1.1 Background

SNOMED CT is a comprehensive clinical terminology that is used to code, retrieve, and analyse health data. It constitutes a basis on which healthcare organisations can plan and document health processes, perform outcome researches, analyse healthcare quality and costs, and develop effective therapeutic recommendations. It resulted from the merger of SNOMED RT (Reference Terminology) and Clinical Terms Version 3. The terminology contains concepts, descriptions and relationships that are necessary to precisely represent clinical information across the scope of health care.

The international edition of SNOMED CT comprises about 360,000 active concepts and is growing. Each concept is represented by active descriptions, i.e. "Fully specified names", "Preferred terms", and other synonyms. The concepts are arranged in hierarchies (systems of concepts) covering areas like symptoms and signs, disorders, operations, treatments, drugs, administrative items, etc. – i.e. all these categories of information are needed in a health record. 

When implemented in software applications, SNOMED CT can be used to represent clinically relevant information consistently, reliably and comprehensively as an integral part of the electronic health record (EHR). Information systems can use the concepts, hierarchies and relationships as a common reference point. 

The global dissemination of SNOMED CT increases the need to provide the terminology in many languages. SNOMED CT has a built-in framework to manage languages and dialects. Entire or partial translations of SNOMED CT are available in US English, UK English, Spanish, French, German, Maori, Danish, Swedish, Norwegian, Estonian, Finnish, Dutch, and even some Sanskrit. The translations can be explored in the SNOMED International SNOMED CT browser by searching the relevant extensions (e.g. for Spanish open the Spanish edition). Translations are also in progress in other SNOMED International Member countries.  

The basic objective of any SNOMED CT translation is to provide accurate representations of SNOMED CT concepts in such a way that they are understandable, reproducible and useful (URU): the principle of concept-based translation must be borne in mind. Due to the inevitably normative nature of a translated version of SNOMED CT, defining a set of linguistic guidelines, including syntactical, morphological, and orthographic rules, is crucial.

Since SNOMED CT is meant to be applied in numerous and various settings by users from the most heterogeneous backgrounds, realms and languages, the communicational aspect of concept definition becomes an issue of paramount importance. A qualitative translation of SNOMED CT is a standardisation of the country’s terminology, in this instance for health and social care.

1.2 Purpose and Scope

These guidelines constitute a part of the SNOMED International quality assurance system for content and are based upon the collective experience from countries that have already translated, are planning to, or are in the process of translating SNOMED CT. 

Within the scope of translation of SNOMED CT, these guidelines offer recommendations regarding the management of a translation project. Members of SNOMED International will be able to find advice and documented experience to support their translation efforts and help avoid mistakes. The Guidelines enable projects to build on best practices from both a qualitative and a cost effective perspective and contribute to “lessons learned”.

The guidelines identify critical steps of the translation project, but are not prescriptive regarding the detailed sequence of the steps in the translation process, since some steps are highly dependent on how the project is organised locally.

This document is a companion guideline for use in combination with the Guidelines for Translation of SNOMED CT.

1.2.1 Translation method

The process described within this document provides for a two-step quality review mechanism that is to be used by translators as well as clinicians. A third level of quality control and assurance (“Improving translation quality”) is described in section 6.

Reverse translation where the produced translations are translated back into English to compare the result to the original English description as a method for quality control is not part of these guidelines since no members has done this yet.  

1.2.2 Out of scope 

This guideline does not include general project management principles, or, reference specific project management methodologies.

This document does not include linguistic guidelines applicable to translations of SNOMED CT. The linguistic guidelines are found in the Guidelines for Translation of SNOMED CT.

1.2.3 Assessment of translation quality

Translation Project Owners (TPOs) should strive to ensure that translations comply with the URU (understandability, reproducibility, usefulness) principles on which SNOMED CT was originally based and that information contained in the translated concepts is semantically equivalent to the meaning in the core source terminology (international release). SNOMED International has developed a document describing how to assess translation quality and evaluate the level of compliance. The document “A methodology and toolkit for evaluating SNOMED CT translation quality”, outlines and defines a number of requirements or “quality characteristics” (QCs) and associated metrics.

There are three types of QCs. In the context of translation quality assessment: 

• structured QCs that relate to the management and organisation of the translation project
• process QCs that relate to the activities taking place during the actual translation
• outcome QCs that relate to the target language translation result. 

A “short-list” of 9 QCs was identified and for each QC, quality metrics (what and how to measure, how to evaluate, etc.), sample questionnaires (to assist with the evaluation) were developed, and an overall “rating” assigned. 

It is recommended that TPOs refer to Appendix A of the Guidelines for Translation of SNOMED CT and to the methodology and toolkit document to ensure that they incorporate any quality metrics designated mandatory into their project and quality plans. Metrics to measure translation quality may also be re-formulated as contractual clauses in formal agreements between a TPO and a Translation Services Provider (TSP) for services and service levels to be provided. 

1.3 Audience

The primary target group for this document are the TPOs: SNOMED International Members, or, other bodies who have been granted permission to translate SNOMED CT, and project managers in charge of managing SNOMED CT translation projects. 

1.4 Attribution

This document was originally created as one of the key deliverables of the former Translation Standard Processes Project Group (TSPPG), under the guidance and direction of the Translation Special Interest Group (SIG). This second version has been revised and expanded by the Translation User Group (TUG).

1.5 Guide Overview

Key activities and actors in the translation process are described in section 4. This is distinguished from: 

• project planning activities described in chapter 2
• translation preparation activities described in chapter 3
• translation process described in chapter 4
• maintenance of translation described in chapter 5.
• improving translation quality described in chapter 6.

A brief list of terms and definitions specific for this document can be found in section 7, and a reference list is found in section 8.

1.6 Review