General

What is the full name of the IHTSDO®?

What is the IHTSDO®?

Where is the IHTSDO® based?

Who are the IHTSDO® Members?

What are the rights and obligations of Members?

Who are the IHTSDO® Charter Members and what does this mean?

I’m a vendor who wants to incorporate SNOMED CT® into my product.  What do I need to do now?

Our hospital or clinic wants to start using SNOMED CT®.  What do we need to do?

I’m an individual who wants to use SNOMED CT® for my own purposes or for research.  What do I need to do?

I thought the IHTSDO® would make SNOMED CT® freely available to the world.  Why is the IHTSDO® licensing the terminology?

What is the General Assembly?

Will there be a forum for the community of license holders?

 

SNOMED CT®

What does the SNOMED® enterprise consist of?

How comprehensive is the core terminology and when will it be complete?

What would it cost to develop and maintain a new Clinical Terminology based on a Global uptake?

 

 Members

What is the purpose of the National Release Centers - also known as the Member Product Management Centers?

How much will it cost to become a Member?

 

Other issues

Why is the IHTSDO® a ‘Standards Development Organisation’?

What is the expected release profile for SNOMED CT®?

Which organization is responsible for acting as a Support Service to the IHTSDO®?

What is a Harmonization Body?

A support service contract has been agreed with the College of American Pathologists (CAP) for various services related to the ongoing support and maintenance of SNOMED CT®. This is for 3 years with extension options.

 

SNOMED CT® Core will be released twice per year in January and July in UK English and US English. SNOMED CT® Core translations from English will be released 3 months following the Core releases.  As SNOMED CT® is translated into more languages and when the technology is delivered it is expected that the Management Board will evaluate the release profile to ensure member needs are being met in the most productive and efficient manner.

The IHTSDO® document, agree and then standardize the processes required to maintain and develop SNOMED CT®.  Existing SNOMED CT® documentation (such as the Style Guide) will be reviewed and updated with the intention of developing a suite of agreed IHTSDO® Standards.

It is also anticipated that the Management Board will begin to explore formal relationships with ISO and other such standards approval bodies following formation of the SNOMED SDO®. 

 

In each member country, the agency listed in the 'Member' section of this website is the host of the National Release Centre.

The purpose of a National Release Center (NRC) - or Member Product Management Center (PMCs)  - is to provide a central (and single) point within the member’s jurisdiction to:

• Interface to the IHTSDO®;

• Interface to other PMCs;

• Interface to all entities within the member’s territory that have an interest in the products or business of the IHTSDO®;

• Manage and control the use of the IHTSDO®’s assets within the member’s territory;

• Interface to CAP in line with IHTSDO® policies, procedures and regulations. Under normal circumstances there should be no direct contact between entities within a member’s territory and CAP.

Has the total responsibility for distribution and support of the Association’s Terminology Products within the member’s territory and the IHTSDO® has no obligation to perform or provide any such distribution or support.

 

The cost of developing a new clinical terminology is estimated to be between $US 25 million and $US 55 million.  The annual maintenance cost is expected to be in the region of $US 8 million and $US 9million per year – which is the same as the estimated costs for the IHTSDO® to maintain and improve SNOMED CT®.  These estimates are based on the historic costs borne by the CAP and the UK NHS.

 

The issue of completeness is always a difficult question to answer because it can be interpreted to mean as many things as there are clinical constituencies to ask it.

Notwithstanding this difficulty with respect to the question, SNOMED CT® contains the vast majority of concepts required to record the process of care across the range of clinical professions in practice. The January 2007 release contained over 308,000 active concepts portrayed by more than 777,000 active descriptions and associated to each other by in excess of 924,000 defining relationships.

 

These concepts with their inherent unique meanings and formal logic-based definitions are arranged into 19 hierarchies covering the following areas:

• Clinical findings
• Procedures/interventions
• Observable entities
• Body structure
• Organism
• Substance
• Pharmaceutical/biologic product
• Specimen
• Qualifier value
• Physical object
• Physical force
• Environments/geographic locations
• Social context
• Situation with explicit context
• Staging and scales
• Link concepts
• Special concepts
• Record artifact and event

New content within existing areas of the terminology are added to each release in response to user requests driven by advances in clinical knowledge over time. At the same time existing content is subject to regular review and refinement where necessary. In addition, new content domains are considered for inclusion on a regular basis.

 

For these reasons SNOMED CT® will never truly be complete, but will continue to develop to reflect the current understanding and recording requirements of the clinical care process.

The SNOMED® enterprise exists at the moment as a number of processes and activities which produce a number of outputs that can be broadly categorized as:

Documents describing the SNOMED CT® standard(s) [specification(s)]

• The terminology files consisting of:
• Concepts
• Descriptions
• Relationships

• A set of specified technical tools for supporting development and request processing

• A set of SNOMED® allied standards, which enable SNOMED® to effectively interoperate with and/or map to, other international information standards

• Includes implementation standards for the successful use of SNOMED including:
• Translations
• Reference implementation instructions

• Services:
• Keeping the terminology database in line with the concepts needed for the modern care of citizens

• Derivative works that help in the uptake and use of SNOMED:
• Implementation guidance
• Training
• Quick reference guides, etc.

 

The way the new SDO has been structured will enable international needs to be supported in a way that enables international interoperability.

Yes.  The Affiliates forum will act as a community of practice concerned with improving the implementation and deployment of SNOMED CT® within products and services purchased on a national and/or international scale.  It will be open to anyone with an Affiliate license. 

 

The General Assembly is the highest authority of the IHTSDO® and will meet at least twice a year in April and October.  All Members have voting rights at the General Assembly and can bring forward items for consideration. 

 

Strategic direction for the IHTSDO® will be provided by the Management Board (of twelve) which reports to the General Assembly.

If you live within a Member nation then you are entitled to use SNOMED CT and we suggest you contact them for further information about how to gain access.

 

If you are in a non-Member nation we suggest you contact the IHTSDO® office.  The IHTSDO® Board recognize the value of research to the progression of SNOMED CT®, and we need to ensure that this is a valid research project, and not de-facto use of the terminology without making contribution to its maintenance.

This was an issue of key discussion within the IHTSDO® Board.  However the key goals of the Board are to ensure that the terminology is

 

1. Sustainable; 
2. Improves interoperability; and  
3. Does not compromise patient safety

 

In terms of sustainability, the IHTSDO® needs an income stream to be able to maintain and improve the quality of SNOMED CT®.   There is an expectation that all users of the terminology need to contribute to the maintenance and running costs of the Association in accordance with their ability to pay.  Maintaining interoperability of the terminology requires changes to the terminology to be constrained, with some level of control over local modifications and enhancements.   Both of these factors have the ability to impact patient safety – which requires process to ensure the quality of the terminology (which in turn costs $ as outlined in #1) and common understanding of encoded data (which requires interoperability as in #2).

 

The IHTSDO® Board therefore decided not to ‘open up’ the existing licensing models unless the impact of such changes could be carefully reviewed and assessed.  Therefore in these formative stages the Board has opted for a licensing model which is not too dissimilar to the status quo.  If in future, Members can be convinced that there are alternative models which allow more open access to SNOMED®, but do not affect any of the three core tenets above, such an alternative model or variation to the licensing conditions may well be accepted through a vote of the General Assembly.

If you are planning to develop your own systems in-house, then the conditions outlined for vendors (above) are applicable to you.

 

If instead you are intending to procure a system from an external vendor, then all you need to do is stipulate the use of SNOMED CT® as one of your requirements when purchasing the system.  The Affiliate license which the vendor must hold will cover your use of SNOMED CT®.

 

If you wish to learn more about SNOMED CT® and its potential, then please find the contact the IHTSDO or one of our members for more information about training courses or working groups.

You’ll need an Affiliate License with the IHTSDO®.

 

If you are based within an existing Member nation, and only wish to use SNOMED CT® within that jurisdiction, we suggest that you simply contact the relevant Member.  They will be able to provide further details of how to access the International Release and will also inform you of any additional materials or conditions relevant for use within that Members territory. 

 

The Affiliate License is a click-through license, and you’ll need to accept the conditions for use prior to accessing SNOMED CT®.  Most members will provide SNOMED CT® free of charge to users, although some may leverage a small fee for cost recovery.

 

If you are based within an existing Member nation, and wish to deploy SNOMED CT® in other countries you’ll need to check whether those countries are also members of the IHTSDO®.  The Affiliate license you’ve received is a world-wide license, so it can be freely used in other IHTSDO® Member’s territories, but there may be additional extensions or local modifications relevant for use in another nation, so you’ll need to check with that Member. 

 

There is charge payable to the IHTSDO® for use in non-member territories.  See the Affiliate License for details.

 

If you are based within a non-Member nation you will need to contact the IHTSDO® directly to purchase a license and receive downloads.

The IHTSDO® believes in principles of fairness and transparency.  To that end, Membership fees are structured on a fair share formula based on your nation’s Gross Domestic Product and population (ie. your ability to pay) and the total cost to the Association of maintaining SNOMED CT®. The ability to pay relies on the trusted third party, namely World Bank GNI Atlas. Version used by the association is published on the website.

 

The spreadsheet on fees will indicate how much your country will pay in a joining fee and annual fee.  More detail on how fees are controlled is contained in the Articles of Association.

The IHTSDO® is very keen to encourage new Members, so please contact us to discuss this further.

 

The process for joining as an Ordinary Member is as set-out in the IHTSDO® Articles of Association and will require a letter from your Ministry of Health stating this intent. The letter would need to identify the people and the agency/organization/Ministerial Department that would be responsible for SNOMED CT® in your jurisdiction.

The Charter Members are those countries that worked together to form the IHTSDO® and include Australia, Canada, Denmark, Lithuania, Sweden, the Netherlands, New Zealand, United Kingdom and United States. Collectively they worked together to form the organization.

 

Representatives from these nine nations lead negotiations with the College of American Pathologists (CAP) and put in many hours of work to develop the guiding principles and governance structures for the IHTSDO®.  In addition, their financial contributions (or Set-up fees as described in Clause 7.4 of the Articles) provided funds to secure the intellectual property of SNOMED CT® and antecedent works.

 

Charter Members are given special status for the first five years of the Association, in that they have an assured seat on the Management Board.  Any vacancies during that time, and all seats after that time, shall be elected on a Regional basis.

The International Health Terminology Standards Development Organisation (IHTSDO®). The organisation is also referred to as the SNOMED SDO® (Standards Development Organisation). 

The IHTSDO® has been established as a not for profit  Association under Danish Law, and its purpose is to:

• Acquire, own and administer the rights to SNOMED CT, other health terminologies and/or related standards and/or other relevant assets (collectively ”Terminology Products”);

• Develop, maintain, promote and enable the uptake and correct use of its Terminology Products in health systems, services and/or products around the World; and

• Undertake any or all activities incidental and conducive to achieving the Purpose of the IHTSDO®.

The main office of the IHTSDO is based in Copenhagen, Denmark.

 

The full postal address is:

IHTSDO®

Rued Langgaards Vej 7, 5te

DK-2300 Copenhagen S 

Current members and their contact details are listed at the Members page.

Membership is open to all countries who are interested in using SNOMED CT® and working towards the goals and purpose of the Association. 

Nations themselves are not members.  Members are an organization which is endorsed by the Government to represent that nation.  All prospective Members of the IHTSDO® must meet certain criteria (refer Clause 4.3.2 of the Articles) in order to join the Association.

The rights and obligations of Members are fully outlined in the Articles of Association.

 

In essence Members, through the Association, jointly govern SNOMED CT® and have the right to influence its ongoing further development. Their membership fee provides for free use of SNOMED CT® within their territory.

 

Members manage the release, adaptation, distribution and sub-licensing of SNOMED CT® and other products of the Association within their Territory (Clause 5 of the Articles).  Details of the conditions under which Members may access and modify SNOMED CT® are fully outlined in Schedule 3 of the Articles.

 

One of the key aims in establishing the SDO has been to foster international collaboration and contributions to accelerate the further development of SNOMED®, and it is anticipated that Members will work together to rapidly improve the quality and comprehensiveness of SNOMED CT®.

In order to deliver the first of the SNOMED SDO® founding principles, to support the care of individual patients by clinical professionals, it will be necessary for SNOMED CT® to interoperate with other standards in the electronic health care environment. Each method of interoperation will have to be defined and conformed to if care delivery is to remain effective and safe.

Effectively therefore, this defined interoperation is in itself a standard. However, this type of standard must be owned both by the SNOMED SDO® and the associated standard, referred to in this brochure and other supporting material as a SNOMED Allied Standard.

 

Allied Standards may take the form of a specification, a service or a product. Regardless of format, the joint ownership of the Allied Standard means its definition and alteration can only be achieved through agreement between the SNOMED SDO® and the associated standard.

 

The creation of a Harmonization Board to manage each SNOMED Allied Standard is the way in which these collaborative efforts will be overseen. This will create a strong link to the governance processes of the Management Board of the SNOMED SDO® yet leave sufficient flexibility for the Allied Standard to be managed in a way that best suits its particular requirements.