At the last April 2022 business meetings, SNOMED International staff, along with its governance bodies and community of practice, gathered in London to learn about the latest SNOMED CT/SNOMED International advances. 

One of the topics of particular interest to many in the audience (and beyond) focused on the organization’s efforts over the past year to engage and support those who would like to contribute content to SNOMED CT. As SNOMED CT evolves and matures, and as the organization works to become more agile and responsive to community needs, it has taken a number of big steps over the past year in the delivery and development of its products. That includes making the SNOMED CT International Edition available on a monthly basis (frequent releases) and making it easier for users to contribute to it. 
 
The following Q&A with Dr. James Case, SNOMED International’s Chief Terminologist, explores these initiatives and their impact on SNOMED CT and its user community.
 
Q: Historically, how has SNOMED CT content been authored and by whom? 
JC: Content changes to SNOMED CT have most often been handled by the SNOMED CT content team, a group of clinical professionals with extensive knowledge and expertise in the editorial rules governing the curation of SNOMED CT.  They are also very skilled in content development tooling, which provides the authoring platform, as well as enforcing the technical rules that provide the quality assurance for SNOMED CT content.
 
Q: What are all the ways people outside of SNOMED International can now contribute to SNOMED CT?
JC: Member countries as well as affiliates both within and outside of Member countries can apply for an extension namespace that allows for external development (i.e. outside of the international release) of SNOMED CT content. This extension content can be requested to be promoted to the international release if it is deemed to be of international relevance.  
 
The community content area is a new aspect of SNOMED that provides a mechanism for Members to contribute content to SNOMED CT that is not an official part of the international release, but can be made visible to users who might want to use that content in their systems.  However, that content does not go through the same quality assurance process that the content in the international release does, so it should be used with caution.
 
Certified external authors are those that have fulfilled the educational requirements and demonstrated skills that would allow them to be approved to edit content directly in the International release of SNOMED CT. We have a number of individuals external to SNOMED International staff who have been approved to do this type of authoring. As they are not members of SNOMED International staff, they collaborate with the SNOMED CT content team to provide authoring support. Thus, an external author is what one is and collaborative authoring is what they do.
 
Q: How do you define each of those terms and how do they interrelate?
JC:  National extensions are independently managed and curated sets of SNOMED CT content that “extend” the scope of the international release to meet specific needs of the affiliate (i.e., Member country, healthcare organization, individual needs). They are dependent on the international release for analytical use and should conform to SNOMED International editorial guidance.
 
Community content is a function provided by SNOMED International to allow content that has not been approved by the SNOMED content team to be made visible to the public. This provides a way for SNOMED CT users to “preview” content that may be promoted to the International release or has limited or highly specific use.
 
As mentioned above, a certified external author is an individual who  has fulfilled the educational and practical requirements for authoring in the international release. Any work being done by these individuals is overseen by a member of the SNOMED International content team.
 
Collaborative authoring is the process of increasing the available editing resources of SNOMED International by cooperative work between an external author and a SNOMED International content team member. This results in the SNOMED authors playing mostly a quality assurance role as opposed to a primarily content development role.
 
Q: Why is SNOMED International taking the approach of inviting qualified external authors (SNOMED CT International Edition) and content contributors (Community Content Area) in the content development process? 
JC: As SNOMED International grows and adds new members, there is increasing pressure on the content team to add and improve the existing content of SNOMED CT. This has forced the content team to prioritize content development based primarily on the strategic plan and input from the Member Forum. This sometimes places content development urgently needed by a Member at a lower priority than they would prefer. If that Member country had a certified external author, they may offer to do the content development themselves, thus speeding up the process of getting new content into SNOMED CT.  
 
With regards to the community content area, some content as originally presented to SNOMED CT does not meet the inclusion criteria for the international release, or is not fully developed according to SNOMED CT editorial guidelines. The community content area allows for this content to be made visible to the SNOMED CT community of practice to determine if it has sufficient usefulness to be considered for inclusion in the international release as well as helping to refine its content model to meet SNOMED CT editorial requirements.  
 
Q: What does this mean for our community of practice?
JC: In general, this means that the community of practice can have a more active role in the development of SNOMED CT content, both in the direct enhancement of content in the international release and in the addition of content via the community area to determine the overall usefulness of content that would not normally be added to the international release (such as specific administrative concepts). It also allows for those with specific domain expertise to assist SNOMED International in improving existing content to conform to current clinical practice. 
 
Q: If we’re speaking about the SNOMED CT International Edition, what do you need to do to become a SNOMED CT certified external author? What are the educational requirements and what is the path external authors typically take?
JC: The requirements to become a certified external author are described in the requirements document recently approved by the SNOMED Senior Management Team. In general, completion of the SNOMED Authoring level 1 and 2 courses are the primary educational requirements followed by successfully passing the certification exams. Once those are completed, an individual can submit a request to SNOMED to be considered for approval as a certified external author. Once approved, the external author will go through an initial evaluation period to determine if their knowledge and skills are sufficient to author in the international release. External authors will only be allowed to author in areas approved by the SNOMED CT content team, based on an authoring project submitted in advance by the external author or developed by the SNOMED Content team.  
 
Q: If we’re speaking about SNOMED International’s Community Content area, what resources are we making available to content contributors to ensure they are qualified and supported?
JC: All of SNOMED International’s elearning courses are available online and will help anyone who wants to contribute to learn about the tools that are used in the Community Content area and to understand the authoring level expected for contributors. Once contributors are suitably qualified, the authoring platform used in the Community Content area adds another level of quality assurance and checking to ensure that content meets the high standards that SNOMED CT is known for.
 
Q: Are there any particular areas that collaborative content authors are currently focusing on, or that we would like them to focus on, such as social care?
JC: Currently we have collaborative authors working in the area of cancer synoptic reporting and mental health as well as a long-standing effort to incorporate the Kaiser Permanente Convergent Medical Terminology. Our primary goal was to provide a mechanism for members who would like to speed up the addition of content that they are particularly interested in, so our intention is to let the Member needs drive the areas where collaborative editing would be of most benefit to them.
 
Q:  What has been the uptake to date? Have we faced or do we anticipate any particular challenges in expanding our pool of collaborative authors, and if so, how will we approach them?
JC: As this is a relatively recent area for SNOMED, there have not been any new requests for approval as an external author. We anticipate that as more people complete the authoring level 2 certification exam, we will be receiving requests for approval as external authors. As we increase the pool of people who have completed the requirements, we will reach out to those who have particular domain knowledge needed by SNOMED. The particular challenges related to this are the same as for any volunteer program, i.e., can the external authors find sufficient time to complete specific content development projects within appropriate timelines.  
 
Q: Is there any one message to our community of practice that you would like to share related to these opportunities? How do you think this will impact content development and authoring?
JC:  We would certainly encourage those who have successfully completed the authoring certification exams and are interested in assisting SNOMED International with content development to contact us with specific areas of content development they see needing improvement. The primary impact to content development will be a mechanism for user-based content priorities to be addressed in a more rapid manner.  The secondary impact will be on the SNOMED Content Team itself, with more emphasis on quality assurance of content developed by external authors, rather than the full content development cycle.

Questions about collaborative authoring and community content? Contact info@snomed.org 

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