SNOMED CT is developed for implementation and use in health IT systems, so it is essential for successful adoption that the terminology fulfill user requirements. To facilitate continued development and enhancement of SNOMED CT, IHTSDO is dependent on ongoing feedback from users. A significant responsibility of an NRC is therefore to provide IHTSDO with feedback from users in the Member countries on errors, limitations and suggestions for changes to the SNOMED CT content. Regarding management of change requests, each NRC must:

1. Maintain a record of problems and other issues reported within the Member country, and
2. Document, submit and support requests for proposed updates and enhancements to SNOMED CT

An NRC must therefore provide a mechanism for supporting requests from users, both related to the National Edition (where it exists) and International Edition of SNOMED CT. Requests for the International Edition should be communicated to IHTSDO, whereas requests for the National Edition must be managed locally.

Figure 10. NRCs manage user requests for changes to both the National and International Editions of SNOMED CT ¹  

How user requests are submitted to the NRC is up to each NRC to decide. An NRC can choose to have its own request submission system, but the solution could also be a simple mailing system or a file-transfer system. This depends on the level of SNOMED CT use (and hence, the number of requests) within the Member country. An NRC could decide to have a simple system in the NRC-establishment phase and then launch a more sophisticated system when the number of requests increases.

SNOMED CT International Requests Submission System (SIRS)

SIRS is IHTSDO's online request submission system, which allows Member countries' NRCs and other authorized users to submit requests for change or addition of new content to the International Edition of SNOMED CT. Hence, all user requests for the International Edition of SNOMED CT should go via the NRC, and each NRC should have access to SIRS. Concepts of only national relevance should not be submitted to IHTSDO. It is the responsibility of the NRC to determine which request is specific to its country and which are of international relevance. NRCs should be aware of the editorial principles for SNOMED CT and only submit requests that meet those principles.
Requests submitted to SIRS are reviewed by IHTSDO Authors, and requests that meet the SNOMED CT International Edition inclusion criteria are added to the International Edition. SIRS is an online tool, which enables users to view the current status of all requests that have been made through the system, see Figure 11.

Figure 11 Screenshot from SIRS. Example of overview of requests submitted to the system. 

Users are notified by email when a request changes status (accepted, not accepted, in process, or clarification requested). If a request is not accepted, a reason is provided to the requestor. A requestor who is unhappy with the reason for not non-acceptance can appeal using a formal appeals process.
For up-to-date information about current arrangements and for access to SIRS see http://snomed.org/sirs

Further details on requesting content changes, or the addition of new content, are available from http://www.ihtsdo.org/snomed-ct/change-or-add-snomed-ct.  The document "Customer Guidance For Requesting Changes to SNOMED CT" is available for download from this page. The document provides details of how to make a request, and what details need to be provided by the requester as part of the process.