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When SNOMED CT is implemented in electronic health records, there may be situations where explicitly stating associations between components can support effective and efficient use of SNOMED CT. 

  In some situations, a set of unordered associations between components may be required. In other situations, an ordered list of directed associations between components may be needed. As illustrated in the table below, unordered associations can be represented using an Association Reference Set , while an ordered list of directed associations can be represented using an  Ordered Reference Set . Associations can be specified between components of any type. However, associations are typically used to link concepts and/or descriptions.

RequirementDescriptionExample UsesReference Set
A set of directed associations between components

A set of directed associations between pairs of concepts

A set of directed associations between pairs of descriptions

Grouping concepts together

  • For example, representing categories of concepts that are used for reporting
5.4. Association Reference Set
Historical associations between components
  • For example, associating inactive and active duplicate concepts
5.4. Association Reference Set

An ordered list of directed associations between components

An ordered list of directed associations between pairs of concepts or descriptions

Defining alternative hierarchies for navigation and selection of concepts or descriptions. Examples include:
  • Ordering hierarchical lists of enumerated body structures such as fingers, vertebrae and cranial nerves
  • Organizing the display of diseases
  • commonly seen in a particular specialty.

5.3. Ordered Reference Set  

For more detailed use case examples, please refer to the following sections:


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