SNOMED International engages in these partnerships with the goal of facilitating the use of SNOMED CT with other international standards and profiles.

The focus of partnerships is to enhance consistency in meaningful data capture and information exchange and to improve safety, while enhancing functionality and enabling interoperability for the growing number of healthcare professions that use and exchange electronic health records using SNOMED CT and related products.

Some of the resulting products include mappings, SNOMED CT subsets and guidance on the use of SNOMED CT alongside, and integrated with, other standards.
 

ADA

The American Dental Association (ADA) is not-for-profit and the largest professional association for dentistry in the United States, representing more than 157,000 dentist members. It is the premier source of oral health information in the United States, if not the entire world, and has advocated for the public’s health as well as promoted the art and science of dentistry since 1859. It has developed and continues to develop the SNODENT dental diagnostic code set.

Additional information

In 2012, ADA and IHTSDO signed a Cooperation Agreement which focused on aligning the content of SNODENT and SNOMED CT, where appropriate, and also saw the instigation of the IHTSDO International Dentistry Special Interest Group (SIG). This Cooperation Agreement was updated to a Collaboration Agreement in April 2016 focusing on agreed joint work, including:
  • Development of a SNOMED CT General Dentistry Diagnoses Subset
  • Release and maintenance of this SNOMED CT General Dentistry Diagnoses Subset
  • Ongoing provision of Subject Matter Experts by ADA
  • Support for maintenance and updating of the linkage between SNOMED CT and SNODENT at respective releases
The SNOMED CT General Dentistry Diagnoses Subset is now released and updated 6 monthly in line with each release of SNOMED CT. It is worth noting that the Dentistry Clinical Reference Group (previously SIG) has also produced an Odontogram subset which is also available through SNOMED International and aligns with SNODENT where appropriate.

AMA

The American Medical Association (AMA) and SNOMED International have a collaborative agreement to coordinate on the design and development of their respective coding and terminology products.  The AMA has also recently announced their Integrated Health Model Initiative (IHMI) which complements the approach that SNOMED International embodies regarding continuous learning and collaboration.  Given both parties are committed to the unambiguous exchange of clinical information across the health system,  SNOMED International is committed to the IHMI collaborative community and its pursuit of safe, effective and patient-driven health care.

Additional information

The AMA and SNOMED International recognize the complementary nature of their various code sets and initiatives and the critical role they play in healthcare delivery and administration. By working in tandem, the collaboration will allow the continued improvement of content to better support existing and emerging uses of health data globally.

ERA-EDTA

SNOMED International and the European Renal Dialysis Association - European Dialysis and Transplant Association DICOM in December 2017 signed a SNOMED CT Licensing Agreement. This built on a previous research agreement that ERA-EDTA had to use SNOMED CT for Primary Renal Disease (PRD) in the ERA-EDTA registry, clarifying further the use of SNOMED CT and how the SNOMED CT content should be managed over time. The SNOMED CT Licensing Agreement is for 5 years and on review can be renewed for a further 5 years.
 

Additional information

The SNOMED CT Licensing Agreement covers the use of an agreed set of SNOMED CT codes and descriptions for the Primary Renal Disease (PRD) in the ERA-EDTA registry. The agreed SNOMED CT set is updated after each SNOMED CT international release (6 monthly), taking into account changes to SNOMED CT and any requests for changes from ERA-EDTA.

The focus of this agreement is to support those who are using SNOMED CT in EHRs to be able to link directly to the ERA-EDTA registry but in addition,  the agreement provides the SNOMED CT set free for use globally for those who have not yet transitioned to the use of SNOMED CT. If, however,  implementers use additional SNOMED CT content (outside scope of the agreed set), they are subject to SNOMED CT licensing arrangements which may incur a fee in SNOMED International non-member countries

GA4GH

SNOMED International, as part of its commitment to developing its approach to Genomics, has become a member of the Global Alliance for Genomics and Health. As a member, SNOMED International contribute to work to identify content requirements, and to provide support for the interoperability challenges faced by the global genomics community.
 

Additional information

The Global Alliance for Genomics and Health was formed to help accelerate the potential of genomic medicine to advance human health. It brings together over 400 leading institutions working in healthcare, research, disease advocacy, life science, and information technology. The partners in the Global Alliance are working together to create a common framework of harmonized approaches to enable the responsible, voluntary, and secure sharing of genomic and clinical data.
 
The work of the Global Alliance is critical to realizing the potential of recent technological advances that make possible the large-scale collection of data on genome sequencing and clinical outcomes. To seize this extraordinary opportunity, it is often necessary to ask questions that span individual datasets. The Global Alliance is working to alter the current reality where data are kept and studied in silos, and tools and methods are non-standardized and incompatible.
 
Engaging collaboratively with its stakeholders, the Global Alliance works to establish, broadly disseminate, and advocate for the use of interoperable technical standards for managing and sharing genomic and clinical data.

ICN

On March 17 2010, the International Council of Nurses (ICN) and IHTSDO announced a collaborative agreement to advance terminology harmonization and foster interoperability in health information systems.  This agreement was updated in 2014 with a focus on agreed collaborative activities and a work plan across both organizations in order to support those using International Classification of Nursing Practice (ICNP) to also be able to use SNOMED CT in the shared electronic health record.

Additional information

ICN and SNOMED International have together delivered the following:
  • A table between ICNP and SNOMED CT for Nursing Diagnoses – this was released in 2015 and is now being maintained and updated in line with the release cycles of both SNOMED CT and ICNP
  • A table between ICNP and SNOMED CT for Nursing Interventions – this was released in 2016 and is now being maintained and updated in line with the release cycles of both SNOMED CT and ICNP
SNOMED International’s Nursing Clinical Reference Group has oversight of the work, bringing an international perspective on both the content and equivalences, thus providing a measure of quality assurance.
 
The human readable versions of both equivalence tables are available from ICN and the RF2 version is available from SNOMED International member countries/territories or SNOMED International.
 

INSERM

IHTSDO and Institut national de la santé et de la recherche médicale (INSERM US14, DR Paris 6) signed a Collaboration Agreement in June 2015 to improve the Rare Disease content of SNOMED CT by incorporating an initial set of Orphanet, which is managed by INSERM. This important agreement will ensure that Rare Disease information can be drawn from the EHR for different purposes and meets the needs of clinicians, IHTSDO Member countries etc who are in some cases required to report information using Orphanet.

Additional information

The Agreement focuses on 2 aspects:
  • Inclusion of an initial set of Orphanet content in SNOMED CT (about 3500)
  • Produce a map between SNOMED CT and Orphanet of this content
In order to deliver this work, a detailed work plan was agreed between the 2 organizations and this has recently been updated. Content is added to SNOMED CT using definitions agreed by Rare Disease experts and incorporated in to Orphanet and released on a 6 monthly schedule through until the SNOMED CT July 2019 release and then a map will be created and released in 2020. This work is a key component of the SNOMED International Genomics strategy.
 

WONCA

In 2009, IHTSDO and WONCA (World Organization of Family Doctors) signed a Cooperation Agreement focused on delivering the following:
  • General Practice/Family Practice (GP/FP) refset based on international requirements
  • Map from this refset to ICPC-2 (International Classification of Primary Care version 2)
  • Establishment of an International General Practice/Family Practice Special Interest Group to provide SME input to the work and direction on the needs of SNOMED CT

Additional information

The focus of the refset was agreed as Health Issues/Reasons for Encounter and source data collected from across the world. The products were released in September 2015 (see press release below) and are maintained and updated in line with each release of SNOMED CT.
 

IBM Watson Health

In March 2017, SNOMED International and IBM announced that Watson Health will adopt SNOMED CT for use in Watson Health offerings in support of IBM’s commitment to comprehensive standardization of patient data worldwide.

Additional information

The agreement between SNOMED International and IBM Watson Health breaks new ground and allows for significant impact, pairing SNOMED CT’s 325,000+ clinical concepts with Watson’s cognitive capabilities. 
 

SNOMED CT presents clinically-relevant concepts and modifiers consistently and comprehensively, providing a ‘global language of healthcare’. Standardizing IBM Watson Health’s offerings on SNOMED CT supports efforts to provide customers and collaborators with clear information to help clinicians arrive at sound medical decisions and support the efficient delivery of quality care.
 

DICOM

In March 2016, IHTSDO and the DICOM Standards Committee signed a SNOMED CT Licensing Agreement. This was the first agreement between the two organizations, clarifying the use of SNOMED CT in DICOM standards and how the SNOMED CT content should be managed over time. The SNOMED CT Licensing Agreement is for 5 years and on review can be renewed for a further 5 years.
 

Additional information

The SNOMED CT Licensing Agreement covers the use of an agreed set of 7,000+ SNOMED CT codes and descriptions in DICOM standards. The agreed SNOMED CT set is updated after each SNOMED CT international release (6 monthly), taking into account changes to SNOMED CT and any requests for changes from the DICOM Standards Committee.
 
Of key importance is that the agreed SNOMED CT set is free for use by both DICOM and implementers of DICOM standards globally. If, however, implementers use additional SNOMED CT content (outside scope of the agreed set), they are subject to SNOMED CT licensing arrangements which may incur a fee in SNOMED International non-member countries
 
The DICOM Standards Committee have been using SNOMED in their standards for many years (through an agreement with the College of American Pathologists) but usage has been largely based on antecedent versions. The agreed set is based on SNOMED CT International Release which will aid existing implementers to migrate over time – IHTSDO/SNOMED International has not set a timeline on the migration for users of the standards since many of the codes are hardcoded in to software in the digital imaging systems.

HL7 International

In November 2016, Health Level Seven® Inc. and IHTSDO announced a 2 year collaboration agreement, building on previous agreements in 2009 and 2014. The agreement again is aimed at improving interoperability, thus focusing on the adoption of working practices that facilitate the use of IHTSDO standards with HL7 standards globally. As previously, both organisations are working towards avoiding duplication of effort and resolving issues related to gaps and overlaps.

Additional information

The focus of the collaboration for both organizations, includes:
  • Implementation of SNOMED CT Development Licences for HL7 Affiliates which are IHTSDO non-member countries, facilitating the development of country specific HL7 artefacts using SNOMED CT- this has led to SNOMED CT Development Licences being issued to HL7 France and HL7 Austria.
  • Exploration and decision on a SNOMED CT freeset for use globally in HL7 International products
  • Review and updating of HL7 value sets with regard to SNOMED CT, by HL7, and management of change requests to IHTSDO
  • Work together on ensuring consistent use of SNOMED CT binding in HL7 artefacts, through contribution to TermInfo
  • A joint project focusing on defining best practice for the use of SNOMED CT with HL7’s FHIR implementations globally.
This work continues to be progressed collaboratively including a joint group of HL7 and SNOMED CT experts working on the use of SNOMED CT and FHIR internationally.

GMDNA

In 2012, IHTSDO and Global Medical Device Nomenclature Agency (GMDNA), responsible for the international Global Medical Device Nomenclature (GMDN), signed a 5 year Cooperation Agreement. A key focus of the Agreement was to exchange, harmonise and incorporate medical device term descriptions from each other to enhance the end-to-end patient risk and safety use cases in healthcare systems incorporating medical device information.

Additional information

Key initial work was the incorporation of relevant GMDN content in to SNOMED CT and production of map between SNOMED CT and GMDN. Both organizations are now in maintenance - monthly updates are provided by GMDNA, reviewed by SNOMED International for scope, incorporated accordingly and mapped. New content is included in each SNOMED CT International release, and the map is updated inline with these releases.
 
Emerging requirements are the need to link EHR information about medical devices to regulation and any safety issues. Therefore, both organizations remain committed to working together in this way and are working towards an updated agreement.
 

GS1

In April 2016, IHTSDO and GS1 signed a Collaboration Agreement focusing on specific areas of joint work, building on a previous Memorandum of Understanding (MoU) established to facilitate liaison between the two organizations and committing to closer working to ensure compatibility between our respective standards where appropriate.
 

Additional information

The focus of the agreement is:
  • Development of guidance/principles for linking SNOMED CT and GTINs that can be applied at the national/local level
  • Exploring options, feasibility and benefits for a technical solution/model at international level to support local/national linkage between SNOMED CT and GTINs. This will come out of the guidance/principles work. 
An Expert Group assisted in the work, based on their requirements for the principles/guidance at a national level. The agreed Scope and Purpose statement and Use Cases for the SNOMED CT to GS1 linkage work as well as the draft Principles are available in the links below.

JIC

The Joint Initiative Council on SDO Global Health Informatics Standardization (JIC) was formed to enable common, timely health informatics standards by addressing and resolving issues of gaps, overlaps, and counterproductive standardization efforts.
 

Additional information

JIC activities include: 
  • A mutually agreed decision process for international standardization needs;
  • Coordinated standards strategies and plans;
  • An integrated work program;
  • Focused, specific resolution of overlapping or counteracting standards within the participating SDOs existing work programs.
The Joint Initiative Council membership is currently made up of CEN/TC251, CDISC, DICOM, GS1, HL7,  IHE International, ISO/TC251, Personal Connected Health (PCH) Alliance and SNOMED International with a maximum of 3 members per SDO.
 
In April 2015, the JIC reinforced its direction with the following goal:
 
“The JIC will contribute to better global patient health outcomes by providing strategic leadership in the specification of sets of implementable standards for health information sharing”
 
Subsequently, SDO members (including SNOMED International) contributed to the development of the first Standards Set which focused on the Patient Summary. This was published early in 2018 and is available for review and usage as a guidance document for stakeholders across health informatics globally.  It is a live document which will be maintained over time and updated in line with changes in standards and supporting guidances.

LOINC

In 2013, IHTSDO and Regenstrief Institute Inc. signed a long-term agreement to begin cooperative work linking their leading global health care terminologies: Logical Observation Identifiers Names and Codes, or LOINC, and SNOMED CT.  This agreement has aimed to improve safety, functionality and interoperability for the rapidly growing number of clinicians who manage and exchange health data with electronic medical records.
 

Additional information

In 2013, IHTSDO and Regenstrief Institute Inc. signed a long-term agreement to begin cooperative work linking their leading global health care terminologies: Logical Observation Identifiers Names and Codes, or LOINC, and SNOMED CT.  This agreement has aimed to improve safety, functionality and interoperability for the rapidly growing number of clinicians who manage and exchange health data with electronic medical records.
 
This agreement builds on and complements the strengths of both organizations and terminologies. The scope of the collaborative work was agreed as:
  1. Laboratory, including discrete orders and observations and panel names for orders (excluding panel structure)
  2. Anthropomorphic measurements and evaluations
  3. Vital signs and physiological measurements
To date, the collaborative work has produced a LOINC/SNOMED CT Expression Association and Map Sets file based on SNOMED CT International Release, July 2017 and version 2.58 of LOINC, released in December 2016.

WHO

In 2010, IHTSDO and WHO entered into a ground-breaking collaborative arrangement that would change the relationship between the two organizations and their respective standards, by enabling users of SNOMED CT to use WHO classifications jointly and interoperably. Initial focus was on ICD-10 but the agreement set out a framework for effectively linking SNOMED CT and ICD-11 so that users who had licenses for both would benefit.

Additional information

In 2015, recognizing that five years had passed since the original agreement had been signed, each organisation decided to conduct its own review of the arrangement and the work done to date. The WHO review resulted in recommendations related to the improvement of relations with the stakeholder community to benefit the work on ICD-11 and realigned timelines and the focus on ICD-11 MMS as the first release. The IHTSDO undertook work on aligning content in line with beta ICD -11 MMS April 2017 drawing on clinical expertise from across the world, whilst the internal review focused on governance, communication, and Intellectual Property. It recommended that the collaborative arrangement be reviewed to ensure that work underway mirrored the wording in the agreement. Further, it recommended enhanced communication, transparent project plans, and more proactive dissemination to stakeholders in order to improve visibility of the IHTSDO contribution and commitment to the ICD-11 project.
 
SNOMED International and WHO remain committed to the overall goal of the original arrangement and are working on developing new ways of moving forward with a revision. Further information will be available once the collaborative arrangement has been formally revised and mutually agreed by both organizations, with a direction for the collaborative work.

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