13.1 
General Questions
a) Are there more than one EMR in each organization?
This varies between organisations. Some organisations may have a variety of EMRS or a mixture of electronic and paper records.
b) Is SNOMED CT implemented into all computer systems or only in the clinical file?
This varies between organisations.
c) What are the technical challenges in managing multiple terminologies?
Different hardware, different software, a variety of technically skilled staff for support, different release cycles, managing dependencies between them, mapping, resources, migration plans and interoperability.
d) What processes were needed to audit and reconcile the transfer from one terminology to another?
Technical mapping (if possible) needs to be clinically reviewed for accuracy. This takes time and resources. This is especially difficult if multiple terminologies are still maintained concurrently.
e) When migrating a system to SNOMED CT should the historical data be mapped to SNOMED CT?
This decision is usually made by the local organisation. The recommended approach is to map historical clinical data to SNOMED CT (for data analysis purposes), but retain the original codes (for medico-legal purposes).
13.2. 
Managing Terminologies in an Organization
a) Is there one platform to manage all different terminology releases?
All SNOMED CT releases are usually managed in a single terminology service. Some terminology services support mulitiple code system releases.
b) In what platform does SNOMED International manage SNOMED CT?
SNOMED International uses SnowStorm – a SNOMED CT terminology service built on Elasticsearch, with a focus on performance and enterprise scalability. See http://github.com/IHTSDO/snowstorm.
c) Should the SNOMED CT code be incorporated into the diagnosis list in an EMR or should there be a reference from within the EMR to the external platform managing the terminology?
We recommend that SNOMED CT concept identifiers are stored directly in the EMR.
d) If the terminology is managed on an external platform, how often is this updated and sent to the live clinical systems?
The frequency with which the terminology is updated varies from system to system, so different organisations may be using different versions of SNOMED CT.
e) Are all organizations implementing the terminology in the same way?
No. Different system suppliers use different formats for storing and processing SNOMED CT.
13.3. 
Mapping
a) Is there an automatic mapping from SNOMED CT to ICD-10?
The maps from SNOMED CT to ICD-9 and from SNOMED CT to ICD-10 are semi-automatic.
b) Is there 100% mapping to ICD-10 or are there terms that have not been successfully mapped?
Only domains of SNOMED CT which overlap in meaning with those of ICD-10 will be mapped. Due to differences in granularity, purpose and rubrics, assignment of a mapping equivalence between the SNOMED CT source and ICD-10 target code is usually not appropriate. Instead, the ICD-10 map will link a SNOMED CT source concept to the ICD-10 code which contains the meaning of the SNOMED CT concept as conceptualized by ICD-10.
All pre-coordinated concepts issued by SNOMED International within the current international release of SNOMED CT with active status within the following SNOMED CT domains may be mapped:
Clinical finding (disorders and findings) Concept.id 404684003 and descendants
Event Concept.id 272379006 and descendants
Situation with explicit context Concept.id 243796009 and descendants
c) In the clinical systems and in the administrative systems are both SNOMED and ICD codes saved or does each system use only one language?
This depends on the system. We recommend that clinical systems collect SNOMED CT codes, and then use the map to suggest suitable ICD codes, which can subsequently be recorded.
13.4. 
Search Engines
a) Is the search engine built in as part of the EMR or is there a link to an external search engine?
Vendor solutions have their own search functionality built in.
b) If it is built into the EMR, have you seen discrepancies in the coding results in different EMR's?
No discrepancies – however, there are differences in the order in which search results are returned and displayed.
c) What are the characteristics of the embedded search engines? Is there a difference in the user experience in different institutions?
See above
d) Is the search in free language? Is it able to search abbreviations?
This varies between systems, and depends on whether abbreviations have been added to the terminology. Typically, systems require a minimum of three characters for most searches – however, this is defined within a vendor system.
e) Are there monitoring systems in place to analyze what terms are searched and what results were chosen?
This is vendor specific.
13.5. 
Managing the Preferred Terms
a) Does a terminology service analyze and remember common uses on the level of the specific user or does the user have to create the common hit list?
Some vendor solutions implement a “favourites” list, which can either be system-defined, user-defined or learnt from common usage.