Introduction

This appendix provides a structured checklist derived from the requirements set out in this guide, reorganised according to the five maturity levels of the SNOMED CT Implementation Maturity Framework (IMF) for Software Products.

While the main body of this guide presents requirements by category (Edition, Language and Content; User Interface; Analytics and Reporting; Maintenance; Storage; and Interoperability), this checklist reframes those same requirements through the lens of maturity. The intent is to give procurement teams and National Release Centers (NRCs) a practical tool for evaluating vendors in a progressive, stage-appropriate way.

How to Use This Checklist

Rather than applying all requirements uniformly, organisations are encouraged to:

1. Set a target maturity level appropriate to their national strategy, use case, or procurement context.

2. Work through the checklist from Level 1 upward, confirming each requirement is met before moving to the next level. Requirements at lower levels remain in force at higher levels.

3. Use the checklist as a basis for vendor evaluation, including request for proposal (RFP) criteria, demonstration scenarios, or contract conditions.

4. Request evidence of compliance for each requirement, such as product documentation, live demonstration, or third-party audit results.

A corresponding mapping of all requirements to their expected maturity level is available in the page of the IMF Guide.

SNOMED CT is present in the system and used for core clinical data, but integration may be limited or isolated.

Edition, Language and Content

• SNOMED CT incorporated as the primary clinical terminology, including the international edition, national edition, and relevant local extensions.

• SNOMED CT implemented in the native language of the implementing country or organisation.

User Interface

• SNOMED CT used for searching, display, storage, communication and querying in core clinical domains: problems/diagnoses, reason for admission, procedures, and allergies.

Storage

• SNOMED CT concept identifiers stored in the health record.

• SNOMED CT concept identifier (or expression) stored alongside the term selected by the user, for each coded data element.

Consistent SNOMED CT capabilities across select clinical areas. Basic update, search and interoperability standards are in place.

Edition, Language and Content

• SNOMED CT edition updated within 12 months of a new version being published, including all changed components and derivative artifacts.

User Interface

• Search supports any preferred or acceptable term from the national language reference set.

• Configurable display options available for the term shown upon concept selection (user-entered, preferred, or institution-specific term).

• Searching restricted to concepts from the SNOMED CT subset bound to the relevant data element.

Analytics and Reporting

• Maps from local code systems to SNOMED CT available for querying and analysis of legacy clinical data.

Maintenance

• The deployed SNOMED CT edition is no more than two versions behind the most current release, keeping all components current. For editions released on a monthly basis, the deployed version remains no more than 18 months behind the most current release.

Storage

• Context of each SNOMED CT concept or expression is clearly represented in the information structure or terminology (but not both).

Interoperability

• SNOMED CT concept identifiers and/or expressions used to populate coded data elements in all relevant message exchanges.

Standardised, well-maintained SNOMED CT implementation across most clinical areas. Mappings, subsets and historical data are actively managed.

Edition, Language and Content

• All required SNOMED CT subsets and maps created or sourced, subject to a documented and approved quality assurance process.

• Feedback mechanism in place for submitting new or missing content, including engagement with the NRC where additional content is required.

User Interface

• Most frequently selected concepts displayed at the top of lists for data elements bound to subsets of more than 20 concepts.

• Code suggestions provided via SNOMED CT maps to other coding systems (e.g. ICD-10), for clinician review and selection.

Analytics and Reporting

• Maps to national and international classifications (e.g. ICD-10) used for analysis and statistical reporting, including of legacy data.

Maintenance

• All subsets and maps maintained with each new SNOMED CT release to ensure continued clinical validity.

Storage

• All inactivated concepts, descriptions and relationships retained and available to support querying over historical clinical data.

Interoperability

• Data sharing aligned with national and local data standards, using SNOMED CT as the common clinical language.

• Mappings to external terminologies supported (e.g. ICD-10, ICPC2, LOINC, Orphanet), accessible in relevant clinical and reporting contexts.

Comprehensive SNOMED CT integration across clinical and administrative functions, with advanced tooling for usability, decision support and analytics.

User Interface

• SNOMED CT-enabled NLP used to suggest possible SNOMED CT encoding from free text clinical entries, for user review and confirmation.

• Post-coordinated expressions supported via predefined templates and automatically generated interface terms (e.g. for laterality, allergies, family history).

• SNOMED CT concept identifiers used to surface patient-specific clinical knowledge and test clinical decision support rules.

Analytics and Reporting

• SNOMED CT defining relationships used in the logic of clinical decision support rules, data extractions and reporting queries.

Integration and Coverage ^{(IMF-derived)}

• SNOMED CT is implemented consistently across both clinical and administrative functions, not limited to specific departments or workflows.

• Active metrics are in place to monitor SNOMED CT usability, coverage, and user adoption across the system.

• SNOMED CT update processes are tracked, version-controlled, and applied consistently across all system components.

Continuous improvement, full automation, and active contribution to the SNOMED CT ecosystem. The vendor goes beyond compliance to drive ongoing quality and innovation.

Maintenance

• SNOMED CT extension authoring is supported in full compliance with SNOMED CT principles: globally unique identifiers, concept permanence (no concept ID reuse), and a robust audit trail for all inactivations including replacement codes.

Automation and Continuous Improvement ^{(IMF-derived)}

• SNOMED CT updates are fully automated, with seamless integration and real-time notifications to relevant stakeholders when new releases are available.

• Continuous evaluation mechanisms are in place to assess SNOMED CT integration quality and drive ongoing improvements, informed by real-time user feedback.

• AI-driven features actively improve SNOMED CT usability and encoding quality based on accumulated usage data and feedback.

Ecosystem Contribution ^{(IMF-derived)}

• Content gaps and quality issues identified within the system are systematically reported back to the NRC or SNOMED International, contributing to broader terminology improvement.

Contact info@snomed.org for additional resources or questions pertaining to the SNOMED CT Example EMR/EHR Requirements Guide.

Provide Feedback

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.

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

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.

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.

The target audience for this Example Guide includes:

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.

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.

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.

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.

Provide Feedback

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).