2.1 The Challenge

The translation of SNOMED CT must remain faithful to terminological and linguistic principles and at the same time be able to produce national terminologies useful for clinicians in their daily work. This is no easy task and will require several considerations regarding competences of the staff.

2.1.1 Key considerations for the project manager 

In the initial phase of the translation project, a number of vital decisions have to be made:

• who has solid knowledge of SNOMED CT concept model?
• who has solid expertise within the healthcare specialties we will focus on?
• what type of education and training is needed – to whom and when?
• who will be responsible for the translated content, from source language to target language?
• which types of IT tools are needed to support translation and the translation process administration/translation management?
• how to ensure the translators have access to relevant information, such as tools, appropriate version of SNOMED CT, maps etc.
• who should write the linguistic guidelines and make principle decisions?
• what should be the strategy for the sequence in which the terminology is to be translated?
• how should the translation process be organised to guarantee the quality of the translation products?

In the sections below, these questions will be addressed.

2.2 Establishing the Organisation

2.2.1 Establishing a team of specialists

To achieve a successful outcome, a number of specialists must be engaged in all parts of the translation process. The following roles have been identified: 

• subject matter specialist, such as health and social care professionals 
• medical translators, e.g.:
• translators of patient information material in the medical area
• translators of research papers
• interpreters 
• linguists
• terminologists
• technical coordinator (to create subsets, translation batches, releases, statistics, QA) 

Knowledge to be considered for all roles:  

• knowledge of current use of health and social care terminology, classification and health informatics
• knowledge of semantics and concept based translation 
• knowledge of the structure and content of SNOMED CT.

2.2.2 Establishing the translation process

The translation can be done in-house or by an external translation service provider. In both cases it is important to specify prerequisites and expectations relating to the process and products. Based on experience from other projects, examples of such prerequisites, include:

• emphasis on concept-based translation
• assurance of delivery on time
• contract with the translators
• an agreed number of translated concepts per given time
• maximum allowable error rate
• maximum allowable number of concepts submitted to the editorial board
• use of subject matter experts
• workflow and quality assurance
• agreement on the point in time when a concept’s translation is complete 
• agreement on which translation tools should be used
• agreement on how feedback should be collected and processed.

Please also see section 2.8 Risk management.

2.2.3 Call for tender and contract issues for translation service provider

Based on the specifications for the translation process and the products and services to be delivered, a procurement process should be initiated and a contract signed with the translation service provider. Since such tendering instruments and procurement processes are often dependent on national legislation or other conditions, they are not described further in this guideline.

2.2.4 Establishing the editorial board

Parts of the translation project need to be coordinated by an editorial board. The board’s major tasks are to 

• support the translation process, see section 4
• manage the linguistic guidelines and make principle decisions
• continuously make and publish decisions on linguistic principles, and
• follow up on translation quality. 

The interdisciplinary editorial board should ideally be composed of professionals with educational and empirical backgrounds within areas like health and social care terminologies, linguistics, translation science, language technology, terminology and health informatics, with knowledge and understanding of SNOMED CT. 

2.3 Establishing an underlying supportive technical infrastructure 

Administering the translation process  requires high performance, reliable IT tools. An ideal toolkit should:

• show all information associated with a concept, most importantly descriptions, relations and hierarchy
• provide a base for terminological services
• support the translation process and the translation team members in every step of the process, including creation, change, delete and edit as well as collaboration, quality assurance and feedback
• control access to the information being processed at any point in time
• produce statistics about progress of the translation work in any stage of the process
• show the current status of the ’life cycle’ of each concept throughout the entire translation process 
• show workload and progress of activity for all project participants

2.4 Establishing linguistic guidelines 

The target language version of SNOMED CT should reflect established national linguistic rules, and health and social care staff should recognise the preferred terms used in their daily activities. Well-maintained linguistic guidelines and principle decisions are the prerequisite for a high quality translation, and the use of these are therefore prescriptive for everyone in the translation process. An initial version of the linguistic guidelines should be ready in advance of the first education session for translators, reviewers and editors. The framework and the content of the linguistic guidelines and principle decisions are described in the Guidelines for translation of SNOMED CT.

2.5 Identifying quality characteristics 

The task of creating quality characteristics and metrics for translations was based on the IHTSDO Quality Assurance Framework. The work was undertaken by the IHTSDO Translation Quality Assessment Project Group  that  defined quality characteristics for Structure, Process and Outcome. These are described in length in a separate document, “A Methodology and toolkit for Evaluating SNOMED CT Translation Quality” and include:  

• participants knowledge of terminology and terminology translation processes including translators and reviewers competencies
• content of style guides and reference materials in the target language
• access to translation software 
• concept-based translation principle
• translation reviews, two-level or two-stage review process necessary.
• ongoing communication, co-operation and translation project process adjustments between the TPO and the TSP
• term equivalence
• clinical acceptability
• compliance with Translation Standards and Guidelines

2.6 International cooperation

2.6.1 Quality of the International Release of SNOMED CT 

Despite ongoing maintenance, errors and inconsistencies occur in the International Release of SNOMED CT both at the concept model level as well as at the description level. Participants in the translation process will undoubtedly identify a number of these.

The translation project should provide a procedure to document these and provide methods and tools for reporting back to SNOMED International during the translation process.

It is recommended to do this via the NRC and use the SNOMED International Content Request Service (CRS) for reporting any anomalies and inconsistencies found in the International Release of SNOMED CT (https://confluence.ihtsdotools.org/display/SCTCR/Accessing+CRS).

2.7 Education and training of team members 

The translation team members will need education and training regarding the structure and content of SNOMED CT, the translation process and access to the documents and tools supporting it. The following examples outline essential education and training requirements:

• SNOMED CT overview: An introduction to SNOMED CT should be provided for everyone involved in the translation process. The e-learning pathway for translation of SNOMED CT from SNOMED International is provided for this purpose.
• Subset administration training: This training should be given to selected members of the team involved in planning, identifying, creating and allocating the selected subsets of SNOMED CT that are going to be translated.
• Education in linguistic guidelines and training in how to use them: This should be provided for all translators, reviewers and editors.
• Translation tools training: This will vary depending on the roles and responsibilities of all translation team members but all will need specifically focused training in the use of any supporting translation tools used to perform their roles
• Language technology training such as searching and analysing text corpora if such resources are available.

2.8  Risk management

It is essential to have methods and routines for monitoring both progress and quality control in place from the very start of the project. Indicators to monitor progress and quality should be defined and shared with project team members. Risk factors should be identified, and the indicators should be able to reflect project status within high-risk areas. Based on previous project experiences, the following examples of important risk factors which could lead to deficient or insufficient implementation or, inadequate quality of the translation products have been identified: 

• poor planning of the translation project at it purpose
• insufficient financing to undertake the project as outlined in plans
• deficient contracts between the TSP and the TPO
• failure of the translation agency to deliver on time
• insufficient translators with experience with the clinical language 
• insufficient organisation of the review process and editorial work
• insufficient time allocated for the translation process
• deficient quality assurance of translations with TSP
• insufficient knowledge of SNOMED CT 
• insufficient IT tools to support translation and validation
• insufficient training in use of tools 
• insufficient access to or use of subject matter experts
• insufficient training in the conceptual principles for translation 
• insufficient project management
• ambiguities and errors in the source language
• source language terms only relevant for certain countries
• inappropriate sequence of subsets for translation