Introduction

Background

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.

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.

Scope

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.

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

Document Structure

This document is organized into five main chapters:

• 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 outlines the practical use cases for terminology services.

• Terminology Service Types describes the different types of terminology services required to enable effective use of SNOMED CT.

• Service Implementation Considerations provides practical information regarding the use of the SNOMED CT release files to meet specific terminology service requirements.