> For the complete documentation index, see [llms.txt](https://docs.snomed.org/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://docs.snomed.org/snomed-ct-practical-guides/implementation-maturity-framework-guide/framework-design/maturity-levels.md).

# Maturity Levels

## Overview

The Implementation Maturity Framework (IMF) provides a consistent yet flexible model for assessing how SNOMED CT is adopted and used across the healthcare ecosystem.

The general maturity levels provide a shared foundation for assessing SNOMED CT implementation and ensure consistency across the ecosystem. However, their application varies by stakeholder, reflecting different roles, responsibilities, and objectives.

* **Members** (National Release Centers) apply the maturity levels at a national or regional level, focusing on governance frameworks, policy alignment, infrastructure, and the breadth of adoption across affiliates and healthcare systems.
* **User Organizations** apply the maturity levels to clinical and operational implementation, including how SNOMED CT is embedded within systems, integrated into workflows, and used to support care delivery, reporting, and decision-making.
* **Vendors / Software Providers** apply the maturity levels to the capabilities of their products or platforms, such as terminology integration, usability, interoperability, and support for analytics and decision support.

While each stakeholder group uses tailored criteria and assessment questions, they remain aligned to the same overarching maturity scale. This ensures:

* A common language for benchmarking and comparison
* Alignment across the ecosystem
* Support for coordinated progress toward higher maturity

<details open>

<summary><strong>Maturity Level Descriptions</strong></summary>

These levels provide a common foundation for assessing SNOMED CT implementation maturity, regardless of stakeholder type. Each level represents a progression in capability, structure, and value realization.

***

#### Level 0 – None

* No awareness or use of SNOMED CT
* No governance, strategy, or supporting infrastructure
* Clinical or operational data captured using free text or local codes only
* No capability for interoperability or standardized data exchange

***

#### Level 1 – Basic

* Limited awareness or early understanding of SNOMED CT
* Minimal or experimental use in isolated areas
* No formal governance, strategy, or implementation roadmap
* Use is inconsistent and not embedded in workflows

***

#### Level 2 – Emerging

* Initial strategy and planning activities underway
* Pilot projects or early implementations in selected areas
* Early governance structures and roles being defined
* Growing stakeholder awareness and engagement

***

#### Level 3 – Advanced

* Broader implementation across systems, departments, or affiliates
* SNOMED CT integrated into key workflows and operational processes
* Established governance, policies, and maintenance practices
* Training and support mechanisms in place
* Data increasingly used for reporting and operational insights

***

#### Level 4 – Integrated

* Widespread, consistent adoption across the organization or ecosystem
* Interoperability enabled through alignment with standards (e.g., HL7, FHIR)
* Strong governance with monitoring, quality assurance, and performance tracking
* SNOMED CT data actively used for analytics and decision support
* Measurable improvements in data quality and outcomes

***

#### Level 5 – Optimizing

* Fully embedded and sustained use across all systems and workflows
* Advanced analytics, real-time decision support, and AI-driven capabilities
* Continuous improvement embedded in governance and operations
* High-quality, interoperable data supporting research, policy, and innovation
* Leadership in terminology management and best practices

</details>

## SNOMED CT Implementation Maturity Matrix

This matrix below provides a side-by-side view of SNOMED CT implementation maturity across Members, User Organizations, and Vendors, using a common set of levels from None to Optimizing. It highlights how each stakeholder progresses along the same maturity scale while focusing on different responsibilities - national adoption, clinical use, and product capability.

The matrix supports comparison, alignment, and a shared understanding of how coordinated advancement across stakeholders enables effective, interoperable, and data-driven healthcare systems.

<table><thead><tr><th width="180.68603515625">Level</th><th>Members</th><th>User Organizations</th><th>Vendors</th></tr></thead><tbody><tr><td><strong>Level 0 – None</strong></td><td>No national activity, no governance, no awareness</td><td>No use of SNOMED CT, reliance on free text/local codes</td><td>No SNOMED CT support, no terminology integration</td></tr><tr><td><strong>Level 1 – Basic</strong></td><td>Awareness exists, informal discussions, no national program</td><td>Limited use in isolated areas, minimal workflow integration</td><td>Basic functionality in limited modules, inconsistent implementation</td></tr><tr><td><strong>Level 2 – Emerging</strong></td><td>Strategy forming, pilots underway, early governance</td><td>Use in selected departments, early workflow integration, basic training</td><td>Implemented in some modules, basic search/tools, early interoperability</td></tr><tr><td><strong>Level 3 – Advanced</strong></td><td>Expanding adoption, governance established, monitoring introduced</td><td>Regular use in key workflows, structured governance and training</td><td>Integrated across core features, improved usability, standards-based interoperability</td></tr><tr><td><strong>Level 4 – Integrated</strong></td><td>Widespread national adoption, strong governance, aligned with national strategy</td><td>Enterprise-wide implementation, interoperability, analytics and decision support</td><td>Broad implementation, advanced usability (e.g., NLP), integrated analytics and CDS</td></tr><tr><td><strong>Level 5 – Optimizing</strong></td><td>Fully optimized national ecosystem, advanced secondary use, global leadership</td><td>Fully embedded, AI-driven insights, continuous improvement</td><td>Intelligent platform, AI-driven features, real-time interoperability, continuous innovation</td></tr></tbody></table>

***

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