8.1. Do the users use the full scope of SNOMED CT or subsets?
We recommend that each specific clinical purpose uses only a subset of SNOMED CT. This will increase the quality of the resulting patient data, by protecting the user from selecting concepts with inappropriate clinical meanings.
8.2. Is the subset chosen by each organization or is it on a national level?
There are examples of both. This depends on the use case. Often a broad subset is chosen at the national level (e.g. any subtype of |Clinical finding|) and then a narrower subset is chosen for a specific clinical use case (e.g. only cardiology-related subtypes of |Clinical finding|).
8.3. How do users get access to the full catalog when needed (if they cannot find their needs within the subset)?
This depends on the vendor system, and how it is configured. Some systems allow users to suggest new codes to be added when a gap in the subset is identified.
8.4. How are subsets managed?
a) Who creates/maintains subsets? What is his/her role in the organization?
Subsets may be created at the international, national or vendor levels. It is recommended that subset creation is a collaboration between clinicians, terminologists and information modellers. Incorporating these 3 professional roles in the creation and review of a subset, increases the likelihood of it being fit-for-purpose.
b) How many different subsets are managed?
In the UK they manage 230 subsets at the national level. In other countries this may be more or less.
c) What are the criteria for creating new subsets? Are they only created by profession (i.e.: orthopedics, pediatrics, ophthalmology etc.)
There are a range of different criteria for creating new subsets, including specialty specific subsets, care-setting specific subsets, clinical use cases, and vendor specific subsets.
d) What is the procedure for updating subsets? Requesting additions? Notification of additions?
Normally there is some form of editorial board that meets virtually and may have responsibility for a number of subsets, or subsets where they are defined by a query specification, that are simply updated and the changes reviewed by the central team. Additions to a subset may be requested by the end user – some systems provide a content request mechanism within the software.
e) How much maintenance does this process involve?
This depends on the type of subset, and how it is defined initially. Subsets defined using a query (e.g. all subtypes of |Cardiovascular finding|) generally require less maintenance. However all subsets should be reviewed when upgrading to a new version of SNOMED CT.
f) How often are there changes in the subset lists?
This varies depending on the subject matter.
g) If there are centrally managed subsets: how is the process carried out- technical aspects, implementation aspects, training aspects, operative aspects.
This varies depending on the approach adopted.
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