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Once requirements have been identified and submitted as requests for additions or changes, the extension producer need to review and assess these requests. This entails an assessment of whether the requested content is relevant for inclusion in:

  • The
    Gloss
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    tInternational Edition
  • A
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    tNational extension
  • Another extension
  • This extension (i.e. the one being managed by this extension producer)

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If the answer to both these questions is "yes", then organization should submit a request to the National Release Center for addition of the required content into the National Edition. If the answer to one or both of these questions is "no", it should be considered for inclusion in a local extension. In situation where the request is considered to be out of scope of SNOMED CT, it may be rejected. provides additional detail on the various outcomes in these considerations.


Relevance of requested contentDescription
Within the scope of the International Edition

If the content requested is within the scope of the International Edition, the organization should request that the content should be added to the International Edition.

As SNOMED CT is a global clinical terminology, the scope of the International edition of SNOMED CT is constrained by a set of principles. For inclusion in the International edition, concepts must be

  • Useful in more than one country
  • Necessary for healthcare conformance and interoperability
  • Within the scope of a clinical terminology 
  • Satisfy the criteria of being
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    tunderstandable, reproducible, useful
    GlosTermUnderstandability, Reproducibility and Usefulness

If there is an urgent need for additional content, it may be added to an extension as an interim measure, pending addition to the International Edition. For more information, please refer to Interim content additions below.

Within the scope of other extension, (National, third-party, or local extension) but outside the scope of the International Edition.

The scope of a national edition may permit the addition of content which falls outside the scope of the International Edition but is required within a country, region or territory. If the content requested is within the scope of a national edition, a request should be submitted to the relevant National Release Center.

An organization may also use an extension which was produced by another organization, such as a vendor, regional body or specialist group. In this case, requests for content which fall within the scope of these extensions should be submitted to the relevant extension producer. 

When there is an urgent need for additional content, it may be added to an extension as an interim measure, pending addition to a national edition or externally maintained extension. For more information, please refer to Interim content additions below.

Outside the scope of other extensions, but relevant to the organization requesting the content.

An organization which maintains an extension is responsible for defining the scope of that extension. The scope of an extension should not overlap with the scope of the International Edition or any other extension with modules on which the extension modules depend on. Note that urgent content additions may be permitted as an interim measure, even when the content is within the scope of another edition or extension. For more information. please refer to Interim content additions below.

Requested content which falls within the defined scope of an extension may be added by the organization which maintains the extension. For additional information about adding local content to an extension, please refer to 5.4 Authoring.

Outside the scope of SNOMED CT

The request is rejected

Referential Integrity and Editorial Principles

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 illustrates the reporting structure for SNOMED International content requests. In general, only NRCs report to SNOMED International directly. Other extension producers will report to SNOMED International indirectly. However in somes cases, an extension producers may submit change requests directly to SNOMED International. For example, if the extension producer is an Affiliate, based in a non-Member territory.

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National Release Centers are responsible for collecting requests for changes detected by Affiliates. Typically requests come from the users or consumers of the extension as they are most familiar with local requirements. Organizations within Member countries can therefore submit their requests for additions and changes to the National Release Center who will make an initial decision about the relevance of the content in the International Edition or the national edition of that country. The NRC may add content to their National Edition if they consider the relevance to be national rather than international. The NRC forwards requests with (what they consider to have) international relevance to SNOMED International for consideration.

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SNOMED International provides the SNOMED CT Content Request Service to gather and process requests for additions and changes to the content of the SNOMED CT International Edition. This service is directly accessible by National Release Centers (NRC) in Member countries and recognized Terminology Authorities within organizations with whom SNOMED International is actively collaborating. Requests that meet inclusion criteria for the International Release are addressed by SNOMED International staff. Some of the reasons behind International content requests are described in. 


Example use caseDescription

Gaps in coverage of scope

Clinical meanings that fall within the scope of the International Edition that are not currently represented by concepts in the International Edition
Changes in clinical knowledgeEvolving clinical knowledge introduces clinical meanings that require the addition of new SNOMED CT concepts
Incomplete definitionsA concept in the International Edition that is missing one or more valid defining relationships
Missing synonymsA concept in the International Edition that is missing one or more widely used synonymous terms

If a request is deemed to have high priority, it should result in action in the next release cycle. However, requests constituting a significant change which impacts other content may take longer to implement. If a request is declined, a reason and explanation are provided to the requester, who may choose to appeal the decision to the Head of Terminology. For more information about the CRS, please refer to the CRS User Guide

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