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An important consideration in the development of a Clinical Decision Support System (CDSS) is the substrate over which the knowledge artifacts are authored and executed. When using SNOMED CT in a CDSS, the substrate is the SNOMED CT content over which the CDS rules are authored or executed. Because medical knowledge is constantly changing, it is important that the substrate over which CDS is applied is kept current. To support this requirement, SNOMED CT releases regular new versions of the terminology, and retains a history of changes using its strong versioning mechanism. With this in mind, both the

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tSNOMED CT edition
 and the specific version of that edition (released on a given date) need to be considered in determining the SNOMED CT substrate. For more information on the topic of versioning, please refer to section  11.4 Versioning in the guide Data Analytics with SNOMED CT.

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Therefore, CDS knowledge artifacts referencing SNOMED CT concepts must be executed (by the inference engine) using a SNOMED CT substrate that includes the same

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or a superset of the modules included in the SNOMED CT substrate used to author the artifact. In addition, the SNOMED CT substrate used to execute the CDS artifacts must use the same version, or a more recent version of these SNOMED CT modules, to ensure that all the referenced concepts are present. Please note that if a newer version of the substrate is used to execute the rules, then it is possible that a concept or relationship used at the time of artifact authoring may have become inactive. Edition and version dependencies such as these should be checked when adopting new CDS artifacts or updating a CDS system to use a newer version of SNOMED CT.

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