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IHTSDO delivering

SNOMED CT

Activity Report 2012


Table of Contents 3 Chairman’s Report 4 CEO Report 5 Strategic Priorities – Achievements 6 Content Report 7 Quality Report 8 Technical Report 9 Implementation and Innovation Report 10 Implementation Showcase – Stockholm 11 Mapping Service 12 Content Development 13 Workbench 14 2012 Lifetime Achievement Award – Martin Severs 16 2012 Award for Excellence – Dion McMurtrie 18 National Reports 28 New Members 29 Additional Members 30 Financial Report 31 List of Contacts

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Chairman’s Report My first report as Chair of the Management Board starts with a big word of thanks to my predecessor, Professor Martin Severs, who played a major role in creating our Association and who propelled it through its first five years of existence. In October 2012, he was recognized with an especially well-deserved IHTSDO Lifetime Achievement Award in Stockholm. Taking on the Chair of the Management Board of a well-developed organization is a tremendous pleasure, as is witnessing the improvement of SNOMED CT and how exceedingly well several harmonization projects are progressing. The Association has survived not only the past few years of financial constraints faced by all of our Member countries but has built a solid financial foundation for the immediate future. Elected in October 2012 by the General Assembly Election Committee, our new Management Board members no longer represent their home countries but were chosen based solely on their respective professional qualities. This new Board, ready to take on an even more active role in the Association, met in London in February 2013 for two productive days of talks, resulting in the creation of a set of committees, both permanent and ad hoc, to improve its usefulness and efficiency. Various key focus areas have been identified for the next few years and include, in particular, more fully meeting the needs of our end users, producing more effective processes and finding additional ways to stimulate aggressive implementation, adoption and deployment of SNOMED CT. Our CEO, Jan-Eric Slot, will address the IHTSDO’s achievements in 2012 and further describe our plans for the immediate future later in this report. (Prior to the publication of this report, Jan-Eric resigned from his position as CEO, and effective June 1, 2013 has left the association). I would like to extend my thanks to our Community of Practice, which consists of hundreds of dedicated volunteers; their dedication to our mission is heartwarming. Thanks are also due to our Executive Team, Chief Executive Officer and the Copenhagen office staff, who professionally and seamlessly handle the immense workload of the various aspects of our Association. Last but certainly not least, I would also like to express our collective appreciation for the leadership and backing of our Member countries, whose support forms the true basis of our existence. Sincerely, John Van Beek

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CEO Report It is with great pleasure that I present the 2012 Annual Activity Report to you. First, I would like to thank Professor Martin Severs for the wisdom, friendship and guidance he has shown me since I joined IHTSDO in 2010. In October 2012, the General Assembly rightly bestowed the IHTSDO Lifetime Achievement Award on Martin in Stockholm. I would also like to express my thanks to Andy Wiesenthal and John Van Beek, who have taken over as Vice Chair and as the new Chair of the Management Board, respectively. The year 2012 was witness to numerous changes and substantial progress at IHTSDO, with our staff more than doubling from ten to over twenty people to include terminologists and mappers as well as technical, support and HR employees. Expanding our staff will allow us to reach the goal of fully producing the 2013 July SNOMED CT International Release in-house without external support. The content of SNOMED CT also grew by well over 10,000 concepts, while the number of concepts for Medical Devices increased by more than 16,000 descriptions. The organization saw the introduction of a new Work Plan Development process involving the Member Forum as the key advisory body to aid the Management Board in prioritizing programs and projects. Taking this step coincided with the introduction of a Portfolio Management approach to allow for agile development to meet Member priorities. In order to fulfill the requirements of the Management Board and General Assembly finance groups, the reporting on this and IHTSDO finances was greatly enhanced. Our financial situation has been bolstered by an overall economic gain after tax due to the collection of an extra fee and additional income, not to mention the delivery of the Work Plan at a cost much lower than anticipated. Some tasks have also been deferred until 2013, when our in-house capacity will be fully operational. Additional expenses for travel, meetings and legal advice, all of which represent an investment in the IHTSDO’s future, however, partially offset the gain. The main tooling activity in 2012 centered around a review of the technical architecture of the Workbench and using the Workbench to create the two International Releases as well as to pilot a Member version as a Managed Service. Other accomplishments comprise inclusion in various worldwide registries, public good use and the implementation of Meaningful Use Stage 2 in the US. After its debut in Sydney in 2011, the Implementation Showcase was once again a success, this time in Stockholm, with a lively Vendor presence and a multitude of presentations, exhibits and posters on the use of SNOMED CT. Preparation began immediately afterwards for an even larger, more relevant event to take place in Washington D.C. in October 2013. With all these accomplishments in mind, I would like to thank our dedicated staff and Community of Practice for their committed efforts to achieving the IHTSDO’s goals and am confident that 2013 will see even greater change and progress. Sincerely Jan-Eric Slot

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Strategic Priorities Achievements 1. Make it easier to use SNOMED CT for priority use cases: Good work has been done in this area. A SNOMED CT Implementation Advisor scheme has been established to develop skilled human resources to assist with the implementation agenda nationally and internationally. The technical platform of the IHTSDO Workbench has been established. 2. Produce robust terminology standards that are fit for purpose for priority use cases: A distributed collaborative editing team has been established and the SNOMED CT Consultant Terminologist Program has contributed towards building a global community of qualified editors. Additionally, the translation guidelines have been developed, approved and published. 3. Facilitate use of SNOMED CT with other international standards: The IHTSDO has undertaken a substantial amount of work to establish cooperation agreements with major international standards development organizations, including WHO, GS1, JIC, IEEE, GMDNA, ICN and Wonca, as well as a Memorandum of Understanding with HL7. Work is in progress to establish a cooperation agreement with LOINC. A pilot project between IHTSDO and WHO delivered an independently validated Technology Preview of mapped concepts between SNOMED CT and ICD-10. 4. Strengthen responsiveness and clinical governance of SNOMED CT: A mechanism for soliciting feedback from Members on key areas of the IHTSDO Work Plan has been established through the Member Forum. Participation of international clinical bodies has been established with, for example, the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (Wonca), the International Council of Nurses (ICN) and others. 5. Sustain and strengthen the organizational foundations of the IHTSDO: The organization has increased membership to 22 countries and many other countries are interested in joining. The IHTSDO is in a healthy financial position. The transition of SNOMED CT delivery in-house from the previous support organization is soon to be completed.

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Content Report The content of SNOMED CT was updated and released on schedule in July 2012 and the Member Release was made available in December 2012, continuing the successful use of the Workbench for distributed and collaborative editing and production of the International Release. There were 763 new concepts with 2,496 new descriptions in the July 2012 release, and 1,678 new concepts and 5,077 new descriptions in the January 2013 release. Two releases of the Spanish translation were also produced on schedule in 2012. The year also saw continued and on-schedule receipt and review of the contributions to SNOMED CT from the Convergent Medical Terminology (CMT) of Kaiser Permanente. There were six content submissions of CMT terms and concepts from several clinical areas, including ophthalmology (2,950), oncology/hematology (2,849), endocrinology and urology (1,638), ear, infectious diseases and gastrointestinal (3,584) and skin and respiratory (2,856). The initial cohort of five candidates was certified as Consultant Terminologists. The program accepted eight new candidates, who made excellent contributions and by year-end were progressing well towards certification, with completion expected early in 2013. The July Release Technical Preview introduced 8,444 concepts for Medical Devices for analysis by the Members and the Community of Practice, while work on the Concept model started in 2012 and will be on-going in 2013. After the Concept model is complete and quality assured, it will move to the regular SNOMED CT International Release.

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Quality Report The IHTSDO Quality Assurance Committee met monthly in 2012 and continued to use small task and finish groups to deliver specific committee work-plan activities. The Terms of Reference were updated in cooperation with other IHTSDO Standing Committees to ensure consistency of approach. In October, there was a change of chair, with Jeremy Thorp replacing Kathy Farndon, both of whom are members of the IHTSDO Management Board. The committee focused on a number of key areas: • IHTSDO Deprecation Policy – this had been identified as a gap within the IHTSDO and the committee produced a draft for consultation within IHTSDO, including a policy, process and template; extensive feedback was received and work continues into 2013 • Risk and Issues Management – the policy, processes and recording mechanisms were tested in 2012 and piloting initiated in four specific work areas, including generation of reports from the tracker • Development of Corporate Metrics – a pan IHTSDO editorial group was established and reported on draft proposals in October 2012 to the General Assembly; further work in 2013 will focus on deriving corporate metrics for targets set in the IHTSDO Strategic Direction to 2015 • Publication of Quality Report – the committee’s second report, it focused on activities in 2011 • IHTSDO Quality Assurance Framework – the committee continued to work with those applying the framework as well as with identifying key development areas. Working through the outlined components and characteristics has ensured that all aspects of activities are taken into account during their setup and when re-evaluating progress As well as helping to put in place organizational policies and processes, the committee worked on initiatives which feed into the quality improvement of SNOMED CT and derivatives. The IHTSDO Management Board approved the completed Translation Quality Assessment process, a highly useful addition to the IHTSDO suite of translation guidance documents. The committee also contributed to the new mapping validation processes, and it views embedding quality within the newly introduced IHTSDO Content Development Process as a key ongoing activity. Ensuring that quality is considered in the whole end-to-end process also includes the introduction of a process for evaluating fully the impact of SNOMED CT model changes. Key challenges for 2013 include integrating risk and issue management in the day-to-day business of the organization at all levels and working towards more effective collection of metrics. Managing quality developments more effectively within the newly transitioned SNOMED CT development area and in relation to derivatives, while working closely with the Content Committee, provides exciting opportunities for the committee in 2013. A new cross Standing Committee group, consisting of Chairs and IHTSDO Executive Officers, will contribute to close cooperation and afford a coordinated approach across all activities of the committees.

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Technical Report

During 2012, IHTSDO designed, piloted and made available to Members the Workbench Managed Service, a new service that provides support for Workbench functionality, enabling Members to author and release their own extensions. Already in use in Sweden, the Workbench Managed Service will be implemented during the first half of 2013 in Denmark, which is currently piloting the Translation Module. IHTSDO sent out two major releases of the Workbench in April and October 2012, incorporating a number of enhancements, including support for content authoring by multiple independent authoring teams without impact to the International Release. As part of the IHTSDO Showcase in October 2012, we offered a number of Workbench training sessions and made the Workbench available for demonstrations at a dedicated booth. The Translation Module underwent extensive testing by an independent team led by Canada Health Infoway, after which the project steering group approved the module. Now being integrated into the rest of the Workbench, the module was made available in all Workbench versions in April 2013. IHTSDO also commissioned a review of the technical architecture of the Workbench. The report was accepted by the Management Board and the General Assembly, and we have incorporated a schedule of architectural improvements into the Workbench Roadmap. Work continued on a number of IHTSDO standards and guidelines, including a Query Language Specification that can be used to define a set of concepts for inclusion in a concept reference set; Diagramming Guidelines to show definitions of SNOMED CT concepts and expressions diagrammatically; and SNOMED CT URIs to uniquely identify SNOMED CT components. The IHTSDO Management Board has now approved the Query Language Specification as a draft standard. During the year, Executive Officers also contributed to various information modeling initiatives, including SemanticHealthNet and the Clinical Information Modelling Initiative (CIMI), in addition to attending Health Level Seven International (HL7) working group meetings to discuss joint tooling and setup of a terminology authority for SNOMED CT submissions from HL7.

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Implementation and Innovation Report During 2012, there were several key developments related to promoting, enabling and guiding more effective implementation of SNOMED CT. Early in 2012, the US announced that SNOMED CT was to be specified as a terminology for use as one of the key vocabularies for Meaningful Use Stage 2, electronic health record (EHR) certification and health information exchange. This announcement, confirmed later in the year by a US federal regulation, also referred to use of the LOINC code system for laboratory medicine. This prompted renewed efforts to simplify implementations of SNOMED CT and LOINC in ways that reduce duplication and facilitate more effective use. As a result, a business agreement was drafted between IHTSDO and Regenstrief Institute (the owners of LOINC). Subject to formal confirmation of a legal agreement, this will be the foundation for practical work to provide implementers with clear guidance on how to use these two leading standards together. During 2012, the SNOMED CT Implementation Advisor (SIA) scheme was launched with an initial intake of five participants. This annual scheme has two objectives: to raise the skilled capacity for supporting SNOMED CT implementation and to progress key work items that seek to enable more effective implementation of SNOMED CT. A particular focus of assignments undertaken by SIA participants in 2012 was to increase the accessibility and consistency of implementation guidance. This resulted in a major review of many sections of key documents (including the Technical Implementation Guide), as well as additional materials, including an initial set of implementation-focused FAQs, which will be expanded further over the next year or two. In addition to addressing the primary objectives noted above, the first year of the scheme provided a learning experience for the IHTSDO. A valuable result of this was a revised plan which will ensure that the 2013 SIA scheme is even more effective in delivering the dual objectives of the scheme for the IHTSDO and in meeting the expectations of participants. In 2012, the IHTSDO issued guidelines on the licensing of free online browser software. As a result, innovators developing tools for searching SNOMED CT now have a clearer understanding of the terms under which they can make their services available without undermining IHTSDO licensing. The IHTSDO is now able to point Members, Affiliates and end users to a variety of free and easy-to-use tools which demonstrate different approaches to accessing SNOMED CT. There are tools which provide alternative user-friendly ways to search and view the terminology that not only address common misconceptions about SNOMED CT but also demonstrate different options for delivering SNOMED CT content to meet practical use cases in ways that are accessible to a range of different types of users. At the end of 2012, a proposal from the Education Special Interest Group (SIG) led to a decision to investigate options for assessing and valuing SNOMED CT implementations skills. Based on the outcome of a short study on this topic, self-assessment tests for SNOMED CT skills will be developed and piloted in 2013. Depending on the development and piloting experience, this may eventually lead to a proposal for more formal testing and certification. Throughout 2012, the Implementation and Innovation Committee provided valuable advice and input on areas the IHSDO should consider when focusing its limited resources to support practical implementation and to develop and test innovative solutions. Towards the end of the year, there was an increasing recognition of the need to look more closely at the growing need for advice on adoption and scalable deployment in countries, hospitals and clinical specialties.

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Implementation Showcase – Stockholm In October 2012, the IHTSDO held its second SNOMED CT Implementation Showcase in Stockholm, Sweden, an event that included conference presentations, workshops and tutorials on SNOMED CT implementation. Twice as many presentation proposals were received compared with 2011, thus allowing a selective review of the submissions. The presentation sessions were complemented by an exhibition featuring SNOMED CT enabled software solutions and poster presentations of implementation experiences. Abstracts and presentations from this event are available for public access from the IHTSDO website. Participation, like proposal submissions, also increased. More than two-hundred people attended the SNOMED CT Implementation Showcase 2012 (up 25% from the previous year) and many presentation sessions were full to capacity. Feedback from attendees, speakers and exhibitors was exceedingly positive, confirming this as the key annual event in the IHTSDO calendar. SNOMED CT Implementation Showcase 2013 will take place near Washington D.C. on October 10-11.

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Mapping Service Following approval by the IHTSDO General Assembly in December 2011, an IHTSDO Mapping Service was established in 2012. This move was only possible because of the work of the IHTSDO Mapping SIG to establish a methodology for mapping SNOMED CT to ICD-10 and a pilot exercise to test this methodology, in conjunction with the World Health Organization (WHO), resulting in a Technology Preview release of SNOMED CT to ICD-10 maps in mid 2012. Detailed planning for the service commenced in January 2012 and international recruitment led to the appointment of two Map Leads and two Map Specialists. Initial training, focused on SNOMED CT to ICD-10 mapping, was undertaken in May 2012, and the IHTSDO took the opportunity to invite Affiliates and Member countries to participate. By September, the IHTSDO Mapping Service was preparing for the first release in early 2013 of a candidate baseline of the SNOMED CT to ICD-10 maps. The scope of the work to date focuses on the US National Library of Medicine CORE Problem List plus other related high usage concepts, with nearly 20,000 SNOMED CT concepts mapping to ICD-10 2010. International collaboration has been a key part of the NHS UK Terminology Centre and the US National Library of Medicine efforts concerning tooling, workflow and quality assurance. In 2013 the IHTSDO began work to progress to in-house tooling to promote further integration between SNOMED CT development and mapping to relevant classifications. The scope of the IHTSDO Mapping Service includes any SNOMED CT mappings to international classifications as required by Member countries. The work in 2013 will continue to focus on SNOMED CT to ICD-10 mapping, based on Member priorities – working through the approximate 80,000 concepts within the scope of ICD-10. A number of Member countries are working closely with IHTSDO to ensure consistency between SNOMED CT maps to the ICD-10 WHO version and ICD-10 country extensions such as ICD-10-CM and this may lead to further collaborative work between IHTSDO and Member countries. It is also the aim of the IHTSDO to provide training on mapping to any Member countries that require it, with the vision of being able to develop shared resources, learning and development. This will ultimately reflect on the quality of mapping products nationally and internationally.

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Content Development During the last year, we have seen the successful introduction of the Content Development process throughout the content production process. The Content Development process has supported the delivery of content projects through the Content Tracker and has seen an increasing number of Content Tracker items successfully reach the Transition phase. The supporting internal workflow remains under development to allow the full functionality of the new SNOMED CT International Request Submission (SiRS) system to be incorporated. We currently have detailed templates in place to support the Inception and Elaboration phases, and Fast Track projects. The documentation will continue to develop through end-user feedback as we attempt to optimize the level of information required. During 2012 (and into 2013), we have seen the development of authoring capacity in support of the transition activities. Internally, we have appointed three new terminology authors, and we continue to develop individuals with terminology expertise through the Consultant Terminologist program. Both of these groups are actively developing content using the Content Development process. For future releases, all International Release content development will be delivered using the Content Development process. This will provide a detailed longitudinal record of terminology change, which will improve the ability of the organization to better meet the needs of its end users and to assist individuals in the maintenance of terminology.

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Workbench Over the last year, IHTSDO has used the Workbench to produce two SNOMED CT International Releases, one in July 2012 and the other in January 2013. IHTSDO’s migration to the Workbench has enabled: • Transition of core authoring and release activities for SNOMED CT in-house, according to a planned timetable. • Migration of IHTSDO’s release format from the old RF1 format to the new RF2 format, enabling a host of benefits for Members and Affiliates using RF2, including comprehensive and consistent history tracking and introduction of an extensibility mechanism based on reference sets. • Provision of authoring tools to a distributed authoring team (located across the world). • Functional enhancements to support authoring, including support for parallel projects (where content development work can be performed independently of the International Release cycle, and merged into a release once work is complete and has been reviewed), development of reference sets based on intentional specifications and support for translation projects. Procurement of the Workbench by IHTSDO has also provided a platform for meeting the authoring and translation needs of some (but not all) Members. Over that last 12 months, the Workbench Managed Service has been established to provide all the technical support necessary to Members who want to author and release their own SNOMED CT extensions using the Workbench. This approach allows a Member to concentrate on SNOMED CT authoring rather than on provision of technical support and release processes. More recently, support for the management and operation of translation projects has been integrated into the Workbench and included in the Managed Service. This new service was tested and accepted in 2012 by Canada Health Infoway and is now being piloted by Denmark before being made available on general release in 2013. As well as being used by IHTSDO to author the SNOMED CT International Release, to produce a trial release of GMDN content, and to perform and release the Spanish translation, the Workbench Managed Service is also being utilized by: • Sweden, which has now produced an initial release of their extension in RF2 format from the Workbench. • The Netherlands, which has piloted the Managed Service and are now considering use of the Workbench to develop and release a number of reference sets as well as SNOMED CT content. • Denmark, which apart from using the Translation Module to translate concepts into Danish, is using the Workbench to develop an extension that includes 10,000 new pharmaceutical concepts. • A number of Members and Affiliates are also using the Workbench without needing the additional support provided by the Managed Service. These include: • The US National Library of Medicine, which is using the Workbench to develop and release their own extension in RF2 format. • The UK Terminology Centre, which is using the Workbench to author new concepts for the refset metadata to support the development of an RF2 release of the UK edition of SNOMED CT. • National E-Health Transition Authority (NEHTA) in Australia, which is using a version of the Workbench (branched in 2010) to author and release their own SNOMED CT extension in RF2 format. • Kaiser Permanente in the US, which is using the Workbench to author and release new content and reference sets within their SNOMED CT extension. • The Veterans Health Administration in the US, which is planning to enhance the Workbench to support concrete domains and incremental classification.

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2012 Lifetime Achievement Award - Martin Severs In October, we were extremely happy to present the IHTSDO Lifetime Achievement Award to Professor Martin Severs, OBE FRCP FFPHM, associate dean of the University of Portsmouth School of Health Sciences and Social Work. For nearly a decade, Professor Severs worked tirelessly to establish the IHTSDO and to set it on a sustainable course. On our five-year anniversary, we were pleased to honor the man who made it all happen. Professor Severs’ significant contributions to the terminology world began in the early 1990s when he played a major role in the Clinical Terms project that expanded the UK’s Read Codes (Clinical Terms Version 3 (CTV3)). When the UK National Health Service and the College of American Pathologists (CAP) agreed to merge CTV3 and SNOMED, Professor Severs was one of three UK representatives on the SNOMED Authority that oversaw that merger from 1998 to 2002. His greatest contribution to date, however, was the development of a new model of international governance and support to promote ongoing improvement, adoption and implementation of standard clinical terminology around the world. Professor Severs was the leading force in establishing the IHTSDO and in arranging its purchase of SNOMED CT from CAP. In fact, it is unlikely that either would have happened without him. He helped to convince CAP that the transition to international governance and ownership was essential to achieving the broader adoption and long-term development of SNOMED CT. He defined and refined the key parameters of international governance, e.g. one member per country, an equitable fee structure based on a country’s relative wealth and population, a management structure that promotes responsible decision making and rapid action and, lastly, uniform international licensing terms for SNOMED CT. He traveled the world to recruit sufficient charter members to found the new organization and to encourage other countries to join after its formation. His energy, perseverance and creativity overcame all obstacles in the complex nine-country negotiations required to establish the new organization as a non-profit association in Denmark and in the negotiations with CAP to establish the terms under which the intellectual property in SNOMED CT and its predecessors would be transferred to the new IHTSDO.

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As the founding chair of the IHTSDO Management Board, Professor Severs devoted this same exceptional energy, perseverance and creativity to guiding the fledgling organization through its critical first five years of existence. During this period, he was instrumental in defining vision and strategy, establishing policies and procedures, making adjustments in organizational structure, hiring IHTSDO officers, responding positively and decisively to the concerns and criticisms of current Members and in working to recruit new Members. He played a key role in establishing enlightened IHTSDO policies that enable use of SNOMED CT in low income countries and inclusion of SNOMED CT names and codes, as a public good, in other standards and in international genetic research databases. On top of all of this, Professor Severs devoted immense time to long, frequently frustrating, but ultimately successful negotiations to establish productive cooperative relationships with other organizations, including the WHO, the GMDN Agency, the Regenstrief Institute and Kaiser Permanente. In sum, Professor Severs has greatly advanced the cause of international clinical terminology standardization as a means for enhancing the health of the world’s citizens.

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2012 Award for Excellence - Dion McMurtrie Whereas our 2012 Lifetime Achievement Award honors someone who helped build IHTSDO from the top down, our Award for Excellence shines the spotlight on someone who helped build the organization and its main product, SNOMED CT, from the bottom up. Back in 2007 when IHTSDO was in its infancy, Dion McMurtrie was a commercial software engineer in his native Brisbane, Australia. He was skilled at building systems that solved problems in banking, insurance, accounting, stock trading and other commercial enterprises. In September of that year, however, Dion’s career took a new path when he took a job with Australia’s NEHTA. The organization, which had just become a charter Member of IHTSDO, was looking for someone who could work on a distributed Java-based terminology authoring system. One of Dion’s first projects involved working on improving the SNOMED CT distribution format with international colleagues. He was involved in providing feedback on the enhanced release specification (ERF) as well as working on the advanced release specification (ARF). These proposals were harmonized, resulting in the development of what has now become known as Release Format 2 (RF2). Notably, he also worked on specification of RF2 post release, quality assurance testing of IHTSDO RF2, and, eventually, harmonization of the Australian and IHTSDO RF2 formats. Although the RF2-like specifications (ERF and ARF) were in development as far back as 2009, many details of how to actually implement them had yet to be fully understood. Australia was the first country to implement an RF2-like release format and its experiences and improvements have helped pave the way for wider IHTSDO implementation. Working with the Australian Medicines Terminology group in NEHTA, Dion also contributed to the development of a new International Medicines Model by developing a concrete domain specification so that SNOMED CT could represent properties such as medicine strength numerically. In addition, he identified a need in SNOMED CT to build a standardized diagramming notation, which has resulted in the development of a proposed Diagramming Guidelines for SNOMED CT that has already been used in three vendor systems.

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Dion has been a key player in the development of the IHTSDO Workbench, helping to reshape its design and architecture. He was also one of the founding members of the IHTSDO Technical Architecture Group, which has provided direction, project oversight, troubleshooting, contract reviews and response evaluations for the Workbench. In 2008, NEHTA nominated Dion to serve on the IHTSDO Research and Innovation Committee, to which he was duly elected. After a year, he switched to the Technical Committee, where he has contributed actively for over three years. He has also represented Australia on the IHTSDO Member Forum since 2008, sharing his experiences in implementation and offering guidance on where to take IHTSDO in the future. Over the years Dion has also volunteered his time for a number of IHTSDO SIGs and projects. Dion is optimistic about the ability of SNOMED CT to help patients and medical professionals all over the world. He wants to reach out to implementers and show them that using SNOMED CT in electronic healthcare information systems does not have to be as complex as they think and that there are great gains to be made in the health and well-being of the global community. During the last six years, Dion has contributed significantly to both SNOMED CT tooling and standards development. His intellect and ability to apply knowledge from disparate areas, together with his inclusive and consultative approach, have enabled him to provide significant benefit to IHTSDO Members.

Dion McMurtrie

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National Reports

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Australia National Activities The National Clinical Terminology and Information Service within NEHTA is responsible for managing, developing and distributing the SNOMED CT Australian Release and the national medicines extension, Australian Medicines Terminology (AMT), in Australia. SNOMED CT-AU is released twice yearly (May and November). AMT is released monthly. Implementation The past year has seen significant improvements in SNOMED CT-AU and AMT. Regarding the former, the predominant focus involved addressing any remaining deviations between the Australian Release and the IHTSDO RF2 specification. The deviations were due to the first Australian RF2 release being based on an RF2 specification that was still a Draft for Trial Use. As of November 2012, however, SNOMED CT-AU is fully compliant with the IHTSDO RF2 specification. In addition, the release bundle directory structure has also been harmonized to that used by IHTSDO. Along with the monthly releases of the AMT version 2, a tremendous amount of ongoing effort is being put into the development of version 3 (v3). The AMT v3 will be an RF2 compliant release that can eventually be integrated with SNOMED CT-AU. NEHTA also reached a major milestone in July 2012 when the

Personally Controlled Electronic Health system (eHealth record system) commenced operation. Clinical Document specifications which describe the content and structure of the clinical information exchanged between healthcare providers are fundamental to this system. Continued terminology support has occurred in the form of reference set development for implementation within the clinical information models used in these specifications. The new year will see a shift in focus to increase support for implementation. Building better external relationships, establishing educational opportunities and creating additional reference sets for use in local systems are all key to improving adoption and use. Affiliate Licensees The current number of Affiliate Licensees, comprising organizations and individuals, is 633. Of these, 106 were issued in 2012. Representatives General Assembly Bettina McMahon Member Forum Cathy Richardson and Dion McMurtrie National Release Center National E-Health Transition Authority nehta.gov.au

Canada National Activities The Canada Health Infoway Standards Collaborative (SC) functions as the central point of coordination for health information standards in Canada. The SC provides liaison support to HL7, ISO/TC215, LOINC/Regenstrief, IHE, DICOM and the IHTSDO, through a harmonized model, to Canadians. The SC also provides domestic support with development, maintenance, education and implementation of the standards. Canada’s SNOMED CT activities for the year focused on developing content and guidelines for Primary Health Care, microorganisms and digital imaging – all with a goal towards increasing implementation and adoption. Our activities resulted in over 2,500 additions (requests for change) to SNOMED CT, many of which have been published in the first pan-Canadian English Extension. With a focus on increasing capacity, the SC continued to deliver and expand its SNOMED CT education and training courses as well as the tooling currently made available to clients. We continue to profile where and how SNOMED CT is being used to collaborate and understand best practices and lessons learned with SNOMED CT implementations in Canada. Canada also worked closely with the IHTSDO on the successful testing of the IHTSDO Translation Module, resulting in a product that any country wishing to translate SNOMED CT can leverage for use.

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Implementation A major SC priority was the launch of a SNOMED CT Adoption Strategy based on delivering products and services needed to enable the adoption of SNOMED CT in Canada. The objectives of the plan include delivery of a comprehensive suite of SNOMED CT tools, products and services used by our clients to enable adoption; ensuring our products remain technically and clinically relevant through improved maintenance and stable releases; evolving into a client-focused organization that meets the needs of our clients; and, finally, building capacity and increasing knowledge of SNOMED CT through improved communication and education. The SC business model and communication strategy is evolving to ensure that the plan can be successfully implemented for our clients. Affiliate Licensees Canada currently has over 450 Affiliate Licensees. Representatives General Assembly Dennis Giokas Member Forum Shari Dworkin National Release Center Canada Health Infoway infoway-inforoute.ca


Denmark National Activities The Danish NRC distributes the semi-annual releases from the IHTSDO in Danish (SNOMED CT-DK) as well as the International version in RF1. The NRC also models new concepts on demand for the Danish Extension. Denmark has continued working with the MiBa project – the National microorganism database that contains all microbiology results – using SNOMED CT to identify bacteria and other organisms in laboratory results. Denmark has also done detailed planning together with IHTSDO to establish a Translation Pilot to implement the IHTSDO integrated Workbench with full translation and authoring functionality.

records management. In 2013, building and maintenance work will be carried out on the Danish Allergy Register that will be a component in the decision support services to be established in 2013. The MiBa project will proceed with other organisms besides bacteria. Procedures and methods are another aspect of laboratory results where SNOMED CT can be used for structuring the procedures and methods used.

Implementation Denmark will build and maintain a Danish Drug Terminology that is directly connected to the generic pharmaceutical products in SNOMED CT. IT-based decision support is a method to reduce and, eventually, prevent medication errors. For such solutions, having access to a database that contains all prescription drugs in a given country is necessary. One way of building and maintaining a database of this nature is to connect it to SNOMED CT, thus making it possible to utilize the SNOMED CT clinical terminology in IT solutions for medication and patient

Affiliate Licensees The current number of Affiliate Licensees, comprising vendors, universities, Ph.D. students and individuals, is 33.

Translations Denmark, which continues to translate new releases, will use the Workbench for translation in 2013.

Representatives General Assembly Flemming Christiansen Member Forum Palle Gerry Petersen National Release Center National Board of e-Health ssi.dk

Iceland National Activities In March 2012, responsibility for management of the national EHR was moved from the Icelandic Ministry of Welfare to the Icelandic Directorate of Health. This restructuring has not yet led to new uses of the SNOMED CT terms, but has strengthened collaboration between the responsible partners for classifications and terminologies with the innovation of electronic solutions. Implementation Icelandic implementation activities mainly focus on using microbiological terms (e.g. bacteria, viruses, fungi and parasites) in a national epidemiological surveillance registry of communicable diseases. There is interest in using SNOMED CT terms in the development of an allergy subset for selecting allergies in the national EHR and other such solutions as the need arises.

Translations Iceland currently has no overall translation plans but is initially using SNOMED CT subsets in EHR where translation is not necessary. Affiliate Licensees No Affiliate Licensees were issued in 2012. Representative General Assembly Lilja Sigrún Jónsdóttir National Release Center Directorate of Health landlaeknir.is

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Israel National Activities Israel, which joined IHTSDO in April 2012 following a strategic decision by the Israeli Ministry of Health to adopt SNOMED CT as the Israeli health system’s clinical terminology, is in the initial phases of implementing the change. The NRC is currently circulating the international version without any national changes using Collabnet as the platform to deliver the SNOMED CT files. Implementation The strategic goal to use SNOMED CT in the entire Israeli health system is still in the planning phase, a schedule set to be determined in 2013. A project aimed to implement SNOMED CT in the hematology wing of one of Israel’s biggest hospitals and in a dialysis national reporting system, however, is in its initial stages. Implementing SNOMED CT in emergency wards is also being considered.

Translations No plans have been made yet to translate SNOMED CT into Hebrew or Arabic. Affiliate Licensees Efforts to deliver SNOMED CT to Affiliate Licensees in Israel are gaining momentum, with hospitals, HMOs and local vendors expected to become Affiliate Licensees in the coming months. Representative General Assembly and Member Forum Nachman Ash National Release Center Ministry of Health health.gov.il

Lithuania National Activities In 2012, the Lithuanian NRC as a part of the Lithuanian Library of Medicine wrote and received approval for a project called, “The creation of uniform a medical terms classifier for the development of quality e-services in health care institutions,” after which a financing and administration agreement was signed between the Lithuanian Library of Medicine and the Central Project Management Agency.

Translations We expect to launch a Lithuanian translation project in 2013, the first stage involving the selection of approximately 40,000 concepts according to defined priorities.

Implementation The main implementation priorities have not changed since 2011 due to the practical actualization and usage of SNOMED CT. The prospective priorities are likely to be: patient demographics, risk factors, blood groups, allergies, sensitivity to medications, habits (including addiction), vaccinations, and problems and terms recommended by epSOS for European Union member states. Plans have been made to begin SNOMED CT projection and development in the latter half of 2013.

Representatives General Assembly Normantas Ducinskas Member Forum Martynas Bieliauskas and Kristina Aputyte

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Affiliate Licensees Lithuania currently has 17 Affiliate Licensees, one of which was issued in 2012.

National Release Center Lithuanian Library of Medicine www.lmb.lt  


Malta National Activities 2012 was Malta’s first full year as a Member of the IHTSDO. Malta’s NRC is managed by the eHealth Strategy & Projects Office of the Information Management Unit of the Ministry of Health, the Elderly and Community Care. The setting and promotion of health data standards fall within the remit of this office, rendering it the logical focus for activity related to SNOMED CT. Implementation For many years, the structuring of health data in EHR in the government health sector in Malta depended mainly on the application of standard classifications such as ICD-10 for diagnoses and ICD-9-CM PCS for procedures. One of the eHealth Office’s main 2012 projects involved the mapping of health data concepts to SNOMED CT concepts, using both controlled vocabularies and free text analysis. This approach allows for a finer conceptual granularity, with the subsequent information benefits. A relatively recent development in Malta is the use of the Anatomic Therapeutic Chemical (ATC) Classification System for the medicines prescribed in government hospitals. SNOMED CT concepts and the Virtual Medicinal Product paradigm are now being used alongside ATC codes, strengthening the information model that underpins the national medicines formulary. Membership in IHTSDO has facilitated Malta’s activity in the epSOS project in relation to the use of a subset of SNOMED CT concepts in a number of epSOS value sets.

Affiliate Licensees have used SNOMED CT as a reference terminology as part of their data management activities. Early interest and use were mainly in the Disorders and Procedures hierarchies and in how SNOMED CT concepts map to standard classifications (ICD-10, ICD-9-CM). There is also interest in the emerging Medical Devices terminology. Translations One of Malta’s two official languages, English is the standard in health documentation; no plans exist to translate SNOMED CT into Maltese. Affiliate Licensees Malta currently has two registered Affiliate Licensees: Mater Dei Hospital (Malta’s main acute and teaching hospital) and the Central Procurement & Supplies Unit (responsible for government procurement of pharmaceuticals and medical supplies). Representative General Assembly Hugo Agius Muscat National Release Center Ministry of Health, the Elderly and Community Care ehealth.gov.mt

Netherlands National Activities Heightening awareness of SNOMED CT remains one of the most important activities of the NRC team. After three successful annual national conferences centered on local, national and international issues, we elected not to hold a national conference in 2012, choosing instead to redirect our focus to the implementation of terminology and code systems and the use of SNOMED CT in particular. The NRC, under the auspices of the National IT Institute for Healthcare (Nictiz), also holds quarterly introductory courses for health professionals, IT professionals, vendors and administrators, thus acquainting over a thousand people with SNOMED CT. Implementation At the beginning of 2012 our staff received in-house training on the use of the Workbench. Initially, we planned to map the Dutch diagnosis thesaurus to SNOMED CT using the Workbench, but quickly discovered that building extra tools was necessary. Therefore, we began developing SNOMED CT “Terminology Explorers,” which apply the same technology used in the semantic web, where every word of every term is indexed, allowing healthcare professionals to make more intelligent, faster searches for correct clinical terms.

The Nictiz Terminology Explorers and server have been combined with a new tooling development called Art-Decor, jointly they support the creation of reference sets, the selection of terms and the translation of those terms. Nationally, we continued mapping, e.g., a diagnosis thesaurus, a code set for laboratory terms, assistive products (ISO 9999) and allergies. A thesaurus on procedures will be compiled in 2013. Translations The NRC does not translate SNOMED CT directly into Dutch, but it enables users to interface with SNOMED CT in Dutch by mapping it to other code systems such as the Dutch version of ICD-10. Affiliate Licensees The Netherlands has 37 Affiliate Licensees. Representatives General Assembly Lies van Gennip Member Forum Jos Baptist National Release Center National IT Institute for Healthcare nictiz.nl

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New Zealand National Activities Use of SNOMED CT, where applicable, is now an evaluation criterion for all major health IT system business cases presented to the National Health IT Board. Implementation Pilot development programs are underway in three areas. First, the National Cervical Screening Programme (NCSP) currently uses a modified version of SNOMED CT for reporting histology results. NCSP plans to introduce SNOMED CT as an enhancement to the current coding system and is in the process of matching current NCSP Register Codes against SNOMED CT codes prior to final implementation. Second, Ambulance NZ is working on an Electronic Patient Report Form that sends patient information and estimated time of arrival to emergency departments (ED). This program is anticipated to align with ED projects and will use SNOMED CT where applicable. Third, a SNOMED CT ED Ref Set will be implemented as a trial into the new ED system at Nelson Hospital, thus forming the basis of a regional and national rollout.

We have received a number of requests for specialty specific SNOMED CT Ref Sets. We currently do not have sufficient resources to develop these and would need access to Ref Sets available through IHTSDO to further progress implementation of SNOMED CT. The above activities all relate to the development and implementation of the New Zealand National Health IT Plan. Affiliate Licensees New Zealand has 46 Affiliate Licensees, eight of whom were new Affiliates, three organizations and five individuals, in 2012. Representatives General Assembly Stewart Jessamine Member Forum: Tracy Thompson and Angie Quinn National Release Center Ministry of Health health.govt.nz  

Singapore National Activities In 2012, Singapore engaged a vendor and began building the tooling environment needed to maintain and manage SNOMED CT, as well as the Singapore Drug Dictionary (SDD). Scheduled to be ready in July 2013, the tool incorporates a web-based end-user version to facilitate standards adoption. Singapore has started creating a SNOMED CT Singapore Extension, the majority of the concepts created to support SDD. The number of Singapore Extension concepts is expected to increase sharply once the SDD is moved to the new tooling environment and the full SDD ontology is created for each drug in the dictionary. Preparation for the second phase of the National Electronic Health Record program was started in 2012, with key initiatives including the creation of ehealth service hubs and data analytics. This phase will put more emphasis on data standards, such as SNOMED CT, to achieve better quality records and to ensure consistency across the different care settings.

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Implementation SNOMED CT has been used since 2011 to code discharge diagnoses in several public hospitals in Singapore. In 2012, the GP IT enablement project also adopted SNOMED CT as the standard for diagnosis. Adoption of SNOMED CT is increasing in public hospitals and state boards have also shown interest. Built on the SNOMED CT ontology, the SDD will be part of the SNOMED CT Singapore Extension Release and is gaining ground as the preferred drug dictionary in Singapore. Affiliate Licensees Singapore has 34 Affiliate Licensees, 12 of which were awarded in 2012. Representatives General Assembly Low Cheng Ooi Member Forum Sari Mckinnon and Reymond Wilaisono National Release Center MOH Holdings Pte Ltd www.mohh.com.sg


Slovak Republic National Activities The National Health Information Center (NHIC) faced economic constraints and organizational changes in 2012 that greatly affected continuation of the eHealth project and medical terminology work regarding the adoption of SNOMED CT in the Slovak Republic. Nevertheless, the Center for Medical Terminology and Standards, which is part of the NHIC and staffed by experts from the field of medicine and science, continued its terminology work, especially on translation of ICD-10 (German version), which will be used for implementing the Diagnosis Related Group system in Slovakia. The NHIC made substantial progress on the National Health Information System’s National Health Portal (NZP) project for creating the basic infrastructure dedicated to new processes and forms of healthcare and healthcare services, as well as the implementation of other eHealth solutions using the program management form. Implementation The Slovak Republic will focus on working towards the use of SNOMED CT for the standardization of the Patient Summary contents in our national EHR system.

Translations The concepts selected for translation into Slovak came from the IHTSDO jurisdictional implementation project priorities and a defined systematic translation approach. The Master Value Set Catalogue was created as a part of the epSOS project; nevertheless, no further progress was made in translating SNOMED CT in 2012. The NHIC plans to create a terminology base comprising a minimum of 50,000 translated concepts necessary for epSOS implementation. NHIC plans and aims for 2013 focus on continuing to map concepts for application in the e-Medication and e-Prescription aspects of the epSOS project, other e-performances in healthcare and the NZP. The NHIC will also continue the translation of selected parts of SNOMED CT concepts for EHR and the NZP. Affiliate Licensees No Affiliate Licensees were awarded in 2012. Representatives General Assembly Pavol Rieger Member Forum Jaroslava Pikusová National Release Center National Health Information Center www.nczisk.sk

Spain National Activities The Spanish NRC is responsible for managing, developing and distributing the SNOMED CT Spanish Release and derivatives. In 2012, our objectives focused on three areas: (1) supporting the development of the national medicines extension and associated ontological models, based on SNOMED CT, for substances, excipients and clinical safety in prescription, maintenance and production of specific subsets for different clinical variables within the National Health System’s Digital Health Records Project (HCDSNS); (2) developing the first version of the extension in the Spanish of Spain; and (3) defining the requirements for a shared terminology server in our National Health System (SNS). Another 2012 highlight has been performing dataset generation for a comparative analytic study between the international core and the Spanish Extension on the situation of content. This study is still under analysis, but the first data of interest are already available. We also continue to work on standardization activities related to data models, validation of archetypes and binding terminologies to model components and user-oriented elements. Implementation Implementation plans are focused on a limited set of high priority projects grouped into three areas of special interest: (1) implementation of terminology services for the National Health

System (stSNS); (2) shared data models; and (3) binding terminologies with special focus on SNOMED CT. The NRC will also continue activities related to training, methodology, dissemination, maintenance of the Spanish Extension and specific subset development. Translations The main objective of the national translation project is to provide terms commonly used in SNS to complement and enrich the extension published in Latin American Spanish. This requires additional validation among extensions. The cross-check is performed concept by concept, with highest priority being given to the needs of HCDSNS. Affiliate Licensees The current number of Affiliate Licensees is 168, comprising public administrations, vendors, researchers and other individuals. Representatives General Assembly Arturo Romero Gutiérrez Member Forum Gonzalo Marco Cuenca National Release Center The Ministry of Health, Social Services and Equality msssi.es 25


Sweden National Activities The National Board of Health and Welfare (NBHW) was commissioned to establish a high level advisory group for national eHealth issues, including information structure and terminology. The group, in existence as of February 2013, comprises, among others, representatives from key actors in health and social care in Sweden. In 2012, additional staff with a clinical or technical background was also recruited to the NRC. The national regulation on how to record patient information in healthcare (SOSFS 2008:14) is currently being updated to include guidelines on the use of SNOMED CT and the national information structure. The new version will be published in 2013. Grants from the Swedish government have been made available to promote pilot implementation projects in eHealth, several of which focus on SNOMED CT implementation. The pilots will take place in 2013 and results reported to the National Board in Q1 2014. Implementation The NBHW will develop a national source for reasons for prescription. SNOMED CT will be used in this project and serve as the foundation for the terminology, as will the national substance registry developed and published by the Swedish

Medical Product Agency. Work on a national SNOMED CT implementation strategy has started and a strategy for integration of SNOMED CT concepts into national clinical guidelines published by the NBHW is under way. Finally, work on how to use SNOMED CT in the data reported to national clinical quality registries is ongoing. Translations The main part of the SNOMED CT core has been translated into Swedish. Translation activities in 2012 focused on the content of new releases. Affiliate Licensees Sweden has 175 Affiliate Licensees comprising regions, municipalities, hospitals, vendors and individuals. Representatives General Assembly Anna AdelĂśf Member Forum Lotti Barlow and Erika Ericsson National Release Center National Board of Health and Welfare socialstyrelsen.se/e-health  

United Kingdom National Activities During 2012, NHS Informatics provision in England underwent a transition which resulted in a new Health and Social Care Information Centre that began hosting UK IHTSDO membership in April 2013. Implementation Our national Information Strategy cites SNOMED CT as the terminology for clinical data, and applications incorporating SNOMED CT continue to be deployed. Some organizations with over three years of SNOMED CT encoded data are now seeking to enhance their analytics, with interesting solutions including visual summaries for clinicians emerging. Great strides, including the removal of many uptake barriers, have been made in preparing the primary care community for the adoption of SNOMED CT. Development of professional clinical subsets for the most common 100 diagnoses, primarily aimed at supporting data entry, plus more extensive subsets have been developed to support specific business functions including care planning. Work in the area of dietetics is progressing with international collaboration and incorporates record keeping standards. On-line education and awareness tutorials continue to be developed (see SNOMED CT Network at networks.nhs.net), with the piloting of a number of modules for professional staff contextualized for their specific domain. Around 400 people attended webinars on these materials in 2012. 26

The NHS dictionary of medicines and devices (dm+d) is now the approved NHS standard for electronic communication of medicines with SNOMED CT codes for each concept required when communicating information about medicines between systems. dm+d underpins the NHS Electronic Prescription Service, with around 3.5 million prescriptions containing over 8 million items dispensed and submitted for payment in 2012. Current work in the medicines arena includes support for GP allergy recording and transfer of information using dm+d concepts with supporting information from the SNOMED CT UK Drug Extension. The UK Terminology Centre continues to run forums and SIGs to support Affiliate Licensees in implementation and deployment with a help desk to support user enquiries and an on-line portal for requests for new concepts and terms in the UK Edition. Affiliate Licensees The current number of registered Affiliate Licensees is approximately 1,500. Representatives General Assembly Sally Greenway Member Forum Gwen Smith, Ian Arrowsmith, Denise Downs National Release Center UK Terminology Centre www.nhscfh.nhs.uk/uktc


United States of America National Activities In 2012, the US National Library of Medicine (NLM) continued providing free access to vocabulary standards (including SNOMED CT), applications and related tools that can be used to meet US EHR certification criteria and to achieve Meaningful Use of EHRs. Additional work was initiated to promote clinical and translational usage of standards that have already been adopted for routine healthcare. NLM launched the NLM Value Set Authority Center (VSAC) in conjunction with the US Office of the National Coordinator for Health Information Technology (ONC) and the US Centers for Medicare and Medicaid Services. VSAC serves as validation and the ground truth dissemination point for vocabulary value sets needed for Meaningful Use (e.g. quality measures). Initially, VSAC provides downloadable access to all official versions of vocabulary value sets contained in the 2014 Clinical Quality Measures. The content of VSAC will gradually expand over time to incorporate value sets for other use cases, as well as for new and updated measures. In conjunction with ONC, NLM also began work on a multi-year project to establish the data and standards infrastructure needed to enable clinical data captured in an EHR at the point of care to be combined with additional data from other sources in

support of patient centered outcomes research. The expectation is that the resulting standards would be incorporated into the requirements for EHRs ultimately established for Stage 3 of Meaningful Use (Stage 2 was finalized in 2012). Implementation SNOMED CT is the sole standard for problem lists, one of the required standards for procedures in US government EHR certification criteria for 2014 and the proposed standard for quality measure value sets in several domains. NLM works closely with relevant US federal agencies to support these efforts. Affiliate Licensees The US has 11,396 Affiliate Licensees, 8,812 of which are US and 2,584 of which are international. Representatives General Assembly Betsy L. Humphreys Member Forum Vivian A. Auld and Steve P. Emrick National Release Center US National Library of Medicine nlm.nih.gov

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New Members

Czech Republic National Release Center Coordination Center for Departmental Medical Information Systems ksrzis.cz

Hong Kong, China National Release Center Secretary for Food and Health ehr.gov.hk

Malaysia Representatives General Assembly Md Khadzir Sheikh Ahmad Member Forum Maizura Musa National Release Center Ministry of Health Malaysia moh.gov.my

Uruguay Representatives General Assembly Jorge Forcella Member Forum Pablo Orefice National Release Center AGESIC www.agesic.gub.uy

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Additional Members

Cyprus

Poland

Representative General Assembly and Member Forum Ioanna Zouvani

Representative General Assembly and Member Forum Marcin Wegrzyniak

National Release Center Ministry of Health www.moh.gov.cy

National Release Center National Centre for Health Information Systems csioz.gov.pl

Estonia Representative General Assembly and Member Forum Piret Simmo National Release Center Estonian eHealth Foundation e-tervis.ee

Slovenia Representative General Assembly Smiljana Voncina Slavec National Release Center Ministry of Health mz.gov.si/en

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Financial Report The financial and business processes of the IHTSDO must ensure a sustainable and robust organization capable of responding to stakeholder requirements. The 2012 audit was unanimously approved by the General Assembly on April 10, 2013.

Income Statement January 1 – December 31, 2012 Membership fees Voluntary contribution fees In-scope licenses Affiliate licenses Other income

USD: 9,590,048 312,851 9,503 14,699 79,000

Income 10,006,101 Staff expenses Office and facilities Travel expenses Other costs Work plan Reversal of provision severance pay, CAP Amortization, SNOMED CT IP Expenditures

- 2,117,308 - 410,624 - 413,767 - 334,011 - 4,559,788 0 - 780,000 - 8,615,498

Profit/loss before Financial Income and Expenses Financial income/expenses, net

1,390,603 - 23,564

Profit/Loss before Tax Tax on profit/loss for the year

1,367,039 0

Profit/Loss for the Year

1,367,039

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List of Contacts IHTSDO Management Board

John Van Beek, Chair Ian Arrowsmith David Bunker Gonzalo Marco Cuenca Kathy Farndon Nilesh Jain, DSc, MBCS, CITP

NICTIZ, The Netherlands National Health Service, UK National E-Health Transition Authority, Australia Ministry of Health, Social Services and Equality, Spain Health Information Standards and Governance, NHS, England CSC, UK

Duncan McNeil

PumpCo, UK

Donald Sweete

Canada Health Infoway

Jeremy Thorp

National Health Service, UK /epSOS Project

Lene Vistisen

National Board of e-Health, Denmark

Andrew M. Wiesenthal, MD, SM

Deloitte Consulting, USA

Julian Zelingher, MD, MSc, MPH

Clalit Health Services, Israel

IHTSDO Executive Team Jan-Eric Slot, MB, MSc, MBA John Gutai

David Markwell, MB, BS, LRCP, MRCS Jane Millar Kent Spackman, MD, PhD Liara Tutina

Chief Executive Officer (Note: as of June 2013, the Transitional CEO is Duncan McNeil) Chief Technical Architect (Note: as of June 2013, IHTSDO tooling is handled by Rory Davidson and Robert Turnbull) Chief Implementation and Innovation Officer Chief Quality Officer Chief Terminologist Chief Program Officer

For further information, please contact us at: info@ihtsdo.org

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IHTSDO Gammeltorv 4 DK-1457 Copenhagen K Denmark Telephone +45 36 44 87 36 Telefax +45 44 44 87 36 General information: info@ihtsdo.org A registered Danish association, IHTSDO is a not-for-profit entity established on 23 March 2007. CVR #30363434, FMBA. IHTSDO速, SNOMED速 SDO, SNOMED CT速 and SNOMED速 are trademarks of the International Health Terminology Standards Development Organisation. www.ihtsdo.org

Snomed - Activity report 2013  
Snomed - Activity report 2013  
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