Establishing a well-functioning NRC is not a trivial task, and awareness about the steps required to achieve an active and effective NRC is necessary in order to plan and recruit appropriately. The processes involved with setting up and running an NRC can be described in three phases: establishment, roll-out and maintenance.

Figure 3. Different stages of setting up and running NRCs

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Each NRC can undertake a variety of responsibilities in order to facilitate implementation and use of SNOMED CT in the Member country. These responsibilities range from development, distribution and maintenance of SNOMED CT to support of SNOMED CT implementation projects, as well as education of people involved with SNOMED CT use and implementation. In the stage of establishing an NRC, it is vital to make decisions about which services will be provided and what national developments the NRC will undertake. These decisions also include deciding on the organization of the NRC, the work processes, the timetable and so on. It is of course possible for the scope of activity of the NRC to be increased (or decreased) in the future, as the needs change.

List of NRC establishment decisions

Prior to establishing an NRC, the following questions should be considered in order to be able to determine the best possible NRC organization and workflow, along with appropriate recruitment and training of staff to match the necessary NRC competencies for the planned national approach and goals. The list is not complete, but includes some core considerations that existing Members have found to be important.

NRC management decisions
Regarding NRC management, decisions need to be made about work processes, timetables and resource allocation. What is the planned timeline for the establishment and roll out of the NRC? What is the purpose/strategy for SNOMED CT in my country? What resources will be spent on tailoring the International Release to meet national requirements? Who will be responsible for managing specific work tasks?
Use of SNOMED CT with other terminologies, classifications and models
Typically a Member country also uses other terminologies, classifications systems or information models, and it is important for an NRC to have a clear strategy for how SNOMED CT is to align with the current or planned use of these other products in the Member country. What set of standard terminologies (in addition to SNOMED CT) will be used in the country? Are these required or suggested? Do you need mappings between SNOMED CT and other terminologies or classifications? Are there any interdependencies with other products (classifications/coding systems/information model initiatives) that would affect SNOMED CT releases, content, etc.?
National adjustment/extensions
An NRC should consider to what extent national SNOMED CT adjustments (translations, extensions, Reference sets, etc.) should be made to develop the SNOMED CT National Extension and conform this to the needs and desired use cases for the Member country. Do you need a translation of SNOMED CT into the language and/or dialects applied of our country? Do you need national Reference sets to constrain the amount of SNOMED CT concepts to be used within specific use cases, clinical domains, etc. and to support consistent use of SNOMED CT within these areas? Do you need national content (extensions to the International Edition of SNOMED CT) in order to meet specific national needs? Who will manage derivatives, for example Reference sets and mappings, in the longer term? The NRC or someone else?
Implementation and use cases
An NRC can take on very different strategies for supporting implementation and use of SNOMED CT in the specific Member country, and therefore an NRC should consider if, or to what extent, it will support specific SNOMED CT implementations. It should also consider how collaboration with the related stakeholders will be carried out. Who is responsible for what, for example in implementation projects? What will be done at the national level? What is the responsibility of the various stakeholders (NRC, clinicians, healthcare organizations, IT vendors, etc.)? Which organizations are already using SNOMED CT in the country and how will you engage with them? What level/type of support will you offer? Are there any priority use cases that you want to communicate? Do you intend to specify compliance standards for use of SNOMED CT in your country?
Education
An NRC should have a clear plan for its role with respect to SNOMED CT education and training of the various stakeholder groups within the country. Do you intend to offer any guidance documents over and above what SNOMED International provides? Do you intend to deliver training on SNOMED CT? At different levels? Will you translate all SNOMED International materials (beyond SNOMED CT terminology, e.g. education materials, translations guidelines, deployment guidelines) into your national language, or is use of English acceptable?
Tooling
It is important for an NRC to explore and discuss what specific tools are required to undertake the work of the NRC and to determine which tools will be used by the NRC. Will you use your own tooling or will you rely on SNOMED International's tools? What existing systems/processes/tooling do you already have in place that can be leveraged to fulfill your activities as an NRC? What tooling is required to support activities of your NRC? Where will these be obtained (from SNOMED International, vendors, in house development)?

Consideration of each of the above questions will lead to additional questions that need to be answered to obtain a realistic overview/estimate of the magnitude and types of resources required to achieve the identified goals. For example, it is not enough to decide that you want to make a translation of SNOMED CT into your national language. This decision also requires elaboration of when and how you plan to do this, who should undertake the work and availability of required funding.

Balance ambitions and resources

If an NRC decides to develop a wide range of services and products to support the use of SNOMED CT in the Member country, it will likely promote successful adoption of the terminology. However, it is important that the NRC set up ambitions and timelines realistic in relation to the resources available. Members should carefully consider and define the national visions for use of SNOMED CT in the Member country. Hence, Members should be clear about the way they expect SNOMED CT to be used, which again must align with the national strategy and infrastructure.

It can be useful to consider a stepwise development process, where the NRC prioritizes the initiatives that should be carried out immediately and sets aside initiatives could be scheduled later. This is better than setting the bar too high and initiating too many projects that are difficult to complete.

Communicate with fellow NRCs

For every stage of NRC development it is essential to get in contact with other NRCs in order to gain insight to existing ways of organizing and running an NRC and to learn from others' experiences. SNOMED International facilitates communication between Members in different ways, for example through workshops during the biannual face-to-face meetings or by participation in the Member Forum (described later in this document).

NRC governance

Every NRC needs a clear governance structure to ensure that the work of the NRC and the strategic decisions are continuously aligned with user needs, national strategic priorities, SNOMED International developments and initiatives, collaborators' work, etc. The NRC should therefore consider what governance structure would be suitable to fulfill the needs of the NRC, as the needs may vary depending on the extent of services and the National Extension the NRC decides to develop.

In the simplest form, NRC governance can be carried out as operational line management of the responsibility for directing the day-to-day work of the NRC. Alternatively, there may be a need for having formal committees to advise on the direction of the NRC. This could, for example, be necessary if a National Extension is developed, as this may entail the need of an editorial committee to define and maintain editorial policies and ensure that they are being followed.