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It is the responsibility of the extension producer to determine which requests are appropriate for their extension vs those which may be appropriate at a higher level. It is therefore important that extension producers are aware of the scope and the editorial principles for the International Edition of SNOMED CT and in some cases a national edition. This will ensure that requests for changes are forwarded to the relevant organization. Furthermore, it is important that extension producers have an established and reliable process for evaluating, processing, and overall tracking of all change requests received. The process needs to have a routing mechanism to ensure that changes applicable to the extension are made in the extension, and external change requests can be forwarded to the responsible organization, such as SNOMED International.

 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 some 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.

Figure 5.3.4-1: Change request reporting structure

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.

For more information about the processes in each country, please consult the relevant Member page

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 Table 5.3.4-1

Table 5.3.4-1: Reasons for requesting content to be added to the International Edition

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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