1. Introduction

SNOMED International has introduced the SNOMED International IPS Terminology release to support the sharing of patient health information coded with SNOMED CT without the need for a SNOMED International license. 

The International Patient Summary (IPS) is an electronic health record extract of essential healthcare information designed to support the needs for ‘unplanned, cross border care’, as well as additional use cases for sharing healthcare information across boundaries. The 2021 promotions from the Global Digital Health Partnership (GDHP) and the G7 have prompted a global effort in the adoption and implementation of the IPS. 

SNOMED International owns and maintains SNOMED CT, the international clinical terminology standard used in electronic health information systems. Because SNOMED CT is adopted globally for health data capture, interoperability, and analytics, the terminology can promote  adoption and implementation of the IPS. Since 2019, SNOMED International has provided a IPS Free Set for non-Members, which is created and maintained in collaboration with HL7 International and CEN. And starting in 2022, SNOMED International will further facilitate the global momentum for IPS, and has created an IPS  subontology from SNOMED CT content. This evolution of the HL7 IPS Free Set, provides advanced features of SNOMED CT for non-affiliates to use in their IPS solutions.

The new IPS Terminology is the next evolution of the HL7 IPS free set, providing advanced terminology features for non-Affiliates to use in their IPS implementations.

This refset includes a set of SNOMED CT content from the International Release as defined by the scope in 2.1. below. 

This document provides information about the IPS RF2 refset package.  It does not include a discussion or recommendation regarding the broader set of all SNOMED CT terms that are related to the IPS. 

2. Background

In 2019, SNOMED International and Health Level Seven International (HL7) announced the formalization of a license agreement in which a relevant "Free for Use" Set of SNOMED CT coded concepts will be used within the HL7 International Patient Summary (HL7 IPS). HL7 is a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services. The HL7 IPS is a minimal and non-exhaustive patient summary dataset, specialty-agnostic, condition-independent, but readily usable by clinicians for the cross-border unscheduled care of a patient. The collaboration is consistent with the aims of both organizations to support international harmonization.  

The International Patient Summary (IPS) is a minimal and non-exhaustive set of basic clinical data of a patient, specialty-agnostic, condition-independent, but readily usable by all clinicians. The primary use case for the IPS is to support cross-border, unscheduled patient care. However, it has the potential to be used in many other use cases where the patient crosses information systems, like travel between provinces, cities, or organizations that use a different Health Information System and require a summary for immediate care. The IPS is maintained by a collaboration of different Standard Development Organizations including ISO, CEN, HL7 International, IHE International, and SNOMED International. To learn more about the IPS please visit the International Patient Summary and the HL7 FHIR IPS Implementation Guide.

In 2019, SNOMED International and Health Level Seven International (HL7) announced the formalization of a license agreement in which a relevant "Free for Use" Set of SNOMED CT coded concepts will be used within the HL7 International Patient Summary (HL7 IPS). HL7 is a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services. The HL7 IPS is a minimal and non-exhaustive patient summary dataset, specialty-agnostic, condition-independent, but readily usable by clinicians for the cross-border unscheduled care of a patient. The collaboration is consistent with the aims of both organizations to support international harmonization. Since 2019, SNOMED International has made a free set of SNOMED CT codes available (the HL7 IPS free set) to support the implementation of the HL7 FHIR IPS specification.

In 2022, SNOMED International has developed the next evolution of the HL7 IPS Free set by providing an advanced terminology features for non-Affiliates to use in their IPS implementations.

The SNOMED International IPS Terminology release is designed as a subontology to facilitate the standardization of the recording of basic medical data that includes the most important clinical information to patient safety and healthcare. The SNOMED CT IPS refset terms have been harmonized with and supports the contents of the HL7 International Patient Summary (HL7 IPS) and CEN's European Standard for the Patient Summary. 

2.1. Scope

SNOMED International's IPS Terminology represents an evolution of the HL7 IPS Free Set, providing advanced terminology features for non-affiliates to use in their IPS solutions. In particular, it adds a hierarchy, defining relationships and extra synonyms from the SNOMED CT international edition, to form a sub-ontology of SNOMED CT. A sub-ontology is a functional set of concepts and relationships extracted from the full SNOMED CT ontology that provides the following features:

• It can be loaded in a SNOMED CT compatible terminology server
• It includes all the active concepts from the HL7 IPS Free Set
• The concepts are organized into the same hierarchies as the SNOMED CT International Edition (e.g. Clinical Findings, Procedures)
• The content is expanded to include a minimal set of additional grouper concepts
• The content also includes (inferred) relationships that define the meaning of the included concepts
• The US-English and GB-English language reference sets are included just like in the complete International Edition
• ECL (Expression Constraint Language) queries can be executed over the IPS Terminology to support value set definitions and simple data analytics

Please note that the IPS Terminology contains only a subset of the full international release of SNOMED CT, and therefore the features above are limited to this restricted content.

The IPS Terminology provides the basic terminology features needed to implement the International Patient Summary. However it does not include the full set of the features provided by a complete SNOMED CT edition - including the version history, historical associations, translations, mappings and the more extensive clinical content.

Access to a complete edition of SNOMED CT is available:

• To users living in a SNOMED International Member country or territory, from the local SNOMED CT National Release Center, or
• To users from a non-Member country, from SNOMED International's Member Licensing and Distribution Service (MLDS).

2.2. Use cases:

An IPS Terminology User Guide has been developed to provide support to non-Affiliates (i.e. users without a license to a full SNOMED CT edition), who need to implement an IPS solution. Examples such as patient data entry, interoperable information exchange, and simple data analytics have been provided. 

3. Content

The HL7 IPS Free set produced by SNOMED International in collaboration with HL7 and  aligned with CEN's European Standard for the Patient Summary consists of more than 8,000 SNOMED CT terms for use in implementations of the HL7 CDA R2 and FHIR IPS Implementation Guides worldwide. The SNOMED CT HL7 IPS free set contains concepts that can record the following data:

• General information about the patient (e.g. gender)
• Medical summary of most important clinical data (e.g. allergies, current medical problems, major surgical procedures)
• A list of current medications

In addition to the 8,000 concepts from the free set, the IPS Terminology includes the parents of those concepts bringing the total to over 13,000 concepts, over 42,000 descriptions, and over 40,000 relationships.

4. Design

4.1. Version

The dependent version of SNOMED CT is the January 2022 International Edition release.

4.2. Ownership

SNOMED International owns and maintains the IPS Terminology. This is made under the terms of the Creative Commons Attribution 4.0 International Public License

Additional information about this license specific to SNOMED International’s release of the IPS Terminology:

• SNOMED CT is © and ® SNOMED International. The right to maintain the IPS Terminology remains vested exclusively in SNOMED International.
• The Licensee can redistribute the IPS Terminology.
• The Licensee can create derivatives or implementation-related products and services based on the IPS Terminology.
• The Licensee cannot claim that SNOMED International or any of its Members endorses the Licensee’s derivative because it uses content from the IPS Terminology.
• Neither SNOMED International nor any of the contributors accept any liability for the Licensee’s use or redistribution of the IPS Terminology.
• SNOMED CT® was originally created by the College of American Pathologists.
• Without obtaining prior written permission from SNOMED International, you are expressly prohibited from using, distributing or reproducing the SNOMED International, SNOMED CT or IPS Terminology logo, service mark or trademark. Please review all terms and conditions of use here.

4.3. Frequency

The first BETA version of the SNOMED International IPS Terminology release was published after the January 2022 International Edition release of SNOMED CT.  Subsequently it is currently planned to be maintained annually. 

5. Obtaining the Release

The SNOMED International IPS Terminology Beta release is available by emailing release@snomed.org. 

The sub-ontology can also be viewed on the IPS Terminology Beta Browser. 

SNOMED International is seeking input from the community regarding the URI for the IPS Terminology. While the IPS Terminology is based on the SNOMED CT terminology, it is not a SNOMED CT derivative, therefore the use of a SNOMED CT International Edition derived URI is not applicable. However input from the community for guidance is welcome. Please send feedback to release@snomed.org with 'IPS Terminology Release" in the subject box by June 30, 2022.  

6. Feedback

Please provide feedback on usage of, or potential improvements to this refset to release@snomed.org with "IPS Terminology Release" in the subject box.

Please feedback by June 30, 2022. 

7. Implementation

The SNOMED International IPS Terminology release User Guide provides information on downloading the package and considerations for its use.  The full url is:  https://confluence.ihtsdotools.org/display/DOCIPSTUG 

8. Technical Notes

8.1. Package format

Please note that this product is NOT published in a standard RF2 package convention.  Instead, it is produced as a SNAPSHOT only package, containing only the populated Snapshot files of those components containing pertinent content.  

If you would like to use the full RF2 content, please contact SNOMED International at support@snomed.org in order to obtain the full version of SNOMED CT.