# The Role of NRCs related to SNOMED CT Licensing

## 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 license&#x73;**.**

<figure><img src="https://3066103899-files.gitbook.io/~/files/v0/b/gitbook-x-prod.appspot.com/o/spaces%2FP1frmzZuNvoHsCrG7SKQ%2Fuploads%2Fgit-blob-fadaa2aee64518daed1e94a5ba463fc359d01481%2F254968145.png?alt=media" alt=""><figcaption></figcaption></figure>

Full details of the conditions of use of SNOMED CT are provided by the [SNOMED CT Affiliate License agreement](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 : [Members](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 Service](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 fees](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 [fees](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 guidance](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.

## 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

<figure><img src="https://3066103899-files.gitbook.io/~/files/v0/b/gitbook-x-prod.appspot.com/o/spaces%2FP1frmzZuNvoHsCrG7SKQ%2Fuploads%2Fgit-blob-6b212245c1cb9a3f3695be9042be4e605a5d9bcd%2F254968144.png?alt=media" alt=""><figcaption></figcaption></figure>

## 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.

<figure><img src="https://3066103899-files.gitbook.io/~/files/v0/b/gitbook-x-prod.appspot.com/o/spaces%2FP1frmzZuNvoHsCrG7SKQ%2Fuploads%2Fgit-blob-b7ddca8f9ef07ad0e80559844c863e0e3a917aac%2F254968143.png?alt=media" alt=""><figcaption></figcaption></figure>

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.

### **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 Services](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.

{% hint style="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.
{% endhint %}

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