available:

*   Full Release: containing the complete history of every component
    
*   Snapshot Release: containing the current state of every component
    

_Note on Delta Release ( includes changes made between one version and the next): Delta files have been removed from the SNOMED International release package, Managed Service Extensions and Derivative packages. However a Delta Generation Tool is available for those who need it. The Delta Generation Tool allows users to create their own Delta between two fixed release dates - you can find it here:_ [_https://github.com/IHTSDO/delta-generator-tool/releases._arrow-up-right](https://github.com/IHTSDO/delta-generator-tool/releases)

The International Edition is provided in both release types. However, as the Snapshot can be generated from the Full Release, the specification only requires that organizations that maintain Extensions provide a Full Release of their extension.

circle-info

A SNOMED CT Derivative is a document, subset, set of maps, or other resource that consists of, includes, references or is derived from one or more components. The standard computer processable representation for most types of SNOMED CT derivatives is a reference set.

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[NextChange Requestschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/change-requests)

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*   [Access to SNOMED CT release files:](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/distribution-of-snomed-ct#access-to-snomed-ct-release-files)
    
*   [Release Lifecycle](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/distribution-of-snomed-ct#release-lifecycle)
    
*   [Members' Release](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/distribution-of-snomed-ct#members-release)
    
*   [Release files](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/distribution-of-snomed-ct#release-files)
    

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# Asesoramiento para la implementación | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

Una función deseable de un CNR es actuar como órgano de recursos y asesoramiento para los Afiliados. Para que la adopción nacional de SNOMED CT tenga éxito, es fundamental que los Afiliados puedan obtener la educación, formación y orientación necesarias. SNOMED International ofrece una serie de recursos de educación y capacitación, que se describen en secciones posteriores. Sin embargo, los Afiliados pueden necesitar más orientación sobre aspectos de implementación, personalización o educación sobre SNOMED CT para grupos de usuarios específicos. Un CNR debe especificar cómo apoyará las solicitudes de consultoría en educación e implementación.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-asesoramiento-para-la-implementacin#usuarios-de-snomed-ct)

Usuarios de SNOMED CT


-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Con el fin de proporcionar el apoyo más eficiente a los usuarios nacionales de SNOMED CT, el CNR debe garantizar que los recursos de implementación y capacitación disponibles se centren en los tipos específicos de usuarios de SNOMED CT. Por lo tanto, el CNR debe conocer los diferentes aspectos relacionados con la implementación y el uso de SNOMED CT, saber cuáles son los diferentes tipos de usuarios de SNOMED CT y comprender el papel y las necesidades de cada uno de estos grupos de usuarios con respecto a los conocimientos y habilidades sobre SNOMED CT.

La Figura 7 ilustra tres tipos de usuarios de SNOMED CT que tienen diferentes necesidades con respecto al aprendizaje de SNOMED CT. Los conocimientos necesarios para los usuarios y profesionales relacionados con el registro de datos clínicos difieren de los conocimientos necesarios para los diseñadores y desarrolladores. Además, los usuarios responsables de la gestión de la información requieren más conocimientos transversales que los profesionales sanitarios, ya que son responsables de conciliar las necesidades de los usuarios, el marco terminológico y la configuración del sistema. Dentro de los diferentes tipos de usuarios de SNOMED CT existen varios roles de usuario, y las personas que desempeñan esos roles de usuario necesitan aprender sobre SNOMED CT a varios niveles de detalle y con diferentes puntos de partida. Estos tipos genéricos de usuarios son intencionadamente amplios. Los Miembros pueden identificar otras categorías y subdivisiones de usuarios relevantes para las circunstancias nacionales, teniendo en cuenta los diferentes enfoques de la estrategia de eSalud y la implementación de SNOMED CT.

**Figura 7 Tres grandes grupos de usuarios de SNOMED CT**

Usuarios

Diseñadores y desarrolladores (de sistemas de TI)

Desarrolladores de terminología

**Educadores y capacitadores**

**Registro de información clínica**

**Sistemas de soporte de decisiones**

**Diseñadores del modelo conceptual**

**Curación de la información clínica**

**Recuperación y análisis**

**Autores de contenido**

**Uso de la información clínica**

E**stándares de comunicación**

**Traductores**

**Servicios terminológicos**

**Desarrolladores de mapas**

**Desarrollo de artefactos terminológicos**

**Desarrolladores de sub-grupos y restricciones**

**Gestores del proceso de publicación**

A continuación encontrará una descripción y ejemplos de los distintos grupos de usuarios:

Los **usuarios** son quienes se dedican a registrar, almacenar, recuperar y/o reutilizar información clínica.

_Ejemplos_

*   Profesionales sanitarios (clínicos, enfermería, terapeutas, etc.)
    
*   Codificadores médicos y secretarios dedicados al registro de datos clínicos
    
*   Proveedores y editores de conocimiento clínico
    
*   Investigadores clínicos
    
*   Analistas de información
    
*   Gestores de la migración de datos preexistentes a la representación de SNOMED CT
    

Los **diseñadores y desarrolladores** son aquellos que diseñan, desarrollan, configuran o implementan sistemas de software que utilizan SNOMED CT. SNOMED International ha elaborado una Guía del proveedor para ayudar a los proveedores a comprender la implementación de SNOMED CT: [Introducción a SNOMED CT para proveedores. Versión en Españolarrow-up-right](https://confluence.ihtsdotools.org/pages/viewpage.action?pageId=259854508)

_Ejemplos_

*   Proveedores de soluciones sanitarias: diseñadores y desarrolladores de software
    
*   Integradores de sistemas
    
*   Investigadores e innovadores
    
*   Expertos clínicos y otras personas implicadas en la personalización de las interfaces de usuario y los protocolos de registro de datos.
    

**Los desarrolladores de terminologías** son organizaciones que desarrollan y distribuyen contenidos y otros artefactos como subconjuntos, mapas, etc.

_Ejemplos_

*   IHTSDO
    
*   Centros Nacionales de Referencia
    
*   Otras instituciones que trabajan con terminologías
    
*   Investigadores e innovadores
    

Los **educadores y capacitadores** son las personas implicadas en la educación y capacitación de las personas relacionadas con la implementación y uso de SNOMED CT.

_Ejemplos_

*   Personas con los conocimientos suficientes para educar y formar a personas dentro de un grupo de usuarios específico y al nivel requerido para el usuario real.
    

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# The Importance of Effective Search | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

Search is an important part of the clinical information life-cycle. Effective search must make it quick and easy for users to accurately select the relevant content for data entry. The selected Concept or Description may need to be stored in ways that represent information consistently and allow it to be processed effectively.

An EHR system must also have a user interface that makes search easy in terms of the time and effort required to find suitable Concepts to enter into the clinical record. Improving the usability of search can help increase the utility of SNOMED CT for data entry, and hence, the overall adoption of clinical systems. Increasing the utility and the added value of clinical systems depends on improving the tradeoff between time taken to code, and the quality of the coded content produced. This is true _whichever_ terminology is chosen to be implemented 'front of house'.

Leveraging SNOMED CT advanced design and implementing it properly is specifically intended to give better leverage in this tradeoff than we could ever have on other coding systems. However, if badly implemented, SNOMED CT will make an already bad situation worse. On the other hand, a multitude of different but generally poor designs is equally dangerous. There is a minimum level of functionality that should be universal, and implementers need to be more prescriptive when designing the search functionality.

Approaches to search embedded in clinical systems need to be tailored to the way different groups of clinicians work and think. While this guide identifies useful techniques to support searching, the ways in which these are applied may need to vary to match the working practices of a clinical specialty or the priorities of a particular health provider organization.

For effective data entry, the interface needs to be designed to meet the requirements for subsequent display and retrieval. Data entered and stored in the clinical record, needs to be displayed in ways that can be easily read and understood. The data should also be retrievable to enable reporting analysis, decision support and appropriate communication to other systems and other users.

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Last updated 7 months ago

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# Use Cases for Searches | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

Searching for a Concept can satisfy a wide range of use cases. This section describes common use cases that require effective search techniques. Each of these use cases may require a different combination of search techniques. The first sub-section describes SNOMED CT within the context of a clinical record application which is directly connected to data entry, and the second sub-section describes the use of SNOMED CT within a browser.

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[PreviousUsing SNOMED CT Features to Support Optimized Searcheschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/2-introduction-to-search/2.2-using-snomed-ct-features-to-support-optimized-searches)
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Last updated 7 months ago

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# SNOMED CT Search and Data Entry Guide | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

The Search and Data Entry Guide provides advice on two related activities that are essential for use of any code system: finding a term and saving the term and related code into the record. The first part of this guide is concerned with searching the content of SNOMED CT to find concepts that represent particular clinical ideas. The second part of the guide is concerned with ways to use SNOMED CT to support entry of relevant clinical information in electronic health records.

[Introduction](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction)

[Introduction to Search](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/2-introduction-to-search)

[Use Cases for Searches](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches)

[Optimizing Searches](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches)

[Optimize Display of Search Results](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results)

[Data Entry](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/6-data-entry)

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© Copyright 2026 International Health Terminology Standards Development Organisation, all rights reserved.

This document is a publication of International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED International owns and maintains SNOMED CT®.

Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. This document may be subject to updates. Always use the latest version of this document published by SNOMED International. This can be viewed online and downloaded by following the links on the front page or cover of this document.

SNOMED®, SNOMED CT® and IHTSDO® are registered trademarks of International Health Terminology Standards Development Organisation. SNOMED CT® licensing information is available at [http://snomed.org/licensingarrow-up-right](http://snomed.org/licensing)
. For more information about SNOMED International and SNOMED International Membership, please refer to [http://www.snomed.orgarrow-up-right](http://www.ihtsdo.org/)
 or contact us at [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#89e0e7efe6c9e0e1fdfaede6a7e6fbee)
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# Search by Identifiers | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

Searching by SNOMED CT identifier either as a Concept Identifier or a Description Identifier is useful in scenarios where the user knows the SNOMED CT Concept or Description they require.

It is useful in use cases for browsers, but is not an appropriate way to search in clinical applications. As a general rule the default behavior of clinical application should not display identifiers and users should never be expected to remember, type or cut-and-paste identifiers for data entry.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Search+And+Data+Entry+Guide&entry.670899847=4.2.%20Search%20by%20Identifiers)

[PreviousSearch by Textchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text)
[NextExtended Searcheschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches)

Last updated 7 months ago

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# Gobernanza, grupos consultivos y eventos de SNOMED International | Practical Guides Guía del Centro Nacional de Referencia (CNR) | SNOMED International Documents

Es importante que todos los Miembros estén familiarizados con la existencia y las responsabilidades de los diferentes órganos y foros de SNOMED International para que sepan qué funciones y responsabilidades desempeñan (o pueden desempeñar) los Miembros y, más concretamente, el CNR, dentro de ellos, pero también para que conozcan el apoyo y el beneficio que cada Miembro puede obtener participando en los diferentes foros.

Los órganos y foros de SNOMED International son la base para el mantenimiento, desarrollo y distribución continuos de SNOMED CT, y proporcionan el marco organizativo para la comunicación y colaboración entre las diferentes partes de la comunidad de SNOMED CT. A continuación se presenta una panorámica de los distintos Órganos y Foros.

**Figura 13 Estructuras de gobierno y asesoramiento de SNOMED International.**

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2133369718-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FI7N0Q2Su8RGW5pAlIrWt%252Fuploads%252Fgit-blob-6ef86a62760f66f5db9b8d2541099f26d6d63dc2%252F259854850.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=76ceb026&sv=2)

\*\*

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-gobernanza-grupos-consultivos-y-eventos-de-snomed-international#asamblea-general)

Asamblea general


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La Asamblea General es la máxima autoridad de SNOMED International y está compuesta por un representante de cada uno de sus Miembros. La Asamblea General es colectivamente responsable de garantizar que se persigan y consigan el Propósito, los Objetivos y los Principios de la Asociación y que se salvaguarden los intereses de SNOMED International. Puede tomar decisiones vinculantes sobre todos los asuntos relacionados con SNOMED International, con sujeción a lo dispuesto en los Estatutos y de conformidad con ellos, como el presupuesto, el plan de trabajo y los objetivos estratégicos. Se recomienda, aunque no es obligatorio, que los representantes de la Asamblea General asistan a todas las reuniones. Las reuniones presenciales suelen celebrarse dos veces al año, con teleconferencias ocasionales y votaciones electrónicas.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-gobernanza-grupos-consultivos-y-eventos-de-snomed-international#consejo-de-administracion)

Consejo de Administración


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El Consejo de Administración es nombrado por la Asamblea General. El Consejo de Administración dirige la Asociación y es responsable de las principales decisiones organizacionales. Celebra al menos cuatro reuniones presenciales al año, con teleconferencias ocasionales entre ellas.

El Consejo de Administración también nombra al Director General (CEO), que tiene la responsabilidad cotidiana de dirigir la organización. Un Equipo de Alta Dirección, cada uno de cuyos Miembros es responsable de una línea de negocio concreta, apoya al Director General y dirige el trabajo de los empleados.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-gobernanza-grupos-consultivos-y-eventos-de-snomed-international#organos-consultivos)

Órganos consultivos


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**Foro de Miembros**

Cada Miembro tiene derecho a nombrar a dos representantes en el Foro de Miembros (MF). El MF actúa como órgano consultivo sin derecho a voto para el CEO y el Equipo de Alta Dirección.

El MF es también un medio para optimizar la colaboración y la coordinación entre los países Miembros de SNOMED International y proporciona un medio para que los Miembros mantengan debates sobre cuestiones específicas de cada Miembro. Además, el MF facilita el contacto y la comunicación entre países con principios, necesidades, prioridades, etc. similares. Se recomienda que cada Miembro participe en el MF.

El MF puede plantear cuestiones de interés al Director General y al Equipo de Alta Dirección, y también se le pide que proporcione información específica sobre las prioridades nacionales y otros asuntos. El MF es el conducto para comunicar ampliamente las consultas que SNOMED International pueda emprender. Estas consultas pueden incluir cuestiones específicas relacionadas con el contenido de SNOMED CT o con los documentos, productos y servicios de SNOMED International. El MF también es un actor clave a la hora de determinar qué temas de trabajo de SNOMED International deben emprenderse y priorizarse.

**Grupos consultivos**

Los Grupos Consultivos se crearon en junio de 2015 para llevar a cabo actividades específicas que contribuyan al cumplimiento de las responsabilidades del Equipo de Alta Dirección o del mandato de la organización. Se pretende que sean ágiles, dadas las necesidades cambiantes y la dirección de la organización, por lo que cada grupo se revisa anualmente para determinar si sigue siendo necesario o si se precisan cambios en el mandato. Por lo general, los Miembros de los Grupos Consultivos poseen aptitudes y capacidades específicas relacionadas con ese grupo concreto.

La función de cada Grupo Consultivo es asesorar al Miembro o Miembros del Equipo Directivo correspondiente en áreas específicas incluidas en el Mandato, con el fin de fomentar el conocimiento y la dirección de la organización. Al principio de cada año, cada Grupo Consultivo elabora un plan de trabajo, determina si es necesario crear subgrupos de trabajo, esboza los recursos necesarios y establece una serie de medidas para supervisar el progreso del plan de trabajo. La organización, con la aprobación del Consejo de Administración, puede optar por solicitar la aprobación de partidas presupuestarias independientes en el presupuesto anual para ayudar a los Grupos Asesores a completar sus planes de trabajo aprobados. Todos los planes de trabajo deben presentarse anualmente al Director General para su revisión y aprobación.

Los CNR deben tener en cuenta que los Miembros del Grupo Consultivo se seleccionan mediante dos procesos de nombramiento diferentes. El mandato de cada grupo consultivo describe cuál de los dos es pertinente (o si se utiliza una combinación de ambos).

**Candidaturas de los Miembros**

Las nominaciones basadas en los Miembros se utilizan cuando SNOMED International pretende crear un foro para que el personal de SNOMED Internacional colabore estrechamente con los Miembros. Según este sistema, los Miembros nombran a representantes para que formen parte de un Grupo Consultivo, de modo que los Miembros del Grupo Consultivo representan a sus países. Normalmente, el Miembro del Equipo Directivo que preside el Grupo Consultivo se pone en contacto con los representantes de la Asamblea General y del Foro de Miembros en mayo o junio y les invita a designar representantes con un conjunto de aptitudes concretas. A continuación, SNOMED International acepta esas candidaturas o un subconjunto de ellas. Los gastos de desplazamiento de los Miembros del Grupo Consultivo para asistir a los actos presenciales aprobados correrán a cargo del Miembro. La negativa o incapacidad de un Miembro para pagar estos gastos no invalida ni perjudica en modo alguno la candidatura, y la teleconferencia es una opción habitual para quienes no puedan asistir en persona.

**Candidaturas estándar**

Otros Grupos Consultivos se basan en un proceso de nombramiento estándar, abierto y basado en competencias. Los Miembros del Grupo Consultivo seleccionados a través de este proceso pueden presentar a SNOMED International cualquier gasto de viaje aprobado para su reembolso con el fin de asistir a eventos presenciales aprobados del Grupo Consultivo (la Política de Viajes de SNOMED International contiene más información sobre los gastos aprobados y los medios de presentación).

¿Pueden los Miembros designar a personas para formar parte de los Grupos Consultivos que utilizan el proceso de designación estándar? Sí. Por ejemplo, un Miembro puede nombrar a su experto en TI del CNR para que forme parte del Grupo Asesor de Modelado, que utiliza el proceso de nombramiento estándar. SNOMED International puede seleccionarlos en función de sus competencias. ¿Quién paga los gastos de viaje para asistir a una reunión presencial del Grupo Consultivo? La persona elegida tendría derecho (pero no estaría obligada) a solicitar el reembolso de sus gastos a SNOMED International, sobre la base de que forma parte del Grupo Consultivo como experto y no como representante de un Miembro.

**Cuadro 1: Grupos consultivos y sus procesos de nombramiento**

Nombre del grupo

Proceso de nominación

[Grupo consultivo de gestores de contenido (CMAG)arrow-up-right](https://confluence.ihtsdotools.org/display/cmag/Content+Managers+Advisory+Group)

Basado en Miembros

[Grupo consultivo de aprendizaje electrónico (ELAG)arrow-up-right](https://confluence.ihtsdotools.org/display/ELAG/E-Learning+Advisory+Group)

Basado en Miembros

[Grupo consultivo de modelado (MAG)arrow-up-right](https://confluence.ihtsdotools.org/display/mag/Modeling+Advisory+Group)

Estándar

[Grupo consultivo editorial de SNOMED CT (EAG)arrow-up-right](https://confluence.ihtsdotools.org/display/editorialag)

Estándar

[Grupo consultivo de desarrollo de software (SDAG)arrow-up-right](https://confluence.ihtsdotools.org/display/SDAG/Software+Development+Advisory+Group)

Estándar

[Grupo consultivo de publicación terminológica (TRAG)arrow-up-right](https://confluence.ihtsdotools.org/display/TRAG)

Estándar

[Grupo de usuarios de los servicios gestionados (MSUG)arrow-up-right](https://confluence.ihtsdotools.org/display/TUAG)

Basado en Miembros

Encontrará más información sobre los Grupos Consultivos en [http://snomed.org/advisory.arrow-up-right](http://snomed.org/advisory)

**Grupos de referencia clínica**

Las aportaciones clínicas para apoyar el desarrollo de SNOMED CT se realizan a través de los Grupos de Referencia Clínica (CRG). Estos grupos se centran en especialidades clínicas, y cada especialidad tiene su propio sitio basado en Confluence. Cada sitio fomenta el debate y el intercambio de conocimientos. El acceso a los Grupos de Referencia Clínica se realiza a través de un portal central de Confluence centrado en las actividades de participación clínica en [http://snomed.org/crgarrow-up-right](http://snomed.org/crg)
.

**Espacio de colaboración de SNOMED International - Confluence**

Confluence es un foro/espacio en línea en el que las personas que forman parte de los Órganos Consultivos y de Gobierno de SNOMED International pueden comunicarse y compartir información. Confluence facilita diversos tipos de comunicación, como discusiones escritas, anuncios de reuniones e intercambio de documentos.

Los Miembros, Afiliados u otras partes interesadas pueden acceder al Espacio de Colaboración para obtener más información sobre SNOMED International y SNOMED CT. El espacio Confluence también permite participar en Grupos Consultivos, Grupos de Referencia Clínica y Grupos de Proyecto.

Encontrará información sobre Confluence en [https://confluence.ihtsdotools.org.arrow-up-right](https://confluence.ihtsdotools.org/)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-gobernanza-grupos-consultivos-y-eventos-de-snomed-international#reuniones-y-eventos-de-snomed-international)

Reuniones y eventos de SNOMED International


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SNOMED International organiza dos eventos al año. En abril celebra una reunión de trabajo y en octubre una segunda reunión de trabajo combinada con la exposición anual SNOMED CT EXPO. El lugar de celebración del acto de octubre varía cada año, por lo que se anima a los Miembros a presentar propuestas para acogerlo en su país.

**Reuniones de trabajo**

Las Reuniones de Trabajo de SNOMED International incluyen reuniones presenciales de los Órganos de Gobierno y Grupos Consultivos de SNOMED International. Las reuniones de trabajo también pueden incluir reuniones presenciales de algunos Grupos de Proyecto y Grupos de Referencia Clínica.

Mientras que las reuniones de los Grupos Consultivos están abiertas a los observadores, algunas sesiones de otros grupos son a puerta cerrada y sólo pueden asistir a ellas los Miembros de los organismos pertinentes.

Una parte fundamental de cada Reunión de Trabajo es la reunión abierta de la Asamblea General, en la que se toman y anuncian las principales decisiones estratégicas, planes y logros.

**SNOMED CT EXPO**

La [SNOMED CT EXPOarrow-up-right](https://www.snomed.org/snomedct-expo)
 es un evento abierto a cualquier persona interesada en SNOMED CT y en las aplicaciones prácticas de la terminología. El evento incluye ponentes principales invitados y varios seminarios de presentaciones revisadas por pares sobre SNOMED CT en general, con especial atención a las experiencias de aplicación y los avances que facilitan un uso más eficaz de la terminología.

La EXPO también incluye tutoriales y talleres para quienes deseen conocer mejor SNOMED CT, una exposición de productos de proveedores que utilizan SNOMED CT y una serie de presentaciones de carteles sobre temas relacionados.

La EXPO es el principal acontecimiento anual del calendario de SNOMED International para todos los interesados en el uso y desarrollo de la terminología sanitaria mundial. Además de las sesiones programadas, ofrece una excelente oportunidad para establecer contactos con otras personas con un interés común en SNOMED CT.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Spanish+NRC+Guide&entry.670899847=Gobernanza%2C%20grupos%20consultivos%20y%20eventos%20de%20SNOMED%20International)

[PreviousDesarrollo de contenidos y personalización de SNOMED CTchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-desarrollo-de-contenidos-y-personalizacin-de-snomed-ct)
[NextMás informaciónchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-ms-informacin)

Last updated 5 months ago

*   [Asamblea general](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-gobernanza-grupos-consultivos-y-eventos-de-snomed-international#asamblea-general)
    
*   [Consejo de Administración](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-gobernanza-grupos-consultivos-y-eventos-de-snomed-international#consejo-de-administracion)
    
*   [Órganos consultivos](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-gobernanza-grupos-consultivos-y-eventos-de-snomed-international#organos-consultivos)
    
*   [Reuniones y eventos de SNOMED International](https://docs.snomed.org/snomed-ct-practical-guides/guia-del-centro-nacional-de-referencia-cnr/spanish-gobernanza-grupos-consultivos-y-eventos-de-snomed-international#reuniones-y-eventos-de-snomed-international)
    

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# Content Development and SNOMED CT customization | Practical Guides SNOMED NRC Guide | SNOMED International Documents

For successful SNOMED CT adoption, it is important that the terminology conforms to the requirements of the specific use cases in the given country or within a given organization. In most situations this requires adjusting or extending the terminology, which can be done in various ways. SNOMED International authorizes Members and Affiliates to maintain and deliver additional components and derivatives known as SNOMED CT Extensions. These extensions are the formal way of conforming SNOMED CT to suit specific user requirements.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#extensions)

Extensions


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Members may maintain and deliver additional terminology components and derivatives that adapt the terminology to meet specific national requirements. Moreover, SNOMED International Affiliates may also maintain and deliver additional terminology components and derivatives that adapt the terminology to meet the needs of a particular organization, customer or software solution. Extensions can therefore be distinguished as either National Extensions or Affiliate Extensions.

*   The [Extensions Practical Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-extension-guide/)
     presents the purpose, process and principles of creating, distributing and managing SNOMED CT extensions. Extension producers should be familiar with this guidance to ensure the quality and integrity of the SNOMED CT editions that they publish.
    

**A National Extension may include:**

*   translation into the national language or adaption to a national dialect;
    
*   additional content to support national policy objectives, a national drug dictionary or other specific requirements;
    
*   derivatives that configure use of SNOMED CT content by specifying subsets of content to be used for particular purposes;
    
*   derivatives that map other code systems used in that country to or from SNOMED CT.
    

**An Affiliate Extension may include:**

*   additional content to enable a health provider organization or clinical specialty group to address its priority use cases;
    
*   derivatives that configure use of SNOMED CT in ways that reflect the needs of a health provider organization or specialty;
    
*   derivatives that configure the way SNOMED CT is used or presented to different customers using particular software applications;
    
*   derivatives that map local or proprietary code systems to or from SNOMED CT.
    

Development of National or Affiliate Extensions requires the NRC or the Affiliate to have a Namespace Identifier, which is assigned by SNOMED International. A Namespace Identifier is used to identify the origin and the affiliation of each extension component. An NRC has the responsibility to ensure that any deployment of SNOMED CT and other SNOMED International terminology product conforms to SNOMED International standards. An NRC therefore serves as a point of contact for Affiliates to obtain guidance and advice in the development and maintenance of Affiliate Extensions.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#extensions-and-editions)

Extensions and Editions

The SNOMED CT International Edition can be used without any Extensions. However, a SNOMED CT Extension cannot be used on its own because all Extensions are dependent on the International Edition, and some Extensions are also dependent on other Extensions. Therefore, for each Extension there is a corresponding Edition that includes the Extension, the International Edition and any other Extensions on which it depends.

Figure 11. A National Edition includes both the National Extension and the International Edition

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3066103899-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FP1frmzZuNvoHsCrG7SKQ%252Fuploads%252Fgit-blob-23856d06ebba40a69090dacd3e643e4fdddf0e74%252F254968155.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=50f41dd&sv=2)

\---|---

All organizations that maintain Extensions should make their Extension available as a separate set of files, even if they also provide a pre-merged Edition. This allows validation of the constituent parts of the Edition and also supports merges to produce bespoke Editions that combine several Extensions.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#translation)

Translation


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The International Release of SNOMED CT contains terms in US English, GB English and Spanish. However, SNOMED CT is designed to support multilingual use by enabling terms in any language to be linked to the same concepts. Many of the current Members do not use English as the primary language in the delivery of healthcare, and therefore Members may require a translation of SNOMED CT to achieve a national terminology resource and to support users in the correct interpretation of the SNOMED CT content. The responsibility for translation is with those Members that use a particular language in the specific Member country. However, while Members are permitted and encouraged to translate SNOMED CT, this is not an obligation of membership. Each Member should consider whether or not to translate SNOMED CT into the native language and/or dialect, given the actual visions for use of SNOMED CT within that Member country.

A number of Members have already translated SNOMED CT into their native languages. These translations are managed within each of the particular Member countries as National Extensions and have been created based on SNOMED International regulations but according to the particular Member's requirements. Each translation may be shared with other Members, and all Members have an obligation according to the Articles of Association to share their translations upon request.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#translation-approaches)

Translation approaches

Translating SNOMED CT does not necessarily mean a translation of the full SNOMED CT International Edition. A Member can decide to translate parts of SNOMED CT to obtain a core set of components to be used within the country. Another approach is to translate concepts that are to be applied within a specific organization, clinical domain, etc., which means a more use-case driven translation.

Figure 12. Different levels of SNOMED CT translation

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3066103899-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FP1frmzZuNvoHsCrG7SKQ%252Fuploads%252Fgit-blob-f8e938a1ca6c0a4f5a6c229a82bdc156724e80a4%252F26837074.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=d3ad1530&sv=2)

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#translation-policy)

Translation Policy

SNOMED International believes that translations of SNOMED CT are very important because a translation can support SNOMED CT adoption due to enhanced understanding of the SNOMED CT content amongst the end users. Therefore SNOMED International has initiated a translation policy that reimburses a Member country for:

1.  100% of the cost of translating concepts, which will be considered the "core" or starter set;
    
2.  The cost of translating one implementation document; and
    
3.  The cost of one SNOMED CT course.
    

(The maximum payment for each Member will be 150,000 USD.)

More information about Translation can be found here: [https://www.snomed.org/use-snomed-ctarrow-up-right](https://www.snomed.org/use-snomed-ct)

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#translation-guidance)

Translation Guidance

Together with Members, SNOMED International has produced documentation that assists Members who decide to translate SNOMED CT. The documentation should support effective translation processes and enable Members to learn from the successes of those that have already set out on this task. The documentation can be found on the SNOMED International website and includes the following:

[Guidelines for Translation of SNOMED CTarrow-up-right](https://www.snomed.org/_files/ugd/49d95c_bd5eb3c589e24e1983d4b0c07b451549.pdf)
 This document describes important issues relevant to the translation of SNOMED CT, formulates recommendations, and establishes guidelines. The general guidelines may be used as a template to develop national guidelines. In addition to linguistic and terminological guidelines, the document includes general recommendations about the steps involved in a translation workflow process and information about source documents or references that must be made available to those involved in the translation process. [Guidelines for the management translations of SNOMED CTarrow-up-right](https://www.snomed.org/_files/ugd/49d95c_a511ae93cd164e749605ea6cb930e3f7.pdf)
 This document is a companion guideline to be used with the "Guidelines for the Translation of SNOMED CT" and offers recommendations on management of a translation project. The purpose is to help new Members undertaking translations to avoid mistakes and enable them to build on existing experiences. [A methodology and toolkit for evaluating SNOMED CT Translation Qualityarrow-up-right](https://www.snomed.org/_files/ugd/49d95c_7eb6e2ac75604e79914f0734e33a3042.pdf)
 This document describes the use of SNOMED International methodology and toolkit for evaluating SNOMED CT translation quality and has been developed to conform to SNOMED International Quality Assurance Framework. The document also includes the actual toolkit and therefore is useful for any Members looking for translation support materials. [SNOMED International Quality Assurance Frameworkarrow-up-right](https://drive.google.com/file/d/1Gt871nFk2bRCJRDX5PfK9cOSoDLfOaYd/view)
 SNOMED International Quality Assurance Framework, with its supporting SNOMED International Quality Assurance Toolkit, was developed by SNOMED International Quality Assurance Committee and aims to support the development and reporting of Quality Metrics across all areas of SNOMED International activity, including organizational processes and support, data products (e.g. terminology reference data, mappings, translations, subsets), documentation, and SNOMED International-responsible services and tooling provisions. Other resources are also available, mostly concerning the practical experiences of those who have undertaken translation development.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#reference-set-development)

Reference set development


---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Many implementations of SNOMED CT do not require users to have access to the full set of content. Often just a part of the data related to a particular discipline or organization will be needed. It is possible to constrain the content required by the use of the subsets or Reference sets.

Reference sets are sets of references to SNOMED CT components. Simple reference sets contain just the information needed to define a subset. However Reference sets can be richer than subsets, as they can also include further information about the components and have been defined for other purposes such as mappings to other vocabularies or providing alternative hierarchical structures.

Reference sets are distributed as tab-delimited text files with each row including a SNOMED CT component identifier for the Reference set member. There are also several standard fields that support versioning and additional fields defined to meet the requirements of specific Reference set types.

Full details on Reference sets and the Reference set format may be found in the [Reference Sets Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/)
.

* * *

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*   [Extensions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#extensions)
    
*   [Extensions and Editions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#extensions-and-editions)
    
*   [Translation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#translation)
    
*   [Translation approaches](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#translation-approaches)
    
*   [Translation Policy](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#translation-policy)
    
*   [Translation Guidance](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#translation-guidance)
    
*   [Reference set development](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization#reference-set-development)
    

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# Vendor Case Studies | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

This section describes a number of commercial products that use SNOMED CT to support their clinical decision support systems. The vendors that have contributed to this review include:

*   [Duodecim](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/duodecim)
    
*   [First Databank](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/first-databank)
    
*   [Orion Health](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health)
    
*   [Practice Fusion](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/practice-fusion)
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=CDS+Guide&entry.670899847=Vendor%20Case%20Studies)

[PreviousUniversity of Utahchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/university-of-utah)
[NextDuodecimchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/duodecim)

Last updated 5 months ago

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# Change Requests | Practical Guides SNOMED NRC Guide | SNOMED International Documents

SNOMED CT is developed for implementation and use in health IT systems, so it is essential for successful adoption that the terminology fulfill user requirements. To facilitate continued development and enhancement of SNOMED CT, SNOMED International is dependent on ongoing feedback from users. A significant responsibility of an NRC is therefore to provide SNOMED International with feedback from users in the Member countries on errors, limitations and suggestions for changes to the SNOMED CT content. Regarding management of change requests, each NRC must:

1.  Maintain a record of problems and other issues reported within the Member country, and
    
2.  Document, submit and support requests for proposed updates and enhancements to SNOMED CT
    

An NRC must therefore provide a mechanism for supporting requests from users, both related to the National Edition (where it exists) and International Edition of SNOMED CT. Requests for the International Edition should be communicated to SNOMED International, whereas requests for the National Edition must be managed locally.

Figure 9. NRCs manage user requests for changes to both the National and International Editions of SNOMED CT

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3066103899-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FP1frmzZuNvoHsCrG7SKQ%252Fuploads%252Fgit-blob-6f5cc7e4d04c8b114525b60545ffd47e99fe94d8%252F254968153.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=1138838&sv=2)

How user requests are submitted to the NRC is up to each NRC to decide. An NRC can choose to have its own request submission system, but the solution could also be a simple mailing system or a file-transfer system. This depends on the level of SNOMED CT use (and hence, the number of requests) within the Member country. An NRC could decide to have a simple system in the NRC-establishment phase and then launch a more sophisticated system when the number of requests increases.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/change-requests#snomed-ct-international-content-request-service-crs)

SNOMED CT International Content Request Service (CRS)


-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

CRS is SNOMED International's online request submission system, which allows Member countries' NRCs and other authorized users to submit requests for change or addition of new content to the International Edition of SNOMED CT. Hence, all user requests for the International Edition of SNOMED CT should go via the NRC, and each NRC should have access to CRS. Concepts of only national relevance should not be submitted to SNOMED International. It is the responsibility of the NRC to determine which request is specific to its country and which are of international relevance. NRCs should be aware of the editorial principles for SNOMED CT and only submit requests that meet those principles.

Requests submitted to CRS are reviewed by SNOMED International Authors, and requests that meet the SNOMED CT International Edition inclusion criteria are added to the International Edition. CRS is an online tool, which enables users to view the current status of all requests that have been made through the system, see Figure 10.

Figure 10. Screenshot from CRS. Example of overview of requests submitted to the system.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3066103899-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FP1frmzZuNvoHsCrG7SKQ%252Fuploads%252Fgit-blob-eae35193be09ea52faf9c0f6aedff12dd5485722%252F115870943.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=8405761&sv=2)

Users are notified by email when a request changes status (accepted, not accepted, in process, or clarification requested). If a request is not accepted, a reason is provided to the requestor. A requestor who is unhappy with the reason for not non-acceptance can appeal using a formal appeals process.

For up-to-date information about current arrangements and for access to CRS see [CRS User Guidearrow-up-right](https://snomed.co/ContentRequestService)

Further details on requesting content changes, or the addition of new content, are available from [https://www.snomed.org/change-or-addarrow-up-right](https://www.snomed.org/change-or-add)
. The document "Customer Guidance For Requesting Changes to SNOMED CT" is available for download from this page. The document provides details of how to make a request, and what details need to be provided by the requester as part of the process.

circle-info

Change requests to the International Edition are submitted to SNOMED International via the online SNOMED CT International Content Request Service (CRS)

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[PreviousDistribution of SNOMED CTchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/distribution-of-snomed-ct)
[NextContent Development and SNOMED CT customizationchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/content-development-and-snomed-ct-customization)

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# SNOMED CT Clinical Decision Support Guide | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

The SNOMED CT Clinical Decision Support guide reviews the approaches, tools and techniques used to implement clinical decision support with SNOMED CT, and shares developing practice in this area. It is anticipated that this guide will benefit members, vendors and users of SNOMED CT by promoting a greater awareness of how SNOMED CT has been and can be used to enhance clinical decision support implementations.

[Introduction](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction)

[Logical Architecture](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture)

[Knowledge Base](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base)

[Inference Engine](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/4-inference-engine)

[Communications](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications)

circle-info

© Copyright 2026 International Health Terminology Standards Development Organisation, all rights reserved.

This document is a publication of International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED International owns and maintains SNOMED CT®.

Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. This document may be subject to updates. Always use the latest version of this document published by SNOMED International. This can be viewed online and downloaded by following the links on the front page or cover of this document.

SNOMED®, SNOMED CT® and IHTSDO® are registered trademarks of International Health Terminology Standards Development Organisation. SNOMED CT® licensing information is available at [http://snomed.org/licensingarrow-up-right](http://snomed.org/licensing)
. For more information about SNOMED International and SNOMED International Membership, please refer to [http://www.snomed.orgarrow-up-right](http://www.ihtsdo.org/)
 or contact us at [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#51383f373e1138392522353e7f3e2336)
.

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[NextIntroductionchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction)

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# Use Cases Directly Connected to Data Entry | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.1-use-cases-directly-connected-to-data-entry#writing-an-entry-into-a-clinical-record-at-or-near-the-point-of-care)

Writing an Entry Into a Clinical Record at or Near the Point of Care


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At the point of care, search is done in order to find a Concept which describes a specific event that occurred during the course of patient care (e.g. documenting the findings related to a physical examination, diagnosis or surgical procedure into a form).

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.1-use-cases-directly-connected-to-data-entry#creating-forms-for-structured-data-entry)

Creating Forms for Structured Data Entry


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Data entry forms in clinical records are often designed for a specific documentation purpose. Designing the interface of a data entry forms and/or its content may entail associating Concepts with a template element or control. In highly structured forms, the design may involve specifying what Concepts should be available for selection. In less structured templates, the design may involve specifying the features useful for conducting an efficient and effective search. Thus, template designers may need to be able to search the whole terminology but also have the competencies to manually constrain the search by various filters and applying advanced functionalities, such as expression views and comparison between Concepts.

For more information on structured data entry, please refer to the "[Structured data entry](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/6-data-entry/6.2-structured-data-entry)
" sub-section.

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Last updated 7 months ago

*   [Writing an Entry Into a Clinical Record at or Near the Point of Care](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.1-use-cases-directly-connected-to-data-entry#writing-an-entry-into-a-clinical-record-at-or-near-the-point-of-care)
    
*   [Creating Forms for Structured Data Entry](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.1-use-cases-directly-connected-to-data-entry#creating-forms-for-structured-data-entry)
    

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# Appendix A - Decision Support Case Studies | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

As discussed in this guide, SNOMED CT is increasingly being used in clinical decision support (CDS) systems to support healthcare providers in making well informed clinical decisions.

This appendix presents two sets of case studies, which demonstrate the use (or planned use) of SNOMED CT in clinical decision support systems.

*   [Organizational Case Studies](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies)
     describes a range of organizations that use SNOMED CT for clinical decision support;
    
*   [Vendor Case Studies](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies)
     describes a number of commercial products that use SNOMED CT to enable clinical decision support.
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=CDS+Guide&entry.670899847=Appendix%20A%20-%20Decision%20Support%20Case%20Studies)

[PreviousCommunicationschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications)
[NextOrganizational Case Studieschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies)

Last updated 5 months ago

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# Education and Training | Practical Guides SNOMED NRC Guide | SNOMED International Documents

Users must be equipped with adequate knowledge and skills that enable them to practice the tasks of the specific user group. Moreover, it is important that users are trained to understand and conduct SNOMED CT implementation in accordance to the visions, strategy and infrastructure of the given Member country. The following sections consider the roles of SNOMED International and NRCs in education and training related to SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#snomed-international-role-in-snomed-ct-education)

SNOMED International Role in SNOMED CT Education


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The overall role of SNOMED International in SNOMED CT education and training is to provide consistent information about SNOMED CT, advice about benefits and guidance on effective ways to use SNOMED CT in order to realize those benefits. In addition, wherever possible, SNOMED International shares its documents and training services in ways that enable NRCs to reuse, translate and customize them to meet national requirements. The documents, educational resources and services that SNOMED International provides to assist the process of learning about SNOMED CT are outlined below.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#snomed-ct-document-library)

SNOMED CT Document Library

The SNOMED CT Document Library provides online access to a wide range of SNOMED CT related documents. These documents range from SNOMED CT introductions targeted at particular audiences, through to detailed specifications, specialized guides and reports. On the Document Library web pages you will find a short introduction to each of the documents, and a link to allow you to freely access these documents. These documents are available either for online browsing or as PDF downloads - and in many cases both formats are provided. Some documents include draft materials, and therefore readers should be aware of the status of the document or section, which is indicated either by textual status notes on individual pages or in the document preface.

The Document Library provides access to the key documents about SNOMED CT.

Key documents include

*   The [SNOMED CT Starter Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/)
     which is a practical and useful starting point from which anyone with a general interest in healthcare information can begin learning about SNOMED CT.
    
*   The [Extensions Practical Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-extension-guide/)
     presents the purpose, process and principles of creating, distributing and managing SNOMED CT extensions. Extension producers should be familiar with this guidance to ensure the quality and integrity of the SNOMED CT editions that they publish.
    
*   [SNOMED CT Release File Specification](https://docs.snomed.org/snomed-ct-specifications/snomed-ct-release-file-specification/)
     which formally defines the file formats in which SNOMED CT is distributed to SNOMED International Members and Affiliates.
    

Feedback from Members on the documentation is important for SNOMED International to ensure that the readers are provided with the best possible materials for learning about SNOMED CT. Members/users/readers are requested to provide any kind of feedback on the documentation, for example if clear faults or missing content are detected, or if there are some unclear parts that need clarification.

Comments on online documents can be posted as comments on the pages of the published document. For documents that are not available online, please look in the document for details of how to comment.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#snomed-ct-starter-tutorial-and-education-resource-guide)

SNOMED CT Starter Tutorial And Education Resource Guide

The SNOMED CT Starter Tutorial provides an overview of the basics of SNOMED CT. The Education Resource Guide provides details of educational material that cover a range of topics related to SNOMED CT. Both can be found [herearrow-up-right](https://elearning.ihtsdotools.org/course/view.php?id=5&section=1)
.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#snomed-ct-e-learning-courses)

SNOMED CT E-Learning Courses

SNOMED International provides a range of Education offerings. The set of courses, learning pathways, and certification exams is introduced below.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#courses)

Courses

*   [**Foundation course**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=FCE)
    
    *   The course aims to provide authoritative coverage of a broad range of topics related to SNOMED CT at a relatively basic level. It also enables the growth of more detailed understanding of SNOMED CT by enabling those who complete this course to join more advanced SNOMED CT E-Learning courses in the future.
        
    
*   [**Implementation course**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=ICE)
    
    *   This course builds on the knowledge gained during the SNOMED CT Foundation course. It provides an understanding of SNOMED CT that is sufficient for those engaged in various parts of the implementation process – from the decision to adopt SNOMED CT, through to specification and procurement and/or design and development of SNOMED CT enabled solutions, to deployment and practical use.
        
    
*   [**Authoring Level 1 course**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=AL1)
    
    *   This course teaches you the knowledge and skills needed to perform basic SNOMED CT authoring tasks. Students will have the opportunity to learn and practice authoring tasks using a training version of SNOMED International’s authoring platform. Authoring exercises will be performed in a fictitious extension.
        
    
*   [**Authoring Level 2 course**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=AL2)
    
    *   This course teaches experienced SNOMED CT authors to extend and develop their authoring skills. The course has a strong focus on students learning through practical authoring exercises performed on our training authoring platform and interactive online webinars with experienced authors. This course is a prerequisite for the SNOMED CT Authoring Level 2 certification exam.
        
    

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#learning-pathways)

Learning Pathways

SNOMED International's learning pathways contain a collection of E-Learning resources designed to teach a specific SNOMED CT skill set in a flexible way. Learning pathways currently available include:

*   [**SNOMED CT for Developers**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=DEV)
     - The goal of this learning pathway is to teach you enough about SNOMED CT in as short as possible a time to enable you to develop software applications that leverage its capabilities.
    
*   [**SNOMED CT for Data Analysts**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=DAN)
     - The goal of this learning pathway is to provide a solid understanding of how SNOMED CT can be used to support your clinical data analytics requirements.
    
*   [**SNOMED CT for Clinicians**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=CLI)
     - The goal of this learning pathway is to provide an introduction to the why, what and how of SNOMED CT from a clinical perspective.
    
*   [**SNOMED CT for Translators**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=TRA)
     - This short education pathway introduces SNOMED CT to Translators and covers the common requirements to understanding SNOMED CT. It incorporates e-learning content from pre-existing courses. By completing this pathway a learner will have the basic SNOMED CT knowledge that a translator may require in performing translation.
    

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#certification-exams)

Certification Exams

SNOMED International's certification exams allow individuals to be recognized for their capabilities in specific skill areas. Currently, SNOMED International offers two certification exams:

*   [**SNOMED CT Authoring Level 1 Certification**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=AC1)
     - This certification recognizes your competence in performing basic SNOMED CT authoring tasks.
    
*   [**SNOMED CT Authoring Level 2 Certification**arrow-up-right](https://courses.ihtsdotools.org/product?catalog=AC2)
     - This certification recognizes your competence in performing basic SNOMED CT authoring tasks.
    

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#education-benefits-for-members)

Education Benefits for Members

As part of the 'Enhanced Membership Benefits', each Member is entitled to the following education benefits:

*   Free SNOMED CT Courses
    
*   Membership discount for all certifications offered
    
*   NRC access to one free certification exam annually
    

Participants will be offered a **membership discount** **automatically** when they login to their E-Learning account during the enrolment process.

SNOMED National Release Centers (NRCs) can claim their **free NRC enrolment** in any of our certification exams by emailing [\[email protected\]](https://docs.snomed.org/cdn-cgi/l/email-protection)
 to request a 'Member free' voucher. This voucher can be used to register for free via our [Course Cataloguearrow-up-right](https://courses.ihtsdotools.org/)
. Please include the name and email of the person who will be enrolling, and the certification intake in which they would like to participate. We will then send the voucher to the selected participant. All 'Member free' voucher allocations must be approved by the Member Forum representative in the respective Member country/territory.

Please note that NRCs can claim their free enrolments in each of our certifications every year - so please take advantage of this offer to educate your local team.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#education-partnerships)

Education Partnerships

SNOMED International seeks to establish partnerships with organizations within our Member countries and territories, who would be interested in translating one or more of our Education offerings into their native language. For more information, please send a request to our education helpdesk ([\[email protected\]](https://docs.snomed.org/cdn-cgi/l/email-protection)
).

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#snomed-in-action)

SNOMED In Action

SNOMED International has a website called SNOMED In Action, which offers Members and other users an opportunity to register SNOMED CT deployments and provide various details about specific SNOMED CT implementation and usages. Other Members and users may be inspired to follow these examples, or get in contact with persons and institutions that have been involved with specific SNOMED CT implementations.

SNOMED International encourages Members and other stakeholders and users to register their SNOMED CT deployments on this site in order to facilitate knowledge sharing and awareness about how SNOMED CT can be applied and how to reap its benefits.

On this webpage you find an overview of different examples of SNOMED CT in use, and you also have the opportunity to register your own SNOMED deployment: [https://www.snomed.org/snomed-in-actionarrow-up-right](https://www.snomed.org/snomed-in-action)
.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#snomed-ct-implementation-support-portal)

SNOMED CT Implementation Support Portal

Successfully implementing SNOMED CT is crucial for leveraging its benefits to users. The [Implementation Support Portal arrow-up-right](https://www.implementation.snomed.org/)
serves as a comprehensive resource for individuals and organizations interested in implementing SNOMED CT in their healthcare systems. It provides access to a wide range of resources and tools, as well as guidance and support, to help users successfully implement.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#product-and-services-catalog)

Product and Services Catalog

This is a comprehensive [guide arrow-up-right](https://www.snomed.org/resources)
to our products and services, complete with descriptions and links. It suggests relevant groups of products and services for different customer groups.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#value-of-snomed-ct)

Value of SNOMED CT

The [Value of SNOMED CTarrow-up-right](https://www.snomed.org/value-of-snomedct)
 webpage is a useful resource including the case for investment and benefits of SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#nrc-roles-in-snomed-ct-education)

NRC Roles in SNOMED CT Education


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------

To address national implementation requirements, NRCs are encouraged to supplement or customize training resources published by SNOMED International. This includes translating documents and training resources where necessary. Education related to some specific aspects of national strategy may be well served by materials developed from scratch by the NRC. For example, if specific reference sets are to be used within specific clinical domains to meet specific reporting requirements, then guidance on the use of these Reference sets could be needed along with information about the reporting procedures.

Whether an NRC develops its own training materials or modifies resources provided by SNOMED International, it is important that any explanation of SNOMED CT be accurate and in accordance with the formal SNOMED CT specifications. Therefore, the NRC should regularly review its SNOMED CT related training materials to ensure alignment with updates to International materials.

If an NRC takes on the education of the national Affiliates and users, it is important that staff of the NRC have a broad and deep understanding of the different implementation levels and possibilities and can facilitate requests from different user groups. Alternatively, the NRC can advise or direct Affiliates to places and persons where they can get the appropriate guidance. The NRC must therefore be aware of people, nationally or internationally, who have the appropriate skillsets to educate and guide users on specific topics. A combination of internal and external resources to provide training and education is a reasonable solution for many NRCs.

Individuals learn in different ways. The NRC may wish to consider delivering face-to-face or online training so that individuals get a chance to ask questions and develop their thinking. Short introductory sessions on the principles of SNOMED CT and a walk through the release are good ways to get people started. They may then find the reference materials much more accessible.

* * *

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=NRC+Guide&entry.670899847=Education%20and%20Training)

[PreviousEngaging stakeholderschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/engaging-stakeholders)
[NextToolingchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/tooling)

Last updated 7 months ago

*   [SNOMED International Role in SNOMED CT Education](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#snomed-international-role-in-snomed-ct-education)
    
*   [SNOMED CT Document Library](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#snomed-ct-document-library)
    
*   [SNOMED CT Starter Tutorial And Education Resource Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#snomed-ct-starter-tutorial-and-education-resource-guide)
    
*   [SNOMED CT E-Learning Courses](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#snomed-ct-e-learning-courses)
    
*   [SNOMED In Action](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#snomed-in-action)
    
*   [SNOMED CT Implementation Support Portal](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#snomed-ct-implementation-support-portal)
    
*   [Product and Services Catalog](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#product-and-services-catalog)
    
*   [Value of SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#value-of-snomed-ct)
    
*   [NRC Roles in SNOMED CT Education](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/education-and-training#nrc-roles-in-snomed-ct-education)
    

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# Duodecim | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

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Duodecim Medical Publications Ltd publishes information content for medical and healthcare professionals in the form of traditional printed products but also as electronic databases, solutions integrated into healthcare systems and an online learning environment. Evidence-Based Medicine Guidelines (EBMG) is designed to provide you with the information you need quickly and using a single search term. Designed for use at the point of care, the guidelines are delivered in a format that makes it easy for a clinician to make a decision regarding treatment.\\

For more information please visit [http://www.duodecim.fi/english/arrow-up-right](http://www.duodecim.fi/english/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/duodecim#ebmeds)

EBMeDS


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The Evidence-Based Medicine electronic Decision Support system (EBMeDS) was developed by Duodecim. It is a platform-independent service, which can be integrated with any EHR that uses structured patient data. EBMeDS contains over 40,000 decision support rules which can be used to generate reminders, therapeutic suggestions, order sets and diagnosis-specific links to guideline sets and other online resources. EBMeDS can also be used to automatically populate calculators and forms with patient-specific data, and to generate summary views and dashboards. In addition to real-time use, the EBMeDS decision support rules can also be run as batch scripts on patient populations to generate reports that measure quality and analyze care-gaps. The rules of EBMeDS are based on the data in the EBMG collection, with several 3rd party resources also used for evidence collection.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/duodecim#using-snomed-ct)

Using SNOMED CT


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

EBMeDS receives encoded patient data from EHRs. The coded data pertains to several \_ data groups \_ including diagnoses, medications, vaccinations, investigation results, surgical procedures, and risk factors (such as smoking). Although multiple coding systems are supported, only SNOMED CT and the Read code system are accepted for all data groups. Within EBMeDS, all codes are mapped to internal aliases. For example, for the concept \_ serum or plasma creatinine \_ includes codes from 10 different coding systems. Duodecim is expecting to derive additional benefits from using SNOMED CT when more EHRs are able to provide SNOMED CT encoded records as outputs.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/duodecim#deployments)

Deployments


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At present, EBMeDS is used mainly in Finland. Duodecim is planning to offer a cloud-based centralized EBMeDS service in the near future, but currently the application is integrated into the local EHR environments. Belgium has a national license for EBMeDS as part of the [EBMPracticeNet](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/ebmpracticenet)
 implementation in Belgium. Several pilots and scientific studies are being performed in Italy, Denmark, Estonia, the United States and the UK.

* * *

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=CDS+Guide&entry.670899847=Duodecim)

[PreviousVendor Case Studieschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies)
[NextFirst Databankchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/first-databank)

Last updated 5 months ago

*   [EBMeDS](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/duodecim#ebmeds)
    
*   [Using SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/duodecim#using-snomed-ct)
    
*   [Deployments](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/duodecim#deployments)
    

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# EBMPracticeNet | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

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In Belgium, the construction of a national electronic point-of-care information service, EBMPracticeNet, was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making... All Belgian health care professionals get free access to an up-to-date database of validated Belgian and nearly 1000 international guidelines, incorporated in a portal that also provides EBM information from other sources than guidelines, including computerized clinical decision support that is integrated in the EHRs.

For more information please visit [https://www.ebmpracticenet.bearrow-up-right](https://www.ebmpracticenet.be/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/ebmpracticenet#overview)

Overview


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EBMPracticeNet is a consortium of Belgian organizations whose mission is to develop a national online knowledge base of clinical practice guidelines based on evidence-based medicine (EBM). The project is funded by RIZIV-INAMI, the Belgian national health insurer. The consortium acknowledges that clinical decision support systems play a vital role in the implementation of evidence-based medicine. EBMPracticeNet is very active in the development, evaluation, and distribution of evidence based CDS knowledge, mainly for use in primary care settings. Their users include family physicians, nurses, physical therapists, occupational therapists, pharmacists, speech therapists, patients, and eventually dentists. Clinicians will access the system through their EHRs with an [Infobuttonarrow-up-right](http://www.hl7.org/implement/standards/product_brief.cfm?product_id=208)
 (called "EvidenceLinker") which links coded diagnoses to relevant guidelines on the platform. The consortium is in the process of conducting an analysis to compare several terminologies to gauge which may be best suited for using encoded health records from a primary care setting with CDS services. An early version of the analysis report has identified SNOMED CT as the terminology with the most comprehensive coverage and best suited to unambiguously describe the concept.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/ebmpracticenet#technology)

Technology


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The EBMPracticeNet consortium hosts a platform of clinical practice guidelines. Seventy five of these are from Belgium, and an additional 1000 international guidelines have been developed by [Duodecim](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/duodecim)
, the Finnish developers of EBM guidelines. The knowledge resources from Duodecim have been translated from its language of origin into both Dutch and French, and localized for Belgium using a variant of the [ADAPTEarrow-up-right](http://www.g-i-n.net/document-store/working-groups-documents/adaptation/adapte-resource-toolkit-guideline-adaptation-2-0.pdf)
 framework. Currently all guidelines are accessible through the EHR using the EvidenceLinker, which suggests relevant guidelines based on the coded diagnosis. The EvidenceLinker currently uses ICPC-2 codes for this linkage. Additionally, EBMPracticeNet uses Duodecim’s [EBMeDS](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/duodecim#ebmeds)
 as the engine in their clinical decision support system, which is currently in the pilot phase. A depiction of the architecture is shown below.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-7f292c6e45755226bf89bcd2274a446713fcc6aa%252F123897700.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=a580f2aa&sv=2)

EBMeDS architecture

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/ebmpracticenet#snomed-ct)

SNOMED CT


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All EBMPracticeNet guidelines are associated with metadata which includes the relevant diagnosis codes for the ICPC-2 and ICD-10 classification systems. Mapping work is being considered that would add the appropriate SNOMED CT codes to this metadata. The SNOMED CT codes could then be used to link diagnoses to relevant clinical guidelines using EvidenceLinker. This EvidenceLinker feature is already available in all commercially available EHR systems in Belgium, which will help to facilitate rapid deployment. The CDSS engine, EBMeDS, has been designed to process SNOMED CT encoded health records.

* * *

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[PreviousOrganizational Case Studieschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies)
[NextKaiser Permanentechevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/kaiser-permanente)

Last updated 4 months ago

*   [Overview](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/ebmpracticenet#overview)
    
*   [Technology](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/ebmpracticenet#technology)
    
*   [SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/ebmpracticenet#snomed-ct)
    

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# Pharmacy Health Information Technology Collaborative | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

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The Pharmacy HIT Collaborative is a coalition of nine professional pharmacy associations and additional members representing the pharmacy profession in all matters related to health information technology. A primary focus of the Pharmacy HIT Collaborative is "to assure the meaningful use of standardized electronic health records (EHR) that supports safe, efficient, and effective medication use, continuity of care, and provide access to the patient-care services of pharmacists with other members of the interdisciplinary patient care team."\\

For more information please visit [http://www.pharmacyhit.org/arrow-up-right](http://www.pharmacyhit.org/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/pharmacy-health-information-technology-collaborative#overview)

Overview


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The Pharmacy Health Information Technology Collaborative (PHIT Collaborative) is a body of pharmaceutical organizations which operates in the United States and was formed in 2010. As the name suggests, they focus on the pharmacists providing patient care services and assess how information technology can be used to support their processes and workflows. Health information technology standards and clinical terminology are used to promote interoperability and to support their strategy of collecting, documenting, and preparing information for sharing with other service providers. Much of the work the PHIT Collaborative does is guided by the [Centers for Medicare & Medicaid Servicesarrow-up-right](https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/mtm.html)
 (CMS) medication therapy management regulations and [Meaningful Usearrow-up-right](https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives)
 (MU) reporting requirements.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/pharmacy-health-information-technology-collaborative#use-of-snomed-ct)

Use of SNOMED CT


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The PHIT collaborative has been working towards the standardization of clinical pharmacy documentation which includes the use of SNOMED CT to record events such as a 404684003 | Clinical finding|, 71388002 | Procedure|, or 243796009 | Situation with explicit context|. This has resulted in a number of SNOMED CT value sets being published in the [National Library of Medicinearrow-up-right](https://www.nlm.nih.gov/)
 (NLM) [Value Set Authority Centerarrow-up-right](https://vsac.nlm.nih.gov/)
 (VSAC), such as the one shown in the figure below.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-bd93bc830a63e36ecd882c8b4deb4bbb455a5418%252F123897690.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=6c819168&sv=2)

Pharmacy HIT Collaborative value set for "Reasons for Interventions Related to Medication Management, Nonadherence"

A major benefit of using SNOMED CT in clinical pharmacy documentation is that SNOMED CT supports the calculation of [electronic Clinical Quality Measuresarrow-up-right](https://ecqi.healthit.gov/ecqms#eCQMs)
 (eCQMs). This ensures that pharmacists are included in the overall measurement of quality in the US health care system and more recently, outcomes-based payment models.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/pharmacy-health-information-technology-collaborative#cds-use-cases)

CDS Use Cases


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In addition to improved interoperability and calculation of eCQMs, the standardization of clinical pharmacy documentation can help to enable decision support and the Pharmacy HIT Collaborative is looking at some potential scenarios. One of the central components of pharmacy documentation includes identification of drug therapy problems. Once a medication problem has been identified, a pharmacist can intervene to optimize a patient medication regimen. But in some US jurisdictions, the direction to adjust a medication must come from the prescribing physician. Clinical decision support could be a huge benefit in these cases by acting on the recommendations of a pharmacist. More specifically, CDS could be used to help identify drug therapy issues, to propose actions, and to notify prescribers.

Using clinical decision support in the documentation of medication adverse reactions, allergies, intolerances and interactions could also benefit pharmacists and their patients. For example, SNOMED CT concepts subsumed by 62014003 | Adverse reaction caused by drug| and 272141005 | Severities| could be used to document adverse reactions . When prescribers are managing medication regimens, improved clinical decision support alerts could provide a mechanism to outline the risk of prescribing a medication based on past experience.

Medication outcomes could also be documented using SNOMED CT. For example, SNOMED CT could be used to document the outcomes of a patient who is involved in clinical trials for a new medication. Lack of an adverse reaction may have multiple explanations, including that the patient may not be adherent to the medication due to cost or the inconvenience of frequent administrations. Documenting the reason why a therapy failed could provide useful information for future prescribing events.

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[NextSundhedsplatformenchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/sundhedsplatformen)

Last updated 4 months ago

*   [Overview](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/pharmacy-health-information-technology-collaborative#overview)
    
*   [Use of SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/pharmacy-health-information-technology-collaborative#use-of-snomed-ct)
    
*   [CDS Use Cases](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/pharmacy-health-information-technology-collaborative#cds-use-cases)
    

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# Data Entry | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

Data entry is the process by which a user submits information containing relevant SNOMED CT Concept identifiers for storage in a record system (e.g. an EHR system).

The way data entry is carried out depends on the setting in which it is performed. In one simple approach a user selects a term from a list of search results, confirms the selection and the Identifier or Description of the selected Concept is added to the relevant field in a database record. This guide considers a range of different modes of data entry which can make it quicker and easier to record different types of information in particular situations.

The focus of this section is on the non-search aspect of data entry but it is also important to recognize that this is usually only one part of the process of recording clinical information. Therefore, the way SNOMED CT data entry is integrated with the overall process of data capture also needs to be considered.

*   [Benefits of Using SNOMED CT for Data Entry](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/6-data-entry/6.1-benefits-of-using-snomed-ct-for-data-entry)
    
*   [Structured Data Entry](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/6-data-entry/6.2-structured-data-entry)
    
*   [Constraining Data Entry](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/6-data-entry/6.3-constraining-data-entry)
    
*   [Entering Refinements for Post-Coordinated Expressions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/6-data-entry/6.4-entering-refinements-for-post-coordinated-expressions)
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Search+And+Data+Entry+Guide&entry.670899847=Data%20Entry)

[PreviousUse Mnemonics and Personal Favorites for Data Entrychevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.6-use-mnemonics-and-personal-favorites-for-data-entry)
[NextBenefits of Using SNOMED CT for Data Entrychevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/6-data-entry/6.1-benefits-of-using-snomed-ct-for-data-entry)

Last updated 7 months ago

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# Practice Fusion | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

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Practice Fusion is a free web-based electronic health record (EHR) company founded in 2005, operated and privately owned by Practice Fusion, Inc. in San Francisco, California. The SaaS startup provides physicians and medical professionals with free, advertising-supported EHR and medical practice management technology that includes charting, scheduling, e-prescribing, medical billing, lab and imaging center integrations, referral letters, Meaningful Use certification, training, support and a personal health record for patients. Practice Fusion is the #1 cloud-based electronic health record (EHR) platform for doctors and patients in the U.S., with a mission of connecting doctors, patients and data to drive better health and save lives.\\

For more information please visit [https://www.practicefusion.com/arrow-up-right](https://www.practicefusion.com/)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/practice-fusion#terminology)

Terminology


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Practice Fusion’s EHR uses the Health Language Enterprise Terminology Management Platform from Wolters Kluwer to support the management of its terminology content. This terminology platform enables Practice Fusion’s patient health records to be encoded using SNOMED CT, ICD-9, ICD-10 and a range of other code systems. Practice Fusion’s EHR uses a physician friendly library of terms, together with mappings to SNOMED CT, ICD-9 and ICD-10, to support the selection of appropriate clinical concepts at the user interface.

Practice Fusion has chosen to make SNOMED CT codes and descriptions available for viewing in the user interface. As shown in the screen shot below, when recording a diagnosis a provider can examine the mappings between the user interface term, ICD-9, ICD-10 and SNOMED CT. This approach has received positive feedback from their users as it provides an additional layer of validation when selecting a concept to record in the patient’s health record. Since 2014, all diagnoses recorded in Practice Fusion’s EHRs have included the associated SNOMED CT codes.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-e4a9b507436d8302fe35700e81f33ecb9ab2d020%252F123897704.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=e18ecbfa&sv=2)

Adding a diagnosis in Practice Fusion’s EHR

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/practice-fusion#clinical-decision-support-advisories)

Clinical Decision Support Advisories


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Practice Fusion includes a feature called Clinical Decision Support (CDS) advisories. When a new encounter is entered, the patient's record is processed against a rule engine with specific criteria to determine whether the patient requires a clinical intervention. If the patient requires an intervention, one or more yellow alerts will appear at the top of the encounter. These alerts can be resolved by following an appropriate sequence of events such as ordering a lab test or completing a screening or assessment.

Practice Fusion creates and maintains value sets which include, SNOMED CT concepts to support criteria for their CDS advisories. SNOMED CT codes recorded in the patient’s record are tested for membership in relevant SNOMED CT value sets, to determine which CDS advisories should be triggered. All diagnosis related value sets and some procedural value sets used by their CDS advisories contain SNOMED CT concepts. In addition, Practice Fusion uses SNOMED CT to define their encounter and attribute value sets.The SNOMED CT value sets used by Practice Fusion’s advisories are mostly defined intensionally using SNOMED CT’s hierarchy and (in some cases) SNOMED CT’s defining relationships. This allows the value sets to be easily updated (by re-executing their intensional definition) when a new version of the terminology is adopted. Practice Fusion has found that SNOMED CT’s polyhierarchy provides a significant advantage when defining these value sets, because similar concepts can easily be grouped together by including all descendants of a common supertype.

SNOMED CT is particularly useful for rare diseases, enabling expression of diagnoses requiring a high degree of specificity and which may not be sufficiently defined in ICD. For example, the screen shot below illustrates a CDS advisory that is triggered when clinical markers considered high-risk for 274864009 | Pompe disease|, are detected in the patient’s health record. Using the hierarchy of SNOMED CT, appropriate value sets were defined that help to identify those patients for which a GAA enzyme assay order should be considered to confirm the presence or absence of the diagnosis.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-a7d17717658d0a0a46aaa6df7252da295596fc5c%252F123897703.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=d35eb3d&sv=2)

CDS advisory for Pompe Disease

Examples of other advisories that use SNOMED CT value sets in their criteria include:

*   Patient requires screening for clinical depression and follow-up plan
    
*   Patient has poor control of hemoglobin A1C and needs a new lab test
    
*   Patient has diabetes and is due for an eye exam
    
*   Patient has hypertension that is not adequately controlled
    
*   Patient has Chronic Obstructive Pulmonary Disorder (COPD) and requires spirometry test
    
*   Patient has COPD and requires bronchodilator
    
*   Patient has asthma and no record of pharmacological treatment
    
*   Patient has asthma and should be evaluated for asthma control every 6 months
    
*   Patient is over 40 with urinary incontinence and requires a care plan
    
*   Patient has clinical markers considered high-risk for paroxysmal nocturnal hemoglobinuria (PNH) according to the International Clinical Cytometry Society (ICCS) guideline and PNH flow cytometry should be considered
    

Practice Fusion has also used SNOMED CT to represent procedures for follow up actions, such as assessments and interventions. CDS advisories are often linked to Clinical Quality Measures (CQM) in the Practice Fusion workflow. When a provider fulfills the requirements associated with a specific CDS advisory, they will get credit for fulfilling the requirements of the associated CQM, such as completing a specific assessment. Using SNOMED CT for these assessments facilitates the capture and storage of the associated treatment plans.

* * *

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=CDS+Guide&entry.670899847=Practice%20Fusion)

[PreviousOrion Healthchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health)

Last updated 4 months ago

*   [Terminology](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/practice-fusion#terminology)
    
*   [Clinical Decision Support Advisories](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/practice-fusion#clinical-decision-support-advisories)
    

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# Use Cases Where Search Browsers are Required | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#creating-queries-for-retrieving-data)

Creating Queries for Retrieving Data


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Search can be required for defining Concepts and Descriptions that are used in subsequent data retrieval from patient records. The effectiveness of a search technique depends on the requirements for reporting and analysis (e.g. creating a query that searches for SNOMED CT coded data within specific subtype-hierarchies).

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#binding-snomed-ct-to-knowledge-artifacts)

Binding SNOMED CT to Knowledge Artifacts


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The integration of clinical decision support tools into clinical record systems can help to improve evidence-based practice. The binding of SNOMED CT to knowledge artifacts enables the linkage between the knowledge content in clinical decision support and the SNOMED CT coded data items in the clinical record. The binding typically entails searching for the SNOMED CT Concept. Effective techniques for searching for SNOMED CT Concepts for data entry can improve the assessment of the context of a Concept within SNOMED CT prior to binding and the overall binding efficiency.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#evaluating-terminology-content)

Evaluating Terminology Content


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_For example to review content coverage_

There can be various use cases for reviewing SNOMED CT content. For example, terminology content can be evaluated to decide whether the coverage of SNOMED CT is a sufficient to fit documentation purposes (e.g. a cardiovascular surgeon could assess whether SNOMED CT covers all cardiovascular terms). This assessment typically entails searching for SNOMED CT Concepts which requires effective search techniques.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#mapping-between-snomed-ct-and-another-code-scheme)

Mapping Between SNOMED CT and Another Code Scheme


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In mapping, searching to identify SNOMED CT Concepts required to be mapped to or from another code scheme (e.g. ICD-10 or local codes) is required.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#creating-reference-sets)

Creating Reference Sets


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_For example to represent subsets of terms and concepts_

Identifying subsets of Concepts or Descriptions for inclusion in a Reference Set typically requires searching SNOMED CT content.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#learning-about-the-structure-and-content-of-the-terminology)

Learning About the Structure and Content of the Terminology


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Realizing and understanding the comprehensiveness and complexity of SNOMED CT may be a steep learning curve for users. Searching and browsing through navigational results can aid the learning process. Thus, effective search techniques increase the chances of finding the required content and understanding where it fits into the overall structure of SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#editing-snomed-ct-descriptions)

Editing SNOMED CT Descriptions


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Terminology authorities such as National Release Centers may need to edit SNOMED CT Descriptions to adhere to national or local linguistic/editorial guidelines. This entails searching large subsets of Concepts and Descriptions. Thus, effective search techniques are required to find the correct Concept or Description within these large subsets.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Search+And+Data+Entry+Guide&entry.670899847=3.2%20Use%20Cases%20Where%20Search%20Browsers%20are%20Required)

[PreviousUse Cases Directly Connected to Data Entrychevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.1-use-cases-directly-connected-to-data-entry)
[NextOptimizing Searcheschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches)

Last updated 7 months ago

*   [Creating Queries for Retrieving Data](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#creating-queries-for-retrieving-data)
    
*   [Binding SNOMED CT to Knowledge Artifacts](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#binding-snomed-ct-to-knowledge-artifacts)
    
*   [Evaluating Terminology Content](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#evaluating-terminology-content)
    
*   [Mapping Between SNOMED CT and Another Code Scheme](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#mapping-between-snomed-ct-and-another-code-scheme)
    
*   [Creating Reference Sets](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#creating-reference-sets)
    
*   [Learning About the Structure and Content of the Terminology](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#learning-about-the-structure-and-content-of-the-terminology)
    
*   [Editing SNOMED CT Descriptions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required#editing-snomed-ct-descriptions)
    

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# Extension and Customization | Practical Guides | SNOMED International Documents

This section provides an overview of:

*   Extension Content
    
*   Reference Sets
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/10-extension-and-customization#why-is-this-important)

Why is this important?


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SNOMED CT is designed to allow the International Edition to be enhanced by adding Extensions that address national or local requirements. Additional content required to support national, local or organizational needs that may not have international relevance or may not meet the editorial guideline for inclusion in the International Edition.

SNOMED CT design also includes the Reference Set mechanism which provides a standard way to customize and enhance content for use in a particular country, language, specialty, application or context. Reference Sets developed nationally or locally can modify search and display of content from the International Edition as well as enhancing Extension content.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/10-extension-and-customization#what-is-this)

What is this?


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### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/10-extension-and-customization#extension-content)

Extension Content

Many clinical concepts are relevant in all countries, organizations and specialties but some concepts are relevant only to a particular environment. SNOMED CT is designed to allow the International Edition to be enhanced by adding Extensions to meet national or local requirements without compromising the main body of SNOMED CT. This is intended to meet the needs of different specialties and countries, regions, vendors and healthcare institutions.

Extensions are managed by Members or Affiliates who have been issued with a Namespace Identifier. A Namespace Identifier distinguishes the Identifiers of the Components created by an organization. The responsibilities of organizations that create an Extension and provide it for use by other organizations include:

*   Maintaining Concept, Descriptions, Relationships, and Reference Sets that they create.
    
*   Inactivating these components as appropriate (duplication, ambiguous, outdated, etc.)
    

The Concepts, Descriptions, Relationship and Reference Sets that form an Extension use a namespace identifier, which ensures that their SNOMED CT identifier is different from components in:

*   SNOMED CT International Release,
    
*   Other SNOMED CT Extensions
    

The namespace identifier is part of the component identifier. Therefore, components are distinguishable not only in the thesaurus, but also when stored in a patient record, query or decision support protocol.

Extensions use the same file structure as the core International Release. This ensures that:

*   SNOMED CT enabled implementations can benefit from the content in these Extensions without the need for any additional software development;
    
*   The same application software can be used to enter, store and process information from different extensions;
    
*   Reference Sets can be constructed that refer to content from the International Release and a variety of Extensions.
    

Software applications should allow the users or user communities to specify the Extensions to be recognized by their systems.

An Extension should only be recognized if:

*   It has been supplied by SNOMED International or another organization authorized by SNOMED International to provide such Extensions;
    
*   The recognizing organization is satisfied with the quality control procedures of the providing organization.
    

The fact that an organization is permitted to produce Extensions does not imply a seal of approval of the quality of Extensions that organization produces. Therefore a person or organization that authorizes or installs an Extension does so entirely at their own risk.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/10-extension-and-customization#reference-sets)

Reference Sets

SNOMED CT has a broad clinical coverage and includes a depth of detail appropriate to a range of health care disciplines and clinical specialties. As a result, it has extensive content, different parts of which are needed in particular environments. The SNOMED CT design includes the Reference Set mechanism, which provides a standard way to refer to a set of SNOMED CT components and to add customized information to a component.

Organizations implementing SNOMED CT benefit from Reference Sets because they allow requirements for use of particular descriptions and concepts to be represented in a standard form that can be applied to any SNOMED CT enabled application. This allows Reference Sets to be shared throughout and between organizations, even when different software is used to meet local or departmental requirements.

Software developers and vendors benefit because Reference Sets provide a common, machine processable representation of requirements for different patterns of use of SNOMED CT. This simplifies local configuration and enhances interoperability with other SNOMED CT enabled applications.

Reference sets can be used for many different purposes, including:

*   **Language and dialects** are represented as Language Reference Sets (see [Translations and Language Preferences](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/11-translations-and-language-preferences)
    ).
    
*   **Maps to and from other code systems and classifications** are represented as Simple, Complex or Extended Map Reference Sets (see [Mapping](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping)
    ).
    
*   **Subsets of concepts, description or relationships** are represented as Simple Reference Sets. The only information that a Simple Reference Set provides is that a component is part of this subset. Subsets may be used for a variety of general and specific purposes, some of which are identified in the following examples.
    
*   **Ordered lists and navigation hierarchies** are represented as Ordered Reference Sets. These offer additional functionality to meet advanced variants of the requirements addressed by component subsets.
    

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/10-extension-and-customization#general-use-cases-for-subsets-represented-as-simple-reference-sets)

General use cases for subsets represented as Simple Reference Sets

*   **Excluding content**
    
    *   Reference sets can be used to exclude concepts that are not required by a particular use case.
        
    
*   **Including content**
    
    *   Limiting searches to content of specific interest to a specialty or specific data entry context
        
    *   In some cases very limited subsets can be presented as dropdown lists or option boxes rather than searches.
        
    
*   **Prioritizing content**
    
    *   In some cases, a subset represents an initial priority list of options but the full content of SNOMED CT is searchable when required.
        
    *   Note that Ordered Reference Sets support more flexible prioritization.
        
    
*   **Managing use of codes in messages and communications**
    
    *   A Simple Reference Set may represent a value set applicable to a particular field in a message.
        
    

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/10-extension-and-customization#specific-use-cases-for-subsets-represented-as-simple-reference-sets)

Specific use cases for subsets represented as Simple Reference Sets

*   **National, jurisdictional or organizational requirements**
    
    *   Collecting particular minimum sets of data using specific codes.
        
    
*   **Regional variations in disease prevalence**
    
    *   Providing prioritized access to diseases that are prevalent in the region where data is being collected.
        
    
*   **Specialty and discipline variations**
    
    *   The frequency of use of particular concepts depends on the professional discipline and/or clinical specialty of the user. Specialty subsets can optimize data entry.
        
    
*   **Supporting data entry protocols**
    
    *   Different subsets of concepts are relevant at different points in different data entry protocols. Subsets represented as Simple Reference Sets can be used to restrict the available options to match the requirements at particular points in a data entry protocol.
        
    

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/10-extension-and-customization#reference-set-development)

Reference set development

Generic data structures for Reference Sets have been used to create a simple core structure that can be extended to meet a variety of requirements. This has been done rather than developing a complex and inextensible structure that can only be used in a finite and constrained number of ways to enforce editorial policy.

Creating a new Reference Set requires access to a namespace in order to generate SNOMED CT Ids. Within that namespace, at least one module ID concept (with an FSN and Preferred Term) should be added under the |module| sub-hierarchy (within the Core Metadata) for each of the authoring organizations. The steps required to create a new reference set include:

1.  Create the Reference Set Concept in the Foundation Metadata hierarchy.
    
2.  Define the Reference Set Attributes within the metadata hierarchy.
    
3.  Create the Descriptor for the Reference Set (by adding members to the Reference Set Descriptor Reference Set).
    
4.  Add members to the Reference Set.
    

Please note that step 2 does not need to be performed if using one of the standard Reference Set types that have been predefined in the international release of SNOMED CT. The Reference Set Attributes for these predefined Reference Set types have already been added to the international release.

It is recommended that for each reference set, there is formal documentation that records (at a minimum) the rules, principles and approach used to determine the members of that reference set.

Reference Sets need to be maintained and the content re-examined when new releases of SNOMED CT are made available. Processes need to be established to address the concepts that have become inactive and the new concepts added in each new release.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Starter+Guide&entry.670899847=Extension%20and%20Customization)

[PreviousContent Developmentchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/9-content-development)
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Last updated 7 months ago

*   [Why is this important?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/10-extension-and-customization#why-is-this-important)
    
*   [What is this?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/10-extension-and-customization#what-is-this)
    
*   [Extension Content](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/10-extension-and-customization#extension-content)
    
*   [Reference Sets](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/10-extension-and-customization#reference-sets)
    

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# Using SNOMED CT in Clinical Information | Practical Guides | SNOMED International Documents

This section provides an overview of:

*   How SNOMED CT supports reuse of clinical information
    
*   Extent of practical use
    
*   Approaches to implementation
    
*   Lessons learnt
    
*   Challenges
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#why-is-this-important)

Why is this important?


---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The objective of SNOMED International and all users of SNOMED CT is to facilitate the accurate recording and sharing of clinical and related health information and the semantic interoperability of health records.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#what-is-this)

What is this?


---------------------------------------------------------------------------------------------------------------------------------------------------------------

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#how-snomed-ct-supports-reuse-of-clinical-information)

How SNOMED CT Supports Reuse of Clinical Information

SNOMED CT is a clinical terminology with global scope covering a wide range of clinical specialties, disciplines and requirements. As a result of its broad scope, one of the benefits of SNOMED CT is a reduction of specialty boundary effects that arise from use of different terminologies or coding systems by different clinicians or departments. This allows wider sharing and reuse of structured clinical information. Another benefit of SNOMED CT is that the same data can be processed and presented in ways that serve different purposes. For example, clinical records represented using SNOMED CT can be processed and presented in different ways to support direct patient care, clinical audit, research, epidemiology, management and service planning. Additionally, the global scope of SNOMED CT reduces geographical boundary effects arising from the use of different terminologies or coding systems in different organizations and countries.

With SNOMED CT, clinical information is recorded using identifiers that refer to concepts that are formally defined as part of the terminology. SNOMED CT supports recording of clinical information at appropriate levels of detail using relevant clinical concepts. The structures of SNOMED CT allow information to be entered using synonyms that suit local preferences while recording the information in a consistent and comparable form. Additionally, the hierarchical nature of SNOMED CT permits information to be recorded with different levels of detail to suit particular uses (e.g. |pneumonia|, |bacterial pneumonia| or |pneumococcal pneumonia|). SNOMED CT also allows additional detail to be added by combining concepts where the available concepts are not sufficiently precise. SNOMED CT allows a range of different options for immediate retrieval and subsequent reuse to address immediate and longer term clinical requirements and the requirements of other users. The nature of SNOMED CT hierarchies allow information to be selectively retrieved and reused to meet different requirements at various levels of generalization (e.g. retrieval of subtypes of |lung disorder| or |bacterial infection| would both include |bacterial pneumonia|).

The SNOMED CT concept model also allows additional details to be considered when retrieving data. For example, the concept |pneumococcal pneumonia| specifies that the |causative agent| is |streptococcus pneumoniae| and this allows the organism causing this disease to be analyzed.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#extent-of-practical-use)

Extent of Practical Use

Many systems use SNOMED CT to represent some types of clinical information. The extent of use is varied in terms of:

*   The clinical content captured (i.e. what is included and what is not).
    
*   How the structure of this content relates to the structures in the records.
    
*   The scope and consistency of use and reuse (i.e. within and across national and local organizations, across departments, within proprietary applications or specifically configured instances of proprietary applications).
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#approaches-to-implementation)

Approaches to Implementation

SNOMED CT has been implemented in a variety of ways which differ in the extent to which they harness particular features of the terminology. In some cases, these differences merely reflect the specific requirements of a particular use. Other factors include the design of existing systems prior to the introduction of SNOMED CT, sophistication of available technology and support for a range of other health informatics standards.

Key determinants for effective benefits realization include:

*   Representation of stored clinical information.
    
    *   To enable effective reuse of clinical information, SNOMED CT should be used within a record structure (or information model) that stores similar information consistently and in ways that can be readily queried.
        
    
*   Ease of data entry
    
    *   Different approaches to data entry are valuable and may be mediated in a variety of ways to enable ease of data entry.
        
    *   The method of data entry should not result in inconsistent representations of the same types of clinical information.
        
    *   The most effective approaches constrain data entry specific to the clinical context and reason for use.
        
    *   Unconstrained searches across the entire content of SNOMED CT are rarely appropriate for routine data entry.
        
    *   Constraints that limit data entry to a fixed set of SNOMED CT concepts are useful where the clinical context and reasons for use are narrow.
        
    *   Constraints that alter dynamically to meet requirements of a particular data entry context offer a more generalizable approach that can be configured to meet different requirements.
        
    *   Natural Language Processing (NLP) to parse and tag text with SNOMED CT expressions has been found useful in some applications.
        
    
*   Communication interfaces, including message structures, need to be designed to retain the common elements of clinical content structure and coding. Communication should enable the receiving system to reuse the clinical information effectively based on the SNOMED CT expressions within it.
    
*   Retrieval, analysis and reuse
    
    *   Record storage and indexing can be designed to optimize use of the semantic features of SNOMED CT for selective retrieval and to support flexible analytics.
        
    *   Retrieval in the patient care setting should result in the display of clinical records including highlighting of critical information selected taking account of the computer processable expressivity of SNOMED CT.
        
    *   Real time decision support ranges from simple flagging of contraindications to guidelines for investigation and management.
        
    *   Batch mode decision support identifies patients with chronic diseases and risk factors who require recalls for review and other scheduled interventions.
        
    *   Analysis of data can be completed for selected populations of patients for a variety of purposes including audit, service planning, epidemiology and clinical research.
        
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#lessons-learnt)

Lessons Learnt

The features of SNOMED CT support reusability of clinical information. However, reusability also requires a consistent structured representation of clinical information that complements the meaning supported by SNOMED CT. Without this, overlaps and conflicts between structural and terminological representations of clinical content can result in ambiguous and potentially conflicting interpretations.

The way in which the use of terminology and structure together contribute to the representation of meaningful information is sometimes referred to as the "model of meaning". To enable widespread clinical information reuse, queries need to be consistently formulated in ways that take account of the way the information is structured and coded. A common model of meaning facilitates widespread reuse of clinical information, ability to reuse queries and a consistent approach to linkage between clinical information and knowledge resources.

Human factors may result in inconsistent recording of similar clinical information. This issue can be minimized by effectively constraining data entry.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#challenges)

Challenges

An important limitation is the diversity of views related to the structure of clinical information and the overlap between information models and terminology. There are also differing views on application design, different requirements for collection of clinical information and different views on record structures and data entry methods appropriate to different use cases.

SNOMED International is working with other standards bodies including the International Organization for Standardisation (ISO) and Health Level 7 (HL7), as well as various collaborative efforts exploring the relationship between terminology and structured clinical information. The objective is to ensure that the role of SNOMED CT as a key component of clinical information and systems is understood as part of overall efforts towards harmonization and interoperability.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Starter+Guide&entry.670899847=Using%20SNOMED%20CT%20in%20Clinical%20Information)

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Last updated 7 months ago

*   [Why is this important?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#why-is-this-important)
    
*   [What is this?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#what-is-this)
    
*   [How SNOMED CT Supports Reuse of Clinical Information](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#how-snomed-ct-supports-reuse-of-clinical-information)
    
*   [Extent of Practical Use](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#extent-of-practical-use)
    
*   [Approaches to Implementation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#approaches-to-implementation)
    
*   [Lessons Learnt](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#lessons-learnt)
    
*   [Challenges](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information#challenges)
    

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# Guidelines | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

The two main approaches to preparing clinical guidelines for use in CDS are to use simple markup (also referred to as "semantic tagging"), and to use a standard guideline representation language.

Simple guideline markup involves annotating free-text clinical guidelines using terminology codes that represent its meaning. This enables relevant guidelines to be retrieved based on specific codes recorded in a patient's health record. For more information on this approach, please refer to [Guidelines with SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#guidelines-with-snomed-ct)
.

An alternative approach is to use a standard guideline representation languages to formally define each guideline. Some examples of standard guideline representation languages, such as the Guideline Definition Language (GDL) and the Guideline Interchange Format (GLIF) are presented in the section [Standards for CDS Guidelines](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#standards-for-cds-guidelines)
.

* * *

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#guidelines-with-snomed-ct)

Guidelines with SNOMED CT


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This section examines how clinical guidelines can be linked to SNOMED CT to enable the automated display of contextually relevant knowledge resources. We begin by reviewing how a guideline can be linked to a SNOMED CT concept using semantic tags. Next we will examine how SNOMED CT concepts can be associated with guidelines using a reference set. Lastly, we will look at the automated display of a contextually relevant guideline, based on the selection of a SNOMED CT concept in a data entry protocol.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#linking-guidelines-to-snomed-ct)

Linking Guidelines to SNOMED CT

One approach known as simple markup, involves the application of semantic tags using terminology codes (such as SNOMED CT concept identifiers) to free text clinical guidelines. When using SNOMED CT, concept identifiers (or expressions) are added as document metadata to the appropriate guideline or text within the guideline. For example, when applying semantic tags to asthma management guidelines, we might add the following concept identifiers, to enable the guideline to be linked to a patient's health record that includes a diagnosis of 195967001 | Asthma|, a regime of 406162001 | Asthma management|, or an assessment scale coded with 445531003 | Asthma control questionnaire| (respectively):

Concept

195967001 | Asthma (disorder)|

406162001 | Asthma management (regime/therapy)|

445531003 | Asthma control questionnaire (assessment scale)|

The diagram below depicts the process of tagging the SNOMED CT concepts mentioned above to an Asthma Management Guideline.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-2e41fa3d8df0beb046bb74cb4e54d06aeac16be4%252F123897818.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=7e346460&sv=2)

Asthma Management Guideline tagged with SNOMED CT concepts

This tagged resource may then be presented as reference material when a relevant clinical scenario arises. For example, the guidelines shown in the image above could be presented upon the diagnosis of | Asthma|. Additional details on the mechanics of this process are provided below in the [Selecting Relevant Guidelines](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#id-3.2.1.guidelineswithsnomedct-selectingrelevantguidelinesselectingrelevantguidelines)
 section below.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#linking-snomed-ct-to-guidelines)

Linking SNOMED CT to Guidelines


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SNOMED CT Annotation Reference Sets can be used as a mechanism to define, share, and distribute links from SNOMED CT components to appropriate guidelines. This approach involves defining one or more links to relevant guidelines (using a URL) as a string based annotation for each relevant concept. An example of this is shown in the table below. In this example, the same clinical guideline is relevant to more than one SNOMED CT concept.

Table: Concepts which refer to NIH: Asthma Care Quick Reference guideline

refsetId

referencedComponentId

Annotation

719999999107 | Guideline annotation reference set|

195967001 | Asthma (disorder)|

[http://www.example.com/asthma\_guidelinearrow-up-right](http://www.example.com/asthma_guideline)

719999999107 | Guideline annotation reference set|

406162001 | Asthma management (regime/therapy)|

[http://www.example.com/asthma\_guidelinearrow-up-right](http://www.example.com/asthma_guideline)

719999999107 | Guideline annotation reference set|

445531003 | Asthma control questionnaire (assessment scale)|

[http://www.example.com/asthma\_guidelinearrow-up-right](http://www.example.com/asthma_guideline)

Another example use case is linking a specific clinical field, such as a diagnosis, to an appropriate clinical guideline. Given the more specific scope, it may be possible to avoid repeating the same guideline for multiple SNOMED CT concepts referenced by the reference set. The table below, shows an example in which disorder concepts are linked to appropriate clinical guidelines.

Table: Respiratory diagnoses linked to relevant clinical guidelines

refsetId

referencedComponentId

Annotation

719999999107 | Guideline annotation reference set|

195967001 | Asthma|

[http://www.example.com/asthma\_guidelinearrow-up-right](http://www.example.com/asthma_guideline)

719999999107 | Guideline annotation reference set|

32398004 | Bronchitis|

[http://www.example.com/bronchitis\_guidelinearrow-up-right](http://www.example.com/bronchitis_guideline)

719999999107 | Guideline annotation reference set|

13645005 | Chronic obstructive lung disease|

[http://www.example.com/COPD\_guidelinearrow-up-right](http://www.example.com/COPD_guideline)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#id-3.2.1.guidelineswithsnomedct-selectingrelevantguidelinesselectingrelevantguidelines)

Selecting Relevant Guidelines


-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

EHR systems, designed to use clinical guidelines marked up with semantic tags, are able to display relevant guidelines to the user when a subtype (or self) of the semantic tag concept is recorded in the health record.

Below is a generic template that could be used in an EHR system to facilitate the display of an appropriate clinical guideline, when a relevant diagnosis is recorded.

IF diagnosis \= << \[\[ + $semanticTag\]\] THEN display clinical guideline

For example, the above template could be used on a clinical guideline that has the semantic tag 195967001 | Asthma|, generating the CDS rule:

IF diagnosis \= << 195967001 | Asthma| THEN display NIH Asthma Care Quick Reference

Using the above CDS rule, if a clinician selects a diagnosis of 195949008 | Chronic asthmatic bronchitis|, the NIH Asthma Care Quick Reference would be displayed because 195949008 | Chronic asthmatic bronchitis| is a subtype of 195967001 | Asthma|.

This enables _contextually relevant_ clinical knowledge to be presented to the user, based on the specific codes recorded in the patient's health record. The diagram below illustrates this scenario:

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-f30e83abe8786243c49bf9fa7281c65050ca5c42%252F123897808.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=2a1a6240&sv=2)

Upon entry of a specific diagnosis, a contextually relevant knowledge resource is presented on the user interface

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#standards-for-cds-guidelines)

Standards for CDS Guidelines


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This section presents some examples of standards used to represent CDS guidelines. Please note that this list is not complete, and other standards and formalisms for representing clinical guidelines do exist.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#guideline-interchange-format)

Guideline Interchange Format

The Guideline Interchange Format (GLIF) is a language for modeling and executing clinical practice guidelines. GLIF uses GELLO, and therefore can make use of SNOMED CT within its language. Users of GLIF have the option of viewing GLIF code in a interactive flowchart to represent guidelines and present pop-up information and instructions. The following screenshot presents the "UI view" of a query / guideline structured in GLIF. This example uses SNOMED CT to answer the questions in the decision shapes:

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-ea3f966f9d2223d914e67492ae336b79c213276e%252F123898014.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=e98e626&sv=2)

UI view of a query / guideline structured in GLIF

For more information about GLIF, please refer to [https://kb.medical-objects.com.au/display/PUB/GLIFarrow-up-right](https://kb.medical-objects.com.au/display/PUB/GLIF)
.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#guideline-definition-language)

Guideline Definition Language

The Guideline Definition Language (GDL) is a syntax designed to express clinical logic as rule inputs and outputs. Discrete rules can be combined together to support simple or complex decision making. The specification which accompanies the GDL describes its status as "trial." One of the goals of the GDL is to be able to share CDS artifacts across languages and technical platforms. GDL artifacts can be applied to point of care (POC) decision support and in population health analytics. The GDL uses reference and archetype models from openEHR and in doing so supports information model references that are language independent. For example, it is possible to add language translations without changing the logical definitions in the rule. It is also possible to bind locally defined terms in the guideline to a single concept, multiple concepts, or reference set in any reference terminology as the language considers a reference terminology to be an external resource.

For more information on the Guideline Definition Language, please refer to [https://specifications.openehr.org/releases/CDS/latest/GDL.htmlarrow-up-right](https://specifications.openehr.org/releases/CDS/latest/GDL.html)
.

* * *

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*   [Guidelines with SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#guidelines-with-snomed-ct)
    
*   [Linking Guidelines to SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#linking-guidelines-to-snomed-ct)
    
*   [Linking SNOMED CT to Guidelines](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#linking-snomed-ct-to-guidelines)
    
*   [Selecting Relevant Guidelines](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#id-3.2.1.guidelineswithsnomedct-selectingrelevantguidelinesselectingrelevantguidelines)
    
*   [Standards for CDS Guidelines](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#standards-for-cds-guidelines)
    
*   [Guideline Interchange Format](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#guideline-interchange-format)
    
*   [Guideline Definition Language](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.2-guidelines#guideline-definition-language)
    

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# Mapping | Practical Guides | SNOMED International Documents

This section provides an overview of:

*   Mapping approaches
    
*   How SNOMED CT represents maps
    
*   Steps in a mapping process
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#why-is-this-important)

Why is this important?


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Clinical information recorded using SNOMED CT may include data that is relevant to reports, statistical returns, billing claims, etc. that need to be encoded using a specific code system or a statistical classification such as ICD-10. Mapping allows relevant information to be used for those purposes, minimizing the requirement for additional manual data entry.

Organizations planning to implement SNOMED CT based solutions may also be faced with data transformation and migration challenges which lead them to consider mapping their existing clinical data, code systems or classifications to SNOMED CT.

As a common global reference terminology, SNOMED CT limits the need for development of "everything to everything" maps between multiple different code systems.

**Problem: Map Everything to Everything**

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F19067948-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FUmSUeu96fIQZWDm7RISx%252Fuploads%252Fgit-blob-badca47ea4521120bd82a2f60dffc444166e56f8%252F29952973.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=74e96b4b&sv=2)

**Solution: Map to SNOMED Clinical Terms**

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F19067948-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FUmSUeu96fIQZWDm7RISx%252Fuploads%252Fgit-blob-db423fbf529603db079b095d72b6bdedf57cb176%252F29952975.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=17589546&sv=2)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#what-is-this)

What is this?


--------------------------------------------------------------------------------------------------------------------------------

Maps are associations between particular codes, concepts or terms in one code system and codes, concepts or terms in another code system that have the same (or similar) meanings. Mapping is the process of defining a set of maps. Maps are developed in accordance with a documented rationale, for a given purpose and as a result there may be different maps between the same pair of code systems to meet different uses cases.

There are a number of different types of mapping activities that an organization may need to undertake. These include mapping:

*   SNOMED CT to a statistical classification (such as ICD-10)
    
*   Classifications to SNOMED CT
    
*   Other standard code systems to or from SNOMED CT
    
*   Locally developed code systems to SNOMED CT
    
*   Locally collected clinical data documented as free text to SNOMED CT
    

The completeness of mapping between two code systems depends on the scope, level of detail provided by the two schemes and the precision of mapping required to safely meet the intended mapping use case.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#mapping-approaches)

Mapping Approaches

The approaches used when undertaking mapping include human mapping, automatic mapping or a combination of both of these.

Automatic mapping is when computer algorithms are used to create maps between concepts and or terms - for example between local clinical content and SNOMED CT. Lexical mapping, where the structure of the words in the clinical term is compared and analyzed as to whether the words are the same, similar or different, is often incorporated within automatic mapping. Significant care must be taken with automatic mapping, because severe mapping errors can result if not done in a controlled way. Automatic mapping, in conjunction with human review (and manual remapping where necessary), is likely to achieve better results than automatic mapping alone.

Human mapping is the use of human knowledge and skill to author maps. Each map is built singly and individually. The process requires examination of each and every concept in the coding system. Informed judgments or decisions are made about the shared meaning of concepts. Electronic or computational tools are used, but only in support of work process.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#how-snomed-ct-represent-maps)

How SNOMED CT Represent Maps

SNOMED CT specifications and content include resources that support mapping to and from other code systems, classifications and terminologies. These resources support simple, complex and extended mappings. Simple maps, where there is a one-to-one Relationship between a SNOMED CT concept and code in a target scheme, are represented using a Simple Map Reference Set. Complex and Extended Map Reference Sets enable the representation of:

*   Maps from a single SNOMED CT concept to a combination of codes (rather than a single code) in the target scheme.
    
*   Maps from a single SNOMED CT concept to choice of codes in the target scheme. In this case, the resolution of the choices may involve:
    
    *   Manual selection supported by advisory notes.
        
    *   Automated selection based on rules that test other relevant characteristics in the source data (e.g. age and sex of the subject, presence or absence of co-existing conditions, etc.).
        
    *   A combination of automated processing with manual confirmation or selection where rules are insufficient to make the necessary decisions.
        
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#steps-in-a-mapping-process)

Steps in a Mapping Process

The main steps to be completed and documented when completing a mapping process include:

*   Evaluate mapping as a solution
    
*   Produce mapping requirements
    
*   Develop and review the maps
    
*   Use the maps
    
*   Review activity
    

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#evaluating-mapping-as-a-solution)

Evaluating Mapping as a Solution

When approaching the creation of a map, the first step is to understand the data which needs to be transformed or migrated and the requirements for use of that data. Key questions to address include:

*   Are the business requirements well understood?
    
*   Are there other options for meeting the business requirements without mapping?
    
*   To what extent can the source data contribute value to the target data?
    
*   What are the options?
    
*   What requirements are there beyond developing and delivering the maps? (e.g. enabling appropriate use of the maps for data conversion).
    
*   What is the scope of the mapping exercise?
    
*   What are the expert resource requirements and costs of creating, quality assuring and maintaining the maps?
    
*   What are the potential risks arising from using the maps?
    

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#produce-mapping-requirements)

Produce Mapping Requirements

It is essential to fully understand the structure, content and semantics of both the source and target code systems. It is also important to understand how the meaning of the codes is affected by the structure and functionality of the source and target systems. Once the code system and how it has been used is fully understood, a document should be created which defines the rules to be applied when creating maps to or from SNOMED CT. These rules will address for example, the approach to inexact mappings, the use of synonyms, postcoordinated expressions and others. In order to be able to understand the evolution of the maps, an audit trail of the map creation and maintenance activity should be maintained.

Human resource requirements are dependent on the mapping scale, the model used for mapping and the type and complexity of the map being developed. The roles that may be required could include mapping sponsor, mapping manager, mapping specialist, clinical specialists and a mapping advisory group.

Once all requirements have been defined, appropriate software tools to support the creation of the maps must be decided upon. The tools required depend on the complexity of the map and mapping process. Three main alternatives include the use of simple multipurpose tools like spreadsheets, dedicated map maintenance applications and/or custom built applications.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#develop-the-map)

Develop the Map

The process of map development needs to be done in a controlled manner and involves:

*   Data preparation
    
*   Algorithmic mapping (where possible and deemed to be safe)
    
*   Human mapping, including map verification
    
*   Publication
    
*   Life cycle management
    

Checks and balances should be used at each stage to ensure that the process is technically accurate and any maps created should be checked either using a map verification process or by parallel independent mapping. Once maps are created and published a cycle of testing should be performed to validate that the results obtained through the use of the maps to transform or migrate data meets the defined requirements.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#use-the-maps)

Use the Maps

Having created the maps to or from SNOMED CT, there are various aspects to consider when using the maps to migrate or transform clinical data. The actual specific use case needs to influence the final requirements of how this is undertaken. Specific attention needs to be paid to reporting, interoperability and data migration. The more common use cases are:

*   Identifying records to include in reports.
    
*   Transforming the original clinical data to meet the messaging specification for sending data to another system.
    
*   Migrating existing clinical data either because a system is being upgraded to use SNOMED CT or to introduce a new system that uses SNOMED CT.
    

Throughout the use of maps, there are fundamental principles and best practices that should be adhered to including:

*   Consider all design elements of the system.
    
*   Maintain an audit trail for transformation or migration.
    
*   Manage future amendments to the mapping table.
    
*   Ensure visibility of original text of mapped items (as recorded prior to mapping).
    
*   Support clinical safety.
    

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#review-activity)

Review Activity

As with any process, a post-activity review stage is recommended. This should ensure that:

*   Appropriate lessons are learnt and documented and thus can be referred to in any future mapping activity.
    
*   Issues that can be addressed within the current mapping are appropriately managed. For example, where the maps are being used for transformation then lessons learnt should be fed back into the process to improve the quality of the transformed data. The same is true in a data migration scenario where maps are reapplied subsequent to the initial migration.
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Starter+Guide&entry.670899847=Mapping)

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*   [Why is this important?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#why-is-this-important)
    
*   [What is this?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#what-is-this)
    
*   [Mapping Approaches](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#mapping-approaches)
    
*   [How SNOMED CT Represent Maps](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#how-snomed-ct-represent-maps)
    
*   [Steps in a Mapping Process](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/12-mapping#steps-in-a-mapping-process)
    

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# Using SNOMED CT Features to Support Optimized Searches | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

The logical model of SNOMED CT is able to the support development of search techniques which can support effective and efficient Concept and Description retrieval.

It is however important to be aware that different techniques apply to different types of searches in order to avoid unconstrained searches which can make browsing SNOMED CT like navigating a jungle. This section presents some features of SNOMED CT which can help support effective and efficient searches.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/2-introduction-to-search/2.2-using-snomed-ct-features-to-support-optimized-searches#benefits-of-using-snomed-ct-hierarchies)

Benefits of Using SNOMED CT Hierarchies


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The | is a | hierarchies in SNOMED CT support searches to be constrained by type, e.g. searches for Concepts which are contained in one of the top-level hierarchies such as | clinical finding | , | body structure | and | procedure | (see [Constrain Searches by Supertype Ancestors](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-supertype-ancestors)
).

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-ab125e57839cbe9f9075714d093a6b5085ad013b%252F52170459.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=f1e33756&sv=2)

Search by subtype hierarchy

This type of search limits the number of search candidates significantly, as it excludes all Concepts of types other than those specified by the chosen subtype hierarchy. More granular Concepts than the top-level Concepts can be used as the basis for this type of search. For instance, searching for subtypes of | Cardiovascular finding | will further concentrate the type and number of candidate results.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/2-introduction-to-search/2.2-using-snomed-ct-features-to-support-optimized-searches#benefits-of-using-reference-sets)

Benefits of Using Reference Sets


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SNOMED CT supports the definition of Reference Sets. Reference Sets are important as they can be used to constrain search and data entry or support SNOMED CT navigation. Hence, searching within a Reference Set will limit the number of search results and ensure that the result set will be relevant for the desired context (see [Constrain Searches by Reference Sets](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-reference-sets)
).

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-d2e2bfe50f4539c72d1fe384940511e7743ee369%252F52170458.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=f45473e6&sv=2)

Search using Reference Sets

Moreover, Reference Sets can also be used to exclude Concepts as possible result candidates. For example, as SNOMED CT contains both animal and human Concepts, for human medicine it is likely that Concepts in the non-human Reference Set needs to be excluded from all searches.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/2-introduction-to-search/2.2-using-snomed-ct-features-to-support-optimized-searches#language-reference-sets)

Language Reference Sets


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It is a benefit that SNOMED CT supports development of Language Reference Sets, as this supports searches by Descriptions that are limited to a specific language or dialect (see [Constrain Searches by Language or Dialect](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-language-or-dialect)
). A Language Reference Set identifies the Descriptions which are considered to be preferred designation for and acceptable as alternatives for SNOMED CT Concepts in the context of a given language and, optionally, dialect.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-a1ce0da7de1f993edb25907f012505d62898d661%252F57815947.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=dc5bc1f3&sv=2)

Search in different languages using language reference sets

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*   [Benefits of Using SNOMED CT Hierarchies](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/2-introduction-to-search/2.2-using-snomed-ct-features-to-support-optimized-searches#benefits-of-using-snomed-ct-hierarchies)
    
*   [Benefits of Using Reference Sets](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/2-introduction-to-search/2.2-using-snomed-ct-features-to-support-optimized-searches#benefits-of-using-reference-sets)
    
*   [Language Reference Sets](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/2-introduction-to-search/2.2-using-snomed-ct-features-to-support-optimized-searches#language-reference-sets)
    

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# Use Mnemonics and Personal Favorites for Data Entry | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

Groups of people, such as practitioners of a discipline or specialty, frequently use similar sets of Descriptions and Concepts. Lists of widely understood (or easily learned) abbreviations or mnemonics that allow rapid entry of these commonly used Concepts are recommended as a way of accelerating repetitive recording.

A similar facility may also be useful for individual users or organizations that have sets of Descriptions and Concepts that they use frequently. Providing an easy way for users to store personal favorites following a search and recall these favorites with user-defined abbreviated access terms will enhance usability and significantly increase the speed of data entry.

User guidance may be necessary to minimize the risk of overusing the shortcuts. Unless the general search facilities are also easy to use, it is likely that users will favor the shortcuts even when it would be more appropriate to use a more accurate but less accessible Concept. An unchecked bias toward easy to record Concepts may lead to deterioration in data quality, statistical anomalies, and in the worst case, inappropriate treatment.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Search+And+Data+Entry+Guide&entry.670899847=5.6.%20Use%20Mnemonics%20and%20Personal%20Favorites%20for%20Data%20Entry)

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# Overview | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#what-is-clinical-decision-support)

What is Clinical Decision Support?


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Clinical Decision Support (CDS) is a service that enables healthcare providers to make well-informed decisions by supplying guidance, knowledge, and patient-specific information at relevant points in the patient journey, such as diagnosis, treatment, and follow-up. CDS uses a range of mechanisms to assist users in this process. Examples of these mechanisms include automated alerts or reminders, clinical guidelines, contextually relevant reference information, conditional order sets, diagnostic support, and patient-focused reports, forms, or templates. The beneficiaries of the information derived from CDS may include patients, clinicians, and others involved in the delivery of health care.

It is important to distinguish the general practice of clinical decision support from the application of tools designed to enhance decision support practices. One is performed by humans who make decisions based on knowledge they possess and information they consume. The other is computed by systems and engines using rules and predefined conditions. Although both are important, the technical components of CDS are designed to assist rather than replace the subtle judgment and guidance provided by the clinician.

Applications and tools that provide clinical decision support are known as as Clinical Decision Support Systems (CDSS). A clinical decision support system is defined as a computer system or software application designed to assist clinicians, caregivers, or patients in healthcare and/or treatment decisions.

Notes

*   Typically a clinical decision support system responds to triggers, such as specific signs or symptoms, diagnoses, laboratory test results, medication selections, or complex combinations of such triggers. The system then provides information or recommendations relevant to the specific patient.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#history)

History


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It has been suggested that the origins of clinical decision support (CDS) can be traced back to the 1950s and 1960s. In an early example from 1961, Dr. Homer Warner, a cardiologist from the University of Utah developed a mathematical model which was used to diagnose heart disease. Since then, there have been countless developments and advancements in the area of decision support. Many theories have been proposed as to how CDS should be approached and applied in clinical practice.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#the-five-rights)

The Five Rights


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When implemented properly, CDS has the potential to enhance patient care, reduce errors and duplication of effort, and introduce efficiencies to the clinical workflow. Conversely, CDS tools can also be distracting and disruptive, even producing unwanted consequences. It is therefore important to consider the lessons learned from previous implementations of CDS and conduct thorough requirements analysis prior to designing or procuring a CDSS. One of the best practice frameworks that has been developed to guide those considering a CDS implementation is the "CDS Five Rights". "The Five Rights" suggests that to realize the full potential of CDS, solutions should:

*   **Supply the** _**right information**_ **(evidence-based guidance, address the clinical need)**
    
*   **To the** _**right people**_ **(entire care team, including the patient)**
    
*   **Using the** _**right channels**_ **(e.g., EHR, mobile devices, patient portals)**
    
*   **In the** _**right intervention formats**_ **(e.g., order sets, flow-sheets, dashboards, patient lists)**
    
*   **At the** _**right points in the workflow**_ **(for decision making or action)**
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#example)

Example


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A typical application of CDS is shown in the diagram below:

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-90c6fd3576bbe7d59d44880c51131d6377633212%252F123897420.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=7443f727&sv=2)

Example of simple application of CDS

The clinical setting in which this hypothetical tool has been applied is the prescribing of a medication. In this example, the patient has previously had an 91936005 | Allergy to penicillin| recorded. When prescribing a new drug, such as 27658006 | Amoxicillin|, an alert is displayed to remind the clinician of the previously diagnosed allergy. The application may also provide a mechanism to search for alternative medications. Note that the mechanics of this workflow uses a predefined rule which specifies a condition to be evaluated and an action to be taken if the condition evaluates to true.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#functional-areas)

Functional Areas


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This section addresses the functional scope of clinical decision support. CDS may be represented in a variety of formats or tools which depend on the clinical situation or environment. These tools are often referred to as CDS formats, types, or interventions and can be deployed to a wide variety of systems and platforms, such as mobile devices.

Within these functional areas, CDS can be further subdivided into tools which are prompted by the tasks a clinician performs such as patient charting or diagnosis, and functions that are triggered by external events such as the expiration of a period of time. Some of the more common CDS functions are described briefly in the table below. Use of these functions may be appropriate in a variety of clinical domains or use cases, some of which are discussed in the [Clinical Areas](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#clinical-areas)
 section.

CDS Function

Description

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897421%2Fimage2016-11-23%252015%253A7%253A43.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=a4f80250&sv=2)**Alerts or Reminders**

One of the more common types of decision support is computerized alerts (or reminders). These are triggered by rules and designed to interrupt clinicians or patients at the appropriate time. These alerts are also referred to as “best practice advisories” and can be implemented as pop-ups on a users screen or in monitoring tools such as a dashboard. Alerts can also be used to trigger other communication mechanisms such as paging or faxing. Examples of alerts include drug to drug interactions, or drug allergy warnings triggered when medications are prescribed.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897421%2Fimage2016-11-23%252015%253A16%253A3.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=9899f9d2&sv=2)**Clinical Guidelines and Reference Information**

These CDS functions are often implemented as links to external references which are published by third party, knowledge experts. Guidelines may be represented in a standardized format to facilitate interoperability - for example, the HL7 Infobutton. References can be based on relevant, context-dependent data captured in a patient health record or another electronic artifact such as an order or clinical document.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897421%2Fimage2016-11-23%252015%253A20%253A52.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=4d4bfd8f&sv=2)**Diagnostic Support Tools**

These tools use a combination of patient data, context-based suggestions and clinical knowledge links to aid the clinician in making a diagnosis. An example would be a tool that prompts a physician for additional findings and suggests additional tests or procedures to help differentiate the diagnosis.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897421%2Fimage2016-11-23%252015%253A8%253A56.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=f8889673&sv=2)**Automatically Triggered Smart Forms**

These documentation tools, which include reports and summaries, are aimed at high quality records, the reduction of errors, and more complete information. These tools can be triggered when a specific patient condition is detected or when a finding is deemed reportable to a jurisdictional health body. These can be represented as focused patient data reports or summaries and are often utilized at the point of care (POC) in real time.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897421%2Fimage2016-11-23%252015%253A27%253A8.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=96b63c1&sv=2)**Conditional Order Sets and Pathway Support**

These are typically designed for complex ordering scenarios. They may be comprised of a proposed set of orders or a treatment regimen which is based on an explicit situation or medical condition. These interventions can ensure compliance with established protocols. They can also be utilized to guide clinicians though complex care pathways.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#clinical-areas)

Clinical Areas


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The focus of this section is the clinical application of CDS tools or how the [functional components](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#functional-areas)
 described earlier can be used in practice. Stakeholders from various clinical domains interact with clinical systems, such as EHRs with CDSS and CPOE (computerized physician order entry). The table below lists some of the clinical areas in which SNOMED CT enabled CDSSs can assist clinicians in making well informed decisions.

Clinical Area

Description

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#id-1.3.clinicalareas)

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897431%2Fimage2016-12-1%25209%253A44%253A48.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=cbd25329&sv=2)

**Medication Management**

A clinician uses an EHR with CDS to prescribe 375374009 | Warfarin sodium 4mg tablet|. The CDSS queries the EHR and discovers that the patient is 77386006 | Pregnant|. The CDSS determines that the proposed drug has 372756006 | Warfarin| as an ingredient. As warfarin in contraindicated during pregnancy, the system triggers an alert to be displayed to the clinician. Relevant clinical guidelines are also displayed to the user. These guidelines suggest a safe alternate, such as 714788005 | Dabigatran|, which the clinician then safely prescribes to the patient.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897431%2Fimage2016-12-1%252010%253A0%253A17.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=ae63bb1f&sv=2)**Diagnosis** (e.g. Diabetes)

A clinician uses an EHR with CDS in a case analysis scenario to aid in diagnosis. The clinician records the patient’s age and gender, then prepares to enter specific clinical findings, history, symptoms, etc. As the physician records symptoms of 55350005 | Hunger| , 84229001 | Fatigue|, and 87715008 | Dry mouth|, a ranked list of common diseases, associated with these clinical findings, is dynamically presented to the clinician. At the top of this list is 73211009 | Diabetes mellitus|. A scale is used to indicate the level of support for each disease. The CDSS then prompts the clinician for additional findings to help differentiate between diseases. Once a confirmed diagnosis is made, the differential diagnoses can be marked as 2667000 | Absent|, 52101004 | Present|, or 261665006 | Unknown|. An additional finding of 17173007 | Always thirsty| is recorded and the level of support for each disease in the list is adjusted accordingly. Support for 73211009 | Diabetes mellitus| has now increased from minimal evidence to sufficient evidence. The clinician then selects 44054006 | Type 2 diabetes mellitus| which opens an evidence screen displaying the recorded findings which either strongly support, support, or do not support the chosen disease. The clinician is then presented with a link that displays all the PubMed articles associated with 44054006 | Type 2 diabetes mellitus|.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897431%2Fimage2016-12-1%25209%253A45%253A36.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=4b884509&sv=2)**Laboratory**

(e.g. Critical Results)

A patient presented at Emergency complaining of 29857009 | Chest pain| and was subsequently admitted to the hospital. The attending physician ordered a series of lab tests including a 271236005 | Serum potassium measurement|. Laboratory tests are completed and published to the laboratory information system (LIS). The CDSS then queries the LIS and learns that the 365760004 | Potassium level| is 166690008 | Low serum potassium level| and considered critical. The CDSS then queries the EHR to confirm the patient has been prescribed 350608001 | Oral form digoxin|, which has 387461009 | Digoxin| as an active ingredient. A knowledge base rule has been defined which stipulates, if the drug prescribed contains 387461009 | Digoxin| and the laboratory test indicates a 166690008 | Low serum potassium level|, then inform the user. An alert, in the form of an urgent pager message, is generated and sent to the attending physician.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897431%2Fimage2016-12-1%25209%253A59%253A11.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=c84f1911&sv=2)**Radiology**

(e.g. Contraindication)

An ordering physician has requested a 1343710007 |Plain X-ray series of upper gastrointestinal tract with barium contrast|, which uses 25419009 | Barium sulfate| materials. The patient presents at the imaging clinic on the day of their exam. During study protocoling, the imaging department uses the CDSS to query the patient record and determine the patient has a 161524000 | History of hay fever|. An alert is triggered to advise the imaging technician about the risk of an allergic reaction. The imaging department, in consultation with the GI radiologist, calls the ordering doctor to discuss the associated risks. Additional guidelines related to preparing for reactions and symptom management ( 247472004 | Hives|, 418290006 | Itching|, 65124004 | Swelling|, etc.) are provided via the CDSS. An additional medication is administered prior to the contrast material to reduce the risk of an allergic reaction. The imaging department proceeds with the planned procedure.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897431%2Fimage2016-12-1%25209%253A51%253A50.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=6b1b5d28&sv=2)**Radiology**

(e.g. Appropriate Imaging)

A clinician records notes into the appropriate fields of an EHR. For example, Clinical notes: “Pt is 75 yo. LBP (lower back pain) for the past 2 weeks. On exam normal SLR (straight leg raise)…” Using NLP, these notes are encoded as part of the record storage process. (For example, as 279039007 | Low back pain| and 298686006 |Straight leg raising normal|.) The clinician orders a series of imaging tests. The CDSS, based on specific quality metrics (e.g., [appropriate use criteriaarrow-up-right](https://en.wikipedia.org/wiki/Appropriate_Use_Criteria)
 or AUC), evaluates whether or not imaging guidelines are being followed by analyzing the patient's health record together with the proposed tests. If the guidelines were not followed, the CDSS will display an alert informing the clinician that they may want to consider alternative imaging or additional tests. For example, an alert may indicate: “The patient has 279039007 | Low back pain| and 309537005 | Numbness of lower limb|. A 394451000119106 | MRI of lumbar spine without contrast| for this case has an appropriateness rating of 8 (scale of 10) and is recommended.”

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897431%2Fimage2016-12-1%25209%253A43%253A31.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=e58a96f4&sv=2)**Emergency Department**

(e.g. Order sets)

A patient has presented at the Emergency Room (ER) complaining of 267036007 | Shortness of breath| . The attending physician records the appropriate clinical finding codes in the EHR. She then prepares a condition-specific order set in a Computerized Physician Order Entry (CPOE) system. The selection of the order set triggers the presentation of new clinical guidelines based on an analysis of the patient record with the proposed treatment. The physician then choses alternative treatment. Suggested dosage guidance is provided by relevant contextual links within the order set.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897431%2Fimage2016-12-1%25209%253A44%253A17.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=216391d&sv=2)**Infectious Disease Reporting**

A primary care physician logs on to their EHR with CDS and opens a patient chart to record a condition deemed communicable, such as 36989005 | Mumps| or 14189004 | Measles|. The CDSS then triggers an alert to advise the provider that this condition is considered reportable to the jurisdictional public health office. The CDSS then provides a pre-populated smart form which facilitates quick, consistent, and accurate reporting of the condition to the local officer of medical health. The smart form is completed and submitted to the jurisdictional health office. The clinical findings in the report are terminology-encoded which promotes interoperability and facilitates population based health reporting.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897431%2Fimage2016-12-1%25209%253A50%253A20.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=4098222e&sv=2)**Clinical Treatment Audit**

A department head uses an EHR with CDS to conduct a treatment analysis. She uses the system to generate a list of all inpatients with a confirmed diagnosis of 128053003 | Deep venous thrombosis|. She then uses the system to determine which of these patients have received 103746007 | Heparin therapy| for at least 72 hours. The patients which have not met this criteria are flagged for appropriate treatment.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897431%2Fimage2016-12-1%25209%253A50%253A56.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=99472011&sv=2)**Acute Asthma Management**

Staff in an Emergency Department (ED) use their EHR with CDS and clinical management pathways to provide a standardized evidence-based approach to patient assessment of 281239006 |Acute asthma| in adults. The guidelines help document indications and contraindications to determine eligibility. A triage nurse queries the EHR and learns that the patient is over 16 years of age, has an 281239006 |Acute asthma|, and one or more episodes of 56018004 | Wheezing| which necessitated 1366004 | Breathing treatment|. The CDSS then triggers an alert to follow the pathway’s medical directives, which are carried out by a Respiratory Therapist (RT). The directives, in this case of 370218001 | Mild asthma|, include 47101004 | Heart rate monitoring|, establishing various baseline 251880004 | Respiratory measurements|, and administration of a 372580007 | Bronchodilator| and 374072009 | Prednisone 50mg tablet| . The RT then notifies the attending physician who fills out and signs discharge instructions which a nurse then reviews with the patient. The desired clinical outcomes of this pathway include improved adherence to evidence-based management and improved patient outcomes such as reduced number of hospitalizations and lower ED return rates.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fthumbnails%2F123897431%2Fimage2016-12-1%25209%253A49%253A33.png%3Fversion%3D1%26modificationDate%3D1615403803000%26api%3Dv2&width=300&dpr=3&quality=100&sign=4b60074c&sv=2)**Nursing Interventions**

Research has provided evidence to show that patients receiving 40617009 | Mechanical ventilation| are at high risk for |Pneumonia| : |due to| = |Aspiration|. Published guidelines recommend 423171007 | Elevation of head of bed| from 30° to 45°, if not contraindicated, to reduce risk of 233604007 | Pneumonia|. A nursing supervisor uses a dashboard-like tool in an ICU to monitor patients in her ward. Patients who meet the criteria for risk of 422588002 | Aspiration pneumonia| are automatically flagged in the system using CDS logic so that the appropriate action may be initiated by nursing staff in the ward. Once the angle of the patient's bed is adjusted, the system is dynamically updated and the flag is removed.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#snomed-ct-features)

SNOMED CT Features


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This section contains a brief summary of key SNOMED CT features and explains how they may be useful in CDSSs.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#concepts)

Concepts

SNOMED CT concepts are used to represent clinical meanings. Every concept in SNOMED CT is uniquely identified by a distinct SNOMED CT Concept Identifier. For example, **195967001** is the concept identifier for the concept 195967001 | Asthma| .

SNOMED CT concepts play an important role in CDS by enabling actions to be triggered based on the meaning of data recorded in the patient records.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#descriptions)

Descriptions

SNOMED CT descriptions provide the human-readable terms associated with SNOMED CT concepts. A concept may have one or more descriptions, which act as synonyms for the same clinical meaning. This is also how SNOMED CT supports different dialects and languages.

SNOMED CT descriptions allow common CDS rules to be consistently applied across patient records recorded using different synonyms, dialects and languages.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#relationships)

Relationships

SNOMED CT relationships link concepts together to formally define the meaning of each concept. For example, one type of relationship is the 116680003 | is a| relationship which relates a concept to a parent or supertype. These 116680003 | is a| relationships define the subtype hierarchy of SNOMED CT concepts.

For example, the concepts 53084003 | Bacterial pneumonia| and 75570004 | Viral pneumonia| both have an 116680003 | is a| relationship to 233604007 |Pneumonia| which has an 116680003 | is a| relationship to the more general concept 128601007 |Infectious disease of lung|. Subtype relationships can be used by CDS rules to refer to codes in an EHR that are any specific type of a relevant clinical concept.

Additional attribute relationships help to define the meaning of a concept. For example, the concept 75570004 | Viral pneumonia| has a 246075003 | Causative agent| relationship to the concept 49872002 | Virus| and a 363698007 | Finding site| relationship to the concept 113255004 |Structure of parenchyma of lung|.

Attribute relationships can be used by CDS rules to refer to codes recorded in an EHR that have a specific meaningful relationship with a concept of interest.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#concept-model)

Concept Model

The SNOMED CT concept model is a set of rules that govern the ways in which SNOMED CT concepts are permitted to be modeled using relationships to other concepts. It defines the types of relationships that may be used on each type of concepts, and the permitted values for each relationship type. The [Machine Readable Concept Model (MRCM)](https://docs.snomed.org/snomed-ct-specifications/snomed-ct-machine-readable-concept-model/)
 represents the rules in the SNOMED CT concept model in a form that can be read by a computer and applied to test that concept definitions and expressions comply with these rules.

The SNOMED CT concept model plays an important role in CDS by providing the rules by which the clinical meaning of SNOMED CT encoded health records can be queried. The MRCM makes it possible to process these rules in a machine-processable way.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#expressions)

Expressions

SNOMED CT provides a mechanism which enables clinical phrases to be represented by a computable expression, when a single concept does not capture the necessary level of detail. For example, the following expression represents a right hip:

SNOMED CT expressions enable additional clinical meanings to be captured in a health record, without requiring the terminology to include countless combinations and permutations of precoordinated concepts.

SNOMED CT expressions facilitate CDS over an expanded set of clinical meanings that extends beyond individual concepts. For more information about expressions, please refer to the [SNOMED CT Compositional Grammar - Specification and Guide](https://docs.snomed.org/snomed-ct-specifications/snomed-ct-compositional-grammar-specification/)
.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#reference-sets)

Reference Sets

SNOMED CT reference sets are a flexible and standardized approach used to support a variety of requirements for the customization and enhancement of SNOMED CT. These include the representation of subsets, language preferences for use of particular terms, mapping from or to other code systems, and ordered lists.

Reference sets may be used in the following aspects of CDS:

*   Representing subsets of SNOMED CT concepts that may trigger a CDS action
    
*   Representing non-standard aggregations of concepts for specific CDS use cases
    
*   Defining language or dialect specific sets of descriptions over which term searches can be performed
    

For more information about reference sets, please refer to the [SNOMED CT Reference Set Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/)
.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#description-logic-features)

Description Logic Features

Description Logic (DL) is a family of formal knowledge representation languages and used as the formal foundation of meaning in SNOMED CT. The way that concepts have been modeled in SNOMED CT permits them to be represented using Description Logic. DL helps computers to make useful inferences about concepts, and to classify SNOMED CT using a DL reasoner. Description Logic also helps by testing expressions for subsumption and equivalence.

The logical inferences supported by DL can be useful when executing CDS rules. For example, when a CDS rule requires an action to be performed when the patient has any type of 195967001 | Asthma| , a DL reasoner may be used to determine that 281239006 |Acute asthma| and 427603009 | Intermittent asthma| are both types of 195967001 | Asthma| and should therefore both trigger the action to be performed.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#abbreviations)

Abbreviations


--------------------------------------------------------------------------------------------------------------------------------------------------------------------

The following table contains the definition of abbreviations used in this document. Please refer to the [SNOMED Glossary](https://docs.snomed.org/snomed-international-documents/snomed-ct-glossary/)
 for additional definitions.

Abbreviation

Full term linked to the SNOMED Glossary definition

CDS

**Clinical decision support**, which is defined as a service that assists clinicians, caregivers, or patients in healthcare and/or treatment decisions.

Notes

*   A **clinical decision support system** is a computer system or software application designed to assist clinicians, caregivers, or patients in healthcare and/or treatment decisions.
    

CDSS

**Clinical decision support system**, which is defined as a computer system or software application designed to assist clinicians, caregivers, or patients in healthcare and/or treatment decisions.

Notes

*   Typically a clinical decision support system responds to triggers, such as specific signs or symptoms, diagnoses, laboratory test results, medication selections, or complex combinations of such triggers. The system then provides information or recommendations relevant to the specific patient.
    

EHR

**Electronic health record**, which is defined as a systematic collection of health information about individual patients or populations that is stored in digital form.

KB

**Knowledge base**, which is defined as the underlying set of facts, assumptions, and rules which a computer system has available to answer a question or solve a problem.

UI

**User interface**, which is defined as the way in which a software application presents itself to a user.

NLP

**Natural language processing**, which is defined as a service in which a computer system converts human-readable text and/or spoken language to formal representations of information.

POC

**Point of care**, which is defined as the time and location at which healthcare professionals deliver healthcare products and services to patients.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=CDS+Guide&entry.670899847=Overview)

[PreviousIntroductionchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction)
[NextLogical Architecturechevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture)

Last updated 4 months ago

*   [What is Clinical Decision Support?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#what-is-clinical-decision-support)
    
*   [History](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#history)
    
*   [The Five Rights](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#the-five-rights)
    
*   [Example](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#example)
    
*   [Functional Areas](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#functional-areas)
    
*   [Clinical Areas](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#clinical-areas)
    
*   [SNOMED CT Features](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#snomed-ct-features)
    
*   [Concepts](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#concepts)
    
*   [Descriptions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#descriptions)
    
*   [Relationships](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#relationships)
    
*   [Concept Model](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#concept-model)
    
*   [Expressions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#expressions)
    
*   [Reference Sets](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#reference-sets)
    
*   [Description Logic Features](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#description-logic-features)
    
*   [Abbreviations](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/1-introduction/1.1-overview#abbreviations)
    

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    182201002 |Hip joint|:
    272741003 |Laterality| = 4028007 |Right|
    

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# Distinguish Identical Terms of Different Concepts | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

A search for a term (e.g. "fundus") may return multiple identical matches. Fully specified name Descriptions are always unique at a specific release. However, the preferred terms or synonyms may not always be unique, as illustrated in the image below.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-7222c46d6c06d49efc9440515179570c3cecdbe5%252F52170513.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=5e186035&sv=2)

Hovering over identical terms of different Concepts

Identical terms of different Concepts can be distinguished by displaying the search results under different headings according to which supertype ancestors they belong to. This technique is particularly useful for searching large unconstrained subsets that belong to more than one supertype ancestors.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-5953ef78a168152f5e27666b800922f28d1f6fd9%252F52170511.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=88362c0f&sv=2)

Categorizing search results under subtype hierarchies

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Last updated 7 months ago

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# Translations and Language Preferences | Practical Guides | SNOMED International Documents

This section provides an overview of:

*   Requirements for translations and language preferences
    
*   Translation approaches
    
*   How SNOMED CT represents translations
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/11-translations-and-language-preferences#why-is-this-important)

Why is this important?


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The basic objective of any SNOMED CT translation is to provide accurate and unambiguous descriptions of SNOMED CT concepts in the target language.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/11-translations-and-language-preferences#what-is-this)

What is this?


--------------------------------------------------------------------------------------------------------------------------------------------------------------

SNOMED CT is a multinational, multilingual terminology. It has a built-in framework to manage different languages and dialects. Today, SNOMED CT is available in several languages, including US English, UK English, Spanish, Danish and Swedish, and more translations are continuously being done by member countries.

The goal of any SNOMED CT translation is to provide accurate representations of SNOMED CT concepts in a way that is understandable, usable, and safe. Translations must be concept-based, as term-to-term translations may yield literal expressions that are often meaningless. Instead, the translator analyses each concept based on the position within the hierarchy, the descriptions, and relationships to other concepts before deciding on the most meaningful translation of a concept. SNOMED International provides guidelines to support countries undertaking translations.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/11-translations-and-language-preferences#translation-approaches)

Translation Approaches

SNOMED CT translation is an interdisciplinary collaboration which requires careful attention to content, structure and clinical relevance. These factors are of foremost importance in order to ensure the usability of the terminology in connection with implementation in electronic health record systems. Both linguistic and semantic quality must be assured.

The core SNOMED CT structure and content continue to evolve. These facts call for vigilance on the part of the translation team members who need to review and analyses the relationships of each concept in order to elucidate the meaning of a term within the terminological context. Looking at the preferred term in English is not sufficient to enable accurate concept-based translation.

Close collaboration between specialists in health informatics, linguistics and terminology is essential for the translation process. A translation based solely on linguistic, morphological-syntactical analysis might result in a seemingly correct term which may not adequately represent the concept in question, nor be used by healthcare professionals. On the other hand, compliance with linguistic, systematic, and orthographic principles is necessary in order to avoid confusion and ensure the practical applicability of the terminology.

It is crucial that those involved in the translation, verification, validation, and approval processes are familiar with the terminological principles on which SNOMED CT is based. It is equally important that they comply with SNOMED International Editorial Guide and that they are conscious of issues such as the choice of lexical variant, term requirements, translation techniques, and the importance of ensuring linguistic consistency.

Additionally, it is important that those involved in the translation process are aware that sometimes, their inability to understand a given term or concept may be caused not by their own lack on insight, but actually an ambiguity in the core terminology (international release) that needs to be corrected. SNOMED CT undergoes constant improvement, corrections are made, and ambiguities are addressed. To ensure this constant enhancement of SNOMED CT, any translation team should register questions, comments or suggestions and forward these to SNOMED International in order to avoid spending extra time on unsolvable issues and at the same time contribute to improvement of the terminology. Currently, questions and remarks from the translation teams are dealt with by the SNOMED International request submission process.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/11-translations-and-language-preferences#how-snomed-ct-represents-translations)

How SNOMED CT Represents Translations

From a practical perspective, the deliverables from SNOMED CT translation include:

*   **Descriptions** – each of which contains a term in the target language which accurately reflects the meaning of the concept with which it is associated.
    
*   **A Language Reference Set** – containing references to each of the descriptions and an indication of whether it is preferred or acceptable for use in the particular language or dialect.
    

This approach allows the same descriptions to be used in other local variants of the language. In this case another Language Reference Set is provided indicating which descriptions contain the preferred and acceptable terms. Descriptions not referenced by a Language Reference Set are not used in that language or dialect.

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*   [Why is this important?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/11-translations-and-language-preferences#why-is-this-important)
    
*   [What is this?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/11-translations-and-language-preferences#what-is-this)
    
*   [Translation Approaches](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/11-translations-and-language-preferences#translation-approaches)
    
*   [How SNOMED CT Represents Translations](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/11-translations-and-language-preferences#how-snomed-ct-represents-translations)
    

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# Introduction | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#purpose-of-this-guide)

Purpose of This Guide


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This guide provides advice on two related activities that are essential for use of any code system: finding a term and saving the term and related code into the record. The first part of this guide is concerned with searching the content of SNOMED CT to find concepts that represent particular clinical ideas. The second part of the guide is concerned with ways to use SNOMED CT to support entry of relevant clinical information in electronic health records.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#who-should-read-this-guide)

Who Should Read This Guide


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This guide should be read by anyone involved in search and data entry. These people fall into two broad categories:

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#end-users-of-applications-that-support-snomed-ct-enabled-search-and-data-entry)

End users of applications that support SNOMED CT-enabled search and data entry

_These people need:_

*   To be aware of the importance of search features that facilitate efficient and accurate SNOMED CT clinical data entry.
    
*   To understand their own data entry requirements in order to select and use configurable search features that meet their needs.
    

_This guide provides:_

*   A high-level description of the importance of different search and data entry features
    
*   Examples of each of the features described.
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#those-designing-developing-procuring-or-evaluating-services-that-include-support-for-snomed-ct-enabl)

Those designing, developing, procuring or evaluating services that include support for SNOMED CT-enabled search and data entry

_These people need:_

*   To understand the range of search features likely to be important for their users.
    
*   To be able to develop and deploy search and data entry techniques that provide their users with effective ways to use SNOMED CT as part of the process of clinical record keeping.
    

_This guide provides:_

*   Descriptions of search and data entry features which enable successful implementation.
    
*   Summaries of tried and tested techniques for delivering many of these features.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#what-is-special-about-searching-snomed-ct)

What Is Special About Searching SNOMED CT?


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At face value it may seem unusual to have a specific guide for searching one terminology. General purpose search routines may seem to be applicable to any list of terms and, by comparison with internet searches, even a terminology with over a million terms does not seem too challenging. However, there are aspects of SNOMED CT that, while presenting challenges to simple searches, also enable enhancements that can deliver highly effective search optimization.

The size, design and broad scope of SNOMED CT present challenges to simple searches:

*   A large terminology related to healthcare is sure to have lots of terms containing similar words (e.g. 'hip' is in more than 1,200 terms).
    
    *   What order should these matches be shown in?
        
    
*   If two or more words or parts of words are typed what should result be
    
    *   Which should of these sets should be shown?
        
    
*   The same clinical idea can be expressed in different ways
    
    *   How can it be made easy to find an idea expressed in a different way
        
    

The logical design of SNOMED CT allows capture of meaningful clinical information and can also be used to support effective search and data entry strategies. If you see SNOMED CT as simply a long list of terms, then you are probably searching the terminology with a general purpose search tool that has overlooked the opportunities for search refinements offered by the design of the terminology.

This guide presents practical ways to make terminology searches which lead to accurate and complete clinical noting. While searches need to be fast, response times of a second or two may be acceptable if the displayed results are more relevant. A well-designed search solution should minimize the overall time to take to record clinical information. This guide does not suggest a single approach but identifies ways to address different requirements with appropriate solutions.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#search-configuration)

Search Configuration


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Many of the search techniques described in this guide can be applied to a range of different requirements. However, some search techniques require a degree of configuration to meet the needs of particular users and particular types of data collection.

Various levels of configuration should be considered including:

*   Default configurations for an organization or group of users. For example, specifying the SNOMED CT version, exclusion of inactive concepts and inclusion of various extensions and supporting derivatives;
    
*   Settings bound to data input fields that make it easy to enter commonly used values and prevent entry of inappropriate values. For example, limiting entries to a particular subset of SNOMED CT content and prioritizing some members of that set.
    
*   User configuration that enables modification while using a front-end application to refine searches. For example, setting the search mode to include complete, partial or pattern based phrase matches or to limit searches to a particular hierarchy.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#about-search-and-data-entry)

About Search and Data Entry


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Search and data entry are closely related and as illustrated the image below; can be regarded as two steps in a single process. A clinical user needs to record a clinical idea (e.g. a sign, symptom, diagnosis or procedure). The user searches for the relevant Concept, views the results, finds the appropriate Concept, selects it for data entry and the data is stored.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-c6ead98f1e0638e8e7fa5e904559df4f3fa1e01e%252F52170451.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=cd9850df&sv=2)

A search and data entry process

Although there is often a close relationship between search and data entry, the two processes also need to be considered separately. This guide has therefore been categorized into two parts: the Search part and the Data Entry part.

SNOMED CT searches are also required for purposes which are not directly connected to data entry including:

*   Reviewing terminology content;
    
*   Creating Reference Sets (e.g. to represent subsets of terms and Concepts);
    
*   Creating templates and protocols for data entry;
    
*   Creating queries to retrieve data;
    
*   Learning about the structure of the terminology;
    

Please refer to the section "Use cases for searches" for further information.

Users may enter data including SNOMED CT terms using techniques that do not involve consciously searching. These include:

*   Structured data entry screens with option controls linked to an appropriate SNOMED CT Concepts which are recorded based on the options selected.
    
*   Natural language processing (NLP) including tagging of particular phrases with particular Concept identifiers. Please note that NLP techniques are out of scope of this guide.
    

For further information about structured data entry techniques, please refer to the "[Data Entry](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/6-data-entry)
" section.

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*   [Purpose of This Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#purpose-of-this-guide)
    
*   [Who Should Read This Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#who-should-read-this-guide)
    
*   [End users of applications that support SNOMED CT-enabled search and data entry](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#end-users-of-applications-that-support-snomed-ct-enabled-search-and-data-entry)
    
*   [Those designing, developing, procuring or evaluating services that include support for SNOMED CT-enabled search and data entry](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#those-designing-developing-procuring-or-evaluating-services-that-include-support-for-snomed-ct-enabl)
    
*   [What Is Special About Searching SNOMED CT?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#what-is-special-about-searching-snomed-ct)
    
*   [Search Configuration](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#search-configuration)
    
*   [About Search and Data Entry](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction#about-search-and-data-entry)
    

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# SNOMED CT Concept Model | Practical Guides | SNOMED International Documents

This section provides an overview of:

*   Concept Model – Top Level Hierarchies
    
*   Concept Model Attributes – Representing Characteristics of a Concept
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#why-is-this-important)

Why is this important?


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The SNOMED CT concept model specifies the way in which SNOMED CT concepts are defined using a combination of formal logic and editorial rules. Concept model rules specify the top level concepts under which concepts are arranged in the subtype hierarchy and the types of relationships that are permitted between concepts in particular branches of the hierarchy.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#what-is-this)

What is this?


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### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#concept-model-top-level-hierarchies)

Concept Model – Top Level Hierarchies

The top of the SNOMED CT hierarchy is occupied by the root concept (|SNOMED CT concept|). All concepts are descended from this root concept through at least one sequence of |is a| relationships. This means that the root concept is a supertype of all other concepts and all other concepts are subtypes of the root concept.

The direct subtypes of the root concept are referred to as 'Top Level Concepts'. These concepts are used to name the main branches of the hierarchy. Each of these Top Level Concepts, together with their many subtype descendants, forms a major branch of the SNOMED CT hierarchy and contains similar types of concepts. As the hierarchies descend (that is, more |is a| relationships are added below the Top Level Concepts) the concepts within them become increasingly specific.

Below is a list of the Top Level Concepts with a brief description of the content represented in their branch of the hierarchy.

*   |**Clinical finding**| represents the result of a clinical observation, assessment or judgment and includes normal and abnormal clinical states (e.g. |asthma|, |headache|, |normal breath sounds|). The |clinical finding| hierarchy includes concepts used to represent diagnoses.
    
*   |**Procedure**| represents activities performed in the provision of health care. This includes not only invasive procedures but also administration of medicines, imaging, education, therapies and administrative procedures (e.g. |appendectomy|, |physiotherapy|, |injection into subcutaneous tissue|).
    
*   |**Situation with explicit context**| represents concepts in which the clinical context is specified as part of the definition of the concept itself. These include presence or absence of a condition, whether a clinical finding is current, in the past or relates to someone other than the subject of the record (e.g. |endoscopy arranged|, |past history of myocardial infarction|, |family history of glaucoma|).
    
*   |**Observable entity**| represents a question or assessment which can produce an answer or result (e.g. |systolic blood pressure|, |color of iris|, |gender|).
    
*   |**Body structure**| represents normal and abnormal anatomical structures (e.g. |mitral valve structure|, |adenosarcoma|).
    
*   |**Organism**| represents organisms of significance in human medicine (e.g. |streptococcus pyogenes|, |domain Bacteria|, |glossina|).
    
*   |**Substance**| represents general substances, the chemical constituents of pharmaceutical/biological products, body substances, dietary substances and diagnostic substances (e.g. |methane|, |insulin|, |albumin|).
    
*   |**Pharmaceutical**/**biologic product**| represents drug products (e.g. |amoxicillin 250mg oral capsule|, |product containing codeine and paracetamol|).
    
*   |**Specimen**| represents entities that are obtained (usually from the patient) for examination or analysis (e.g. |urine specimen|, |specimen from prostate obtained by needle biopsy|).
    
*   |**Special concept**| represents concepts that do not play a part in the formal logic of the concept model of the terminology, but which may be useful for specific use cases (e.g. |navigational concept|, |alternative medicine poisoning|).
    
*   |**Physical object**| represents natural and man-made physical objects (e.g. |vena cava filter|, |implant device|, |automobile|).
    
*   |**Physical force**| represents physical forces that can play a role as mechanisms of injury (e.g. |friction|, |radiation|, |alternating current|).
    
*   |**Event**| represents occurrences excluding procedures and interventions (e.g. |flood|, |earthquake|).
    
*   |**Environments and geographical locations**| represents types of environments as well as named locations such as countries, states and regions (e.g. |intensive care unit|, |academic medical center|, |Denmark|).
    
*   |**Social context**| represents social conditions and circumstances significant to health care (e.g. |occupation|, |spiritual or religious belief|).
    
*   |**Staging and scales**| represents assessment scales and tumor staging systems (e.g. |Glasgow Coma Scale|, |FIGO staging system of gynecological malignancy|).
    
*   |**Qualifier value**| represents the values for some SNOMED CT attributes, where those values are not subtypes of other top level concepts. (e.g. |left|, |abnormal result|, |severe|).
    
*   |**Record artifact**| represents content created for the purpose of providing other people with information about record events or states of affairs. (e.g. |patient held record|, |record entry|, |family history section|).
    
*   |**SNOMED CT Model Component**| contains technical metadata supporting the SNOMED CT release.
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#concept-model-attributes-representing-characteristics-of-a-concept)

Concept Model Attributes – Representing Characteristics of a Concept

SNOMED CT attributes (or relationship types) are used to represent a characteristic of the meaning of a concept. SNOMED CT currently uses more than one hundred defining attributes when defining the meaning of concepts. Each SNOMED CT attribute can be applied to concepts in one or more branches of the hierarchy. The set of concepts to which an attribute can be applied is called the 'domain' of the attribute. The permitted set of values for each attribute is called the 'range' of the attribute.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#domain)

_**Domain**_

The _domain_ is the hierarchy to which a specific attribute can be applied.

For example:

The domain of the attribute |associated morphology| is the |clinical finding| hierarchy. Therefore, a |procedure| cannot have an |associated morphology|. However, a |procedure| can have a |procedure morphology|.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#range)

_**Range**_

The _range_ is the set of SNOMED CT concepts or concrete values that are allowed as the value of a specified attribute.

For example:

The range for the attribute |associated morphology| is the concept |morphologically abnormal structure| and its subtype descendants. The range for the attribute |finding site| is |anatomical or acquired body structure| and its subtype descendants in the |body structure| hierarchy.

_Examples of the domain and range specified for the attributes_ _|__finding site__|_ _and_ _|__laterality__|_

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F19067948-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FUmSUeu96fIQZWDm7RISx%252Fuploads%252Fgit-blob-3ecaa9a0662b4dcbc6b863c5d074017f6ab9e236%252F29952962.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=4648c058&sv=2)

Some SNOMED CT attributes (or relationship types) have a hierarchical relationship to one another. The hierarchy formed from such relationships is known as an 'attribute hierarchy'. In an attribute hierarchy, one general attribute is the parent of one or more specific subtypes of that attribute. Subtypes of a concept defined using the more general attribute can be defined using a more specific subtype of that attribute. For example, |after|, |causative agent| and |due to| are subtypes of |associated with|, because they have a more specific meaning.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#concept-model-and-editorial-guidance)

Concept Model and Editorial Guidance

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#editorial-guide)

Editorial Guide

SNOMED CT is an evolving terminology, which means that the attributes used to define concepts in specific hierarchies may change over time. Additionally, editorial principles, that are specified to ensure consistent representation of the same type of concepts may also change. When authoring SNOMED CT content, it is therefore important to always refer to the current SNOMED CT Editorial Guide. The Editorial Guide specifies the attributes that are valid to use within each hierarchy and the valid values that can be assigned to each attribute. It also presents general editorial rules for SNOMED CT content, along with specific guidance on authoring concepts within each hierarchy.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#machine-readable-concept-model)

Machine Readable Concept Model

The Machine Readable Concept Model (MRCM) represents rules in the SNOMED CT concept model in a form that can be read by a computer and applied to test that concept definitions and expressions comply with the rules. The MRCM may be used for a variety of purposes, including the authoring and validation of SNOMED CT concepts, expressions, expression constraints and queries, Natural Language Processing and terminology binding to support semantic interoperability. For further information, please visit the guide on the Machine Readable Concept Model or visit the MRCM Browser.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#attributes-used-to-define-snomed-ct-concepts)

Attributes Used to Define SNOMED CT Concepts

The SNOMED CT defining attributes are used to represent the meaning of concepts in many hierarchies, for example:

*   Clinical finding concepts
    
*   Procedure concepts
    

For further information, please refer to the SNOMED CT Editorial Guide.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#attributes-used-to-define-clinical-finding-concepts)

Attributes Used to Define Clinical Finding Concepts

Below is a list of some of the attributes used to define |clinical finding| concepts, and a brief description of their meaning:

|**Finding site**| specifies the body site affected by a condition.

|**Associated morphology**| specifies the morphologic changes seen at the tissue or cellular level that are characteristic features of a disease.

|**Associated with**| represents a clinically relevant association between concepts without either asserting or excluding a causal or sequential relationship between the two.

|**After**| represents a sequence of events where a clinical finding occurs after another |clinical finding| or |procedure| or |event|.

|**Due to**| relates a |clinical finding| directly to a cause such as another |clinical finding| or a |procedure|.

|**Causative agent**| identifies the direct causative agent of a disease such as an |organism|, |substance| or |physical force|. (Note: This attribute is not used for vectors, such as mosquitos transmitting malaria).

|**Severity**| used to sub-class a |clinical finding| concept according to its relative severity.

|**Clinical course**| represents both the onset and course of a disease.

|**Episodicity**| represents episodes of care provided by a physician or other care provider, such as a general practitioner. This attribute is not used to represent episodes of disease experienced by the patient.

|**Interprets**| refers to the entity being evaluated or interpreted, when an evaluation, interpretation or judgment is intrinsic to the meaning of a concept.

|**Has interpretation**| when grouped with the attribute |interprets|, designates the judgment aspect being evaluated or interpreted for a concept. (e.g. presence, absence etc.)

|**Pathological process**| provides information about the underlying pathological process of a disorder, i.e. it describes the process that results in the structural or morphologic change.

|**Occurrence**| refers to a specific period of life during which a condition first presents.

|**Finding method**| specifies the means by which a clinical finding was determined. This attribute is frequently used in conjunction with |finding informer|.

|**Finding informer**| specifies the person (by role) or other entity (e.g. a monitoring device) from which the clinical finding information was obtained. This attribute is frequently used in conjunction with |finding method|.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#attributes-used-to-define-procedure-concepts)

Attributes Used to Define Procedure Concepts

Below is a list of some of the attributes used to define |procedure| concepts, and a brief description of their meaning:

|**Procedure site**| describes the body site acted on or affected by a procedure.

|**Procedure morphology**| specifies the morphology or abnormal structure involved in a procedure.

|**Method**| represents the action being performed to accomplish the procedure. It does not include the surgical approach, equipment or physical forces.

|**Procedure device**| describes the devices associated with a procedure.

|**Access**| describes the route used to access the site of the procedure.

|**Direct substance**| describes the |substance| or |pharmaceutical / biologic product| on which the procedure's method directly acts.

|**Occurrence**| refers to a specific period of life during which a procedure is undertaken.

|**Priority**| refers to the priority assigned to a procedure.

|**Has focus**| specifies the |clinical finding| or |procedure| which is the focus of a procedure.

|**Has intent**| specifies the intent of a procedure.

|**Recipient category**| specifies the type of individual or group upon which the action of the procedure is performed.

|**Revision status**| specifies whether a procedure is primary or a revision.

|**Using substance**| describes the substance used to execute the action of a procedure, but it is not the substance on which the procedure's method directly acts.

|**Using energy**| describes the energy used to execute an action.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#all-attributes-values-used-to-define-snomed-ct-concepts)

All Attributes Values Used to Define SNOMED CT Concepts

For attribute values or range, please consult the Editorial Guide (refer to section on [Domain Specific Modelingarrow-up-right](https://docs.snomed.org/snomed-ct-specifications/snomed-ct-editorial-guide/readme/authoring/domain-specific-modeling)
, then the appropriate Attributes Summary) or the [MRCM Browserarrow-up-right](https://browser.ihtsdotools.org/mrcm)
.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Starter+Guide&entry.670899847=SNOMED%20CT%20Concept%20Model)

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Last updated 3 months ago

*   [Why is this important?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#why-is-this-important)
    
*   [What is this?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#what-is-this)
    
*   [Concept Model – Top Level Hierarchies](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#concept-model-top-level-hierarchies)
    
*   [Concept Model Attributes – Representing Characteristics of a Concept](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#concept-model-attributes-representing-characteristics-of-a-concept)
    
*   [Concept Model and Editorial Guidance](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#concept-model-and-editorial-guidance)
    
*   [Attributes Used to Define SNOMED CT Concepts](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model#attributes-used-to-define-snomed-ct-concepts)
    

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# Optimizing Searches | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

Today, a variety of general purpose text search tools and software libraries are in everyday use. Many of these general techniques can be applied to SNOMED CT though this does not automatically mean that they should be or that they are sufficient. Optimal indexing of SNOMED CT Descriptions may require a customized indexing solution. There are several widely available SNOMED CT browsers and related search tools, some of which use general purpose search techniques, and others which use some of the specific features discussed in this section. However, SNOMED CT searches often result in a very long list of terms, complete with additional information which must be assessed to fully understand the difference between terms in the search results. For example, searching for "diabetes" in most browsers returns a long list of lexical matches from multiple sub-type hierarchies. Choosing the appropriate term from this list can be a challenge if the terminological context is not apparent from the list.

Effective implementation of SNOMED CT depends on the speed and simplicity with which users can locate the terms and Concepts that they wish to use. A busy clinical user may become frustrated if the content they need cannot be quickly located when they search using familiar words or phrases. For this reason an efficient search strategy should address the many of the following key issues:

*   Search should not be too sensitive to word order or exact phrasing:
    
    *   Search should be insensitive to word - order variants:
        
        *   For example, "head pain" for | pain in head |
            
        
    *   Allow use of acronyms or abbreviations for frequently used terms:
        
        *   For example, "MI" for "myocardial infarction" or "mitral incompetence".
            
        
    
*   Excessive search results should not hinder selection of the required Concept:
    
    *   When several synonyms of the same Concept match the search key, only one may need to be displayed.
        
    
*   Speed result ordering
    
*   Speed of search:
    
    *   Search speed should be optimized
        
        *   For example, use appropriate indexes (e.g. single key index).
            
        
    

The purpose of this section is to describe various strategies that might be used to implement the search requirements outlined above. A balance must be kept between the completeness and specificity of searches. Therefore, the next sections consider techniques that extend searches to improve completeness and techniques that constrain searches to improve specificity.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Search+And+Data+Entry+Guide&entry.670899847=4.%20Optimizing%20Searches)

[PreviousUse Cases Where Search Browsers are Requiredchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/3-use-cases-for-searches/3.2-use-cases-where-search-browsers-are-required)
[NextSearch by Textchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text)

Last updated 7 months ago

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# Display Navigation Results Effectively | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

Results navigation is a useful feature for search browsers to have in addition to the conventional display of search results (see [Order Search Results Rationally](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.1-order-search-results-rationally)
 and [Rationalize Search Results by Subsumption Checking](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.4-rationalize-search-results-by-subsumption-checking)
). The decision to design navigation results in a browser may depend on space availability in the application's user interface. This sub-section describes two different types of hierarchies for browsing search results.

*   [Using the Subtype Hierarchy](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.1-using-the-subtype-hierarchy)
    
*   [Using the Navigation Hierarchy](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.3-using-the-navigation-hierarchy)
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Search+And+Data+Entry+Guide&entry.670899847=Display%20Navigation%20Results%20Effectively)

[PreviousRationalize Search Results by Subsumption Checkingchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.4-rationalize-search-results-by-subsumption-checking)
[NextUsing the Subtype Hierarchychevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.1-using-the-subtype-hierarchy)

Last updated 7 months ago

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# SNOMED CT Basics | Practical Guides | SNOMED International Documents

This section provides an overview of:

*   SNOMED CT features
    
*   Exploring SNOMED CT
    
*   SNOMED CT design and development
    
*   SNOMED CT components and hierarchies
    
*   SNOMED CT characteristics
    
*   SNOMED CT supporting different languages
    
*   SNOMED CT products and services
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#why-is-this-important)

Why is this important?


----------------------------------------------------------------------------------------------------------------------------------------------------------

An awareness of SNOMED CT features, components, characteristics and products provides an initial foundation on which to build greater understanding. It also informs discussions leading to decisions about adoption, implementation and use of this terminology.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#what-is-this)

What is this?


----------------------------------------------------------------------------------------------------------------------------------------

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#snomed-ct-features)

SNOMED CT Features

SNOMED CT:

*   Is the most comprehensive, multilingual clinical healthcare terminology in the world.
    
*   Is a resource with comprehensive, scientifically validated clinical content.
    
*   Enables consistent, processable representation of clinical content in electronic health records.
    
*   Is mapped to other international standards.
    
*   Is already used in more than eighty countries.
    

When implemented in software applications, SNOMED CT can be used to represent clinically relevant information consistently, reliably and comprehensively as an integral part of producing electronic health information.

Implementation requires an understanding of the way that SNOMED CT content is represented by components and supported by reference sets (Refsets).

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#exploring-snomed-ct)

Exploring SNOMED CT

While reading the guide, you may find it useful to explore the content of SNOMED CT. You can do this using one of a range of online browsers listed on our web site at [https://www.implementation.snomed.org/browsersarrow-up-right](https://www.implementation.snomed.org/browsers)
. Note that the listed browsers are not endorsed by SNOMED International and they should only be used to a get feel for the content and structure of the terminology. It is useful to experiment with several different browsers as they vary in the way they present particular features of the terminology.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F19067948-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FUmSUeu96fIQZWDm7RISx%252Fuploads%252Fgit-blob-b81d144eb3437c9b8d30f8ccd46403c1990a21a3%252F29952942.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=5ce5a141&sv=2)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#snomed-ct-design-and-development)

SNOMED CT Design and Development


-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#snomed-ct-components)

SNOMED CT Components

SNOMED CT is a core clinical healthcare terminology that contains concepts with unique meanings and formal logic based definitions organized into hierarchies. SNOMED CT content is represented using three types of components:

*   Concepts representing clinical meanings that are organized into hierarchies.
    
*   Descriptions which link appropriate human readable terms to concepts.
    
*   Relationships which link each concept to other related concepts.
    

These components are supplemented by reference sets, which provide additional flexible features and enable configuration of the terminology to address different requirements.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#concepts)

Concepts

SNOMED CT concepts represent clinical thoughts, ranging from |abscess| to |zygote|. Every concept has a unique numeric concept identifier. Within each hierarchy, concepts are organized from the general to the more detailed. This allows detailed clinical data to be recorded and later accessed or aggregated at a more general level.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#descriptions)

Descriptions

SNOMED CT descriptions link appropriate human readable terms to concepts. A concept can have several associated descriptions, each representing a synonym that describes the same clinical concept. Each translation of SNOMED CT includes an additional set of descriptions, which link terms in another language to the same SNOMED CT concepts. Every description has a unique numeric description identifier.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#relationships)

Relationships

SNOMED CT relationships link concepts to other concepts whose meaning is related in some way. These relationships provide formal definitions and other properties of the concept. One type of relationship is the |is a| relationship which relates a concept to more general concepts. These |is a| relationships define the hierarchy of SNOMED CT concepts.

*   For example, the concepts |bacterial pneumonia| and |viral pneumonia| both have an |is a| relationship to |pneumonia| which has an |is a| relationship to the more general concept |infectious disease of lung|.
    

Other types of relationships represent aspects of the meaning of a concept.

*   For example, the concept |viral pneumonia| has a |causative agent| relationship to the concept |virus| and a |finding site| relationship to the concept |structure of parenchyma of lung|.
    

Every relationship has a unique numeric relationship identifier.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#reference-sets)

Reference sets

Reference sets (Refsets) are a flexible standard approach used by SNOMED CT to support a variety of requirements for customization and enhancement of SNOMED CT. These include the representation of subsets, language preferences for use of particular terms and mapping from or to other code systems. Every reference set has a unique numeric concept identifier.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#snomed-ct-hierarchies)

SNOMED CT Hierarchies

SNOMED CT concepts are organized in hierarchies. Within a hierarchy concepts range from the more general to the more detailed. Related concepts in the hierarchy are linked using the |is a| relationship.

*   Examples of some of the hierarchies include |clinical finding|, |procedure|, |observable entity|, |body structure| and |organism|.
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#snomed-ct-characteristics-comprehensive-scalable-and-flexible)

SNOMED CT Characteristics - Comprehensive, Scalable and Flexible

SNOMED CT has a broad coverage of health related topics. It can be used to describe a patient's medical history, the details of an orthopedic procedure, the spread of epidemics, and much more. At the same time, the terminology has an unmatched depth, which enables clinicians to record data at the appropriate level of granularity.

Specific applications tend to focus on a restricted set of SNOMED CT, such as concepts related to ophthalmology. These subsets can be used to present relevant parts of the terminology, depending on the clinical context and local requirements. This means for example, that a drop down list to select diagnoses in an electronic health record in a mental health facility can be tailored to that setting. Similarly, subsets can be defined for problem lists for physician specialties or to provide appropriate medication lists for nurses in community care.

When individual jurisdictions have needs beyond those that can be reflected in a global terminology, perhaps due to requirements in local legislation, they can develop local or national extensions. Thus, even though SNOMED CT is global in scope, it can be adapted to each country's or areas requirements. SNOMED CT maps work to provide explicit links to health related classifications and coding schemes in use around the world, e.g. statistical classifications such as ICD-10. Maps to or from several national code systems are also available from, or under development, by Members. Maps to or from clinical domain specific code systems are also maintained by specialty groups with which SNOMED International has collaborative agreement. Maps facilitate reuse of SNOMED CT based clinical data for other purposes, such as reimbursement or statistical reporting.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#supporting-different-languages)

Supporting Different Languages

SNOMED CT is a multinational, multilingual terminology. It has a built-in framework to manage different languages and dialects. The International Release includes a set of language independent concepts and relationships. Today, SNOMED CT is available in many languages that can be viewed in the SNOMED International SNOMED CT Browser. The basic objective of any SNOMED CT translation is to provide accurate representations of SNOMED CT concepts in a way that is understandable, usable, and safe. Translation must be concept based. Translators need to analyse concepts based on the fully specified name and take account of its position within the hierarchy, its descriptions, and its relationships to other concepts. This enables a meaningful translation of a concept based on phrases that are well used and clearly understood in all countries. SNOMED International maintains guidelines and other materials to support countries undertaking translations.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#snomed-ct-products-and-services)

SNOMED CT Products and Services

Members and organizations covered by the SNOMED CT Affiliate License have access to a range of products and services, including:

*   SNOMED CT terminology files consisting of:
    
    *   Concepts
        
    *   Descriptions
        
    *   Relationships
        
    
*   Derivative works that help in the uptake and use of SNOMED CT, including Reference Sets that support:
    
    *   Identification of subsets of SNOMED CT content
        
    *   Language or dialect preferences for use of particular descriptions
        
    *   Maps to other code systems and classifications
        
    *   Other relevant metadata to support use of SNOMED CT components.
        
    
*   Guidance for successful use of SNOMED CT including:
    
    *   Implementation guidance
        
    *   Translation guidance
        
    *   Editorial guidance for content development
        
    
*   Access to services supporting submission of requests for changes or additions to content and documentation.
    
*   Participation in the global SNOMED International community through an electronic collaborative space and meeting of special interest groups.
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Starter+Guide&entry.670899847=SNOMED%20CT%20Basics)

[PreviousUsing SNOMED CT in Clinical Informationchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/3-using-snomed-ct-in-clinical-information)
[NextSNOMED CT Logical Modelchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/5-snomed-ct-logical-model)

Last updated 7 months ago

*   [Why is this important?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#why-is-this-important)
    
*   [What is this?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#what-is-this)
    
*   [SNOMED CT Features](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#snomed-ct-features)
    
*   [Exploring SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#exploring-snomed-ct)
    
*   [SNOMED CT Design and Development](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#snomed-ct-design-and-development)
    
*   [SNOMED CT Components](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#snomed-ct-components)
    
*   [SNOMED CT Hierarchies](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#snomed-ct-hierarchies)
    
*   [SNOMED CT Characteristics - Comprehensive, Scalable and Flexible](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#snomed-ct-characteristics-comprehensive-scalable-and-flexible)
    
*   [Supporting Different Languages](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#supporting-different-languages)
    
*   [SNOMED CT Products and Services](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/4-snomed-ct-basics#snomed-ct-products-and-services)
    

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# Using the Subtype Hierarchy | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

The most visible hierarchical construct in SNOMED CT is the subtype hierarchy. This is constructed using a set of logical rules.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-252741d030a1f464d2f68f040330f1851ee29a6e%252F52170524.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=7fd14e53&sv=2)

Matches shown in the subtype hierarchy

The primary use of the SNOMED CT subtype hierarchy is to support effective retrieval and aggregation of data.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.1-using-the-subtype-hierarchy#example)

Example:

The Concept "Laparoscopic emergency appendectomy" can be reliably located by subtype navigation from any of its supertypes: "appendectomy," "laparoscopic appendectomy" or "emergency appendectomy."

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.1-using-the-subtype-hierarchy#enhanced-hierarchical-displays)

Enhanced Hierarchical Displays


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

It is possible to start at the top of hierarchy and navigate from parent to child in order to find a Concept or term in SNOMED CT. A more efficient approach, however, is to use the hierarchy to supplement a keyword search by enabling the user to look at related Concepts in order to consider them as alternative matches, or to check the context of a search result. The following examples illustrate these two uses of the SNOMED CT hierarchy.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.1-using-the-subtype-hierarchy#examples)

Examples:

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.1-using-the-subtype-hierarchy#id-1.-checking-supertypes)

1\. Checking supertypes:

A user wishes to find a _Description_ that relates to the condition of a patient who is hypersensitive to an allergen. The user performs a search on the _keyword_ "Hypersensitivity" and finds an exact match. Before the user selects the _Description_ for inclusion in the patient record, they check the _Fully Specified Name_ , which is | Sensitivity (finding) |. The user then checks the _hierarchy_ and discovers that the selected _Concept_ has | Psychological finding | as an _ancestor_ , which indicates that this is not the correct _Description_ to use in this context.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.1-using-the-subtype-hierarchy#id-2.-checking-subtypes)

2\. Checking subtypes:

A user wishes to find a _Description_ that relates to the condition of a patient who is hypersensitive to an allergen. The user searches for the _keyword_ "allergy," and finds one _Concept_ having a _Description_ that is an exact match. The user then looks at the _children_ of the _Concept_ (i.e. those _Concepts_ immediately below it in the _hierarchy_). One of the _children_ has the preferred _Description_ | Contact Hypersensitivity | which matches the user's intended meaning. The user selects this _Concept_ for inclusion in the patient record.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.1-using-the-subtype-hierarchy#the-challenge-of-subtype-navigation)

The Challenge of Subtype Navigation


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The same hierarchy can be used for data entry navigation following search but it is not designed for this purpose. Its depth and breadth are determined by logical rules of subsumption rather than by usability. As a result: There is no upper limit on the number of subtypes a Concept may have. This is true because there is no rule that determines the number of subtypes that a real world Concept may have. However, long lists of options are not conducive to effective data entry.

There is no fixed limit to the number of hierarchical steps between a generalized Concept and its most refined subtype. This is true since there is no preordained limit on the extent of possible refinement of a real world Concept. However, data entry procedures that involve stepping through several levels of choices before reaching the required selection impair usability.

The subtypes of a Concept do not have any particular order. The | is a | Relationship is primarily a property of the subtype Concept and does not express an ordinal position. This is true because logical subtypes are inherently an unordered set. However, a user is likely to find it easier to locate their required selection if members of hierarchical lists are displayed in some recognizable order.

The issues of depth, length and order noted above are also subject to change between releases. The addition of an intermediate Concept or reclassification after the addition of new defining characteristics will introduce new layers in the hierarchy. Some Concepts will then move from the list of immediate subtypes of a Concept to become subtypes of a more refined Concept. Hierarchical changes may sometimes simplify navigation by reducing the number of choices at a given hierarchical level. However, the general effect of improvements in the subtype hierarchy will be to increase its depth and thus to increase the number of steps from a particular general Concept to its most refined subtypes.

The poly-hierarchical structure allowing for a concept to have more than a single parent concept means that there may be many routes from a given Concept to its more general ancestors. This means that some of the choices presented for user selection are redundant since they simply offer alternative routes to the same Concept.

Routine use of subtype hierarchy navigation is not recommended for data entry. However, despite the drawbacks listed above, the subtype hierarchy may be useful for undertaking an exhaustive search for a particular refined Concept.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Search+And+Data+Entry+Guide&entry.670899847=Using%20the%20Subtype%20Hierarchy)

[PreviousDisplay Navigation Results Effectivelychevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively)
[NextUsing the Navigation Hierarchychevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.3-using-the-navigation-hierarchy)

Last updated 7 months ago

*   [Example:](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.1-using-the-subtype-hierarchy#example)
    
*   [Enhanced Hierarchical Displays](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.1-using-the-subtype-hierarchy#enhanced-hierarchical-displays)
    
*   [Examples:](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.1-using-the-subtype-hierarchy#examples)
    
*   [The Challenge of Subtype Navigation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively/5.5.1-using-the-subtype-hierarchy#the-challenge-of-subtype-navigation)
    

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# University of Utah | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

circle-info

The University of Utah School of Medicine is widely recognized for interdisciplinary research in the genetics of disease, cancer, biomedical informatics, infectious diseases, and other areas of leading-edge medicine. Innovation is a key priority of the Biomedical Informatics Core (BMIC), and information technology is critical to advancing the conduct of clinical and translational research.\\

For more information please visit [http://medicine.utah.edu/arrow-up-right](http://medicine.utah.edu/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/university-of-utah#overview)

Overview


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The Department of Biomedical Informatics at the University of Utah is an internationally recognized leader in both research and education in the field of medical informatics. The university has been a major contributor to the development of health information standards and open source initiatives, many of which have been leveraged in their own solutions, including their clinical decision support systems.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/university-of-utah#standards-architectures-techniques)

Standards, Architectures, Techniques


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

As a major contributor to the development of the [OpenCDSarrow-up-right](http://www.opencds.org/)
 collaborative, the University of Utah has been able use the architecture from OpenCDS to provide a service-based approach to their CDSS and clinical quality measurement efforts. As part of this effort, they have made use of HL7 International’s [Decision Support Servicearrow-up-right](http://www.hl7.org/implement/standards/product_brief.cfm?product_id=334)
 (DSS). The University also played a key role in the development of [OpenInfobuttonarrow-up-right](http://www.openinfobutton.org/)
, an opensource web service and reference implementation of HL7's infobutton standard. Infobuttons are context-sensitive links, which can be embedded in EHR systems as buttons or tabs. OpenInfobutton was funded by the US Veterans Health Administration (VHA) and developed by researchers at the VHA, Duke University, and the University of Utah.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/university-of-utah#using-snomed-ct)

Using SNOMED CT


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

SNOMED CT value sets are used to map to clinical concepts referenced in the University's CDS rules. SNOMED CT value sets are also used to configure patient problem lists in OpenInfobutton. Since the Infobutton standard uses SNOMED CT for problem lists, SNOMED CT concept identifiers are embedded in the requests and responses between the EHR and OpenInfobutton architecture, as shown in the figure below.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-f37c69ad567995df4fd5ec0cade23d862df0b339%252F123897687.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=eeed99f3&sv=2)

Infobutton architecture which uses SNOMED CT for patient problem lists

The University has benefited from using a standardized clinical reference terminology which can be used across clinical domains. By using SNOMED CT in OpenInfobutton, the University has improved the interoperability between EHR systems and knowledge resources, by providing more efficient access to the indexed knowledge content.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=CDS+Guide&entry.670899847=University%20of%20Utah)

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[NextVendor Case Studieschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies)

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*   [Overview](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/university-of-utah#overview)
    
*   [Standards, Architectures, Techniques](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/university-of-utah#standards-architectures-techniques)
    
*   [Using SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/university-of-utah#using-snomed-ct)
    

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# Rationalize Search Results by Subsumption Checking | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

Filtering a search by using subsumption checking is an effective technique to enhance the display of search results. It reduces the list of search results by nesting the subsumed Concepts under the general Concept. If the user wishes to select a narrower Concept, they can expand the node to select the nested subtype.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.4-rationalize-search-results-by-subsumption-checking#an-example-illustrating-rationalization-by-subsumption-cross-checking)

An Example Illustrating Rationalization by Subsumption Cross-Checking


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Unconstrained search for descriptions that begin with "hernia" returns a total of 49 Concepts which belong to many subtype hierarchies such as | Clinical Finding | and | Morphologic abnormalities |.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-30ef4ea47553e4125e49c28c2f9092a6e8480fe3%252F52170522.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=f415e14c&sv=2)

Rationalize search results by subsumption checking

Constraining a search for "hernia" by the "clinical findings" supertype returns 35 matches which is still considered to be a long list, many of which are subsumed by the general Concept "hernia". \[see [Constrain searches by supertype ancestors](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-supertype-ancestors)\
\]

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-c6deeafc5b290ff19163f87a4d1d1a6ee791ecaa%252F52170521.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=24dea9cb&sv=2)

Rationalize search results by subsumption checking - clinical findings only

Rationalisation by subsumption cross-checking can further reduce the matches by nesting the subsumed Concepts such as | perineal hernia | under | hernia |. If the user wishes to select a narrower Concept, they can expand the node to select the nested subtype.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-1967889c39b53d8acb03cf2f10d6205f21e0b9d8%252F52170520.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=9eb321cf&sv=2)

Subsumed Concepts nested under "hernia"

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[PreviousAvoid Multiple Hits on the Same Conceptchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.3-avoid-multiple-hits-on-the-same-concept)
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Last updated 7 months ago

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# Distribution | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents

Reference Sets can be distributed as part of the International Release, as part of a National Edition or as part of an Affiliate Edition, and the way the reference set is distributed will typically depend on how the Edition is distributed. However, in some situations, reference sets may be distributed independently.

Distributing reference sets usually involves performing any additional quality checks required to ensure that the data can be exported correctly, and then exporting the reference set from the terminology management tool. Finally, the reference set is distributed to the users, for example as release files accessed from an online library using a terminology server API.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/6-reference-set-development/6.4-distribution#distribution-format)

Distribution Format


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The standard format for distributing SNOMED CT reference sets are the reference set format, as described in [Common Reference Set Format](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/4-reference-set-design#common-reference-set-format)
. For example, an extensional definition of a subsets of components is represented as a [simple reference set](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/5-reference-set-types#simple-reference-set)
, and the standard format for distributing intensional definitions of concept subsets is as a [query specification reference set](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/5-reference-set-types#query-specification-reference-set)
. As part of the SNOMED CT release format, reference sets support unique identification, versioning and recognition of dependencies.

Using the reference set format for distributing SNOMED CT derivatives is beneficial from the view of maintenance, because the versioning attributes is identical to the versioning attributes used for SNOMED CT components. This means that the checks that need to be done as part of a regular release cycle is easier to manage compared to having a range of different versioning mechanisms to adjust to.

Other distribution formats may be used where necessary. For example to comply with requirements for representation of value sets including codes from other code systems. However, care should be taken to ensure that distributed subsets are uniquely identified and versioned. Subsets need to be accessed, selected and where appropriate bound to information models using standard approaches.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/6-reference-set-development/6.4-distribution#release-cycle)

Release Cycle


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Some subsets will be distributed biannually as part of the International Release. However, some others may not require this release schedule. Release processes must include a period of time dedicated to subset manipulation, following the 'freezing' of SNOMED CT itself. This is the period where all the changes has been made to the core components of SNOMED CT. Timing of release and distribution of specific subsets will be dictated by individual use case-specific requirements. These should be identified and documented initially as part of the subset development process. These may change over time based on user feedback.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Refset+Guide&entry.670899847=Distribution)

[PreviousDevelopmentchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/6-reference-set-development/6.3-development)
[NextImplement and Usechevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/6-reference-set-development/6.5-implement-and-use)

Last updated 5 months ago

*   [Distribution Format](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/6-reference-set-development/6.4-distribution#distribution-format)
    
*   [Release Cycle](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/6-reference-set-development/6.4-distribution#release-cycle)
    

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# Communications | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications#overview)

Overview


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The purpose of the communications mechanism is to handle CDS communications into and out of the system. Examples of user inputs include entry of clinical data, and the selection of a proposed drug, order set, or treatment regime. Examples of outputs include CDS interventions such as alerts, guidelines, diagnostic refinements, and smart forms. These outputs are typically delivered to the u ser interface. SNOMED CT has limited involvement in the communications mechanism of CDS as most of the codes and features will be used by the knowledge base and inference engine. That being said, it is possible that SNOMED CT terms are used at the user interface level as part of the data entry process. For more information on using SNOMED CT to support data entry, please refer to the [SNOMED CT Search and Data Entry Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/)
. SNOMED CT can also be used in the CDSS outputs. For example, using the relevant terms in the alert messages, populating smart forms with SNOMED CT codes, or linking terms in CDS guidelines to other appropriate clinical knowledge sources.

The figure below depicts the key interactions of the CDS communications mechanism.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-572ad2632f73e1ceec32c482ad04ff8292bbe89b%252F123897663.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=e550f049&sv=2)

Communications key interactions

Once the inference engine has determined that an intervention is appropriate, the communications mechanism takes over and handles its delivery. Conversely, user inputs are also delivered into the CDSS by the communications mechanism. Note that guidelines or knowledge resources may reference externally hosted content, which may be accessed by the user via a link. An example of this would be a PubMed citation for biomedical literature.

Note that the diagram also shows how the internal CDSS communications (associated with the external inputs and outputs) are related to the components of the CDS rule. The communication 'inputs' feed into the event (from "ON event") and the condition (from "IF condition") components of the rules, while the 'outputs' are the result of the action (from "THEN action") that is performed if the event occurs and condition is true.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications#example)

Example


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The following screenshot was generated from an EHR with CDS capabilities. This illustrates what a typical CDS intervention may look like.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-40ac517af80f519fcee89dc139578e7a330fb1b5%252F123897662.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=2e62713e&sv=2)

User Interface depicting CDS intervention which links to knowledge resource

Note that the contents of this alert have been magnified for the purpose of this illustration. Characteristics of this alert include:

*   It appears at the top of the screen using fonts and colors that help to distinguish it from other content. (Alerts, by design, are intended to be noticed.)
    
*   It includes mechanisms to process the intervention as appropriate (e.g. to acknowledge, accept or discard the alert). In this case, the alert my be closed (by clicking the X) or the suggestion to order a lab test may be accepted (by clicking on "order a lab").
    
*   It provides a link to applicable reference information (as illustrated above by the PubMed screenshot.)
    
*   It includes an option to "minimize notifications". This option allows the user to minimize the number of alerts displayed, by selecting the types of alerts they wish to receive in their user preferences.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications#alert-fatigue)

Alert Fatigue


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Alert fatigue is an unwanted side effect of CDS. Alert fatigue occurs when clinicians become overwhelmed by or desensitized to CDS alerts because of their sheer number, intrusive nature, or non-relevance to a clinical situation. The danger of alert fatigue is that the clinician will miss something important as a result. Strategies are required to minimize alert fatigue. Some of the interesting ideas proposed by thought leaders in CDS include:

*   Increasing the specificity of alerts;
    
*   Allowing users to customize CDS alerts by types of interventions
    
*   Using a human factors approach to designing alerts
    

SNOMED CT is able to help with the first two items above. Firstly, it can be used to increase the specificity of the CDS conditions that trigger the alerts. And secondly, it can be used to distinguish between different types of interventions to enable customization to occur. Please refer to [False Positives and False Negatives](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base/3.1-rules#false-positives-and-false-negatives)
 in the section Context in CDS Rules for more information on minimizing alert fatigue.

* * *

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications#standards-for-cds-communications)

Standards for CDS Communications


-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

An example of a standard which relates to CDS communications is provided below.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications#cds-hooks)

CDS Hooks

CDS Hooks is a relatively new CDS initiative which aims to automate the launching of applications that assist with decision support. CDS Hooks are designed around the premise of a clinician initiating a triggering activity within the EHR. When the triggering activity occurs, the EHR automatically sends a notification in real time to a decision support service (DSS). This notification is considered the "hook" to the decision support logic. An example of a triggering activity would be a clinician writing a prescription. Some pre-defined hooks have already been developed and new hooks can be defined and added to the catalogue as required. Once the DSS is aware of the specific event, it may generate a response in the form of a "card" to be displayed in the UI of the EHR. An example of an "information" card might be one that contains pricing data about a proposed drug. The DSS could then propose a more cost effective "suggestion" card as an alternative. The other type of card the DSS may offer is an "app link" card which, as the names suggests, provides a link to an external application that can assist with further decision support. This architecture eliminates the need for the user to be aware of specific decision support applications that may be useful. The final outcome or choice, initiated by the app link card process, can then be automatically transferred to the appropriate field(s) in the EHR. A clinician has the option to accept or decline any suggestions present in the card. References to external knowledge resources may also be present in CDS Hooks cards.

The screen shot below captures part of a CDS hook. Note that the condition the clinician is treating is represented using the SNOMED CT code for 396275006 | Osteoarthritis|.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-2b9d3093d629d9af83ed68efa81b1e39cd82e841%252F123897674.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=2b7e7b16&sv=2)

CDS Hooks demonstration tool

For more information about CDS Hooks, please refer to [http://cds-hooks.org/arrow-up-right](http://cds-hooks.org/)
.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=CDS+Guide&entry.670899847=Communications)

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Last updated 4 months ago

*   [Overview](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications#overview)
    
*   [Example](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications#example)
    
*   [Alert Fatigue](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications#alert-fatigue)
    
*   [Standards for CDS Communications](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications#standards-for-cds-communications)
    
*   [CDS Hooks](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications#cds-hooks)
    

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# SNOMED CT Reference Set Guide | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fattachments%2F27591252%2FSNOMED%2520International%252Btagline_RGB-small.png%3Fversion%3D1%26modificationDate%3D1483202866000%26api%3Dv2&width=768&dpr=3&quality=100&sign=76e490a6&sv=2)

The SNOMED CT Practical Guide to Reference Sets starts by identifying practical use cases and the requirements that must be met to address them. It then explains how different types of reference sets can be used to meet those requirements. It also provides advice on different approaches to creating, editing, maintaining and using reference sets to support effective localization and customization of SNOMED CT.

[Introduction](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/1-introduction)

[Subsets, Value Sets and Reference Sets](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/2-subsets-value-sets-and-reference-sets)

[Requirements and Use Cases](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/3-requirements-and-use-cases)

[Reference Set Design](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/4-reference-set-design)

[Reference Set Types](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/5-reference-set-types)

[Reference Set Development](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/6-reference-set-development)

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This document is a publication of International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED International owns and maintains SNOMED CT®.

Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. This document may be subject to updates. Always use the latest version of this document published by SNOMED International. This can be viewed online and downloaded by following the links on the front page or cover of this document.

SNOMED®, SNOMED CT® and IHTSDO® are registered trademarks of International Health Terminology Standards Development Organisation. SNOMED CT® licensing information is available at [http://snomed.org/licensingarrow-up-right](http://snomed.org/licensing)
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 or contact us at [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#137a7d757c537a7b6760777c3d7c6174)
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Last updated 5 months ago

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# Improve Search Speed | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

The intention of improving search speed is to improve the usability of data entry. This section describes techniques that can help speed up searches.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed#enable-real-time-searching)

Enable Real Time Searching


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Real time searching offers suggestions to finish the words being typed by the user or displays the results while the user is typing. It can improve the user experience by reducing the number of keystrokes a user has to make and to help reassure them that the system 'understands' their intentions.

Conventional text searches require the user to decide how many words to enter and then explicitly request a search. When a search fails to find any matches or returns a very long list of matches, the user is obliged to repeat the process. The need to undertake this type of user interaction for every coded entry is likely to create a significant disincentive to effective data entry.

While auto-completion may generally be a useful technique, it may not be useful for data entry at or near the point of care as it may be distracting to the user and could potentially slow down the clinical documenting. It also requires the user to pay close attention to ensure that the auto-completed phrase is the one that the user intended to capture.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed#show-an-indication-of-estimated-number-of-matches-before-starting-a-search)

Show an Indication of Estimated Number of Matches Before Starting a Search


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One possible solution to show the number of search results is an interface that performs real-time checking of the number of search results while the user is typing. The interface may indicate this to the user, allowing them to decide when to stop typing and commence the search. A further enhancement is to automatically return the list of matches whenever the user stops typing, or when the number of matches is reduced to an acceptable level.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed#allow-slow-searches-to-be-paused-or-cancelled)

Allow Slow Searches to be Paused or Cancelled


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When a search is slow to find any matches, it may be useful to give the user the option to pause or cancel the search. This technique would benefit applications or scenarios which either require:

*   Less frequent data entry;
    
*   Searching a large SNOMED CT subset;
    
*   A lot of processing power, which could potentially impact search performance or the overall system performance, or
    
*   Access to a terminology server via an Application Programming Interface (API).
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed#enable-background-encoding)

Enable Background Encoding


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Techniques that support real-time searches \[see [Enable real time searching](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed#enable-real-time-searching)\
\] and qualifier resolution \[see [Extend search by postcoordinated searching](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches#extend-search-by-postcoordinated-searching)\
\] may also be extended to enable background encoding of complete sentences as they are entered. This method can be applied to text entered by typing or by voice recognition.

As text is entered, the search mechanism attempts to narrow the selection. If there are multiple possible matches, then these are presented to the user for selection. If there is a single match, the encoding is accepted by default; otherwise the user can override the match by selecting an alternative Concept or Description. A single good match is found at the end of the process, thereby encoding the text in the sentence.

There are many possible variants on this technique. For example, as the possible matches are narrowed down, the system could offer an auto-completion option similar to that used in web browsers and word-processors.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed#enable-automatic-and-semi-automatic-encoding)

Enable Automatic and Semi-Automatic Encoding


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Techniques similar to those used for background encoding can be applied to previously entered text or to text entered by voice recognition or optical character recognition. Where such methods are used there is likely to be a need for manual intervention to resolve uncertain encoding. The requirement for manual intervention will depend on the sophistication of the matching techniques and the extent to which accuracy is safety-critical. If encoded data is to be used by clinical decision support protocols, which may influence the treatment of a patient, extreme care is needed when using automatic encoding and tools that allow manual review are essential. A less rigorous approach may be acceptable where the purpose of encoding is for aggregation and analysis of large volumes of population data.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed#optimize-indexing)

Optimize Indexing


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Indexing SNOMED CT content facilitates fast and accurate text searches. Search functionality queries the indexed content (by keyword) to return a list of search candidates matching the query. General purpose index features may be sufficient for enabling rapid SNOMED CT searches. However, developers and users should be aware that search tools may need to be configured for SNOMED CT searches due to different stop word indexes and to ensure effective searches of the types described in this guide.

See [**Appendix A - Using Search Index Files**](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/appendix/appendix-a-using-search-index-files)
 for further information.

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*   [Enable Real Time Searching](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed#enable-real-time-searching)
    
*   [Show an Indication of Estimated Number of Matches Before Starting a Search](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed#show-an-indication-of-estimated-number-of-matches-before-starting-a-search)
    
*   [Allow Slow Searches to be Paused or Cancelled](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed#allow-slow-searches-to-be-paused-or-cancelled)
    
*   [Enable Background Encoding](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed#enable-background-encoding)
    
*   [Enable Automatic and Semi-Automatic Encoding](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed#enable-automatic-and-semi-automatic-encoding)
    
*   [Optimize Indexing](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed#optimize-indexing)
    

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# Value Set | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents

A **value set** is a uniquely identifiable set of valid concept representations, where any concept representation can be tested to determine whether or not it is a member of the _value set_.

A _value set_ is typically used to represent the possible values of a coded data element in an information model. The members of a _value set_ may represent concepts using either simple codes or postcoordinated expressions.

There are a number of use cases for value sets, including constraining the permitted values for elements in a communication specification, specifying the values in a pick list on a user interface and defining the required values to use for reporting. Value sets may range from a simple flat list of codes from a single code system, to an unbounded hierarchical set of post-coordinated expressions drawn from multiple code systems. Value sets containing only SNOMED CT components may be represented as SNOMED CT reference sets.

For example, a message or reporting specification might define a single value set for a problem list, which includes:

*   SNOMED CT 64572001 | Disorder| concepts
    
*   SNOMED CT expressions that are subtypes of 64572001 | Disorder|
    
*   ICD-10 classification codes representing diseases
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/2-subsets-value-sets-and-reference-sets/2.2-value-set#value-set-example)

Value Set Example


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The diagram below illustrates an example of an Observation model, which may be used to support diagnosis, monitor progress, determine patterns in clinical data, etc. Each data element in the information model is linked to a value set, which represents the value values for that element. As shown below, the value sets used in this information model may be selected from different code systems. In some cases, a single value set may also include concepts from different code systems.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1485734576-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FqOI2v58ZsXOoklmwBOk4%252Fuploads%252Fgit-blob-793ea5f5640a0832ddddbf9b4bc5a5e64b268404%252F35985808.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=c8e91a1e&sv=2)

Value sets used in an information model

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Last updated 4 months ago

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# Requirements and Use Cases | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents

Reference sets are useful for a range of purposes, and different types of reference sets have been defined to meet various requirements. It is therefore important to understand the requirements for reference set usage in order to be able to select the appropriate reference set design.

Reference sets are useful for including, excluding and prioritizing content or managing the use of codes for data entry, communication or analysis purposes. Reference sets are important when customizing the use of SNOMED CT to meet specific requirements. For example, to meet national, jurisdictional or organizational requirements for recording clinical information, or to assess regional variations in disease prevalence or health delivery.

Practical use cases for SNOMED CT span the entire clinical information lifecycle from data entry, through to storage, display, communication, retrieval, analysis and reuse. Reference sets support effective and efficient use of SNOMED CT for a range of purposes at different stages in that lifecycle. For example, reference sets can assist with user interface customization, specification of reporting criteria, mapping to statistical classifications and representation of links to knowledge resources. They can also be used to represent terminology bindings and to validate the content of both inbound and outbound communications.

The subsequent sections will introduce some of the typical requirements and use cases for reference sets and the different types of reference sets which support these use cases.

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# Reference Set Development | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/6-reference-set-development#general-development-process)

General Development Process


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The lifecycle of reference set work spans from the point where there is an initial idea related to a specific clinical information requirement based on SNOMED CT through reference set development to long term maintenance. At each stage it is essential that a defined process is followed which ensures the quality and validity of the product is maintained. The following figure provides an overview of the steps that are relevant to any project that either builds its own reference set, or adapts reference sets authored from elsewhere. The general process is similar to the process used when developing other information artefacts, and as for many development processes it is essential to be clear and specific about the requirements to be met, and to ensure that these requirements drive the design and implementation of the artefact. Related to reference set development this means that the process is not just about creating a reference set, but more about how to address the requirements, and this will often mean a combination of development of different reference sets.

The overview provided in following diagram is not intended to imply that a waterfall methodology should be used to develop a reference set. It may be delivered using agile or iterative project methodologies, with the reference set and supporting project documentation evolving as the project develops.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1485734576-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FqOI2v58ZsXOoklmwBOk4%252Fuploads%252Fgit-blob-4fe02442a26b548ba44e3973386fa70648649411%252F35985706.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=dda315dd&sv=2)

Reference set development process

* * *

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Last updated 5 months ago

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# Logical Architecture | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

This section provides an overview of the logical architecture of an electronic health record (EHR) which uses CDS.

In particular, it focuses on the logical architecture of knowledge-based CDSSs, which use pre-loaded CDS artifacts (such as rules and guidelines) that closely match a human's natural reasoning process. Non-knowledge-based CDSSs, which use artificial intelligence (AI) or machine learning to acquire knowledge over time, are outside the scope of this guide.

The logical architecture of knowledge-based CDSSs are explored in the following subsections.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture#ehr-system-architecture)

EHR System Architecture


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To understand how clinical decision support (CDS) works, it is important to understand how CDS fits within the logical architecture of an EHR system. This section describes the major architectural components of an EHR system, and the interactions between these components.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture#id-2.1.ehrsystemarchitecture-majorcomponents)

Major Components

Table: Descriptions of the major architectural components of an EHR system

EHR System Component

Description

[**User Interface**](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/)
 ![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252FcIzwGqzHvrmAcHqSaCJF%252Fimage.png%3Falt%3Dmedia%26token%3D0409619c-b396-4e3b-9d07-d7fb01384431&width=300&dpr=3&quality=100&sign=901906cf&sv=2)

The user interface (UI) is a fundamental component of almost any clinical application, and is used within an EHR to both enter and display patient health records. The UI also has two main CDS functions. Firstly, the UI is used to provide inputs to the CDSS, such as recording a proposed medication or an observed finding. The second function of the UI is to display alerts, advisories and clinical guidelines to the user in an appropriate format, on behalf of the CDSS.

**Record Services** ![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252FBzSGiXEAHzjdcgEC2lRF%252Fimage.png%3Falt%3Dmedia%26token%3Dec05bc42-beef-472c-b8eb-d59bf50e4487&width=300&dpr=3&quality=100&sign=1f570e8f&sv=2)

Record services are a set of services for managing patient health records. Record services provide functions like entering data into health records, searching for and retrieving health records, querying or extracting data from health records, and communicating or exchanging health records with other systems or applications. Record services interact with other components in this model such as the CDSS and the UI.

[**Terminology Services**](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/)
 ![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fm5FLYeKPJ0fq0yT3i540%252Fimage.png%3Falt%3Dmedia%26token%3Df821b93b-ca2d-4307-aa13-a26672c14481&width=300&dpr=3&quality=100&sign=39537d60&sv=2)

Terminology services are those services that directly manage the terminology resources. They include functions like querying concepts, relationships and reference sets, and installing or updating SNOMED CT from release files. Terminology services interact with the CDSS component in this model.

**Clinical Decision Support System** ![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252FvlzgZZknp3M2pU29FH0z%252Fimage.png%3Falt%3Dmedia%26token%3D597dc75b-cd7d-487a-9b1a-cc3bd2aa561c&width=300&dpr=3&quality=100&sign=d5d69eb5&sv=2)

The primary role of the CDSS is to execute the decision support logic. The CDSS does this using a number of subcomponents and subprocesses, which will be described in the next section - CDS System Architecture. The CDSS interacts with each of the other major components in the EHR.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture#interactions)

Interactions

The major architectural components of an EHR system that incorporates CDS interact with each other in a variety of ways to support the overall functioning of the EHR. The diagram below uses orange arrows to illustrate the primary interactions between these EHR components.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-e4cc83bc8353c4e703aed089fc70b51166859606%252F123897454.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=15162805&sv=2)

EHR components and key interactions

As shown above, the UI communicates with the record services to facilitate the storage and subsequent retrieval of health record data. The UI also provides inputs to the CDSS and displays alerts and guidelines on its behalf. The CDSS uses the inputs from the UI and data from the record and terminology services to processes decision support rules. The CDSS uses the inputs from the record and terminology services to determine whether or not the CDS conditions have been met, and if so then CDS interventions, such as alerts or knowledge resources, are delivered back to the UI. The internal components and processes of the CDSS will be described in more detail in the next section.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture#cds-system-architecture)

CDS System Architecture


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This section describes the major architectural components of a CDSS and explores how they work together with the components of an EHR, as described in [EHR System Architecture](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture#ehr-system-architecture)
.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture#id-2.2.cdssystemarchitecture-majorcomponents)

Major Components

Table: Descriptions of the major architectural components of a CDSS

CDSS Component

Description

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252F1e7i3DgHGMEoqoH6xEbS%252Fimage.png%3Falt%3Dmedia%26token%3D96499878-0d2d-4ed7-89e8-5a28f61d2ff7&width=300&dpr=3&quality=100&sign=d458fc9a&sv=2)**Knowledge Base**

The knowledge base (KB) stores clinical knowledge developed by domain experts as CDS artifacts. These knowledge artifacts (e.g. rules and guidelines) are stored in a machine processable format and made available to the inference engine to drive the CDS workflow.

For additional information on this component please refer to the [Knowledge Base](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base)
 section.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252FUiJjuEvE9fvhNsDOH8dZ%252Fimage.png%3Falt%3Dmedia%26token%3Da9c26816-72ae-4dce-b5de-f0297fc424d0&width=300&dpr=3&quality=100&sign=d084288e&sv=2)**Inference Engine**

The inference engine processes the CDS knowledge artifacts, using information from the record services, the terminology services and user input to execute the CDS logic. A key part of this process is to determine which actions should be performed, based on the given patient's circumstances.

For additional information on this component please refer to the [Inference Engine](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/4-inference-engine)
 section.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252FNCadNMlECmEl99nr7Tqc%252Fimage.png%3Falt%3Dmedia%26token%3Df5195220-2810-419a-ac77-a8e446d27d42&width=300&dpr=3&quality=100&sign=6b8b5ccb&sv=2)**Communications**

The communications mechanism is responsible for accepting inputs from the user and delivering the outcomes of the inference engine back to the user. For example, when a clinician prescribes a drug, this information is communicated to the inference engine as an input. If the inference engine discovers that the medication is contraindicated, the communications mechanism will deliver an alert to the user interface.

For additional information on this component please refer to the [Communications](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/5-communications)
 section.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture#logical-architecture)

Logical Architecture

The diagram below illustrates how the components of the CDSS (shown in the blue box) work together with the components of the EHR system (shown in the red box).

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-c719e18905142b3917c578fbbcfb1eff8e6941ad%252F123897780.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=5989c938&sv=2)

CDSS components and key interactions

Internal CDSS interfaces are represented by the green directional arrows, while external CDSS interfaces are represented by the orange arrows. Note that the inference engine interfaces directly with record and terminology services while communications, which is focused on the delivery of CDSS inputs and outputs, interfaces directly with the user interface.

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[NextKnowledge Basechevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/3-knowledge-base)

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*   [EHR System Architecture](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture#ehr-system-architecture)
    
*   [Major Components](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture#id-2.1.ehrsystemarchitecture-majorcomponents)
    
*   [Interactions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture#interactions)
    
*   [CDS System Architecture](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture#cds-system-architecture)
    
*   [Major Components](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture#id-2.2.cdssystemarchitecture-majorcomponents)
    
*   [Logical Architecture](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/2-logical-architecture#logical-architecture)
    

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# Terminology Services Overview | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents

This chapter defines SNOMED CT terminology services, and it describes the general terminology service categories. Furthermore, it presents three key roles with an interest in SNOMED CT terminology services including end-users and those involved in the procurement of healthcare applications.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview#terminology-services-definition)

Terminology Services Definition


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SNOMED CT terminology services are defined as a set of software functions that interface with and provide effective access to the content and features of one or more SNOMED CT editions.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview#notes)

Notes

*   Each terminology service is a software function that interfaces with and provides access to information from one or more representations of a terminology.
    
*   The software application that provides _SNOMED CT terminology services_ is known as a SNOMED CT terminology server.
    
*   While terminology services may be applicable to several different terminologies, applications that provide _SNOMED CT terminology services,_ should support access to the specific design features of SNOMED CT. These include the subtype hierarchy, description logic concept definitions, reference sets and expression constraints.
    

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview#examples)

Examples

*   Find a concept based on a set of search criteria. The criteria may include text to be matched against terms associated with the concept and constraints requiring a concept to be a subtype of an identified _concept_ or a member of an identified reference set.
    
*   Show the preferred term associated with an identified concept.
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=SNOMED+Terminology+Services+Guide&entry.670899847=Terminology%20Services%20Overview)

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# Optimize Display of Search Results | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

This section describes how search results can be ordered rationally. When developing browsers and search functionality within clinical applications, careful consideration must be taken when specifying the prioritization of search results as adopting many of the techniques below may compromise the speed of search. The benefits of presenting the results in the best manner should therefore be evaluated against the speed of the search.

*   [Order Search Results Rationally](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.1-order-search-results-rationally)
    
*   [Distinguish Identical Terms of Different Concepts](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.2-distinguish-identical-terms-of-different-concepts)
    
*   [Avoid Multiple Hits on the Same Concept](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.3-avoid-multiple-hits-on-the-same-concept)
    
*   [Rationalize Search Results by Subsumption Checking](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.4-rationalize-search-results-by-subsumption-checking)
    
*   [Display Navigation Results Effectively](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.5-display-navigation-results-effectively)
    
*   [Use Mnemonics and Personal Favorites for Data Entry](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.6-use-mnemonics-and-personal-favorites-for-data-entry)
    

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[PreviousImprove Search Speedchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed)
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Last updated 4 months ago

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# Sundhedsplatformen | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

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The 'Sundhedsplatformen' is a new EHR-system which is currently being rolled out in eastern Denmark where it replaces a large number of outdated and disjointed IT systems. It gives the staff a common digital solution for communication and use of data. Through its workflow-related construction the 'Sundhedsplatformen' introduces new ways to perform clinical work, and creates the basis for treatment which considers international best practices.

For more information please visit [https://www.regionh.dk/sundhedsplatformarrow-up-right](https://www.regionh.dk/sundhedsplatform)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/sundhedsplatformen#overview)

Overview


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Sundhedsplatformen which translates to _the health platform_, is a jurisdictional electronic health record (EHR) in Denmark with decision support capabilities. The system, provided by Epic, operates in the Capital and Sealand regions of Denmark, which cover a population of approximately 2.6 million people (almost half of the population of Denmark). The system uses SNOMED CT as the basis for its diagnosis-related decision support services. The first clinical rollout of the system was performed in May 2016. When the rollout is complete at the end of 2017, the system will provide services for up to 45,000 clinical users.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/sundhedsplatformen#standards-and-technology)

Standards and Technology


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One of the design considerations of this system is to capture and store clinical data as structured content ( as opposed to unstructured or free text). This use of structured health data reduces the need for mapping and creates many opportunities including clinical decision support. In terms of terminology, Denmark’s national classification system, called _Sundhedsvæsenets Klassifikations System_ (SKS) , is based on ICD-10 and a range of other classification systems. Traditionally, SKS has been used for statistical aggregation and for billing purposes. Although not designed for clinical use, SKS was selected as the primary classification system for the Sundhedsplatformen project to maintain the legacy requirements associated with billing and classification. There was therefore a need to represent both procedures and diagnoses within SKS.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/sundhedsplatformen#use-of-snomed-ct)

Use of SNOMED CT


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It is worth noting that SNOMED CT is already used in many existing clinical databases and registries throughout Denmark. So from an interoperability perspective, there was incentive for the regional EHR to incorporate SNOMED CT in its implementation approach. As previously mentioned, Epic’s diagnosis-related decision support system is widely based on SNOMED CT. For example, the ability to traverse SNOMED CT’s hierarchy is a key component of all diagnosis related decision support in the Epic system. Since the region chose SKS as the classification system, there was a need to map their local concepts to SNOMED CT to be able to perform decision support. Over 20,000 diagnosis concepts from SKS were mapped to SCT over a period of 8 months. The mapping was performed through several steps, the first of which was based on the international SNOMED CT to ICD-10 map. Compared to the alternative (i.e. mapping from scratch), this approach was a major help and significantly increased the speed and ease of the mapping process.

* * *

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*   [Overview](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/sundhedsplatformen#overview)
    
*   [Standards and Technology](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/sundhedsplatformen#standards-and-technology)
    
*   [Use of SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/sundhedsplatformen#use-of-snomed-ct)
    

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# Extended Searches | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

Extended searches enable the search to return more candidate matches. The intention of extending searches is to maximize the likelihood that the required Concept or Description will be included in the candidate matches. This sub-section describes some recommended techniques for extending searches.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches#extend-search-by-word-equivalents)

Extend Search by Word Equivalents


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In healthcare, there are many words with equivalent meanings. Synonyms provide alternative phrases referring to the Concept. However, Synonyms are not created automatically for every possible combination of words with an equivalent meaning. The success of simple searches using one or more keywords depends on the text of the available Descriptions. Therefore searches will fail or will be incomplete where a different but equivalent word is used in the search.

SNOMED CT cannot and does not attempt to enumerate all possible _synonyms_ for all Concepts. Neither to enumerate all possible semantically equivalent typographic, part-of-speech or ordering variations of the synonyms it does include. To do so, especially automatically, would both require a considerable lexical resource and hugely increase the number of Descriptions and the size of any associated index tables. An alternative technical architecture involves a selective, logical expansion of search expressions and the relevant fragment of Description-space at run-time, using substantially the same lexical resources

For example: | Kidney stone | and | Renal calculus | are synonymous Descriptions in SNOMED CT. However, a search of SNOMED CT for the target phrase "kidney stone fragmentation" yields the result | Percutaneous nephrostomy with fragmentation of kidney stone | while a search for "Renal stone fragmentation" yields no results. One way of addressing this problem is to maintain a table of _word equivalents, and_ a table of this type is a prerequisite for exhaustive synonym generation.

Individual implementers will wish to add additional _word equivalents_ to meet the requirements of their particular medical specialty or user needs. The resulting table then acts as an additional resource to assist searching and parsing of phrases. It need not be a comprehensive dictionary of words.

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The Word Equivalent Table can be found in the Lexical Resources folder, which is available from the **Technical** **Resources** in the **Document Library**.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches#example)

Example:

"Tap" and "aspiration" are equivalent in the context of _terms_ such as "pleural tap", "pleural aspiration", but not in the context of a "patella tap", a physical "tap" on a bag or catheter, or the clinical disorder "neonatal aspiration syndrome".

When searching using incomplete words and/or wildcards, use of _word equivalents_ may impede effective searches by increasing the number of spurious potential matches. This either extends the processing required to filter the real matches from the potential matches or increases the length of the list of choices presented to the user.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches#example-using-word-equivalents-table-to-extend-a-failed-search)

Example: Using word equivalents table to extend a failed search

A system user enters the search string "Fragmentation of renal calculus;" the search returns no results. The search application that the user has been provided with has the option to extend the search by using the word equivalents table.

Word Equivalents Table Example

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-a7cc505060a15eb72559a5afd93e9a25d35a47dc%252F33490616.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=8a79a3a9&sv=2)

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-0788e20e116fe85555b8b75879aa275e4ccf3b30%252F33490617.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=56bf5355&sv=2)

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-18cd6af1d67410bb0e9211dc63f5fdfff78d4e3c%252F52171324.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=3483c1b7&sv=2)

Extending searches with word equivalents - step 1

The user selects this option (or it is invoked automatically because the initial search without word equivalents found nothing) and searches again using the same search _string_. The table is used to make substitutions in the search _string_ to produce all possible unique search variants:

*   "Fragmentation of renal calculus"
    
*   "Fragmentation of renal stone"
    
*   "Fragmentation of kidney stone"
    
*   "Fragmentation of kidney calculus"
    
*   "Fragmentation of Nephrolith"
    
*   "Fragmentation of renal calculus"
    
*   "Fragmentation of renal calculi"
    
*   "Fragmentation of kidney calculi"
    

These 8 search variants are used as the target phrases for the searches. The search results of these variants are combined, duplicate Concepts are eliminated and the list of search results is returned.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-f8f8efdbfd9d322ea6e7792cf852f98f39b841da%252F52171323.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=a0a3b4a5&sv=2)

Extending searches with word equivalents - step 2

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches#extend-search-by-postcoordinated-searching)

Extend Search by Postcoordinated Searching


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A SNOMED CT search can be expanded to support appropriate or commonly used qualifiers. This technique is useful in situations where searches fail to find a precoordinated Concept. This is particularly useful in clinical applications which support the storage of postcoordinated expressions. This technique is likely to increase the ease of entry of postcoordinated expressions in the clinical record as well as the overall usability of search and data entry.

As a basic implementation, a limited facility for recognizing commonly qualifying words may be used. For example, Concepts such as | left |, | right |, | routine |, and | emergency | are applicable as qualifiers for some Concepts when not already included in a precoordinated Concept.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches#example-1)

Example:

The phrase "emergency closed reduction fracture left femur" might list "closed reduction of fracture of femur, emergency, left" which refers to the postcoordinated expression

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-89d9748f4f3c59913437dcfe6629112e6eb25605%252F52171326.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=72954121&sv=2)

Extending searches by post-coordination - step 1

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-3aec5487929ff129dd9feb2ab222421b5ef1498e%252F52171327.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=d14eb570&sv=2)

Extending searches by post-coordination - step 2

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Last updated 7 months ago

*   [Extend Search by Word Equivalents](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches#extend-search-by-word-equivalents)
    
*   [Example:](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches#example)
    
*   [Example: Using word equivalents table to extend a failed search](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches#example-using-word-equivalents-table-to-extend-a-failed-search)
    
*   [Extend Search by Postcoordinated Searching](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches#extend-search-by-postcoordinated-searching)
    
*   [Example:](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches#example-1)
    

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    112777008 |closed reduction of fracture of femur| : 
    260870009 |priority| = 25876001 |emergency| , 272741003 |laterality| = 7771000 |left|

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# SNOMED CT Terminology Services Guide | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents

The Terminology Services Guide describes the terminology services required to support effective access to the content and features of SNOMED CT. This guide primarily focuses on the terminology service requirements of applications that enable the use of SNOMED CT for clinical purposes.

* * *

[Introduction](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/1-introduction)

[Terminology Services Overview](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview)

[Terminology Service Use Cases](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/appendixes/appendix-a-summary-of-types-and-use-cases)

[Terminology Service Types](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types)

[Service Implementation Considerations](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/5-service-implementation-considerations)

[Appendixesarrow-up-right](https://github.com/SNOMED-Documents/snomed-terminology-services-guide/blob/main/broken-reference/README.md)

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© Copyright 2026 International Health Terminology Standards Development Organisation, all rights reserved.

This document is a publication of International Health Terminology Standards Development Organisation, trading as SNOMED International. SNOMED International owns and maintains SNOMED CT®.

Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International. This document may be subject to updates. Always use the latest version of this document published by SNOMED International. This can be viewed online and downloaded by following the links on the front page or cover of this document.

SNOMED®, SNOMED CT® and IHTSDO® are registered trademarks of International Health Terminology Standards Development Organisation. SNOMED CT® licensing information is available at [http://snomed.org/licensingarrow-up-right](http://snomed.org/licensing)
. For more information about SNOMED International and SNOMED International Membership, please refer to [http://www.snomed.orgarrow-up-right](http://www.ihtsdo.org/)
 or contact us at [\[email protected\]envelope](https://docs.snomed.org/cdn-cgi/l/email-protection#7f161119103f16170b0c1b1051100d18)
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Last updated 5 months ago

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# Requirements | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents

A terminology server supporting postcoordination should support the general features of a SNOMED CT-enabled terminology server ([Terminology Services Guidearrow-up-right](https://confluence.ihtsdotools.org/display/DOCTSG)
), and additionally, support the features required to manage and use postcoordinated expressions. This involves an expression repository to store the postcoordinated expressions, and a set of services to access, process and query the expressions in the same way as pre-coordinated SNOMED CT content. This section provides an overview of the general requirements of an expression repository and the associated services.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Postcoordination+Guide&entry.670899847=Requirements)

[PreviousExpressions in a Terminology Serverchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-postcoordination-guide/expressions-in-a-terminology-server)
[NextExpression Repository Requirementschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-postcoordination-guide/expressions-in-a-terminology-server/requirements/expression-repository-requirements)

Last updated 7 months ago

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# Communication | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents

Messages and communication services are a means of exchanging data and thus enable effective and efficient communication among healthcare professionals and between patients and providers. SNOMED CT is important for communication because it serves as a semantic foundation for the meaning expressed in a message. Hence, SNOMED CT can ensure consistent and accurate representation of the information communicated, and support correct interpretation of the clinical information within a message.

Communicating clinical data through messages support a range of purposes, including:

*   Delivering accurate, accessible, and actionable health information that is targeted or tailored.
    
*   Facilitating the meaningful use and exchange of health information among healthcare professionals.
    
*   Supporting shared decision-making between patients and providers.
    
*   Providing personalized self-management tools and resources.
    
*   Building social support networks.
    
*   Increasing health literacy skills.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/3-requirements-and-use-cases/3.2-use-cases/3.2.4-communication#use-of-snomed-ct-in-messages)

Use of SNOMED CT in Messages


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Healthcare messages include fields that can be populated with codes from clinical coding schemes. SNOMED CT provides concept identifiers as a means of encoding concepts. These concept identifiers are suitable for use in appropriate fields of many clinical messages.

Implementations of clinical messaging typically constrain the range of values that can be applied to particular fields several reasons for this are listed in the following table.

Table: Reasons for constraining the content of fields in clinical messages

Reason

Example

To ensure that the information encoded is meaningful as a value for the specified field.

A field that is intended to describe the nature of investigation may contain a code that means "Serum glucose measurement" but should not contain a code that means "Hypoglycemia."

To ensure that receiving application is able to process the message.

A locally added code value may be valid in a particular application but should not be used if the receiving application needs to retrieve, process or analyze the coded part of the message.

To ensure adequate detail and specificity.

A field used to report an operative procedure could contain a code for "Abdominal procedure." However, this would not be adequate to meet the business purpose served by a message.

To avoid unnecessary detail or diversity.

A biochemical investigation could be reported using a code that represents various detailed aspects of the method used to perform the investigation. Such details may be unnecessary to a clinician and may complicate the analysis, charting and graphing of a series of results reported at different levels of detail.

For a more detailed use case example, please refer to the following section:

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/3-requirements-and-use-cases/3.2-use-cases/3.2.4-communication#constraining-the-coded-content-of-messages)

Constraining the Coded Content of Messages


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Communication specifications define structures designed to meet particular requirements. For example, recording a decision to prescribe a particular pharmaceutical product or substance might trigger an electronic prescription sent to the pharmacy. Reference sets may also be used to specify the allowed values in messages and for constraining the codable elements in data entry models. For some bindings it may be relevant to apply certain conditions, to enable that one value set is displayed given a specified criteria, and another value set is displayed given another criteria (or set of criterions). An example of such conditional value set binding is illustrated below.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1485734576-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FqOI2v58ZsXOoklmwBOk4%252Fuploads%252Fgit-blob-e434d1c5c45d4eac6894be4ea2c10f39a0d3f8cb%252F35985555.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=e5624bff&sv=2)

Conditional value set binding

Table: Types of Reference Sets applicable for messages

Type

Description

**Simple reference sets**

A [simple reference set](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/5-reference-set-types#simple-reference-set)
 may be used to represent a SNOMED CT-based value set applicable to a particular field in a message. The items to be populated in a particular field in the message can be constrained by filtering searches so that only concepts within that reference set are returned.

**Query specification reference set**

[Query specification reference sets](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/5-reference-set-types#query-specification-reference-set)
 may be used to represent a set of **intensionally** defined SNOMED CT subsets, where each subset represents the value set for a particular field in a communication messages. One query specification reference set may therefore be used to hold all value sets applicable within a single communication messages, or within a set of messages.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Refset+Guide&entry.670899847=Communication)

[PreviousReporting and Analyticschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/3-requirements-and-use-cases/3.2-use-cases/3.2.3-reporting-and-analytics)
[NextLanguage and Dialectchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/3-requirements-and-use-cases/3.2-use-cases/3.2.5-language-and-dialect)

Last updated 5 months ago

*   [Use of SNOMED CT in Messages](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/3-requirements-and-use-cases/3.2-use-cases/3.2.4-communication#use-of-snomed-ct-in-messages)
    
*   [Constraining the Coded Content of Messages](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/3-requirements-and-use-cases/3.2-use-cases/3.2.4-communication#constraining-the-coded-content-of-messages)
    

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# National Institutes of Health: Intramural Research Program | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

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The Intramural Research Program is the internal research program of the National Institutes of Health. With 1,200 Principal Investigators and more than 4,000 Postdoctoral Fellows conducting basic, translational, and clinical research, the IRP is the largest biomedical research institution on earth.\\

For more information please visit: [https://www.nih.gov/arrow-up-right](https://www.nih.gov/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/national-institutes-of-health-intramural-research-program#overview)

Overview


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The [National Institutes of Healtharrow-up-right](https://www.nih.gov/)
 (NIH) is a federally sponsored biomedical research program in the United States. The NIH is made up of 27 separate institutes and centers. The [Intramural Research Program'sarrow-up-right](https://irp.nih.gov/about-us/what-is-the-irp)
 (IRP) programs are embedded in 24 of the NIH Institutes. One of those institutes, the [National Library of Medicinearrow-up-right](https://www.nlm.nih.gov/)
 (NLM) is the world's largest biomedical library and the SNOMED CT National Release Center for the United States. The NLM curates an extensive collection of medical knowledge in various formats which is used by millions of people around the world. Across the IRP, some of their Principal Investigators (PIs) use SNOMED CT in their research. A selection of the Intramural Research Program's initiatives which relate to SNOMED CT and CDS, are briefly described below.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/national-institutes-of-health-intramural-research-program#value-set-authority-center)

Value Set Authority Center


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The [Value Set Authority Centerarrow-up-right](https://vsac.nlm.nih.gov/)
 (VSAC), managed by the NLM, is a service designed to maintain and distribute the value sets defined in [electronic Clinical Quality Measuresarrow-up-right](https://ecqi.healthit.gov/ecqms)
 (eCQMs). Each VSAC value set consists of codes and terms from clinical vocabularies such as SNOMED CT, RxNorm, LOINC and ICD-10-CM . Value sets derived from SNOMED CT are used to support the calculation of data quality measures which in turn provide feedback to clinicians about the quality of care. Note that VSAC is a project administered by NLM, but the actual data quality computations are done at individual healthcare sites.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-3b7c2035b1d900a065d1dd07641576d274a0bfb9%252F123897697.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=dc3382d9&sv=2)

VSAC NLM Value Set Repository

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/national-institutes-of-health-intramural-research-program#medline-plus-connect)

Medline Plus Connect


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[Medline Plus Connectarrow-up-right](https://medlineplus.gov/connect/overview.html)
 is an [Infobuttonarrow-up-right](http://www.hl7.org/implement/standards/product_brief.cfm?product_id=208)
 resource which accepts requests for information on diagnoses (problem codes), medications, and lab tests, and returns related information from [MedlinePlusarrow-up-right](https://medlineplus.gov/)
. The API is available as a web [applicationarrow-up-right](https://medlineplus.gov/connect/application.html)
 or as a web [servicearrow-up-right](https://medlineplus.gov/connect/service.html)
, which can be integrated with an EHR. MedlinePlus accepts SNOMED CT problem codes as input and provides CDS in the form of _targeted information prescription_. The example below shows how the Medline Plus Connect request and response are structured. Note that the response includes the title and link of the matched topic and may include synonyms, attribution acknowledgements, and related links.

Example: A patient diagnosed with 13645005 | Chronic obstructive lung disease (disorder)|

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252F71OpZr0LFY42Rmti2WWx%252FMedline%2520Plus%2520Connect%2520Example.png%3Falt%3Dmedia%26token%3Dad88964d-6781-4bc1-b9f3-352e11f2c6c2&width=768&dpr=3&quality=100&sign=30b90645&sv=2)

The requests conform to the [HL7 Context-Aware Knowledge Retrieval (Infobutton) Knowledge Request URL-Based Implementation Guidearrow-up-right](http://wiki.hl7.org/index.php?title=Product_Infobutton#Product_Name_-_HL7_V3_IG:_URL-Based_Implementations_of_the_Context-Aware_Information_Retrieval_.28Infobutton.29)
. A screen shot of the application's response to a request for information on | Asthma| is provided below:

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-541127eeb4957aae6779a3440c0dbd984a37c300%252F123897692.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=d35ba561&sv=2)

MedlinePlus Connect web application response to request for information on problem code 195967001 | Asthma (disorder) |

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/national-institutes-of-health-intramural-research-program#observational-health-data-sciences-and-informatics-ohdsi)

Observational Health Data Sciences and Informatics (OHDSI)


---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Some NLM researchers also participate in external projects which utilize SNOMED CT. One such project is [OHDSIarrow-up-right](http://ohdsi.org/)
. This collaborative uses SNOMED CT to integrate diagnostic data. This semantic data integration is then used by research studies which in some cases serves as input into the authoring of CDS knowledge artifacts.

One of the programs related to OHDSI is [Innovation in Medical Evidence Development and Surveillancearrow-up-right](https://reaganudall.org/projects/research/imeds)
 (IMEDS), which includes a number of projects led by NIH researchers, such as:

*   NIH Investigators
    
*   Ferdinand Dhombres (NIH)
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=CDS+Guide&entry.670899847=National%20Institutes%20of%20Health%3A%20Intramural%20Research%20Program)

[PreviousKaiser Permanentechevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/kaiser-permanente)
[NextPharmacy Health Information Technology Collaborativechevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/pharmacy-health-information-technology-collaborative)

Last updated 4 months ago

*   [Overview](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/national-institutes-of-health-intramural-research-program#overview)
    
*   [Value Set Authority Center](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/national-institutes-of-health-intramural-research-program#value-set-authority-center)
    
*   [Medline Plus Connect](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/national-institutes-of-health-intramural-research-program#medline-plus-connect)
    
*   [Observational Health Data Sciences and Informatics (OHDSI)](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/national-institutes-of-health-intramural-research-program#observational-health-data-sciences-and-informatics-ohdsi)
    

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# Terminology Service Categories | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents

SNOMED CT terminology services can be subdivided into categories based on the following two defining characteristics:

1.  **Access requirements** : Does the service need to update the terminology?
    
2.  **User interface requirements** : Does the service include its own user interface controls?
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.2-terminology-service-categories#access-requirements)

Access Requirements


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The following table describes the distinction between terminology services that provide read-only access to the terminology and those that also allow the terminology to be updated. Practical requirements for using SNOMED CT to enter, display, and report clinical data can be met by read-only terminology services. Services that are able to update the terminology are only required by those involved in the development, maintenance, or customization of the terminology.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.2-terminology-service-categories#terminology-access-requirements)

Terminology Access Requirements

Characteristic

Description

Additional Notes

**Read-Only**

Read-only terminology services enable access to SNOMED CT content and features.

These services meet requirements for practical use of SNOMED CT including collecting, displaying, communicating, and analyzing SNOMED CT coded data.

**Add-Update**

Add-update terminology services can add, modify, or inactivate SNOMED CT components and/or reference set members.

These services include functions that support terminology authoring, maintenance, and distribution. A full suite of development services meets the requirements of organizations responsible for creating and maintaining a SNOMED CT edition, or a SNOMED CT extension containing additional clinical concepts. Limited sets of development services can meet the requirements of organizations responsible for a SNOMED CT extension that consists only of reference sets representing subsets, maps, or data that is used to customize the terminology to meet specific purposes.

The image below illustrates the association between the different types of terminology services and record services.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2349888344-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252Ft4wRQcj6gyQPunraJrP0%252Fuploads%252Fgit-blob-4cbc74ce7f4d4c1aa8f5725dae67456033e3a1ca%252F115872331.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=f30c1c70&sv=2)

Examples of Terminology services and Record services and their associations.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.2-terminology-service-categories#user-interface-requirements)

User Interface Requirements


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The table below differentiates between services based on whether the service includes user interface components, in addition to its application programming interface. Terminology services that do not include user interface components are capable of delivering a full range of essential terminology services but they require the client application to provide the user interface components to interact with those services. Terminology services that include user interface components have the potential to simplify client application development and configuration. Some examples of potentially beneficial terminology services with user interfaces are noted in the table below.

Section [Terminology Service Use Cases](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/3-terminology-service-use-cases)
 notes the need for combinations of the terminology services identified in [Terminology Service Types](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types)
 to address each use case. Most of these use cases also need interfaces to allow users to interact and access the results of those services. However, the detailed specification of the user interface functionality of these combined services is beyond the scope of the current version of this guide.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.2-terminology-service-categories#user-interface-inclusion)

User Interface Inclusion

Characteristic

Description

Additional Notes

**No UI**

Terminology services that only provide access to SNOMED CT through an API.

Client applications using these services are responsible for providing any user interfaces required to enable practical use of these services. Client-developed user interfaces can be closely integrated with the look and feel of the client application UI. They limit dependency on a specific terminology service provider, as services without a UI have less variability and are more likely to include shared, common features.

**UI**

Terminology services that, in addition to an API, also provide a user interface through which users can interact with the terminology.

Services in this category range from individual terminology-bound UI controls to fully functioning tools that enable viewing or editing the terminology. User interface controls included as part of the terminology service may facilitate more rapid development and can be useful when client applications have limited requirements for SNOMED CT searching and display. **Examples:** • _Terminology search control_ (Use Case 3.2 – Support EHR Data Entry):

– Text search with constraints set by data entry – Display results to support selection of appropriate concepts – Option to add postcoordinated refinements • _Report and analysis query development tool_ (Use Case 3.4 – EHR Reporting and Analytics): – Enables creation of valid expression constraints or SNOMED CT queries

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.2-terminology-service-categories#terminology-service-category-examples)

Terminology Service Category Examples


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The following tables provide examples of services in each of the four categories defined by applying the terminology access and user interface criteria.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.2-terminology-service-categories#read-only-access)

Read-Only Access

User Interface

Examples

**No UI**

• Get details of a concept using its concept ID. • Search for concepts based on term search criteria or expression constraints. • Retrieve reference set data (e.g., subset membership, language acceptability, maps, history). • Test if a set of concepts or expressions is subsumed by a specified concept or expression constraint.

**UI**

• SNOMED CT browser that allows exploration and supports API-based integration with applications. • Terminology-bound UI controls (e.g., dropdown lists populated via reference sets or constraints). • Tools to analyze records containing SNOMED CT-coded data.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.2-terminology-service-categories#add-update-access)

Add-Update Access

User Interface

Examples

**No UI**

• Create new SNOMED CT concepts. • Add or modify axioms for defining concepts. • Classify SNOMED CT content to infer relationships. • Add descriptions to concepts. • Inactivate concepts or descriptions. • Create new reference sets of specific types. • Add members to reference sets.

**UI**

• SNOMED CT authoring tools for creating concepts with full descriptions and axioms. • Tools for maintaining subsets as reference sets. • Translation tools to manage language-specific descriptions and acceptability settings. • Mapping tools to develop and maintain crosswalks to other terminologies or code systems.

circle-check

Many of the general use cases identified in [Terminology Service Use Cases](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/3-terminology-service-use-cases)
 can be met in different ways by different combinations of the terminology services detailed in [Terminology Service Types](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types)
 with user interface components or forms. Therefore, detailed specifications of the specific functionality of combined terminology services would inevitably be either incomplete or overly restrictive.

Furthermore, user interfaces presented by a combined terminology service will typically need to be integrated with client applications. Client applications may adopt different user interface styles and these styles may evolve overtime. Therefore, flexibility in the design of the user interface through which a service is accessed may be preferable to a rigid detailed specification of each type of service.

Depending on feedback from readers, consideration will be given to providing more guidance on combined terminology services in future versions of this guide.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=SNOMED+Terminology+Services+Guide&entry.670899847=Terminology%20Service%20Categories)

[PreviousTerminology Services Overviewchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview)
[NextTerminology Service Roleschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.3-terminology-service-roles)

Last updated 5 months ago

*   [Access Requirements](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.2-terminology-service-categories#access-requirements)
    
*   [User Interface Requirements](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.2-terminology-service-categories#user-interface-requirements)
    
*   [Terminology Service Category Examples](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.2-terminology-service-categories#terminology-service-category-examples)
    
*   [Read-Only Access](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.2-terminology-service-categories#read-only-access)
    
*   [Add-Update Access](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.2-terminology-service-categories#add-update-access)
    

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# First Databank | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

circle-info

FDB (First Databank)... is the leading provider of drug knowledge that helps healthcare professionals make precise medication-related decisions... FDB enables our information system developer partners to deliver a wide range of valuable, useful, and differentiated solutions. As the company that virtually launched the medication decision support category, we offer more than three decades of experience in transforming drug knowledge into actionable, targeted, and effective solutions that improve patient safety and healthcare outcomes.

For more information please visit [http://www.fdbhealth.com/arrow-up-right](http://www.fdbhealth.com/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/first-databank#overview)

Overview


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First DataBank (FDB) were in the first wave of suppliers to recognize the potential of SNOMED CT and begin to integrate support for SNOMED CT into their existing clinical decision support solutions. Their primary use of SNOMED CT in the patient's electronic health record (EHR) is to detect safety issues arising from certain combinations of medications, diagnoses and drug adverse reaction histories. In 2006 FDB introduced support for products and packs encoded using the NHS SNOMED CT UK Drug Extension. In the following year FDB launched new modules within the Multilex drug knowledge base supporting Drug-Condition Checking and Drug Sensitivity (Allergy) checking for the SNOMED CT EHR.

System vendors implementing Multilex decision support within SNOMED CT-enabled medical record applications include CSC (Lorenzo system), EPIC and JAC in secondary care, and CSE Servelec (_RiO system)_ in community/mental health. Currently only pre-coordinated expressions are supported by the live Multilex SNOMED CT based decision support solutions.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/first-databank#drug-condition-contraindication-checks)

Drug-Condition Contraindication Checks


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The contraindications module alerts the clinician when a medication proposed to treat a disorder is incompatible with another of the patient's disorders or clinical states. For example a beta blocker like propranolol might be prescribed to treat someone with high blood pressure. However if that patient also has asthma, their asthma might significantly worsen or a dangerous acute attack might be produced by the drug.

Thousands of such drug-condition contraindications exist and nearly all medications have at least one. Without point of care decision support, the clinician must rely on memory or search reference sources for each drug prescribed. Also there is a risk that a contraindicating condition may be in the record but unknown to the prescribing clinician.

In a SNOMED CT enabled EHR, both the drugs (e.g. 318353009 | propranolol hydrochloride 40mg tablet| ) and the conditions (e.g. 370219009 | moderate asthma| ) are encoded.

Internally FDB maintain their own local ontology representing only those conditions relevant to prescribing decision support (e.g. asthma, gastric ulcer, heart disease, pregnancy). The items in this ontology are linked to SNOMED CT codes as required to support this (contraindication checking) use case. These SNOMED CT links range from the obvious, such as linking 195967001 | asthma| to FDB's 'asthma', to the more subtle, such as linking 447413000 | drainage of amniotic fluid using ultrasound guidance| to FDB's 'pregnancy'.

FDB reviews the relevant SNOMED CT domains (i.e. | Clinical finding|, | Procedure| and | Situation with explicit context| ) for concepts applicable to drug-condition checking. The FDB linking tool uses the SNOMED CT | is a| hierarchy and a SNOMED CT derived transitive closure table to locate and suggest links from the FDB ontology to SNOMED CT concepts. Other SNOMED CT relationships also help find related concepts via the browser but discovery is mainly by clinical knowledge combined with description based searches assisted by the rich synonym content of SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/first-databank#drug-sensitivity-allergy-checks)

Drug Sensitivity (Allergy) Checks


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The sensitivities module alerts the clinician when a proposed drug for a patient is _either_ stated in that patient's record to have caused a previous adverse reaction _or_ when an adverse reaction has occurred to a similar drug and thus likely to elicit a similar adverse response. For example, a patient allergic to penicillin is likely to react to most other drugs containing a β-lactam ring in their molecular structures.

In a similar way to how FDB links SNOMED CT conditions to its own internal ontology, SNOMED CT concepts which suggest allergy or previous adverse reactions to a medication are also linked to an internal FDB ontology for representing medication ingredients. This ontology is designed specifically to support allergic and adverse reaction cross-reactivity.

* * *

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Last updated 4 months ago

*   [Overview](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/first-databank#overview)
    
*   [Drug-Condition Contraindication Checks](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/first-databank#drug-condition-contraindication-checks)
    
*   [Drug Sensitivity (Allergy) Checks](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/first-databank#drug-sensitivity-allergy-checks)
    

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# Introduction to Search | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

Search is the process by which a user finds a Concept or Description to represent a clinical idea for a specific purpose.

The way a search is carried out depends on the setting in which it is performed. A simple search may involve typing a word or phrase in a search box, getting a list of matching terms and viewing the list to identify the appropriate Concept. This Guide considers a range of enhancements to SNOMED CT searches which can make it quicker and easier for users to find the appropriate Concept.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-d92f3217ab69ac0ec44838a836588e6f753bd403%252F52170899.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=b600689&sv=2)

Search process

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Search+And+Data+Entry+Guide&entry.670899847=Introduction%20to%20Search)

[PreviousIntroductionchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/1-introduction)
[NextThe Importance of Effective Searchchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/2-introduction-to-search/2.1-the-importance-of-effective-search)

Last updated 7 months ago

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# Terminology Service Types | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents

This section describes services required to enable effective use of SNOMED CT. The guide does not mandate a particular way to meet these requirements. In some cases, a single terminology service API call may address several of the requirements identified in this section of the guide. In other cases, multiple API calls may be required to address a single requirement.

*   [Select Edition and Version](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.1-select-edition-and-version)
    
*   [Get a Concept, Description or Relationship](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.2-get-a-concept-description-or-relationship)
    
*   [Get Terms for a Concept](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.3-get-terms-for-a-concept)
    
*   [Get Definition of a Concept](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.4-get-definition-of-a-concept)
    
*   [Get and Test Concept Subtypes and Supertypes](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.5-get-and-test-concept-subtypes-and-supertypes)
    
*   [Get and Test Reference Set Membership](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.6-get-and-test-reference-set-membership)
    
*   [Validate and Apply Expression Constraints](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.7-validate-and-apply-expression-constraints)
    
*   [Find Concepts](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.8-find-concepts)
    
*   [Identify Changes to the Terminology](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.9-identify-changes-to-the-terminology)
    
*   [Get Data from a Reference Set](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.10-get-data-from-a-reference-set)
    
*   [Get History Data](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.11-get-history-data)
    
*   [Get Mapping Data](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.12-get-mapping-data)
    
*   [Get Concept Model Rules](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.13-get-concept-model-rules)
    
*   [Validate Concept Definitions and Expressions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/validate-concept-definitions-and-expressions)
    
*   [Test Expression Subsumption](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.15-test-expression-subsumption)
    

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[PreviousSupport Terminology Authoring and Reviewchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/3-terminology-service-use-cases/support-terminology-authoring-and-review)
[NextSelect Edition and Versionchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.1-select-edition-and-version)

Last updated 5 months ago

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# Avoid Multiple Hits on the Same Concept | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

In many instances, several synonyms associated with the same Concept contain the same keyword _._ For example, | herniated structure |, | hernia |, | herniated tissue |, | herniated structure | and | herniation | all begin with "hernia". A search for the target Concept "hernia" would return the first phrase found during the search. Designing a filter that gives the user the option of filtering the results by description type such as the Preferred Term or the Fully Specified Name can significantly reduce the results, as illustrated in the image below.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.3-avoid-multiple-hits-on-the-same-concept#avoid-multiple-hits-on-the-same-concept-by-filtering-the-search-by-description-type)

Avoid Multiple Hits on the Same Concept by Filtering the Search by Description Type


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Step 1

Step 2

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252F6bnsgKYbcWYvA3RaJaCI%252FStep%25201%25205.3%2520hernia.png%3Falt%3Dmedia%26token%3D580cd053-bd63-4918-a4fe-ace6a3bc1e94&width=768&dpr=3&quality=100&sign=43521044&sv=2)

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252FMCgFvjVfm6x6dJrjyY76%252F5.3%2520Step%25202%2520hernia.png%3Falt%3Dmedia%26token%3Dbcffb774-c16a-46f6-8b19-8ed7ea617f53&width=768&dpr=3&quality=100&sign=47c82883&sv=2)

_Filtering search results to show only the Fully Specified Name (search also constrained by supertype ancestor)_

Designing a filter gives the user the option of filtering the results to show only the Description associated with the Concept that is the closest match to the search term, as illustrated in the image below.

Step 1

Step 2

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252FN9eoIxXOLQxmPj9AhYcf%252F5.3%2520step%25201%2520closest%2520match.png%3Falt%3Dmedia%26token%3De44a5ce9-aac0-401e-ba37-233c6a60cc22&width=768&dpr=3&quality=100&sign=433ffac&sv=2)

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252FhaQok5PZwj1otHlzTH5m%252F5.3%2520Step%25202%2520closest%2520match.png%3Falt%3Dmedia%26token%3D94f20a05-0e5e-4ece-9c19-faa716f29963&width=768&dpr=3&quality=100&sign=715fe94c&sv=2)

_Filtering search results to show only the closest match to the search term, hernia (search also constrained by supertype ancestor)_

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[PreviousDistinguish Identical Terms of Different Conceptschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/5-optimize-display-of-search-results/5.2-distinguish-identical-terms-of-different-concepts)
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Last updated 7 months ago

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# Search by Text | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

This section describes different techniques that can be used when searching by text.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-by-text-containing-diacritic-and-accented-characters)

Search by Text Containing Diacritic and Accented Characters


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Diacritic and accented characters should be properly retrieved and displayed to ensure the completeness of a search. For instance, Sjögren must also be found by 'sjogren' and Ménière by 'meniere'). This example is specific for searches in English or in languages that do not use special characters. In countries, such as Swedish and Danish, that use special characters, it would be wrong to return "Sjögren" when searching from "Sjogren".

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-for-description-that-begin-with-the-search-text)

Search for Description that Begin with the Search Text


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This technique enables the user to find Concepts and Descriptions that begin with the text string entered in the search box. This search potentially reduces the number of keystrokes required to enter the search string. This technique is also used in scenarios where the user needs to find Concepts where they know the start of the description, but not the entire description. It is maybe, for many uses cases, a very useful technique to be configured as a pre-selected option that is user configurable.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-bf7c4642efc33d7aac765ee3db152738ffaa80b9%252F52171310.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=ef7f8ac9&sv=2)

Search for descriptions that start with "hernia"

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-for-descriptions-that-contain-the-search-text)

Search for Descriptions that Contain the Search Text


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This technique may be used in scenarios where a user needs to find the required text anywhere in the term string including in the middle of words. However, this technique may take a lot of processing power, which could potentially impact search performance or the overall system performance. A large number of results may be returned which contain non-useful fragments (e.g. 'ete'). On the other hand, using this technique may be useful in languages that use contractions, such as German and Dutch, and there may be scenarios where the user may want to extensively search for the required text anywhere in the term string including in the middle of words such as medical pseudo-Latin & Greek terms (e.g.'gastroduodenostomy'). It is therefore useful to have this option user configurable and not have it configured as a default option.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-d7be3b184a1ca6f745ffbedfcc304ea7651db526%252F52171312.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=1ef7b3c7&sv=2)

Searching for descriptions that contain "hernia"

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-for-descriptions-that-end-with-the-search-text)

Search for Descriptions that End with the Search Text


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This technique enables the user to find Concept and Descriptions that end with word ending(s) entered in the search box. This is not considered to be a very useful technique for many use cases, nevertheless, there may be scenarios where the user may want to search for the required text at the end of words. E.g. drugs ending in "statin" – finds Atorvastatin, Cerivastatin, Fluvastatin. It may be useful to have this option user configurable and configured as a default option.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-b803f1a1dbac0565ae6758bc9c6ea454af430405%252F52171314.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=b8dc7b2a&sv=2)

Searching for descriptions that end with "hernia"

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-for-words-within-any-order)

Search for Words within Any Order


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This technique enables the user to find descriptions that contain the search text string(s), whether these are at the beginning, at the end or in the middle of a description. This search type would be useful for users who do not know how words are ordered in the descriptions. It may be useful to have this option user configurable and not have it configured as a default option.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-4109a08bd992e62b4637bbe6c05a97b64fea7488%252F52171316.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=a0b8bd7a&sv=2)

Searching for words in any order

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-for-identical-terms)

Search for Identical Terms


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This technique enables exact matches to be found in the search result instantly regardless of the interposing words; otherwise, search on a single word may produce many matches. This technique should be used in scenarios where the wording of the desired description is known to the user who wants to search for and instantly select from the search candidates without having to scroll through a long list of search results. It may be useful to have this option user configurable and not have it configured as a default option as it may overly constrain the search leading to missing candidates.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-d503e174fdee66afda8e43a2871d737a6568169f%252F52171318.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=1b2ef95e&sv=2)

Searching for identical terms

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-for-words-in-a-specific-order-or-a-matching-phrase)

Search for Words in a Specific Order or a Matching Phrase


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This technique enables the user to find Descriptions that matches all words in the search text. This means that the order of terms in the Concept or Description should be in the exact same order as the terms fully or partially represented in the search text. It may be useful to have this option user configurable and not have it configured as a default option.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-bdc9580e988e0d068b17fcc7ae36c6e0a7d6c252%252F52171321.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=eeb93e41&sv=2)

Searching for words in order or a matching phrase

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Search+And+Data+Entry+Guide&entry.670899847=Search%20by%20Text)

[PreviousOptimizing Searcheschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches)
[NextSearch by Identifierschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.2-search-by-identifiers)

Last updated 7 months ago

*   [Search by Text Containing Diacritic and Accented Characters](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-by-text-containing-diacritic-and-accented-characters)
    
*   [Search for Description that Begin with the Search Text](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-for-description-that-begin-with-the-search-text)
    
*   [Search for Descriptions that Contain the Search Text](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-for-descriptions-that-contain-the-search-text)
    
*   [Search for Descriptions that End with the Search Text](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-for-descriptions-that-end-with-the-search-text)
    
*   [Search for Words within Any Order](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-for-words-within-any-order)
    
*   [Search for Identical Terms](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-for-identical-terms)
    
*   [Search for Words in a Specific Order or a Matching Phrase](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.1-search-by-text#search-for-words-in-a-specific-order-or-a-matching-phrase)
    

sun-brightdesktopmoon

sun-brightdesktopmoon

---

# Choosing an Approach to Implementation | Practical Guides Vendor Introduction to SNOMED CT | SNOMED International Documents

*   What is the target configuration for the particular EHR where SNOMED CT will be used?
    
*   Should the target configuration be achieved in just one stage or in a sequence of stages, and if so what are the stages?
    
*   Should SNOMED CT content be held alongside other system reference data or separately?
    
*   Should SNOMED CT implementation be done natively within the EHR system or through integration with a third-party provider of terminology services?
    

The diverse nature of EHR systems, as well as the wide scope of SNOMED CT, means that there can be no universal approach. There are different ways to achieve similar outcomes and variation between the development sequences taken to reach the same outcome.

Implementation strategy and planning is discussed here by addressing:

*   The different locations for use of SNOMED CT within EHR systems and subsystems
    
*   What is commonly done for each
    
*   Some common implementation stages: moving to more extensive or more integrated use
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#introduction-to-target-configurations)

Introduction to Target Configurations


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The simplified depiction of an EHR system shown in Figure 5 is used to illustrate a variety of alternative configurations in which SNOMED CT is implemented in one of more of the component parts of an EHR.

Figure 5. Schematic illustration of an EHR system

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-9fa2404590ecb011248831250ca7c2d62cee5045%252F29951611.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=18a8e269&sv=2)

The illustration above shows as separate components the user interface, data storage and external data communication, for systems interoperation. In the SNOMED CT documentation these are considered collectively to be part of a Clinical Records implementation. Other types of implementation include linking to Knowledge Resources and Aggregation and Analysis. These are illustrated above by the Knowledge Resources and Reporting and Analytics components. In the diagram, a distinction is made between Reference Data such as SNOMED CT or ICD-10, and the clinical data records held in the clinical data store. Separate from both of these is the Analysis Data Store in which copies of parts of the collection of clinical data records are held separately in support of data analysis and reporting.

One way of categorizing the components illustrated above is:

*   Used by clinicians caring for individual patients – entry, display, use of decision support
    
*   Used by those interested in management, statistical or other population/cohort data – retrieval, analysis, research, epidemiology
    

The diagrammatic conventions used in this section are shown in Figure 6 below

Figure 6. Color key for Figure 7 to Figure 16 inclusive

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-516d9b8b3cb60b73ea30026fb1927676feea2c7a%252F29951612.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=fe1fb118&sv=2)

The rest of the section introduces ten ways in which SNOMED CT can be used in EHR systems. As mentioned earlier, these are not exhaustive or even fully mutually exclusive, but just illustrative. Ten approaches of using SNOMED CT are:

1.  As a reference terminology for communication
    
2.  As a reference terminology for data integration
    
3.  As an indexing system for data retrieval
    
4.  As a code system for clinical data storage
    
5.  As an interface terminology for data entry
    
6.  For simple aggregation and analysis
    
7.  For complex analytics using description logic
    
8.  For knowledge linkage
    
9.  As an extensible foundation for representing clinical data
    
10.  Full use of all SNOMED CT features
    

Based on the categorization introduced earlier about clinician use or use by others, approaches 1, 2, 4, 5, 8, 9 and 10 are primarily aimed at clinician use, whereas approaches 3, 6 and 7 are primarily aimed at use by others. However approaches 6 and 7 include elements of interest to clinicians, and approaches 9 and 10 include elements of interest to others.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-1.-snomed-ct-as-a-reference-terminology-for-communication)

1\. SNOMED CT as a Reference Terminology for Communication


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Figure 7. SNOMED CT as a Reference Terminology for Communication

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-b697d2adfd4d69dc24d4e780eebf2cc5dbfd0186%252F29951613.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=e06d69e4&sv=2)

This approach uses SNOMED CT as a 'Reference Terminology', mapping clinical record data to SNOMED CT for inbound and outbound communications with other systems. Where there is a need to exchange SNOMED CT encoded clinical data with other systems, this approach has merit. For an EHR system without any pre-existing SNOMED CT implementation, this approach is likely to have lower costs for re-engineering than other options; however it does not offer any benefits apart from enhanced data exchange. The transformation to and from SNOMED CT will need to be maintained over time and the mapping may result in some information loss.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits)

Benefits

*   Communication using shared meaning based on SNOMED CT Concept identifiers
    
*   No changes required to core clinical system
    
*   Supports research and analysis in external systems
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#considerations)

Considerations

*   The benefits derived from a more extensive use of SNOMED CT are not realized
    
*   This approach allows continuity of systems interoperation despite limited use of SNOMED CT, in an environment which requires some use of SNOMED CT
    
*   This requires that a sufficient proportion of existing coded clinical items can be successfully mapped to and from SNOMED CT
    
*   Mapping between the terminology scheme used in the EHR and SNOMED CT needs to be kept up-to-date
    
*   Exceptions will need to be gracefully handled
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-2.-snomed-ct-as-a-reference-terminology-for-data-integration)

2\. SNOMED CT as a Reference Terminology for Data Integration


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Figure 8. SNOMED CT as a Reference Terminology for Data Integration

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-5973b58f79605d22c1969bea87aa37ba500461b0%252F29951606.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=f0e6c851&sv=2)

This approach uses SNOMED CT as a 'Reference Terminology' for data integration, by transforming the various codes and free text received from external systems into SNOMED CT. This approach will usually be combined with one of the following approaches that uses the integrated data for reporting, querying, decision support, or displaying to the user in a consistent way.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-1)

Benefits

*   Patient data may be integrated from a variety of structured and unstructured sources, including hospital health record systems and mobile devices
    
*   Patient data coded in a consistent way can be used for analytics, querying, decision support or displaying to the user
    
*   Correlations between data from disparate sources can be made using SNOMED CT's defining relationships
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#considerations-1)

Considerations

*   Mapping between the source code systems and SNOMED CT needs to be kept up-to-date
    
*   Natural Language Processing to encode unstructured records may need manual validation to ensure high quality coding
    
*   Exceptions will need to be handled gracefully
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-3.-snomed-ct-as-an-indexing-system-for-data-retrieval)

3\. SNOMED CT as an Indexing System for Data Retrieval


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Figure 9. SNOMED CT as an Indexing System for Data Retrieval

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-d4df913a110a0e736dda65c5259dc34bdcc5b9f8%252F29951607.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=de61a9be&sv=2)

This approach has benefits for those who perform data analysis as well as for front-line clinical users. It features no change to data entry or the principal clinical data storage. Records stored as narrative text or using other code systems are processed by a routine that matches the stored codes (and/or narrative text) to appropriate precoordinated SNOMED CT concepts. The end result is a representation of relevant parts of the record information tagged and indexed using SNOMED CT. The resulting index is then used by the Reporting and Analytics subsystem to support querying, retrieval and analysis using terminology based on SNOMED CT.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-2)

Benefits

*   Supports research and analysis in a local system or shared data warehouse
    
*   Supports use of SNOMED CT for analysis and reporting
    
    *   For identification of cohorts of patients for research studies
        
    *   For exploration of data in support of clinical process review
        
    *   To improve the user experience of longitudinal record review
        
    
*   Zero or minimal disruption to run-time processes
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#considerations-2)

Considerations

*   The benefits derived from a more extensive use of SNOMED CT are not realized
    
*   This requires that a sufficient proportion of existing coded clinical items can be successfully mapped to and from SNOMED CT
    
*   Individual coded items may map to more than one target in SNOMED CT; in some computations, this will require the selection of just one target from the set of candidates, in others it will be unproblematic
    
*   Quality of the clinical data itself may be the dominant factor in the value of this approach, more than the existence of exceptions e.g. where no single map exists for a coded item
    
*   Exceptions will need to be gracefully handled
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-4.-snomed-ct-as-a-code-system-for-clinical-data-in-the-ehr)

4\. SNOMED CT as a Code System for Clinical Data in the EHR


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Figure 10. SNOMED CT as a Code System for Clinical Data in the EHR

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-57d2f0e6bd6933a9958b49dab3f8a73cedaf0ea3%252F29951608.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=9d9c48c1&sv=2)

An implementer who is motivated to introduce SNOMED CT records, but who is also keen to keep changes to the clinical user experience to an absolute minimum, may choose this approach. It can be a low risk step towards a more extensive use of SNOMED CT. The quality of the map between the 'retained interface terminology' and precoordinated SNOMED CT concepts will need to meet a variety clinical governance requirements, as set locally. As the data store content uses SNOMED CT, SNOMED CT concept codes are available for communicating with external systems. An approach of this type is likely to be recognized as 'storing and exchanging records using SNOMED CT'.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-3)

Benefits

*   No change to terms that clinicians are used to seeing in the user interface
    
*   Patient data stored using SNOMED CT concepts
    
*   Communication using shared meaning
    
*   Can utilize internationally developed mappings such as the mappings to ICD-9 and ICD-10
    
*   SNOMED CT is available for direct use in electronic communications
    
*   Standardized integration with decision support rules
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#considerations-3)

Considerations

*   This requires that a sufficient proportion of existing interface terminology can be successfully mapped to SNOMED CT
    
*   An ideal map between the interface terminology and SNOMED CT is a one-to-one map.
    
    *   Exceptions will need to be handled gracefully where no map exists between an existing interface item and SNOMED CT.
        
    *   It may be appropriate to adjust the interface item to remove any ambiguity.
        
    
*   Mapping between the interface terminology and SNOMED CT needs to be kept up-to-date
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-5.-snomed-ct-as-an-interface-terminology-for-ehr-data-entry)

5\. SNOMED CT as an Interface Terminology for EHR Data Entry


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Figure 11. SNOMED CT as an Interface Terminology for EHR data entry

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-acfd47903e9985a9effd3a8df2cd1197252d916a%252F29951609.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=da71d66b&sv=2)

Employing SNOMED CT at the user interface is the distinction of this approach from the preceding one. It removes the complexity of creating and maintaining a map from the interface terminology to SNOMED CT. Given the large number of terms available in SNOMED CT, this approach may be supported by the use of SNOMED CT subsets to constrain the search for the appropriate SNOMED CT concept. As the data store content uses SNOMED CT, concept codes are available for communicating with external systems. Furthermore SNOMED CT can act as a readily available source of master reference data e.g. allergen list.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-4)

Benefits

*   Standardized descriptions in the user interface
    
*   No mapping required between interface terms and codes stored in patient record
    
*   Supports enhanced techniques for data entry, search and display e.g. searching over synonyms of the same concept
    
*   Patient data stored using SNOMED CT concepts
    
*   Readily available master reference data e.g. allergen list
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#considerations-4)

Considerations

*   This approach may require a transition of the user experience. However, it should be noted that new descriptions may be added to SNOMED CT to meet the expectations of the users.
    
*   Subsets need to be created and maintained to support users in searching for and recording the appropriate SNOMED CT concepts
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-6.-snomed-ct-for-simple-aggregation-and-analysis-of-data)

6\. SNOMED CT for Simple Aggregation and Analysis of Data


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Figure 12. SNOMED CT as a dictionary for simple aggregation and analysis of data

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-d5207bc6b279441b84fc9a4c051575557dd384f7%252F29951610.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=9b5458c0&sv=2)

Building on the previous implementation approach, the addition of analytics functions using SNOMED CT, as shown in Figure 12, provides enhanced capabilities. For example, this approach enables the identification of cohorts of patients based on given criteria, the ability to review conformance to care standards and responding to mandatory reporting requirements. A key advantage of this approach is that it does not rely on any terminology mappings, either from a local terminology or from an interface terminology. Using SNOMED CT's hierarchies and defining relationships, this approach supports querying and aggregation over health records. Both data analysts and clinicians gain the analytic power from SNOMED CT.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-5)

Benefits

*   Supports the use of SNOMED CT for analysis and reporting purposes, such as:
    
    *   To improve the user experience of longitudinal record review
        
    *   For exploration of data in support of clinical process review
        
    *   For identification of cohorts of patients for research studies
        
    *   To meet mandatory reporting requirements
        
    
*   Can utilize internationally developed mappings such as the mappings to ICD-9 and ICD-10
    
*   Standardized descriptions in the user interface
    
*   Patient data stored using SNOMED CT concepts
    
*   Communication using shared meaning
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-7.-snomed-ct-for-analytics-using-description-logic)

7\. SNOMED CT for Analytics Using Description Logic


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Figure 13. SNOMED CT as a dictionary for analytics using Description Logic

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-4e5ee3da322bca7fe74ca1c53ef38d615febbb6e%252F29951603.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=dd51273a&sv=2)

This approach may suit users who value the additional analytics capability that may be achieved with full computational use of SNOMED CT concept definitions. The enhanced analytic capabilities of this approach enables more effective record retrieval by minimizing the occurrence of false negative results, thereby improving the user experience.

In the Reporting and Analytics tools, this approach uses techniques from Description Logic. It does not include the use of SNOMED CT postcoordinated expressions for data entry and storage, however it does exploit the definitions of each SNOMED CT concept based on description logic.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-6)

Benefits

*   More sophisticated and flexible reporting and analysis
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-8.-snomed-ct-for-knowledge-linkage)

8\. SNOMED CT for Knowledge Linkage


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Figure 14. SNOMED CT for knowledge linkage

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-6fe78d3f11d7365ff679247932fb415c9b446b94%252F29951604.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=ebf8af19&sv=2)

An enhancement to the approach set out earlier in Figure 11 is the addition of one or more SNOMED CT-enabled knowledge resources. This configuration includes a collection of knowledge resources (such as clinical guidelines or decision support systems) which use the SNOMED CT codes stored in a patient's record to determine which actions should be performed. This may include presenting alerts to the user, displaying relevant clinical guidelines and treatment protocols, or automatically populating an order, message or report.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-7)

Benefits

*   Enables integration of EHR with knowledge bases
    
*   Rules can use SNOMED CT's hierarchy and defining relationships for aggregation and querying
    
*   Can be used to provide real-time clinical alerts relevant to the given patient
    
*   Can be used to suggest relevant clinical guidelines and protocols relevant to the given patient
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-9.-snomed-ct-as-an-extensible-foundation-for-representing-clinical-data)

9\. SNOMED CT as an Extensible Foundation for Representing Clinical Data


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Figure 15. SNOMED CT as an Extensible Foundation for Representing Clinical Data

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-4575471a41a1f339525cff7e758e6c512aa2a310%252F29951605.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=1e4eb02&sv=2)

Figure 13 showed the exploitation of SNOMED CT concept definitions for analysis, but did not feature postcoordinated SNOMED CT expressions in the patient records. In contrast, the approach illustrated in Figure 15 supports the creation, storage, retrieval and display of records which use postcoordinated SNOMED CT expressions. It does not necessarily feature analytics tools dedicated to postcoordinated content. One reason to adopt this approach is to enable combinations of content to be stored together as a single data field e.g. to record the laterality of a procedure together with the procedure in a single field, rather than using separate fields.

This approach allows a variety of refinements to be made to existing concepts, e.g. 'pneumonia caused _by streptobacillus_ ' (as illustrated on page ). An option for this approach is to use a SNOMED CT expression repository to identify, store and share the postcoordinated expressions which have been used.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-8)

Benefits

*   Increases the scope of supported clinical meaning using structured data
    
*   Supports the construction of concepts as SNOMED CT expressions either:
    
*   By the end users themselves
    
*   During system design and configuration
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#considerations-5)

Considerations

*   External systems to which patient data is sent may not have the capability to process postcoordinated SNOMED CT expressions
    
*   Data storage and message fields, which need to include SNOMED CT postcoordinated expressions, must support an adequate field length
    
*   Retrieving patient records with postcoordinated content may require a more sophisticated approach to querying
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-10.-full-use-of-snomed-ct-to-deliver-all-its-powerful-features-in-an-ehr)

10\. Full Use of SNOMED CT to Deliver all its Powerful Features in an EHR


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Figure 16. Full use of SNOMED CT to deliver all its powerful features in an EHR

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1723233442-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FQoBkzGO8Ufkm7izM5BB1%252Fuploads%252Fgit-blob-460d298a6c354170db9edbf5155abd6545ca0c3d%252F29951602.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=f0563ed7&sv=2)

This illustration shows a system in which all components are capable of using and exploiting the full features of SNOMED CT. Throughout the system it is possible to exchange, interpret and use information encoded as postcoordinated SNOMED CT expressions, and to perform analytics using Description Logic.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-9)

Benefits

*   This system combines all the benefits identified for the preceding approaches.
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#summary)

Summary


------------------------------------------------------------------------------------------------------------------------------------------------------------

The collection of approaches listed in this section illustrate that there are a variety of ways by which this 'Full use' can be reached. These approaches can be summarized by considering the set of SNOMED CT features that are used in each:

*   Concepts and maps (approaches 1 and 4)
    
*   Concepts, relationships and maps (approaches 2 and 3)
    
*   Concepts, descriptions and subsets (approach 5)
    
*   Concepts, descriptions, relationships and subsets (approaches 6 and 8)
    
*   Concepts, descriptions, relationships, subsets and description logic (approach 7)
    
*   Concepts, descriptions, relationships, subsets and expressions (approach 9)
    
*   Concepts, descriptions, relationships, subsets, description logic, expressions and maps (approach 10)
    

While the last approach (approach 10) could be considered as a possible target configuration, for most EHR products a staged journey towards a more comprehensive design is most appropriate.

* * *

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Vendor+Introduction&entry.670899847=Choosing%20an%20Approach%20to%20Implementation)

[PreviousIntroduction to SNOMED CTchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/3-introduction-to-snomed-ct)
[NextImplementation Strategies and Considerationschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/5-implementation-strategies-and-considerations)

Last updated 7 months ago

*   [Introduction to Target Configurations](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#introduction-to-target-configurations)
    
*   [1\. SNOMED CT as a Reference Terminology for Communication](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-1.-snomed-ct-as-a-reference-terminology-for-communication)
    
*   [Benefits](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits)
    
*   [Considerations](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#considerations)
    
*   [2\. SNOMED CT as a Reference Terminology for Data Integration](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-2.-snomed-ct-as-a-reference-terminology-for-data-integration)
    
*   [Benefits](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-1)
    
*   [Considerations](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#considerations-1)
    
*   [3\. SNOMED CT as an Indexing System for Data Retrieval](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-3.-snomed-ct-as-an-indexing-system-for-data-retrieval)
    
*   [Benefits](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-2)
    
*   [Considerations](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#considerations-2)
    
*   [4\. SNOMED CT as a Code System for Clinical Data in the EHR](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-4.-snomed-ct-as-a-code-system-for-clinical-data-in-the-ehr)
    
*   [Benefits](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-3)
    
*   [Considerations](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#considerations-3)
    
*   [5\. SNOMED CT as an Interface Terminology for EHR Data Entry](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-5.-snomed-ct-as-an-interface-terminology-for-ehr-data-entry)
    
*   [Benefits](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-4)
    
*   [Considerations](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#considerations-4)
    
*   [6\. SNOMED CT for Simple Aggregation and Analysis of Data](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-6.-snomed-ct-for-simple-aggregation-and-analysis-of-data)
    
*   [Benefits](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-5)
    
*   [7\. SNOMED CT for Analytics Using Description Logic](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-7.-snomed-ct-for-analytics-using-description-logic)
    
*   [Benefits](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-6)
    
*   [8\. SNOMED CT for Knowledge Linkage](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-8.-snomed-ct-for-knowledge-linkage)
    
*   [Benefits](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-7)
    
*   [9\. SNOMED CT as an Extensible Foundation for Representing Clinical Data](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-9.-snomed-ct-as-an-extensible-foundation-for-representing-clinical-data)
    
*   [Benefits](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-8)
    
*   [Considerations](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#considerations-5)
    
*   [10\. Full Use of SNOMED CT to Deliver all its Powerful Features in an EHR](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#id-10.-full-use-of-snomed-ct-to-deliver-all-its-powerful-features-in-an-ehr)
    
*   [Benefits](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#benefits-9)
    
*   [Summary](https://docs.snomed.org/snomed-ct-practical-guides/vendor-introduction-to-snomed-ct/4-choosing-an-approach-to-implementation#summary)
    

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# Appendix B: Editions, Versions and Extensions | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents

This appendix explains the different types of SNOMED CT editions, versions, and extensions. It also outlines the requirements for terminology services and applications that use them.

* * *

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/appendixes/appendix-b-editions-versions-and-extensions#requirements)

Requirements


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*   **Terminology service providers** must deliver services that can load data from SNOMED CT release packages that conform to the Release File Specifications.
    
    *   They must enable client applications to access the content of a selected SNOMED CT versioned edition.
        
    *   They should also enable access to extended versioned editions that include additional modules compatible with the selected edition.
        
    *   They must provide access to data identifying which versioned edition (or extended versioned edition) is currently being accessed.
        
    
*   **Terminology service users** must ensure that the services they procure can be configured to access the SNOMED CT versioned editions (or extended editions) required by their organization, specialty, or national authority.
    
*   **Healthcare application providers** must ensure that applications:
    
    *   Support access to configurable terminology services that can provide the required editions.
        
    *   Track the history of the edition or extension in use, since this may affect data interpretation and analysis.
        
    

> A **SNOMED CT edition** is a complete set of SNOMED CT components and reference set members that either belong to an identified module, or to one of the modules on which that module depends.

* * *

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/appendixes/appendix-b-editions-versions-and-extensions#notes-on-editions)

Notes on Editions


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

*   The module that defines the scope of an edition is called the **focus module**.
    
*   All editions (except the International Edition) combine one or more extension modules with the International Edition.
    
*   A complete edition may be prepared and released by SNOMED International, a National Release Center, or an Affiliate.
    
*   Dependencies between modules are recorded in the **Module Dependency Reference Set**.
    
*   Editions can be identified using a **Uniform Resource Identifier (URI)** as defined in the URI Standard.
    

* * *

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/appendixes/appendix-b-editions-versions-and-extensions#edition-types)

Edition Types


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Edition Type

Definition

Notes

**International Edition**

The set of SNOMED CT components and reference set members that belong to the International focus module or its dependencies.

Includes foundational content required by all other modules. The focus module is currently the **SNOMED CT core module**, with **SNOMED CT model component module** as a dependency. Can be supplemented by national or affiliate extensions.

**Member / National Edition**

A set of components and reference set members that belong to a focus module defined by a National Release Center (NRC) or its dependencies.

NRCs may produce multiple editions. Typically combines a national focus module with the International Edition and other required extensions. Distributed as part of a National Release.

**Affiliate Edition**

A set of components and reference set members that belong to a focus module created by an Affiliate Licensee with an allocated namespace, or its dependencies.

May extend the International Edition or a National Edition.

**Extended Edition**

A SNOMED CT edition to which additional modules have been added.

Used to add modules containing maps, subsets, or other derivatives. Dependencies must be satisfied. Additional modules may include reference sets, metadata concepts, and subtype relationships, but not new clinical concepts, descriptions, or relationships.

**Versioned Edition**

A SNOMED CT edition that is published on a specific date.

International releases occur twice a year (January and July). National extensions often follow, with some delays. Some extensions (e.g., medication-related) may release more frequently.

**Extended Versioned Edition**

A versioned edition with additional modules added.

Must satisfy all module dependencies. Additional modules may include reference sets, metadata concepts, and subtype relationships, but not new concepts, descriptions, relationships, or OWL members.

* * *

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=SNOMED+Terminology+Services+Guide&entry.670899847=Appendix%20B%3A%20Editions%2C%20Versions%20and%20Extensions)

[PreviousAppendix A: Summary of Types and Use Caseschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/appendixes/appendix-a-summary-of-types-and-use-cases)

Last updated 5 months ago

*   [Requirements](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/appendixes/appendix-b-editions-versions-and-extensions#requirements)
    
*   [Notes on Editions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/appendixes/appendix-b-editions-versions-and-extensions#notes-on-editions)
    
*   [Edition Types](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/appendixes/appendix-b-editions-versions-and-extensions#edition-types)
    

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# Kaiser Permanente | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

circle-info

Founded in 1945, Kaiser Permanente is one of the nation’s largest not-for-profit health plans, serving more than 11.3 million members, with headquarters in Oakland, California. The (Kaiser Permanente HealthConnect ) system facilitates communication between our members and health professionals to help make getting well and staying healthy easy and convenient. It improves member safety and quality of care by providing access to comprehensive patient information and the latest best practice research in one place. \\

For more information please visit [https://healthy.kaiserpermanente.org/arrow-up-right](https://healthy.kaiserpermanente.org/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/kaiser-permanente#overview)

Overview


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Kaiser Permanente (KP) has a long history with SNOMED CT, dating back to the 1990s when they collaborated with the College of American Pathologists (CAP) on the development of SNOMED RT (Reference Terminology). KP was also one of the first healthcare organizations to implement a SNOMED CT enabled health record (EHR). [KP HealthConnectarrow-up-right](https://share.kaiserpermanente.org/total-health/connectivity/)
 (KPHC), Kaiser Permanente's enterprise electronic medical record, was developed by Epic and hosts the records of over 10 million patients. KPHC uses a set of clinician and patient friendly terminologies, collectively known as the Convergent Medical Terminology (CMT), with SNOMED CT as its core reference terminology. KP has made their contributions to SNOMED CT available to the broader community by donating CMT to SNOMED International and the US National Library of Medicine (NLM).

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/kaiser-permanente#kp-healthconnect)

KP HealthConnect


-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

KP loads SNOMED CT in its native RF2 format into the HealthConnect EMR system. The EMR "Chart Search" functionality can execute a global search for diagnoses, procedures, and laboratory results against a given patient. All patient encounters that match the resulting criteria are displayed to the clinician. This provides a global summary of all encounters which relate to a given condition. This function takes advantage of the hierarchical structure of SNOMED CT. KP also maps the "clinician friendly" terms used in the EMR to SNOMED CT to meet [Meaningful Usearrow-up-right](https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives)
 and Health Information Exchange reporting requirements.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/kaiser-permanente#value-sets)

Value Sets


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Value sets are an integral part of terminology management services at Kaiser Permanente. Value set identification, development, deployment, and maintenance is performed using a custom tool developed within KP. This "Subset Management" tool utilizes the native ontological structure of SNOMED CT and adds KPHC local terminology as additional artifacts within the terminology model. The formal concept definitions of SNOMED CT are used to define and generate the required value sets. The "CMT Query" tool also uses the hierarchy of SNOMED CT and description logic reasoning to identify value sets of clinician friendly terms used in patient clinical encounters. These value sets are also used within KPHC to drive business intelligence (including CDS), support workflow, and enable data reporting and analytics. As shown in the screen shot below, the queries used to define value sets leverage SNOMED CT defining relationships, such as those using the attributes 363698007 | Finding site| and 116676008 | Associated morphology|.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-01792d09ce3b9688a92546a3ae95c40b4b6cc94a%252F123897680.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=f71f5f74&sv=2)

KP Query Tool enables subset management using SNOMED CT's hierarchy and defining relationships

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/kaiser-permanente#clinical-decision-support)

Clinical Decision Support


-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

KP uses the native functions provided by Epic to define and maintain CDS rules. This accounts for all criteria used in the rules, such as inclusions and exclusions. A screen shot of the tool used to define these criteria is shown below.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-2ec2d80b5781d69bbb928fb82a1cee998aedd255%252F123897681.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=204d14cb&sv=2)

KP uses Epic's built-in functions to define CDS rules (in this case a best practice advisory).

Clinical decision support at Kaiser Permanente leverages the value sets developed by their CMT team. For example, a CDS rule which uses value sets associated with 195967001 | Asthma| and 33252009 | beta-blocker| drugs is used to trigger an alert when specific conditions are met in the patient encounter, diagnosis, or problem list. The diagram below shows the associated value sets used in this rule.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-e8658796ae8fc4691e235fc9098737ba38aedd3e%252F123897684.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=2fef840&sv=2)

An example of an alert that uses SNOMED CT value sets in business intelligence and CDS at KP

* * *

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=CDS+Guide&entry.670899847=Kaiser%20Permanente)

[PreviousEBMPracticeNetchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/ebmpracticenet)
[NextNational Institutes of Health: Intramural Research Programchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/national-institutes-of-health-intramural-research-program)

Last updated 4 months ago

*   [Overview](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/kaiser-permanente#overview)
    
*   [KP HealthConnect](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/kaiser-permanente#kp-healthconnect)
    
*   [Value Sets](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/kaiser-permanente#value-sets)
    
*   [Clinical Decision Support](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/kaiser-permanente#clinical-decision-support)
    

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# Service Implementation Considerations | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents

SNOMED CT is made available to license holders in release packages containing sets of files that represent SNOMED CT components and. The content of these files provides the source data to which a terminology service provides access. This chapter provides guidance on how the structure and content of different release packages should be accessed and used to enable desired services. This chapter is important for those designing, developing, and maintaining terminology services, as they require a thorough understanding of the structure and content of different release packages and the release files they contain.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=SNOMED+Terminology+Services+Guide&entry.670899847=Service%20Implementation%20Considerations)

[PreviousTest Expression Subsumptionchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.15-test-expression-subsumption)
[NextTerminology Data Storage and Accesschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/5-service-implementation-considerations/5.1-terminology-data-storage-and-access)

Last updated 5 months ago

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# Introduction | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/1-introduction#background)

Background


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SNOMED CT is a clinically validated, semantically rich, controlled terminology. SNOMED CT is comprised of concepts with human-readable descriptions and a hierarchical structure supported by machine-readable logic-based definitions. SNOMED CT is used within electronic health records to support data capture, retrieval, and subsequent analysis and reuse for a range of purposes. The SNOMED CT design also includes features that support multilingual terms, subsets, maps to other codes systems, formal constraint specifications and comprehensive history tracking.

When implemented in software applications, SNOMED CT can represent clinically relevant information consistently, reliably and comprehensively as an integral part of electronic health records. This requires effective access to terminology content in ways that leverage the features of the terminology. A terminology service is a software function that interfaces with and provides access to information from one or more representations of a terminology.

Some services described in this guide are also applicable to other code systems, classifications and terminologies. However, delivery of the full set of benefits of SNOMED CT also requires terminology services that access and make effective use of features that are specific to SNOMED CT.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/1-introduction#purpose)

Purpose


--------------------------------------------------------------------------------------------------------------------------------------

The purpose of this document is to identify and describe the terminology services required to support effective access to the content and features of SNOMED CT. The guide also outlines approaches to delivery for some of the most important services. In some cases, more extensive details of service requirements and delivery options are provided by reference to other SNOMED CT documents or appendixes to this document. Where appropriate, this document may also include practical illustrations of a service by reference to specifications of existing tools or interfaces.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/1-introduction#scope)

Scope


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The content of this guide is primarily focused on the terminology service requirements of applications that enable the use of SNOMED CT for clinical purposes. This include electronic health record applications that enable entry, viewing, and reporting of clinical data. It also includes applications that support clinical data analytics and decision support. Some services and use cases mentioned in the guide are also relevant to terminology content authoring. However, it is important to note that the scope of this guide does **not** cover the full set of requirements for terminology development, authoring, and distribution services.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/1-introduction#audience)

Audience


----------------------------------------------------------------------------------------------------------------------------------------

This guide is designed to be of value and interest to the following audience groups:

*   **Consumers of SNOMED CT terminology services** :
    
    *   _**Procurers and implementers of healthcare applications**_
        
        *   People involved in procuring and/or deploying applications that enable entry, viewing, reporting, and analysis of healthcare data coded using SNOMED CT
            
        
    *   _**Testers and evaluators of specific healthcare applications**_
        
    *   End-users responsible for testing or evaluating applications that enable entry, viewing, reporting, and analysis of healthcare data coded using SNOMED CT
        
    
*   **Providers of healthcare applications that use SNOMED CT:**
    
    *   People involved in designing, developing, or maintaining applications that enable entry, viewing, reporting, and analysis of healthcare data coded using SNOMED CT
        
    
*   **Providers of SNOMED CT terminology services** :
    
    *   People involved in designing, developing, maintaining, or delivery of terminology services that include support of access to SNOMED CT
        
    

The needs of each of these audience groups vary, and as a result, the sections likely to be of most interests to each of these audience groups are noted in the _Document Structure_ section below

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/1-introduction#document-structure)

Document Structure


------------------------------------------------------------------------------------------------------------------------------------------------------------

This document is organized into five main chapters:

*   [Terminology Services Overview](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview)
     introduces the definition of SNOMED CT terminology services, it describes the general terminology service categories, and it presents three key roles with an interest in SNOMED CT terminology services and provides notes on issues relevant to each role.
    
*   [Terminology Service Use Cases](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/3-terminology-service-use-cases)
     outlines the practical use cases for terminology services.
    
*   [Terminology Service Types](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types)
     describes the different types of terminology services required to enable effective use of SNOMED CT.
    
*   [Service Implementation Considerations](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/5-service-implementation-considerations)
     provides practical information regarding the use of the SNOMED CT release files to meet specific terminology service requirements.
    

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*   [Background](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/1-introduction#background)
    
*   [Purpose](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/1-introduction#purpose)
    
*   [Scope](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/1-introduction#scope)
    
*   [Audience](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/1-introduction#audience)
    
*   [Document Structure](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/1-introduction#document-structure)
    

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# The Organization Behind SNOMED CT | Practical Guides | SNOMED International Documents

This section provides an overview of:

*   SNOMED International
    
*   Members and National Release Centers
    
*   SNOMED International Forums, Advisory Group and Special Interest Groups
    
*   SNOMED International Collaborative
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#why-is-this-important)

Why is this important?

SNOMED International is the not-for-profit organization that owns and administers SNOMED CT, and owns the rights to SNOMED CT and related terminology standards. What is this?

SNOMED International the trading name of IHTSDO is an association governed by a General Assembly that contains one representative of each of its national Members.

SNOMED International seeks to improve the health of humankind by fostering the development and use of suitable standardized clinical terminologies, notably SNOMED CT, in order to support safe, accurate, and effective exchange of clinical and related health information. The focus is on enabling the implementation of semantically accurate health records that are interoperable.

The purpose of SNOMED International is to develop, maintain, promote and enable the uptake and correct use of its terminology products in health systems, services and products around the world, and undertake any or all activities incidental and conducive to achieving the purpose of the Association for the benefits of the members.

The bodies and forums of SNOMED International are the foundation for the continuous maintenance, development and distribution of SNOMED CT, and they provide the organizational framework for communication and collaboration between the different parts of the SNOMED community.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#members-of-ihtsdo)

Members of IHTSDO

SNOMED International current members can be found at the SNOMED International web page ([http://snomed.org/members/arrow-up-right](http://snomed.org/members/)
). Members can be either an agency of a national government or another body endorsed by an appropriate national government authority within the country it represents. SNOMED International welcomes new Members.

Members pay a fee, based on national wealth, to SNOMED International which gives them the right to a seat on the General Assembly. SNOMED International does not charge Affiliate Licensees for use of the SNOMED CT International Edition within Member countries. Licensing is also free in the poorest countries and for certain approved public-good uses in other countries. In other cases, low-cost per-institution charges apply to the use of SNOMED CT in operational systems involved in data creation and/or analysis. All use of SNOMED CT is subject to the acceptance of the terms of the SNOMED CT Affiliate License agreement ([https://www.snomed.org/get-snomedarrow-up-right](https://www.snomed.org/get-snomed)
) and the terms of sublicenses issued to end-user organizations by Affiliate Licensees. Members may also impose additional conditions on use of SNOMED CT within their countries. For example, a Member may require licensees to support and include its National Extension in its implementations.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#national-release-centers)

National release centers

Members undertake a range of activities related to their involvement in SNOMED International and their role in distributing, extending and supporting the use of SNOMED CT in their country. The organization or agency that coordinates this role in each country is referred to as a National Release Centre (NRC). National Release Centers provide a single point of contact for communications with SNOMED International and other Members. Within their own countries, NRCs manage the use of SNOMED CT and communicate with a range of stakeholders, including SNOMED CT Affiliate Licensees, healthcare institutions, clinical groups and end users.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#governance)

Governance

An overview of SNOMED International governance and advisory structures are shown in the following figure.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F19067948-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FUmSUeu96fIQZWDm7RISx%252Fuploads%252Fgit-blob-5de71cc944f6307daad4c1a1ebf0d0bf185556c9%252F291078243.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=46555d41&sv=2)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#general-assembly)

General Assembly


-----------------------------------------------------------------------------------------------------------------------------------------------------------------

The General Assembly is the highest authority in SNOMED International and contains one representative from each of its national Members. The General Assembly is collectively responsible for assuring that the Purpose, Objects and Principles of the Association are pursued and that the interests of SNOMED International are safeguarded. It can make binding decisions regarding all matters relating to SNOMED International, subject to and in accordance with the provisions of the Articles of Association, such as budget, work plan and strategic goals. It is recommended though not required that General Assembly representatives attend all meetings. Face-to-face meetings occur usually twice per year with occasional teleconferences and electronic voting.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#management-board)

Management Board


-----------------------------------------------------------------------------------------------------------------------------------------------------------------

The Management Board is appointed by the General Assembly. The Management Board directs the Association and has the responsibility for key business decisions. It has at least four face-to-face meetings per year with occasional teleconferences between these meetings.

The Management Board also appoints the Chief Executive Officer (CEO), who has day-to-day responsibility for running the organization. A Senior Management Team, with members each responsible for a particular line of business, supports the CEO and directs the work of employees.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#advisory-bodies)

Advisory bodies


---------------------------------------------------------------------------------------------------------------------------------------------------------------

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#member-forum)

Member Forum

Each Member is entitled to nominate two representatives to the Member Forum (MF). The MF acts as a non-voting advisory body to the CEO and Senior Management Team.

The MF is also a means for optimizing the collaboration and coordination among SNOMED International Member countries provides a means for Members to have discussions on specific Member issues. Moreover, the MF facilitates contact and communication between countries with similar foundations, needs, priorities, etc. It is recommended that each Member gets involved in the MF.

The MF can raise issues of concern to the CEO and Senior Management Team and is also requested to provide specific feedback on national priorities and other matters. The MF is the conduit for communicating widely on consultations that SNOMED International may undertake. These consultations may include specific issues related to SNOMED CT content or SNOMED International documents, products and services. The MF is also a key player in determining which SNOMED International work items should be undertaken and prioritized.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#advisory-groups)

Advisory Groups

Advisory Groups were established in June 2015 to conduct specific activities that contribute to the fulfillment of the Senior Management Team's responsibilities or the organization's mandate. They are meant to be agile, given the changing needs and direction of the organization, therefore, each group is reviewed on an annual basis to determine if it is still required or if changes in the Terms of Reference are needed. Generally, Advisory Group members have specific skills and abilities related to that particular group.

The role of each Advisory Group is to provide advice to the applicable Senior Management Team member(s) on specific areas that are included in the Terms of Reference to further the knowledge and direction of the organization. At the beginning of each year, each Advisory Group develops a group work plan outline, determines whether Task and Finish sub-groups are required, outlines any resource requirements needed, and lays out a set of measures in order to monitor the progress of the applicable group work plan. The organization, with the approval of the Management Board, may elect to seek approval for separate budget items in the annual budget to assist the Advisory Groups in the completion of their approved work plans. All work plans are to be submitted to the CEO annually for review and approval.

NRCs should note that Advisory Group members are selected by two different nomination processes. The Terms of Reference of each Advisory Group describes which of the two is relevant (or if a combination of the two is used).

**Member-based nominations**

Member-based nominations are used when SNOMED International seeks to create a forum for SNOMED International staff to work closely with Members. Under this system, Members nominate representatives to serve on an Advisory Group, so the Advisory Group members represent their countries. Typically the Senior Management Team member who chairs the Advisory Group contacts the General Assembly and Member Forum representatives in May or June and invites them to nominate representatives with a particular skill set. SNOMED International then accepts all of those nominees or a subset of them. Any travel expenses of the Advisory Group members to attend approved face-to-face events are then assumed to be the responsibility of the Member. A Member's refusal or inability to pay these expenses does not invalidate or prejudice the nomination in any way, and teleconferencing for those who cannot attend in person is a typical option.

**Standard nominations**

Other Advisory Groups rely on a standard, open, skills-based nomination process. Advisory Group members selected through this process may submit to SNOMED International any approved travel expenses for reimbursement to attend approved face-to-face Advisory Group events (the SNOMED International Travel Policy has more information about approved expenses and means of submission).

Can Members nominate individuals to serve on Advisory Groups that utilize the standard nomination process? Yes. For example, a Member may nominate its NRC IT expert to serve on the Modeling Advisory Group, which uses the standard nomination process. SNOMED International may select them based on their skills. Who then pays for the travel expenses to attend an Advisory Group face-to-face meeting? The elected person would be entitled (but not required) to submit their expenses for reimbursement from SNOMED International, on the basis that they are serving on the Advisory Group as an expert, and not as a Member representative.

Table 1: Advisory Groups and their Nomination Processes

Group name

Nomination process

[**Content Managers AG**arrow-up-right](https://confluence.ihtsdotools.org/display/cmag/Content+Managers+Advisory+Group)

Member-based

[**E-Learning AG**arrow-up-right](https://confluence.ihtsdotools.org/display/ELAG/E-Learning+Advisory+Group)

Member-based

[**Modeling AG**arrow-up-right](https://confluence.ihtsdotools.org/display/mag/Modeling+Advisory+Group)

Standard

[**SNOMED CT Editorial AG**arrow-up-right](https://confluence.ihtsdotools.org/display/editorialag)

Standard

[**Terminology Release AG**arrow-up-right](https://confluence.ihtsdotools.org/display/TRAG)

Standard

[**Manage Service User Group**arrow-up-right](https://confluence.ihtsdotools.org/display/TUAG)

Member-based

More information about Advisory Groups can be found at [http://snomed.org/advisoryarrow-up-right](http://snomed.org/advisory)
.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#clinical-reference-groups)

Clinical Reference Groups

Clinical input to support the development of SNOMED CT is delivered through Clinical Reference Groups. These groups are focused on clinical specialities, with each specialty are having its own Confluence based site. Each site supports discussion and knowledge sharing. Access to the Clinical Reference Groups is though a central Confluence portal focused on clinical engagement activities at [http://snomed.org/crgarrow-up-right](http://snomed.org/crg)
.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#business-meetings)

Business Meetings

SNOMED International arranges two events a year. In April it holds a Business Meeting and in October a second Business Meeting is combined with the annual SNOMED CT EXPO.

SNOMED International Business Meetings include face-to-face meetings of SNOMED International Governance Bodies and Advisory Groups. Business Meetings may also include face-to-face meetings of some Project Groups and Clinical Reference Groups.

While meetings of Advisory Groups are open to observers, some sessions of other groups are closed and may only be attended by members of the relevant bodies.

A key part of each Business Meeting is the open meeting of the General Assembly, where the key strategic decisions, plans and achievements are made and announced.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#snomed-international-collaborative-space-confluence)

SNOMED International Collaborative Space – Confluence

Confluence is an online forum/space where the people within SNOMED International Governance and Advisory Bodies can communicate and share information. Confluence facilitates a range of types of communications, including written discussions, meeting announcements and document sharing.

Members, Affiliates, or other interested parties can gain access to the Collaborative Space to learn more about SNOMED International and SNOMED CT. The Confluence space also enables participation in Advisory Groups, Clinical Reference Groups and Project Groups.

Information about Confluence is available at [https://spaces.snomed.orgarrow-up-right](https://spaces.snomed.org/)
.

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*   [Why is this important?](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#why-is-this-important)
    
*   [Members of IHTSDO](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#members-of-ihtsdo)
    
*   [Governance](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#governance)
    
*   [General Assembly](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#general-assembly)
    
*   [Management Board](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#management-board)
    
*   [Advisory bodies](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#advisory-bodies)
    
*   [Member Forum](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#member-forum)
    
*   [Advisory Groups](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#advisory-groups)
    
*   [Clinical Reference Groups](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#clinical-reference-groups)
    
*   [Business Meetings](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#business-meetings)
    
*   [SNOMED International Collaborative Space – Confluence](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct#snomed-international-collaborative-space-confluence)
    

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# Organizational Case Studies | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

This section describes a range of organizations that have used SNOMED CT for clinical decision support. The organizations that have contributed to this review include:

*   [EBMPracticeNet](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/ebmpracticenet)
    
*   [Kaiser Permanente](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/kaiser-permanente)
    
*   [National Institutes of Health: Intramural Research Program](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/national-institutes-of-health-intramural-research-program)
    
*   [Pharmacy Health Information Technology Collaborative](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/pharmacy-health-information-technology-collaborative)
    
*   [Sundhedsplatformen](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/sundhedsplatformen)
    
*   [University of Utah](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/organizational-case-studies/university-of-utah)
    

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# Implement and Use | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents

When a reference set has been developed and tested it should be prepared for use by implementing it in the environment where it is going to function. I.e. the implementation process and the tasks involved will vary dependent on the setting.

Often, implementation of a reference set will mean integration with one or more software artefacts, to enable data capture, represented by appropriate reference set members.

An important part of this process is proper binding between the information model and the reference set to ensure effective integration with data entry and storage functions. Many situations will also involve implementation of two or more interdependent reference sets, which require their dependencies to be considered to reach the most optimal implementation.

In this guide we highlight two aspects that are important when implementing SNOMED CT reference sets, i.e. supporting implementation with proper implementation guidance and considerations related to optimizing the reference set for a particular implementation.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/6-reference-set-development/6.5-implement-and-use#implementation-guidance)

Implementation Guidance


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The tasks involved with implementing a reference set will depend on the situation and the technical setting where the reference set is going to function. To support successful implementation, and to ensure that the reference set is used as intended it is important with precise and clear instructions for the people responsible for implementing the reference set, i.e. the people preparing the reference set for routine use within a particular setting.

Implementation guidance should, as a minimum, include instructions on:

*   The overall purpose and intended use of the reference set
    
*   The reference set design, i.e. attributes and data types
    
*   Dependencies to terminology artifacts, such as
    
    *   other reference sets
        
    *   content in the international edition of SNOMED CT
        
    *   content in SNOMED CT extensions
        
    
*   Dependencies to software artifacts, such as
    
    *   information model structures, i.e.
        
        *   data entry template structures
            
        *   storage model structures
            
        *   message structures
            
        
    
*   Maintenance
    
    *   release cycles
        
    *   change management
        
    *   request for change
        
    

Additionally, it is valuable to include instructions on how to test the implementation, i.e. exemplar test cases with information on expected outcome given a specific action.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/6-reference-set-development/6.5-implement-and-use#optimization-for-implementation)

Optimization for Implementation


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

As part of an implementation process it is relevant to consider any optimization that could be done to meet requirements for implementation or result in a more effective and/or efficient use at runtime. Because, even though reference sets are distributed in separate files and represented according to the reference set file format, it may be useful to transform these reference sets files into another structure that is more appropriate for the specific use case.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1485734576-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FqOI2v58ZsXOoklmwBOk4%252Fuploads%252Fgit-blob-5e32e8814a622b7edbc3af1656d066a43c5b48bf%252F35985731.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=10d80975&sv=2)

Prior to implementation a reference set may be transformed into one or more formats, which are optimized for the particular use of the reference set

Optimizations that could be considered include:

*   **Controlled redundancy.** For some matters it may be useful to introduce some level of redundancy, e.g. by joining reference sets or release files together so that the data is more efficient to access at runtime
    
    *   e.g. combining a simple reference set of concepts with the description file, so that the term preferred for display can be retrieved directly from the subset file.
        
    *   e.g. combining the description file with a language refset, so that the term is in the same row as the acceptability of the description, and the concept id that it describes.
        
    
*   **Terminology reduction (constrain)**. For the purpose of supporting effective use and ensuring that only relevant components are accessed during runtime it may be useful to filter the components down to only those that are relevant for a specific use case.
    
    *   One way of doing this is by creating simple reference sets of the components that are relevant in a given situation, for example:
        
        *   A subset of relevant concepts.
            
        *   A subset of descriptions acceptable or preferred for the set of concepts.
            
        *   A subset of relationships that are important to know about for that specific subset of concepts and for the given use case. What relationships to include will be very dependent on the use case. In some situations, the relationship subset may be irrelevant, and in other situations it may be important to include all defining relationships and all transitive 'is a' relationships of the subset members.
            
        
    
*   **Filtering to a snapshot view of the subset.** As for any other SNOMED CT component changes to reference set members are likely to occur, and as for SNOMED CT components, reference set members can be updated or inactivated. Therefore, it may be useful to create a snapshot view of the reference set to be used for implementation, so that only the latest version of all reference set members can be accessed during runtime. Alternatively, it may be useful to create a view which only includes the most recent version of all active reference set members. This will depend on whether the inactive members should be accessible for viewing or not.
    

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Last updated 5 months ago

*   [Implementation Guidance](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/6-reference-set-development/6.5-implement-and-use#implementation-guidance)
    
*   [Optimization for Implementation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/6-reference-set-development/6.5-implement-and-use#optimization-for-implementation)
    

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# Introduction | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/1-introduction#background)

Background


-------------------------------------------------------------------------------------------------------------------------------------

SNOMED CT provides the core clinical terminology for the electronic health record (EHR) and contains more than 300,000 active concepts with unique meanings. These concepts are organized into hierarchies and have formal logic-based definitions. When implemented in software applications, SNOMED CT can be used to represent clinically relevant information consistently, reliably and comprehensively as an integral part of producing electronic health records. Due to the comprehensiveness and expressivity of SNOMED CT it is often useful to constrain its use to a subset of concepts, descriptions or relationships relevant to a particular use case. SNOMED CT reference sets provide a standard way to represent subsets of SNOMED CT components. Reference sets also provide an extensible mechanism to customize the terminology to meet a wide range of practical requirements.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/1-introduction#purpose)

Purpose


-------------------------------------------------------------------------------------------------------------------------------

The aim of this document is to provide a high level introduction to SNOMED CT reference sets, and to explain the different types of reference sets and their usage. Furthermore, the document includes an introduction to the reference set format and provides guidance on the development and management of reference sets. Thus, the objective of this document is to support users of SNOMED CT in :

*   Understanding the purpose of reference sets
    
*   Knowing about the different types of reference sets and their characteristics
    
*   Choosing the correct type of reference set for a specific purpose
    
*   Creating, developing and maintaining reference sets
    
*   Using reference sets together with other SNOMED CT resources (for entry and display, analytics, knowledge linkage, communication)
    
*   Sharing reference sets
    
*   Adopting or adapting existing reference sets
    
*   Exploring and assessing the content of existing reference sets
    

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/1-introduction#audience)

Audience


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The intended audiences for this guide are those involved in the creation, maintenance and usage of SNOMED CT reference sets. More specifically, this includes:

*   SNOMED International Members who wish to learn about the practical uses of reference sets or who are involved with defining reference sets
    
*   Clinicians, informatics specialists and technical staff involved in the planning, management, design or implementation of reference sets.
    
*   Software vendors, data analysts, epidemiologists and others designing SNOMED CT based solutions.
    

This document assumes a basic level of understanding of SNOMED CT. For background information the reader should refer to the [SNOMED CT Starter Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/)
.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1485734576-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FqOI2v58ZsXOoklmwBOk4%252Fuploads%252Fgit-blob-fe6599903f3551a41c9f216caa524788641ea0ca%252F35985764.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=e06553e3&sv=2)

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Last updated 5 months ago

*   [Background](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/1-introduction#background)
    
*   [Purpose](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/1-introduction#purpose)
    
*   [Audience](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/1-introduction#audience)
    

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# Learning More About SNOMED CT | Practical Guides | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/15-learning-more-about-snomed-ct#documentation)

Documentation


-------------------------------------------------------------------------------------------------------------------------------------------------------

This [Starter Guide](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide)
 is intended as a practical and useful starting point from which anyone with a general interest in healthcare information can begin learning about SNOMED CT. It provides a broad overview of SNOMED CT from which to start a more detailed exploration of areas that are of particular interest. Besides from the Starter Guide, SNOMED International provides a range of formally approved specifications and practical guidance documents. These can be accessed from the online [document library](https://docs.snomed.org/)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/15-learning-more-about-snomed-ct#courses)

Courses


-------------------------------------------------------------------------------------------------------------------------------------------

SNOMED International provides online courses, tutorials and other materials that are designed to enable you to learn more about SNOMED CT. Additionally, we offer completion certificates to those who pass course assessments. To find out more about these education services please visit [https://www.snomed.org/educationarrow-up-right](https://www.snomed.org/education)
 on the SNOMED International website. For access to courses, tutorials and other educational materials go to the [SNOMED CT E-Learning Serverarrow-up-right](http://snomed.org/elearning)
.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/15-learning-more-about-snomed-ct#snomed-ct-expo)

SNOMED CT Expo


---------------------------------------------------------------------------------------------------------------------------------------------------------

The [SNOMED CT Expoarrow-up-right](https://www.snomed.org/snomedct-expo)
 is an open event for anyone interested in SNOMED CT and practical applications of the terminology. The event includes invited keynote speakers and several tracks of peer-reviewed presentations about SNOMED CT in general with a focus on implementation experiences and developments that facilitate more effective use of the terminology.

The Expo also includes tutorials and workshops for those seeking greater understanding of SNOMED CT, an exhibition of vendor products that use SNOMED CT and a range of poster presentations on related topics.

The Expo is the main annual event in the SNOMED International calendar for anyone interested in the use and development of the global healthcare terminology. In addition to the scheduled sessions, it provides an excellent opportunity to network with others with a shared interest in SNOMED CT.

Watch past Expo recordings - [https://www.youtube.com/@snomedct/playlistsarrow-up-right](https://www.youtube.com/@snomedct/playlists)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/15-learning-more-about-snomed-ct#additional-resources)

Additional resources


---------------------------------------------------------------------------------------------------------------------------------------------------------------------

**Information about SNOMED International** Find out more about the organization, members, newsletter and events.

*   [www.snomed.orgarrow-up-right](http://www.snomed.org/)
    
    *   [https://www.snomed.org/about-usarrow-up-right](https://www.snomed.org/about-us)
        
    *   [http://snomed.org/membersarrow-up-right](http://snomed.org/members)
        
    *   [https://www.snomed.org/newsarrow-up-right](https://www.snomed.org/news)
        
    *   [http://snomed.org/eventsarrow-up-right](http://snomed.org/events)
        
    *   [https://www.snomed.org/our-partnershipsarrow-up-right](https://www.snomed.org/our-partnerships)
        
    *   [https://www.snomed.org/snomed-ct-marketplacearrow-up-right](https://www.snomed.org/snomed-ct-marketplace)
        
    
*   [SNOMED Forumsarrow-up-right](https://forums.snomed.org/)
     is used for announcements, colloboration and discussion. It is used for connecting the SNOMED CT Community through open discussion and knowledge sharing.
    
*   [SNOMED Spacesarrow-up-right](https://conf.spaces.snomed.org/wiki/spaces)
     is a space where the people within SNOMED International Governance and Advisory Bodies can view information. The space also enables viewing information about Advisory Groups, Clinical Reference Groups and Project Groups.
    

**General information about SNOMED CT** Materials include a benefits and information about licensing.

*   [https://www.snomed.org/value-of-snomedctarrow-up-right](https://www.snomed.org/value-of-snomedct)
    
*   [https://www.snomed.org/get-snomedarrow-up-right](https://www.snomed.org/get-snomed)
    

**Documentation Library** Access to a wide range of documents about SNOMED CT.

*   [http://snomed.org/doc](https://docs.snomed.org/)
    

**SNOMED CT Browsers** A range of online and offline tools to search SNOMED CT content.

*   [http://browser.ihtsdotools.orgarrow-up-right](http://browser.ihtsdotools.org/)
    
*   [http://snomed.org/browsersarrow-up-right](http://snomed.org/browsers)
    

**SNOMED CT in Action** Examples of how SNOMED CT is being used around the world.

*   [https://www.snomed.org/snomed-ct/snomed-in-actionarrow-up-right](https://www.snomed.org/snomed-ct/snomed-in-action)
    

**SNOMED CT Vendor Guide**

The Vendor Introduction to SNOMED CT provides an informative practical introduction to SNOMED CT focused primarily on the needs of vendors and developers of EHRs.

*   [http://snomed.org/vendorintroarrow-up-right](http://snomed.org/vendorintro)
    

**SNOMED CT National Release Center Guide**

Provides an introduction to SNOMED International and SNOMED CT for those working in or planning to development a National Release Center.

*   [http://snomed.org/nrcg](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/)
    

**SNOMED CT Implementation Support Portal** A dedicated portal to support SNOMED CT implementations.

*   [https://www.implementation.snomed.orgarrow-up-right](https://www.implementation.snomed.org/)
    

**SNOMED CT E-Learning Server** Sign up for SNOMED CT courses or see publicly accessible presentations.|

*   [http://snomed.org/elearningarrow-up-right](http://snomed.org/elearning)
    
*   [Starter tutorialarrow-up-right](https://elearning.ihtsdotools.org/course/view.php?id=5&section=1)
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Starter+Guide&entry.670899847=Learning%20More%20About%20SNOMED%20CT)

[PreviousThe Organization Behind SNOMED CTchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/14-the-organization-behind-snomed-ct)

Last updated 5 months ago

*   [Documentation](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/15-learning-more-about-snomed-ct#documentation)
    
*   [Courses](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/15-learning-more-about-snomed-ct#courses)
    
*   [SNOMED CT Expo](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/15-learning-more-about-snomed-ct#snomed-ct-expo)
    
*   [Additional resources](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/15-learning-more-about-snomed-ct#additional-resources)
    

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# Terminology Service Roles | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents

This section identifies three roles with an interest in SNOMED CT terminology services. The perspective of each of these roles is summarized with notes on general issues that those in particular roles should consider and references to relevant sections in the guide. The roles considered are as follows:

*   [Terminology Service Users](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.3-terminology-service-roles/2.3.1-terminology-service-users)
    
*   [Healthcare Application Providers](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.3-terminology-service-roles/2.3.2-healthcare-application-providers)
    
*   [Terminology Service Providers](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.3-terminology-service-roles/2.3.3-terminology-service-providers)
    

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[PreviousTerminology Service Categorieschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.2-terminology-service-categories)
[NextTerminology Service Userschevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/2-terminology-services-overview/2.3-terminology-service-roles/2.3.1-terminology-service-users)

Last updated 5 months ago

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# Orion Health | Practical Guides SNOMED CT Clinical Decision Support Guide | SNOMED International Documents

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health#orion-health)

Orion Health


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

circle-info

Orion Health is an award-winning, global provider of healthcare information technology advancing population health and precision medicine solutions for personalised care across the entire health community. Orion Health's solutions capture the vast amounts of heath data available and provide the tools to support healthcare professionals and health insurers who manage their members' wellness programmes to make more effective decisions - through applying analytics and employing care management and patient engagement.\\

For more information please visit [https://orionhealth.comarrow-up-right](https://orionhealth.com/global/about-us/our-story/vision-values/)

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health#overview)

Overview


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Orion Health currently has four products which leverage SNOMED CT for Clinical Decision Support. These are:

*   Global Drug Model (GDM);
    
*   Orion Health Medicines;
    
*   Orion Health Problem List; and
    
*   Clinical Decision Support (CDS) application.
    

To allow for multiple customers to be supported worldwide, these products adopt a modular approach to terminology deployment. A customer selects the relevant data loader for their jurisdiction and the experience is customized for their region automatically. When deployed in SNOMED CT member countries, this process involves loading the relevant SNOMED CT National Edition and local medication codes. Drug data is represented using a common model based on SNOMED CT. This enables customers already using SNOMED CT coding to migrate to these products very quickly. Other local medication codes can be translated to the SNOMED CT equivalent representation using integrated mappings. Orion’s Medicines platform provides support for terminologies from the UK, Australia, New Zealand, USA and France, as well as support for other customers with local data sets.

SNOMED CT offers a range of significant benefits to Orion Health’s CDS solutions. SNOMED CT’s relationships and drug class information are used to optimize the drug database during the import process. Orion Health has also developed several algorithms which allow for extremely fast retrieval of medication data, traversal of the medication hierarchy and testing for concept subsumption. These SNOMED CT features are used extensively by the Clinical Decision Support APIs and are therefore a core part of Orion Health’s CDS applications. These products also provide the ability to add new medications that are not predefined in the terminology, such as extemporaneous medications, clinical trial drugs or medications obtained in a different country. New medications can be fully modeled within the GDM concept hierarchy, and assigned a valid SNOMED CT extension identifier using the customer’s assigned namespace.

The Amadeus Clinical Portal as shown in the diagram below provides a single point of access for clinicians to manage patient information. This portal integrates the CDS products mentioned above, including the Medicines and Problem List applications. All Orion Health’s CDS applications expose their data using FHIR’s RESTful APIs. The use of SNOMED CT in these products also facilitates easier translation to standard messaging formats, such as HL7 CDA or other message structures mandated by local jurisdictions.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-51b72654b54b6486d71b3d216c2d7f097c2d250e%252F123897713.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=db392e75&sv=2)

Clinical Portal

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health#global-drug-model)

Global Drug Model


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The _Global Drug Model_ (GDM) enables Orion’s software to be deployed worldwide. This application standardizes and normalizes data sets from many different countries into a single data model. Customers upload their local SNOMED CT edition into GDM via an application that runs inside the Orion Health Clinical Portal. GDM processes the data and then publishes it using HL7 FHIR’s RESTful APIs. The processing performed by GDM makes heavy use of the SNOMED CT defining relationships, as well as discovering data about drug classes that is present in the terminology releases. This application facilitates a number of clinical decision support functions, including duplicate therapy checking and linking to relevant drug monographs. The use of SNOMED CT concepts in the GDM is illustrated in the screenshot shown in the diagram below.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-797f1ef9cc3d618ed939f7d6cd4d2b3295c2366f%252F123897708.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=cffc46&sv=2)

Global Drug Model

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health#orion-health-medicines)

Orion Health Medicines


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

_Orion Health Medicines_ supports an authoritative medication list for each patient, and enables its curation, reconciliation and management. The Medicines application uses the FHIR APIs from GDM to allow the discovery and validation of medications. Patients can also manage their own list of medications via the Orion Health Patient Portal or the Orion Health Engage mobile application.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health#orion-health-problem-list)

Orion Health Problem List


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

_Orion Health Problem List_ is a centralized and web-based list of patient problems. It enables healthcare providers to view, create and change clinical information, procedures, psychosocial and cultural issues that may affect the care of the patient, as well as safety and security concerns that may be relevant to medical staff caring for the patient. The Problem List application also integrates with GDM via the FHIR APIs, and enables clinicians to record allergies, adverse reactions and intolerances at the drug class level. The Problem List application is fully integrated with SNOMED CT, with a variety of fields using SNOMED CT subsets.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health#clinical-decision-support)

Clinical Decision Support


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The _Clinical Decision Support_ (CDS) application is a new product that integrates with the three applications mentioned above, as well as other third party decision support applications. The CDS application provides APIs to support duplicate drug therapy checking, drug allergy checking, links to drug monographs and additional drug information, and grouping of similar medications based on a common ingredient or therapeutic moiety.

For example, when new medications are added to a patient’s medication list, they are automatically screened against the current list of medications for that patient using the CDS Duplicate Therapy API. This check ensures that the clinician is advised of existing medications with the same ingredients. Clinicians viewing medications are able to access drug monographs and any other additional information listed against a medication. The medication list is also screened using the CDS Drug Allergy API, which presents a warning if a drug allergy or intolerance to a particular medication or drug class is detected. These checks use data traversal algorithms that were developed by Orion Health for fast traversal of the SNOMED CT concept hierarchy and defining relationships. The warnings have been specifically designed to minimize alert fatigue. The Orion Health Problem List application is shown below in the diagram below with an adverse reaction alert.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1288462658-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FXxY5vKuPdiVBdqbdZl1x%252Fuploads%252Fgit-blob-f19e1a36b5b4db3e371fe0a25e497d97185ad969%252F123897711.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=6cbfab8e&sv=2)

Problem List with CDS alert functionality

* * *

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[PreviousFirst Databankchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/first-databank)
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Last updated 5 months ago

*   [Orion Health](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health#orion-health)
    
*   [Overview](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health#overview)
    
*   [Global Drug Model](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health#global-drug-model)
    
*   [Orion Health Medicines](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health#orion-health-medicines)
    
*   [Orion Health Problem List](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health#orion-health-problem-list)
    
*   [Clinical Decision Support](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-clinical-decision-support-guide/appendix-a-decision-support-case-studies/vendor-case-studies/orion-health#clinical-decision-support)
    

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# Expressions in the EHR | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents

This part of the guide describes one way in which postcoordination might be applied in an EHR. This involves introducing the steps involved with setting up an expression repository, including approaches taken to create and add expressions to the repository.

This section also introduces how postcoordination can be implemented to support essential EHR tasks including entering, storing, displaying, querying, and communicating expressions. In addition, references to the terminology services required to support these approaches will be provided to function as a practical source of reference for implementers wishing to enable postcoordination in their EHR.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2240938627-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FusjN9isxKh4cLDTFopLg%252Fuploads%252Fgit-blob-b15e664489481b0c46b8575d7cd4720b5e75a6c0%252F180917633.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=8c862231&sv=2)

Components and services required to enable postcoordination in an EHR

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[NextPreparing Expression Repositorychevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-postcoordination-guide/expressions-in-the-ehr/preparing-expression-repository)

Last updated 7 months ago

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# Reference Set | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents

A **reference set** is defined as: a standard format for maintaining and distributing a set of references to SNOMED CT components.

#### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/2-subsets-value-sets-and-reference-sets/2.3-reference-set#notes)

Notes

*   A _reference set_ can be used to represent a subset of components (concepts, descriptions or relationships).
    
*   A _reference set_ may also associate referenced components with additional information such as:
    
    *   Ordered lists of components
        
    *   Sets of associations between components
        
    *   Mapping between SNOMED CT concepts and other systems codes, classifications, or knowledge resources.
        
    

Hence, reference sets are a mechanism that can be used to represent subsets and value sets of SNOMED CT components. However, they can also be used for many other purposes, including those summarized in the [Use Cases](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/3-requirements-and-use-cases/3.2-use-cases)
 section. The following table lists the attributes used in the standard reference set format, and their purpose.

Table: Standard reference set format

Attribute

Purpose

_id_

**General versioning information**

_effectiveTime_

**General versioning information**

_active_

**General versioning information**

_moduleId_

**General versioning information**

_refsetId_

**Reference set identifier**

_referencedComponentId_

**Component reference**

_< attribute-1 \_ … attribute-n >_

**Additional information depending on reference set type**

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/2-subsets-value-sets-and-reference-sets/2.3-reference-set#reference-sets-in-an-extension)

Reference Sets in an Extension


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SNOMED CT is designed to allow the International Edition to be extended to meet national or local requirements. A SNOMED CT Extension may contain components of various types including concepts, descriptions, relationships and derivatives including reference sets. Since the International Release and extensions share a common structure, the same application software can be used to enter, store and process information from different extensions. Extensions can also be shared without requiring additional software procurement or development. Most Extensions are managed by Members or Affiliates of SNOMED International.

Reference sets authored in an extension use the same common format as those in the International Edition. This makes it easier to use the same software to create, maintain and share extension reference sets, as used by international reference sets. The reference set format can also be customized in an extension using a standardized customization approach, as explained in section [Pre-defined and Customized Reference Sets](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/4-reference-set-design#pre-defined-and-customized-reference-sets)
.

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# Entering Expressions in an EHR | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents

When enabling postcoordination in an EHR, it is important to be aware of how the approach selected for entry of the expression impacts the storage and the display of the expression.

There are three main approaches to entering postcoordinated clinical data into an electronic health record.

*   [Prepopulated expressions](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-postcoordination-guide/expressions-in-the-ehr/entering-expressions-in-an-ehr/prepopulated-expressions)
    
*   [Form-based selection of expression parts](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-postcoordination-guide/expressions-in-the-ehr/entering-expressions-in-an-ehr/form-based-entry-of-expressions)
    
*   [Free text with Natural Language processing to encode the free text with SNOMED CT](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-postcoordination-guide/expressions-in-the-ehr/entering-expressions-in-an-ehr/free-text-with-natural-language-processing)
    

The following pages will elaborate on each of these approaches and clarify key requirements for each. Furthermore, best practice approaches to the storage and display of expressions will also be presented.

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# Display EHR Data | Practical Guides SNOMED CT Terminology Services Guide | SNOMED International Documents

Data stored in an electronic health record (EHR) that includes SNOMED CT concepts or expressions may also include a human readable term associated with each concept identifier. In this case, EHR data can be displayed without using any terminology services. However, as shown in the table below there are several situations in which it may be necessary to lookup and display a term rather than relying upon a term stored in the rec.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/3-terminology-service-use-cases/display-ehr-data#reasons-for-looking-up-terms-when-displaying-ehr-data)

Reasons for Looking Up Terms when Displaying EHR Data


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The table below shows a summary of the services required to support display of EHR data including looked up terms.

Reason

Notes

**To display the preferred term or fully specified name of a concept in the following situations:**

*   If a record entry contains a concept identifier without an associated term
    

It is good practice to store the selected term as well as the concept identifier but this is not mandatory.

*   If a communication contains a concept identifier without an associated term
    

It is good practice to communicate the selected term as well as the concept identifier but this is not mandatory. In some cases, the design of a message or interchange format may not support the inclusion of terms for all concept identifiers. This may be a particular issue when postcoordinated expressions are communicated as some interchange formats may not support the inclusion of terms for each concept identifier in an expression.

*   If the synonym in a record entry or communication is ambiguous
    

The term stored or communicated may be appropriate to the concept but may not be sufficiently clear.

*   For example, the term "fundus" is a valid synonym for four different concepts. Looking up the fully specified name for the concept identifier allows the display of term that removes this ambiguity.
    

**To display the preferred term for a concept in a familiar language:**

*   If the term stored or communicated is in an unfamiliar language
    

The term stored or communicated may be in a language that the user does not understand. If the concept is also included in the edition used by the viewer, it should be possible to display the term in the viewers own language.

**To confirm that a term linked to a concept identifier is a valid:**

*   If there is a requirement for quality assurance validation
    

Even when a term is stored or communicated with a concept identifier, it may be useful to confirm that the term included is associated with that concept identifier.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/3-terminology-service-use-cases/display-ehr-data#services-required-to-enable-display-of-ehr-data)

Services Required to Enable Display of EHR Data


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Practical Requirement

Required Services

Dependencies

Enable the selection of SNOMED CT edition and version to be used REQUIRED

[Select Edition and Version](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.1-select-edition-and-version)

N/A

Display terms for the concepts in EHR record entries and communications REQUIRED

[Get Terms for a Concept](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/4-terminology-service-types/4.3-get-terms-for-a-concept)

N/A

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Last updated 5 months ago

*   [Reasons for Looking Up Terms when Displaying EHR Data](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/3-terminology-service-use-cases/display-ehr-data#reasons-for-looking-up-terms-when-displaying-ehr-data)
    
*   [Services Required to Enable Display of EHR Data](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-terminology-services-guide/3-terminology-service-use-cases/display-ehr-data#services-required-to-enable-display-of-ehr-data)
    

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# Alternatives to Postcoordination | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents

Before you launch into a postcoordinated solution it’s important to understand that in some cases there are alternatives to postcoordination that may be easier to implement.

The two main alternatives to postcoordination are:

**Create extension concepts:**

*   Firstly, and perhaps the most obvious alternative to postcoordination is to add the new clinical meanings to an extension, as precoordinated content. This approach enables the use of standard SNOMED authoring tools to classify the concepts and distribute them in a way that supports queries. However, this alternative is not an option for everyone, and in those cases, postcoordination may be considered.
    

**Use information model structure:**

*   The second alternative is to define the postcoordination structure using the information model, using separate coded data elements for the focus concept, and each of the refinement values in the expression. For example, rather than using an expression for ‘fracture of the foot’, two separate data elements could be applied, one for the SNOMED CT concept for 'fracture' and the other for the SNOMED CT concept for 'foot'. This approach has good accuracy for data capture but introduces significant limitations for the execution of semantic queries over the clinical data, as the focus concept is separated from the refinements and is not combined into a single SNOMED expression. In some situations where data is captured separately and follows the SNOMED CT concept model, post-processing can be applied to convert information models into postcoordinated expressions, after data capture.
    

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# NRC Responsibilities | Practical Guides SNOMED NRC Guide | SNOMED International Documents

Manage translations

Technical/ITThe best way to organize an NRC depends on a wide range of factors, including the number of potential Affiliates, the vision and strategy for use of SNOMED CT in the country, the national eHealth infrastructure, the extent of customization, etc. But Members of SNOMED International are, at a minimum, required to fulfill a set of core responsibilities within the Member's territory, as shown in Figure 2 and specified in the [Articles of Associationarrow-up-right](https://www.snomed.org/governance-and-advisory)
. Typically, the NRC fulfills most of these obligations, however a Member may make other arrangements to fulfill some of the obligations.

Figure 2. Obligations of Members.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F3066103899-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FP1frmzZuNvoHsCrG7SKQ%252Fuploads%252Fgit-blob-e7547b212e2b56ee0b6f7c3977cafd00215cb16f%252F254968140.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=b6cde7b5&sv=2)

circle-info

\* NRCs are required to serve as primary points of contact for SNOMED International with regards to all aspects of the management of the terminology products.

*   **NRCs are the primary points of contact for Affiliates within a Member country.**
    
    *   Affiliates should be able to contact the NRC for guidance and direction with respect to implementation and use of SNOMED CT within the Member country.
        
    *   The NRCs should serve as intermediaries between the Affiliates and the SNOMED CT community, for example:
        
        *   Encouraging experts and other appropriate persons to contribute to the work of SNOMED International;
            
        *   Assisting SNOMED International to communicate with Affiliates and experts entitled to and wishing to be enrolled as SNOMED International Affiliates.
            
        
    
*   **NRCs are required to establish and maintain processes necessary for distribution and licensing of SNOMED CT and the other terminology products.**
    
    *   This includes developing the appropriate mechanisms for users to gain access to National (where applicable) and International Editions of SNOMED CT and related products, and mechanisms to retrieve and manage Affiliate licenses. (See page on [Tooling](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/tooling)
         for process support).
        
    *   This includes managing license reporting annually and reporting Affiliates' activities in non-Member countries to SNOMED International.
        
    
*   **NRCs are required to ensure that any deployment of a terminology product owned by SNOMED International conforms to SNOMED International standards.**
    
*   **NRCs must facilitate feedback from users on SNOMED CT, including managing change requests.**
    

Besides these areas, there is a range of other responsibilities that NRC may decide to undertake. The table below lists a set of possible responsibility areas. The list is not exhaustive but includes the main areas that NRCs currently cover. Some of the areas are marked as "Required," as these are part of the core responsibility areas.

Table 1. NRC Responsibility areas

Responsibility area

Required

Optional

**Manage Licenses**

(manually or automatically)

check

**Distribute International Release**

check

**Manage Extensions** (Authoring, release, distribution and maintenance)

check

**Manage Reference sets** (Authoring, release, distribution and maintenance)

check

**Manage Mappings** (Authoring, release, distribution and maintenance)

check

**Manage Translations** (Authoring, release, distribution and maintenance)

check

**Offer Tooling**

*   As user service : To enable users to access and explore SNOMED CT
    
*   As NRC tool : Support SNOMED CT management
    

check

**Manage Change Requests**

for organizations in the country

check

**Offer Education, Promotion and Training**

check

**Engage Stakeholders**

check

**Offer Implementation Consultancy**

check

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-nrc-guide/nrc-responsibilities#nrc-competencies)

**NRC competencies**


----------------------------------------------------------------------------------------------------------------------------------------------

The competencies required for an NRC are dependent on what services the NRC chooses to deliver. However, most NRC staff should have a general understanding of SNOMED CT and SNOMED International.

If an NRC is unable to provide a specific type of service, it should seek to identify other resources that are able to meet the requirements of implementers and users in the Member country.

The following core competencies are typical for the work of an NRC. Some of these competency areas can be considered assignment-specific, as they will not be required as a constant competency within the NRC but are required to fulfill specific assignments, such as translation, mapping and development of Reference sets.

**General competencies required**

*   Terminology
    
*   Technical and IT
    
*   Communication
    
*   Implementation
    
*   Education
    

**Assignment-specific competencies**

*   Clinical and scientific domain specialty knowledge
    
*   Linguistics and translation
    

Specific competencies required to undertake particular NRC related tasks are outlined below.

Table 2. Competencies and skills required to undertake particular NRC tasks

Tasks

Main competencies

Knowledge/Skills areas

**Distribute International Release and National Extension**

*   Communication
    
*   Technical/IT
    

*   Communication with Affiliates, e.g. news updates
    
*   Tooling support for access to the International Release and National Extension
    

**Manage Extensions**

*   Content
    

*   Terminology
    
*   Domain specialty
    
*   Translation
    

*   Content development
    
*   Terminologies, description logic
    

*   Technical
    

*   Technical/IT
    

*   Tooling support for extension development and management
    

**Manage Reference Sets**

*   Content
    

*   Terminology
    
*   Domain specialty (clinical experts, etc.)
    

*   Reference set development and maintenance
    
*   Domain insight, depending on the purpose of the Reference Set
    
*   Concept selection
    
    *   Logical and concept model
        
    
*   Search techniques
    

*   Technical
    

*   Technical/IT
    

*   Tooling support for Reference set development and management
    

**Manage Mappings**

*   Content
    

*   Terminology
    
*   Domain specialty
    

*   Map development and maintenance
    
*   Knowledge of current practice for use of classifications and terminologies in the Member territory
    

*   Technical
    

*   Technical/IT
    

*   Tooling support for Reference Set development and management
    

**Tooling Developments**

*   Browsing
    
*   Developing content
    
*   Reference Sets
    
*   Quality Assurance
    
*   Distribution
    

*   Technical/IT
    

*   SNOMED CT technical specifications and file formats
    
*   Software and database design and development
    
*   Information modeling/information model standards
    
*   SNOMED CT search and data entry techniques and software
    
*   Authoring and distribution requirements
    
*   Quality assurance techniques
    

**Manage Translations**

*   Terminology
    
*   Linguistics
    
*   Domain specialty
    

*   Translation processes
    
*   Concept definition
    
*   Quality assurance
    
*   Terminology authoring technology
    

**Change Requests**

*   Content
    

*   Communication
    
*   Terminology
    
*   Translations
    

*   Content development
    
*   Terminologies, description logic
    

*   Technical
    

*   Technical/IT
    

*   Terminology authoring tool
    
*   Tooling support for change request submissions and management of change requests.
    

**Education, Promotion and Training**

**Engaging Stakeholders**

*   Communication
    
*   Implementation
    
*   Education
    

*   Dissemination competencies
    
*   Users and user needs
    
*   Broad and deep knowledge of SNOMED CT, users and implementation aspects.
    
*   Examples, use cases
    
*   National health IT-infrastructure, current practices and regulation
    

**Implementation Consultancy**

*   Implementation
    
*   Technical/IT
    
*   Business Analysis
    

*   Broad and deep knowledge of SNOMED CT, users and implementation aspects.
    
*   Examples, use cases
    
*   Implementation levels and technical opportunities
    
*   Ability to understand requirements and relate to terminology
    

**Manage Licenses**

*   manually or automatically
    

*   Communication
    
*   Technical/IT
    

*   Communication with Affiliates
    
*   Tooling support, e.g. license repository
    

circle-info

Note that the range of tasks that different NRCs undertake may vary.

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# Design | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents

This part of the guide introduces the design features of a terminology server supporting postcoordination with SNOMED CT.

This design meets the requirements outlined in [Requirements](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-postcoordination-guide/expressions-in-a-terminology-server/requirements)
 and includes:

*   [Expression Repository Design](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-postcoordination-guide/expressions-in-a-terminology-server/design/expression-repository-design)
    
*   [Terminology Services Design](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-postcoordination-guide/expressions-in-a-terminology-server/design/terminology-services-design)
    

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# Appendix B: Deprecated Reference Set Types | Practical Guides SNOMED CT Reference Set Guide | SNOMED International Documents

This section contains information about reference set types that are now deprecated and replaced by enhanced reference set. The fact that a referenced set type is deprecated does **not** imply that reference sets of that type cannot be used. However, it does indicate that there is another reference set type that more effectively meets the use case(s) for which these reference sets were originally designed.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#ordered-reference-set)

Ordered Reference Set


--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

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This reference set type has been deprecated in favour of two new reference set types. Please see following sections for introduction to the:

*   [Ordered component reference set](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/5-reference-set-types#ordered-component-reference-set)
    
*   [Ordered association reference set](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/5-reference-set-types#ordered-association-reference-set)
    

The design of the ordered reference set supports three overall purposes:

1.  To specify a sequential order of a subset of components
    
2.  To specify prioritized groups within a subset of components
    
3.  To define alternative hierarchies of components
    

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#orderedreferenceset-ordering)

Ordering

Ordered reference set can also be used to create a simple ordered list of components, i.e. a list that do not include any nesting, or groups. For ordered lists that do not require grouping or hierarchical arrangement the value of linkedToId should be the digit zero (0), as this attribute becomes irrelevant.

This type of ordered reference set can for example be used to prioritize the sort order of the descriptions with identical terms when they are displayed. It can also be used to specify the order of descriptions displayed in a simple pick list.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1485734576-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FqOI2v58ZsXOoklmwBOk4%252Fuploads%252FdaIm3JFcJ3AdYrUNvm0B%252Fimage.png%3Falt%3Dmedia%26token%3Dc67e13aa-7691-472b-abbf-1da647e7c143&width=768&dpr=3&quality=100&sign=50259e5&sv=2)

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fattachments%2F35985666%2Fworddav1bc9228010e80acf97a985485c16361f.png%3Fversion%3D1%26modificationDate%3D1482423992000%26api%3Dv2&width=768&dpr=3&quality=100&sign=72f00187&sv=2)

Ordered reference set with no groups

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#orderedreferenceset-prioritizationprioritization)

Prioritization

Prioritization is similar to order but multiple components may have the same rank. In this case the value of the order attribute specify a priority order for a group of components.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1485734576-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FqOI2v58ZsXOoklmwBOk4%252Fuploads%252F5bso3bRFYou1uD7kN64s%252Fimage.png%3Falt%3Dmedia%26token%3De5e79122-753c-4104-935c-2c49885f5805&width=768&dpr=3&quality=100&sign=a7848c9f&sv=2)

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fattachments%2F35985666%2Fimage2016-7-21%25208%253A55%253A31.png%3Fversion%3D1%26modificationDate%3D1482423992000%26api%3Dv2&width=768&dpr=3&quality=100&sign=163b148a&sv=2)

Ordered reference set with prioritized groups

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#orderedreferenceset-alternativehierarchy)

Alternative hierarchy

The diagram below Illustrates how the three attributes referencedComponentId, order and linkedToId are used to create an alternative hierarchical order of some of the concepts from the subtype hierarchy.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fattachments%2F35985666%2Fworddav607276daeb2cf6f6bb54a6e6e3c871b5.png%3Fversion%3D1%26modificationDate%3D1482423992000%26api%3Dv2&width=768&dpr=3&quality=100&sign=f25c7322&sv=2)

Ordered reference set example.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#orderedreferenceset-referencesetspecificattributes)

Reference Set Specific Attributes

**Specific reference set attributes used to build an alternative hierarchical view of SNOMED CT**

Attribute

Description

**referencedComponentId**

The identifier of a SNOMED CT component that is included in the ordered list of alternative hierarchy.

**order**

Specifies the sort order of the list. The list is ordered by applying an ascending sort of the order value. The value of order =1 represents the highest priority. A value of '0' is not allowed. Duplicate values are permitted and the sort order between two members with the same order value is not defined. If the linkedToId value is not 0, sorting occurs within subgroups that share the same linkedToId value.

**linkedToId**

The identifier of a SNOMED CT component that acts as a grouper or hierarchy node, collecting together a subgroup from within the list. This field either enables reference set member linked into a number of subgroups. These subgroups can be nested allowing representation of alternative hierarchies. To link members into a subgroup, all components in the same subgroup should reference the same component. This can either be a component that represents the name of that subgroup or the first member of the subgroup. In the latter case, the first row of each subgroup will contain the same identifier in referencedComponentId and linkedToId and with order =1. To link a number of children concepts to a single parent concept, one member record should exist per child, with the referencedComponentId field referencing the parent and this field referencing the child concept. The order field is then used to order the children concepts under the parent concept.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#annotation-reference-set)

Annotation Reference Set


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900000000000516008 | Annotation type reference set| allows String to be associated with components for any specified purpose. So, where the 900000000000521006 | Association type reference set| linked a SNOMED CT component to another SNOMED CT components, the 900000000000516008 | Annotation type reference set| allow a SNOMED CT component to be linked to a non-standardized string annotation.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F1485734576-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FqOI2v58ZsXOoklmwBOk4%252Fuploads%252FOIEKSiZXu0e2z9lksm1B%252Fimage.png%3Falt%3Dmedia%26token%3Da105fcc9-5c20-4f54-b6e8-3b04c96bea79&width=768&dpr=3&quality=100&sign=fbd1f3b1&sv=2)

\\

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#annotationreferenceset-referencespecificattributes)

Reference Specific Attributes

Besides from the 4 identification and versioning attributes, the annotation reference set type has following attributes.

Field

Data type

Purpose

referencedComponentId

SCTID

The identifier of the component to be annotated.

annotation

String

The text annotation to attach to the component identified by referencedComponentId.

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See specification: [DEPRECATED: Annotation Reference Set](https://docs.snomed.org/snomed-ct-specifications/snomed-ct-release-file-specification/reference-set-release-file-specification/5.2-reference-set-types/5.2.1-content-reference-sets/5.2.1.6-deprecated-annotation-reference-set)

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Refset+Guide&entry.670899847=Appendix%20B%3A%20Deprecated%20Reference%20Set%20Types)

[PreviousAppendix A: Overview of Reference Set Typeschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-a-overview-of-reference-set-types)

Last updated 4 months ago

*   [Ordered Reference Set](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#ordered-reference-set)
    
*   [Ordering](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#orderedreferenceset-ordering)
    
*   [Prioritization](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#orderedreferenceset-prioritizationprioritization)
    
*   [Alternative hierarchy](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#orderedreferenceset-alternativehierarchy)
    
*   [Reference Set Specific Attributes](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#orderedreferenceset-referencesetspecificattributes)
    
*   [Annotation Reference Set](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#annotation-reference-set)
    
*   [Reference Specific Attributes](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-reference-set-guide/appendix-b-deprecated-reference-set-types#annotationreferenceset-referencespecificattributes)
    

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# System Components | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents

Enabling postcoordination in an Electronic Health Record (EHR) usually requires an EHR design that is prepared to support the use of expressions.

When developing EHRs, these are usually designed with both a health record data store to record health-related information about each patient, and a terminology server to store the codes and terms that may be used in the health records as illustrated in the image below.

A SNOMED CT-enabled terminology server stores the terminology content and provides the services required by the EHR to access the content. A terminology repository is included to hold the released terminology content, for example, a specific version of a national Edition of SNOMED CT plus any required SNOMED CT derivatives. When supporting postcoordination, the terminology server should support the storage of expressions, for example using an expression repository. In addition, dedicated services are required to enable the processing and use of the expressions in the same way as the released, precoordinated SNOMED CT content.

The recommended approach to ensure efficient use of a SNOMED CT-enabled terminology server is to use a service-oriented approach where dedicated terminology services are provided via an API enabling access and processing of the content within the terminology and expression repository.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2240938627-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FusjN9isxKh4cLDTFopLg%252Fuploads%252Fgit-blob-b563ce32cdbb68ec84107eb08d500607e5039954%252F180917859.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=3801053a&sv=2)

Overall design of an EHR supporting postcoordination. The EHR data store is used to hold the health related information recorded about each patient, and the terminology server includes the terminology content required by the EHR. This includes both a terminology repository for the released SNOMED CT content and an expression repository for the postcoordinated expressions.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Postcoordination+Guide&entry.670899847=System%20Components)

[PreviousAlternatives to Postcoordinationchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-postcoordination-guide/snomed-ct-expressions/alternatives-to-postcoordination)
[NextExpressions in the EHRchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-postcoordination-guide/expressions-in-the-ehr)

Last updated 7 months ago

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# Store Expression Identifier | Practical Guides SNOMED CT Postcoordination Guide | SNOMED International Documents

In some cases, it may be preferred or required to use a single identifier to represent the stored expression. With this approach, a unique local identifier is assigned to each expression, so that this can be stored in the health record in the place of the full expression. This approach may be selected if the clinical system has a limit on the length of the codes that are recorded in their health records.

When local expression identifiers are used, these are then linked to the corresponding full expression and display term within an Expression Repository, as illustrated in the image below.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F2240938627-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FusjN9isxKh4cLDTFopLg%252Fuploads%252Fgit-blob-442859b10540c1741194bcce4f96b5e52ceea2a2%252F180917663.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=794fecb4&sv=2)

This image illustrates the principles of storing postcoordinated expressions in an expression repository. The EHR data store uses local expression identifiers which are linked to a SNOMED CT expression and display term within the expression repository

**Terminology services**

Storing an expression identifier requires the expression to first be added to the expression repository, and assigned a unique identifier. The resulting identifier will be stored in the EHR data store. For this purpose, the following services may be required:

*   [Lookup Expressionarrow-up-right](https://github.com/SNOMED-Documents/snomed-postcoordination-guide/blob/main/expressions-in-the-ehr/storing-patient-data-using-expressions/broken-reference/README.md)
     [arrow-up-right](https://github.com/SNOMED-Documents/snomed-postcoordination-guide/blob/main/expressions-in-the-ehr/storing-patient-data-using-expressions/broken-reference/README.md)
    \- to get the identifier of the expression to be stored.
    
*   [Add Expressionarrow-up-right](https://github.com/SNOMED-Documents/snomed-postcoordination-guide/blob/main/expressions-in-the-ehr/storing-patient-data-using-expressions/broken-reference/README.md)
    . This is only required in cases where the expression does not already exist in the expression repository.
    

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Postcoordination+Guide&entry.670899847=Store%20Expression%20Identifier)

[PreviousStore the Full Expressionchevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-postcoordination-guide/expressions-in-the-ehr/storing-patient-data-using-expressions/store-the-full-expression)
[NextStore Expression Parts Individuallychevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-postcoordination-guide/expressions-in-the-ehr/storing-patient-data-using-expressions/store-expression-parts-individually)

Last updated 7 months ago

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# Constrained Searches | Practical Guides SNOMED CT Search and Data Entry Guide | SNOMED International Documents

Constraining searches enables the search browser to return fewer candidate matches. This is opposite to extending searches (see [**Extended Searches**](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches)
). The intention of constraining a search is to avoid getting a long list of search results to scroll through. This shortens the time the user needs to find the required Concept, thereby increasing the usability of the application.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-excluding-stop-words)

Constrain searches by excluding "stop words"


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Frequently used words with limited semantic specificity can be excluded from search indexes to improve the speed and specificity of searches. Examples of English words typically included in "stop word" lists include: a, an, and, as, at, be, by … of … the, etc.

General purpose search software often includes a default list of "stop words" but these may not be entirely appropriate for SNOMED CT searches. For example, the MySQL default "Full-Text Stopwords" includes "no", "non", "not", "without" and many other words which may be highly significant when searching for clinical terms.

The SNOMED CT International Release includes a suggested "stop list" (referred to as the _ExcludedWords_ Table). This is only available in English and is the list of exclusions used when generating keyword lists distributed with the same release.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-2cd8b77cd820865a79bcfa4004eaa2ff76c8742c%252F57815673.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=900e0258&sv=2)

Constraining words in any order searches by excluding stop-words - step 1

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-09b2e4a3e397eafb4fd910000da879d0435523c8%252F57815675.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=64a55005&sv=2)

Constraining words in any order searches by excluding stop-words - step 2

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-status)

Constrain Searches by Status


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Searches should usually be filtered so that only Active Descriptions associated with Active Concepts are returned.

There are a few use cases where a user may legitimately wish to search _Inactive Concepts_ and _Descriptions._ Possible cases include creating or editing queries that locate previously entered data recorded using _Concepts_ and _Descriptions_ that are no longer recommended for _active_ use. Therefore, searches intended to be used for these cases should allow the default active status filter to be disabled.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-b2c85d18a467abf244961eeda3fcea4af8606dc2%252F52171330.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=3da211bc&sv=2)

Constraining searches by filtering by active status

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**Important Note**

For use cases involving data entry or design of data entry template or Reference Set, this filter should always be applied and set as active. This should not even be a filter option.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-supertype-ancestors)

Constrain Searches by Supertype Ancestors


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Searches may usefully be limited to _Concepts_ that have a specified supertype ancestor, which is appropriate for the context of a particular field, template or protocol.

### 

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#example)

Example

When attempting to record the diagnosis "renal calculus," it is not helpful for a search to include the procedures that may be carried out to treat a renal calculus.

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-0e38085c806a640c6ca3ccd5ba69cf18e7f77317%252F52170499.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=59d99eb9&sv=2)

![](https://docs.snomed.org/~gitbook/image?url=https%3A%2F%2F655065570-files.gitbook.io%2F%7E%2Ffiles%2Fv0%2Fb%2Fgitbook-x-prod.appspot.com%2Fo%2Fspaces%252FCEAcChvWjWEu16YmwNrz%252Fuploads%252Fgit-blob-364337fcec46a3f6b947e5c3b762e357cef2059e%252F52170500.png%3Falt%3Dmedia&width=768&dpr=3&quality=100&sign=5104870e&sv=2)

Constraining the search by filtering by supertype ancestors

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-reference-sets)

Constrain Searches by Reference Sets


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Searches for Descriptions or Concepts may need to be constrained by Reference Sets. Applications should allow searches to be filtered, ordered or otherwise prioritized in accord with one or more active Reference Sets. Specifically, the search mechanism should support the following functions with respect to the following types of Reference Sets:

*   A Simple Reference Set may be used to filter, sort or highlight the results of text search or hierarchical navigation. This may simplify or encourage selection of Concepts or Descriptions used in a particular country, organization or specialty.
    
*   A Simple Reference Set or an Ordered Reference Set may be used to specify or order the valid Concepts for entry in a particular field.
    

Reference Set may also be used to exclude subsets of Concepts and Descriptions that are not relevant or appropriate in browsers and in-built search functionalities. For example, it may be beneficial for the search not to return any members of the non-human Reference Set, unless the search is explicitly customized to include them.

[hashtag](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-language-or-dialect)

Constrain Searches by Language or Dialect


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Constraining searches by language or dialect is a type of constraining by Reference Sets. For every translated version of SNOMED CT, this technique is mandatory. Filtering of search and navigation results to include only those Descriptions that are referenced by the Language Reference Sets may be applied to limit a search to those Descriptions applicable in a particular language or dialect. A single common encoding language should be mandatory in search use cases directly connected to data entry, to avoid confusion and ambiguity. There are a few use cases where a user may legitimately wish to search for Descriptions included in extensions of other countries _._ For example, when mapping SNOMED CT to other code sets, en-US (American) Descriptions may be required if extensions are not available in the UK language Reference Set.

[Provide Feedback](https://docs.google.com/forms/d/e/1FAIpQLScTmbZIf0UEQwYDkY27EEWBkaiYkHSbR0_9DmFrMLXoQLyL7Q/viewform?usp=pp_url&entry.1767247133=Search+And+Data+Entry+Guide&entry.670899847=Constrained%20Searches)

[PreviousExtended Searcheschevron-left](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.3-extended-searches)
[NextImprove Search Speedchevron-right](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.5-improve-search-speed)

Last updated 7 months ago

*   [Constrain searches by excluding "stop words"](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-excluding-stop-words)
    
*   [Constrain Searches by Status](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-status)
    
*   [Constrain Searches by Supertype Ancestors](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-supertype-ancestors)
    
*   [Example](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#example)
    
*   [Constrain Searches by Reference Sets](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-reference-sets)
    
*   [Constrain Searches by Language or Dialect](https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-search-and-data-entry-guide/4-optimizing-searches/4.4-constrained-searches#constrain-searches-by-language-or-dialect)
    

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