Appendix A: Summary of Types and Use Cases

Table Appendix A:-1 provides a summary of the main types of terminology service requirements. For each requirement type, use cases are identified with a more specific description of the terminology services required to address that use case.

Table Appendix A:-1: Terminology service requirement types summary

Required Terminology Services	Use Cases	Application of Terminology Services to Specific Use Cases
4.1 Select Edition and Version	All	Unless the server only hosts one edition and version these settings are required prior to or as part of service request.
4.2 Get a Concept, Description, or Relationship	3.1 Explore and Review SNOMED CT	Get specified concepts to enable exploration of their descriptions, definitions and position in the hierarchy.
	3.2.3 EHR Data Entry	Record data in an EHR using a single concept.
	3.2.2 EHR Data Entry Design	Create or edit a user interface template or control that records specific concepts in an EHR depending on user selections.
	3.4 EHR Reporting and Analytics	Add selected concepts to constrain or extend EHR query criteria.
	3.5 Reference Set Editing	Create or edit subsets, maps (or other artifacts represented by SNOMED CT reference sets).
	3.8 Support Terminology Authoring and Review	Select supertypes, attributes, and values to define a concept.
4.3 Get Terms for a Concept	3.1 Explore and Review SNOMED CT	Display terms for concepts in search results, hierarchy views, and concept definitions.
	3.2.2 EHR Data Entry Design	Display terms for a concept and enable the selection of a term for display in a user interface template or control.
	3.2.3 EHR Data Entry	Display terms in user interface template or control.
	3.3 Display EHR Data	Display terms for concepts recorded in an EHR.
	3.4 EHR Reporting and Analytics	Display terms for concepts to provide human-readable EHR reports and analytics results.
	3.8 Support Terminology Authoring and Review	Display terms for concepts in search results, definitions, expressions, and expression constraints.
4.4 Get Definition of a Concept	3.1 Explore and Review SNOMED CT	Display inferred necessary normal form definition of a concept from relationships.
	3.1 Explore and Review SNOMED CT	Display the stated definition of a concept from stated OWL axioms.
	3.8 Support Terminology Authoring and Review	Display stated and inferred necessary normal form definitions of a concept in the authoring environment.
4.5 Get and Test Concept Subtypes and Supertypes	3.1 Explore and Review SNOMED CT	Display subtype and supertypes in a hierarchical view.
	3.2.2 EHR Data Entry Design	Enable selection of subtype constraints on data entry template controls.
	3.2.3 EHR Data Entry	Apply subsumption tests to constrain concept searches and selection for data entry.
	3.4 EHR Reporting and Analytics	Apply subsumption tests in reporting and analytics queries.
4.6 Get and Test Reference Set Membership	3.2.2 EHR Data Entry Design	Enable selection of reference set membership constraints on data entry template controls.
	3.2.3 EHR Data Entry	Apply reference set membership test to constrain concept searches and selection for data entry. Display members of a reference set as options for data entry.
	3.4 EHR Reporting and Analytics	Apply reference set membership tests in reporting and analytics queries.
	3.5 Reference Set Editing	List the members of a reference set.
4.7 Validate and Apply Expression Constraints	3.2.2 EHR Data Entry Design	Create or edit a user interface template including expression constraints that limit permitted values that can be entered through a specific data entry control.
	3.2.3 EHR Data Entry	Apply expression constraints to concept searches for data entry.
	3.4 EHR Reporting and Analytics	Create or edit reporting specifications using expressions constraints to represent query criteria Apply expression constraints in reporting and analytics queries.
	3.5 Reference Set Editing	Create or edit subsets using expression constraints to intensionally define their members.
4.8 Find Concepts	3.1 Explore and Review SNOMED CT	Find concepts to be displayed.
	3.2.3 EHR Data Entry	Find concepts to be entered.
	3.2.2 EHR Data Entry Design	Find concepts for inclusion in a template.
	3.4 EHR Reporting and Analytics	Find concepts to be used as inclusion criteria in reports and analytic queries.
	3.8 Support Terminology Authoring and Review	Find concepts to be used in the definition of another concept.
4.9 Identify Changes to the Terminology	3.7 Terminology Change Management	Identify components that have been added, changed or inactivated since the previous release.
	3.7.3 Manage Impact of Changes on EHR Applications	Review user interface templates and controls for concepts or descriptions that are now inactive. Review existing EHR records for concepts that are now inactive. Review existing EHR queries for inclusion (by reference or subsumption) of concepts and that are now inactive.
	3.7.4 Manage Impact of Changes on Extensions	Review extension for any dependencies on concepts and descriptions that have been inactivated in modules on which the extension depends.
4.10 Get Data from a Reference Set	3.1 Explore and Review SNOMED CT	Get acceptability of a specified description in an identified language reference set
4.11 Get History Data	3.7 Terminology Change Management	Identify reasons for inactivation of concepts used in existing EHR records and assess the impact of these records using these concepts on reports: Get inactivation reason for a specified inactive concept or description Get active concept(s) with historical associations from a specified inactive concept Produce human-readable reports of changes in a new release: For each inactive concept, the report should include the reason for inactivation and potential replacements based on historical associations For each inactive description, the report should include the reason for inactivation
	3.7.3 Manage Impact of Changes on EHR Applications	Use historical associations to identify potential alternative concepts to replace inactive concepts in: Data entry templates Queries used for reporting or analysis
	3.7.4 Manage Impact of Changes on Extensions	Use historical associations to identify potential alternative concepts to replace inactive concepts in definitions of extension concepts.
4.12 Get Mapping Data	3.2.7 Mapping Data to or from or from Another Code System	Get maps for a specified concept in an identified map reference set.
4.13 Get Concept Model Rules	3.2.3 EHR Data Entry	Facilitate, constrain, and validate refinements applied to entered concepts. This applies to refinement specifically entered by a user and to refinements created by natural language processing of free text. It also applies whether the refined data is represented in the record by a postcoordinated expression or by records that contain additional fields for specific refining values (e.g. laterality, body site, etc.).
	3.2.2 EHR Data Entry Design	Facilitate, constrain, and validate the design of data entry templates to ensure the use of the resulting template results in data that is consistent with the concept model.
	3.4 EHR Reporting and Analytics	Facilitate, constrain, and validate the creation of expression constraints and/or queries used to generate reports and to analyze records. Assuming the data complies with the concept model, queries should also conform to that model. However, queries may also be written to look for or apply reporting techniques to data that does not conform to the model.
	3.8 Support Terminology Authoring and Review	Facilitate, constrain, and validate the creation and modification of concept definitions.
4.14 Validate Concept Definitions and Expressions	3.2.3 EHR Data Entry	Record data in EHR using an expression (in cases where no specific concept matches the required meaning).
4.14 Validate Concept Definitions and Expressions	3.2.2 EHR Data Entry Design	Create or edit user interface templates or controls that record specific expressions in an EHR depending user selections (in cases where no specific concept matches the required meaning).
4.15 Test Expression Subsumption	3.2.3 EHR Data Entry	Apply expression subsumption tests in an expression constraint or query.
4.15 Test Expression Subsumption	3.4 EHR Reporting and Analytics	Include subsumed or equivalent expressions in EHR data queries.

Please note that the primary focus of this guide is on read-only services without a user-interface.

The rationale for focusing on read-only services is as follows:

Read-only terminology services are applicable to all healthcare applications that require access to SNOMED CT.
Add-update services are only required by those responsible for the development and maintenance of SNOMED CT editions or extensions. This smaller audience reduces the value of including detailed documentation of development services in this guide.
Add-update services have a high degree of interdependence to ensure that updates are handled in ways that enable effective version control, validation, and quality-assured management and distribution. Therefore, describing generalized versions of individual update services without the surrounding architectural context would serve little purpose and could be misleading.
The functionality of specific SNOMED CT authoring tools is described in the documentation associated with those tools. Given the limited number of organizations requiring these services, there is no clear case for replicating that material in this guide.

The rationale for focusing on services that without a user interface is as follows:

Terminology services without a user interface can provide applications with access to the content of SNOMED CT.
Terminology services without a user interface can provide access in ways that exploit the design features of the terminology while leaving each client applications to present data inline with its own design styles.
Terminology services that include a user interface are in practice combinations of several general terminology services with one or more user interface components. There are many possible combinations of terminology services with specific user interface controls and it not feasible to document all of these. Instead, this guide notes a few general examples of ways in which terminology services described in this guide may be bound to user interface controls.

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Appendix A: Summary of Types and Use Cases