Enabling postcoordination in an Electronic Health Record (EHR) usually requires an EHR design that is prepared to support the use of expressions.
When developing EHRs, these are usually designed with both a health record data store to record health-related information about each patient, and a terminology server to store the codes and terms that may be used in the health records as illustrated in Figure 3-1.
A SNOMED CT-enabled terminology server stores the terminology content and provides the services required by the EHR to access the content. A terminology repository is included to hold the released terminology content, for example, a specific version of a national Edition of SNOMED CT plus any required SNOMED CT derivatives. When supporting postcoordination, the terminology server should support the storage of expressions, for example using an expression repository. In addition, dedicated services are required to enable the processing and use of the expressions in the same way as the released, precoordinated SNOMED CT content.
The recommended approach to ensure efficient use of a SNOMED CT-enabled terminology server is to use a service-oriented approach where dedicated terminology services are provided via an API enabling access and processing of the content within the terminology and expression repository.
Figure 3-1: Overall design of an EHR supporting postcoordination. The EHR data store is used to hold the health related information recorded about each patient, and the terminology server includes the terminology content required by the EHR. This includes both a terminology repository for the released SNOMED CT content and an expression repository for the postcoordinated expressions.
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