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Authoring and managing reference sets require some level of tooling support, and broadly . Broadly speaking, two types of tooling support exists:

1. Combination of browsing functionality and simple spreadsheets or database system
2. Dedicated reference set management tools with extended features

However, the The extend of sophistication of the tool required depends on various factors, and the combination of those factors:

• Type and size of reference set
  • Simple reference sets with few members
    
  • Large reference sets of various types
• Use of reference set
  • Local vs. distributed
  • Dependencies (Editions, versions)
• Maintenance of reference set
  • Cycle
  • People

Functionalities

Relevant functionalities for reference set creation and management include:

• Creation of both extensional and intensional reference sets
  • Services for browsing and displaying SNOMED CT content for manually selecting reference set members
  • Services for manual and intensional expansion of reference set (inclusion of reference set members)
  • Services for manual and intensional exclusion of reference set members
  • Create reference sets according to a specific reference set pattern
  • Create customized reference sets
• Version management of created reference sets
  • Computation of the effect of a related SNOMED CT edition and version on a reference set 
• Workflow support
  • Mechanism for approval of reference set before publishing 
  • Facility for external feedbackand request for change
• Searching existing reference sets, as well as entries about reference sets that may be available elsewhere
• Distribution services

Considerations Related to using Spreadsheets to Manage Reference Sets

Generally, it is not recommended to use a spreadsheet approach for managing reference sets, because of the there is a dependency between the reference set and the core content of SNOMED CT. The core SNOMED CT release files of SNOMED CT are important for interpretation of interpreting the components referenced by the reference set, e.g.for example:

• Description file: Access to the descriptions are required to display the terms of the components referenced by the reference set.
• Concept file: Access to the concept file is required to assess whether the components referenced by the reference set are active or inactive

However, in some situations spreadsheets (suported supported by a browsing facility) may be feasible. E.g. if it is only a few, small reference sets that are used locally, and when , for example,

• If the reference set only consists of a few members
• If the reference set is only used locally
• If only one person is responsible for managing the reference

...

• set

If a spreadsheet approach is chosen it is recommended to create a a human-readable version of  of that reference set to support interpretation of the identifiers used in the reference set.

Functionalities

Relevant functionalities for reference set creation and management include:

...

• Services for browsing and displaying SNOMED CT content for manually selecting reference set members
• Services for manual and intensional expansion of reference set (inclusion of reference set members)
• Services for manual and intensional exclusion of reference set members
• Create reference sets according to a specific reference set pattern
• Create customized reference sets

...

• Computation of the effect of a related SNOMED CT edition and version on a reference set 

...

• Mechanism for approval of reference set before publishing 
• Facility for external feedbackand request for change

...