Updated November 26, 2008
SNOMED Terminology Solutions, a division of the College of American
Pathologists, was created upon the launch of the International Health
Terminology Standards Development Organisation (www.ihtsdo.org).
SNOMED Terminology Solutions was formerly known as SNOMED International.
It achieved many significant milestones from the early development
of the Systemized Nomenclature of Medicine to the breakthrough releases
of SNOMED Reference Terminology (SNOMED RT) and SNOMED Clinical Terms
SNOMED Milestones 1965-2005
For most 2006-present milestones, please visit News/Events.
History of Creating a World Class Terminology
For more than 40 years, the College of American Pathologists invested in the research and development of SNOMED. It successfully evolved from a pathology-centric terminology that was distributed and used in print format to works delivered electronically and integrated into computer applications.
In 1995, the College began collaboration with Kaiser Permanente to revolutionize SNOMED’s structure to reflect the advances in medical informatics and the science of computing (e.g., the use of description logics, distributed development, relational database structures) in a desktop PC world. As a result, SNOMED RT was launched in May 2000.
SNOMED, with its roots in specialty medicine, ranked #1 in various third-party studies assessing terminology options. The United Kingdom’s READ Codes, with its origin in primary care, typically ranked second. Thus to achieve world class terminology status and conserve the limited global supply of medical terminology expertise, the College and the UK Minister of Health agreed to combine the College's SNOMED RT with the UK’s Clinical Terms Version 3 (formerly known as the READ Codes) to create SNOMED CT. SNOMED CT, first released in January 2002, combined SNOMED RT's strengths in the basic sciences, laboratory and specialty medicine with the richness of the UK’s work in primary care. The end result was a comprehensive and precise clinical reference terminology that provides unsurpassed clinical content and expressivity for clinical documentation and reporting.
SNOMED CT nearly doubled the content of SNOMED. It further expanded its technical infrastructure providing greater flexibility to localize content for specific use (e.g., develop subsets, create extensions, develop mappings to other works). Formal evaluation in the UK, cross validation by US and UK development teams, and external validation by more than 42 alpha test sites in six countries further refined the content.
Consistent with its strategy to become a world-class clinical terminology, various domain-specific vocabularies were systematically integrated into SNOMED (e.g., the nursing vocabularies, lab LOINC, SNODENT). Key classifications and data sets were mapped to SNOMED (e.g., ICD-9CM, ICD-10, ICD-O, PNDS) and alignment with leading messaging standards (e.g., HL7, DICOM, XML) was pursued.
Major Milestones in SNOMED’s Development include:
- SNOP - 1965
- SNOMED - 1974
- SNOMED II - 1979
- SNOMED Version 3.0 - 1993
- LOINC codes integrated into SNOMED - 1997
- SNOMED Version 3.5 - 1998
- SNOMED RT - 2000
- SNOMED CT (SNOMED RT + CTV3) - First release January 2002
- SNOMED CT Spanish Edition - April 2002
- SNOMED CT German Edition - April 2003
June 3, 2005
Federal Health IT Report Recognizes SNOMED CT
A June 3 report from the Department of Health and Human Services summarizes more than 500 responses to a Nov. 15, 2004, request for information (RFI) by the federal Office of the National Coordinator for Health Information Technology. The office issued the RFI to gather comment from organizations and individuals on how the federal government should develop and deploy national health information network (NHIN).
In its report, the HHS identifies SNOMED CT along with seven other medical
coding and terminology systems that respondents recommended for
a master list of standards that would provide a national baseline
for electronic data exchange. The report notes that standards on
the master list could function as “the bridge between custom implementations
of other standards, where translations to/from the master set would
facilitate health information exchange among health applications.”
January 25, 2005
The CAP licenses to NLM mappings from Nursing classifications
The College of American Pathologists has licensed to the National Library of Medicine (NLM) mappings from SNOMED CT to NANDA International (NANDA® ) Taxonomy II, Nursing Interventions Classification (NIC) Version 4, and Nursing Outcomes Classification (NOC) Version 3. NLM will provide access through its Unified Medical Language System® (UMLS®) Metathesaurus®, a knowledge source containing biomedical concepts and terms from many controlled vocabularies and classifications.
May 6, 2004
HHS Secretary Tommy G. Thompson announces access to SNOMED CT through
the National Library of Medicine.
At a Secretarial Summit
on health information technology (IT) on May 6, 2004, HHS Secretary
Tommy G. Thompson announced that the English edition of SNOMED Clinical
Terms (SNOMED CT) core content is now available, free of charge,
through the National Library of Medicine's (NLM) Unified Medical
Language System® (UMLS®) Metathesaurus® .
January 29, 2004
CHI Recommends SNOMED CT The Consolidated Health
The Consolidated Health Informatics (CHI) Initiative recommended and endorsed
SNOMED CT as the terminology of choice for the domains of anatomy,
nursing, diagnosis and problems, and non-lab interventions and procedures.
NCVHS and CHI Domain area
January 22, 2004
President Bush Reiterates the Need for Computerized Health Records
In his State of the Union address, President Bush addressed the need for computerized health records as one of the “critical issues in healthcare””. Having a standardized clinical terminology is critical to electronic medical information. Recommended as the core general terminology for an electronic health record (EHR) in the US, SNOMED CT is becoming the standard that will make computerized records and President Bush’s promise a reality.
December 3, 2003
SNOMED CT Encoded CAP Cancer Checklists Standardize Information to Revolutionize Cancer Data Management
The CAP announced the availability of the SNOMED CT encoded CAP Cancer Checklists to assist surgical pathologists in reporting the most common forms of adult cancer and for effectively delivering the information necessary to provide quality patient care. The addition of detailed, prospective SNOMED encodings to the CAP Cancer Checklists will allow multiple and interdisciplinary providers to communicate about a patient's health accurately and consistently by means of the electronic medical record.
The American College of Surgeons (ACOS), in an effort to facilitate more accurate and complete staging, adopted incorporation of the CAP cancer protocols checklist elements as standards for hospital cancer registries participating in the ACOS Approvals Program. This requirement became effective for cancer registries as of January 1, 2004.
November 12, 2003
120303 Cancer Checklists
Federal Advisory Panel Backs Use of SNOMED
The National Committee on Vital and Health Statistics (NCVHS), an advisory panel of the Department of Health and Human Services recommended SNOMED CT as the general core terminology to support the patient medical record information (PMRI).
Federal Advisory Panel Backs Use of SNOMED
CDC Grant Renewed
Funding was approved by the Centers for Disease Control and Prevention (CDC) cooperative grant, Standardized Reporting and Encoding of Surgical Pathology Report (Grant No. H75/CCH517569-02). The objectives of this initiative include the continuing validation of the scope and granularity of SNOMED for encoding, retrieving and electronically communicating information in a surgical pathology report. The grant’s successes include an increased knowledge of SNOMED, particularly by cancer registrars, which has led to involvement in pilot projects in California and Ohio. In addition, new concepts have been mined from the CAP Cancer Protocols and incorporated into SNOMED CT ensuring up-to-date pathology content.
October 1, 2003
SNOMED Collaborates With the Anesthesia Patient Safety Foundation to Improve Patient Outcomes
SNOMED International announced a five year collaboration agreement with The Anesthesia Patient Safety Foundation (APSF) to enhance the anesthesia content currently available in SNOMED CT Core content. This standardized clinical data set will support documentation in the operating room, improving data collection and analysis to reduce anesthetic errors and increase patient safety.
September 30, 2003
CAP Receives ANSI Approval for the Healthcare Terminology Structure Standard
CAP, an American National Standards Institute (ANSI) Standards Developer Organization (SDO) received ANSI approval for the Healthcare Terminology Structure standard. This standard specifies a standard file structure for use in distributing healthcare terminology.
July 1, 2003
CAP and NLM Sign Major License Agreement for SNOMED CT
College of American Pathologists (CAP) signed a $32.4 million, five-year sole source contract with the National Library of Medicine (NLM) to license English and Spanish language editions of SNOMED Clinical Terms (SNOMED CT) in the United States. The NLM is part of the National Institutes of Health within the U.S. Department of Health and Human Services (HHS).
This agreement is one more step to a paperless health care system and lays the terminology foundation for a health care information infrastructure that will help to improve the quality of care and ensure patient safety for years to come.
SNOMED International Provides Testimony to IOM
Diane J. Aschman, MS, RPh and John Neff, MD, FCAP, representing the College of American Pathologists, provided public testimony to the Institute of Medicine (IOM) Committee on Guidance for Patient Safety Data Standards at its meeting on November 25-26 in Washington, D.C.
Epic Systems Corporation Integrates SNOMED CT into Award-Winning EpicCare Electronic Medical Record
Epic Systems Corporation executed a license agreement with SNOMED International to integrate SNOMED CT into its EpicCare electronic medical record product suite for hospitals and physician group practices. The agreement will provide EpicCare customers with a standard medical terminology across all EMRs to facilitate data exchange, enhance clinical decision support, and improve interoperability. Epic planned to begin the integration immediately and expected to ship systems using SNOMED CT by the end of 2002.
SNOMED International Hosts Fourth Annual Users Group
SNOMED International hosted the Fourth Users Group meeting on November 8 in San Antonio. This one-day educational conference featured cutting-edge health care organizations who shared their knowledge and experiences in implementing SNOMED CT into their information system solutions. The keynote address featured a panel from NASA discussing the longitudinal astronaut medical record project.
SNOMED International Delivers SNOMED CT Spanish Edition October 2002 Release
SNOMED International introduced the second release of the SNOMED CT Spanish Edition subset. The October 2002 release translated content of seventy two percent of the July 2002 release of SNOMED CT (English Edition). It continues to advance the vision of an international terminology that supports the integrated electronic medical record.
ComMedica Becomes First U.K. Vendor to License SNOMED CT
ComMedica, an electronic healthcare system vendor based in the U.K., announced plans to include SNOMED CT in a forthcoming release of its Web-based clinical information server, PIRILIS. The integration means that ComMedica can offer an electronic patient record environment in which the terminology for hundreds of thousands of clinical conditions and treatments has been standardized on a globally recognized basis.
Kent Spackman, MD, PhD, FCAP Testifies at NCVHS Hearings
Kent Spackman, MD, PhD, FCAP testified at the NCVHS hearing regarding Patient Medical Record Information (PMRI) terminology. Dr. Spackman recommended an action-oriented solution to the Committee. Given the College of American Pathologists’ track record in developing and delivering clinical terminology to the healthcare community coupled with acknowledged market acceptance, he advised the Committee to make the obvious choice, SNOMED CT, as the “best of breed” PMRI terminology. In the interest of health care, Dr. Spackman encouraged the committee to avoid "analysis paralysis" and disruption of a forward trend with industry and providers.
The CAP Ballots First Proposed ANSI Standard, SNOMED CT
The College of American Pathologists, an ANSI standards developer organization, closed balloting of its first proposed ANSI standard, the SNOMED CT structure. Seventy-two percent of the canvass list responded to the ballot. Of those responding, 86 percent voted to approve the SNOMED CT structure.
Cerner Licenses SNOMED CT for Electronic Medical Record
Cerner became the first major healthcare information technology provider to begin integrating SNOMED CT into its electronic medical record. Integration of SNOMED CT into Cerner Millennium solutions will allow health information within the electronic medical record to be coded using SNOMED terms. By marrying the terminology of SNOMED with Cerner Millennium solutions, clinicians can retrieve, share and aggregate patient data more easily and completely.
SNOMED CT Nursing Content Expanded
The College of American Pathologists and Elsevier Science (Mosby, Inc.) executed an agreement on behalf of the Center for Nursing Classification and Clinician Effectiveness at the University of Iowa College of Nursing to integrate concepts from the Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) into SNOMED CT. The mapping of these two leading nursing classifications into SNOMED CT will improve nurses' access to the tools necessary to consistently and uniformly document nursing treatment and outcomes within electronic health records at the point of care.
SNOMED International Holds First Industry Advisory Group Meeting
SNOMED International’s first Industry Advisory Group meeting was held in July. Twenty-two software suppliers representing the market leaders in enterprise-wide solutions, laboratory information systems, decision support solutions, surgical suite systems and interactive Web-based information tools were in attendance. The purpose of the Industry Advisory Group is to solicit broad, inclusive involvement from the software supplier community to position and advance SNOMED as a premier health care terminology. Discussions included insight into the conditions necessary for universal acceptance of a clinical nomenclature and advice for strategic direction to meet the future information needs of the global health care community.
SNOMED Delivers SNOMED CT July 2002 Release
SNOMED International introduced the second release of the most comprehensive international and multilingual clinical reference terminology available in the world. SNOMED CT July 2002 Release builds upon the unparalleled content and scope of the SNOMED CT First Release, which was introduced in early 2002. This release of the terminology provides expanded content to support the uniform capture, sharing and aggregation of diverse health information across a wide range of clinical specialties, geographies and languages.
SNOMED Clinical Terms Spanish Edition Released
SNOMED International advanced the vision of an international terminology that supports the integrated electronic medical record with the release of the SNOMED Clinical Terms‚ (SNOMED CT) Spanish Edition April 2002 reference terminology subset. This was the first foreign-language edition of SNOMED CT to be published.
Cedars-Sinai Medical Center Licenses SNOMED CT for Physician Order Entry System
SNOMED CT concepts will be used as the core clinical terminology to code problem and diagnoses lists within the system. It will serve as the basis for clinical decision-support at Cedars-Sinai Medical Center. The system will automate the physician order-entry process and thus integrate clinical, accounting and patient management functions across departments of the hospital. The physician order-entry system is the largest non-capital project ever undertaken by Cedars-Sinai Medical Center.
SNOMED Clinical Terms First Release Introduced
SNOMED CT First Release is the most comprehensive international and multilingual clinical reference terminology available in the world. The unparalleled terminology delivers to the entire health care community unprecedented uniformity for medical communications that spans languages, clinical specialties and geographic borders. A wide range of clinical specialties in the U.S., U. K., Europe, South America and Australia contributed to the development and testing of the terminology’s content, from the basic sciences to laboratory, specialty and primary care medicine. SNOMED CT First Release contains approximately 325,000 concepts linked to clinical knowledge to enable accurate recording of data without ambiguity. The terminology’s content also includes more than 800,000 descriptions or synonyms relating to clinical concepts, as well as more than 950,000 links, known as semantic relationships, between clinical concepts. SNOMED CT First Release cross maps to other medical terminologies, such as ICD-9-CM, ICD-O3, ICD-10, Laboratory LOINC and OPCS-4, eliminating duplicate data capture and facilitating enhanced health reporting, billing and statistical analysis. The possible applications of SNOMED CT First Release are nearly limitless.
Greenway Medical Technologies Announces it Will Incorporate SNOMED Reference Terminology into its Point-Of-Care Electronic Medical Record Solution
Greenway Medical Technologies, a software and service provider of a Web-based ambulatory software suite, licensed SNOMED RT as a key component of its point-of-care electronic medical record (EMR) solution, PrimeChart. The incorporation of SNOMED into the EMR will ensure complete and consistent clinical documentation within the patient record to improve the physician's understanding of each patient's condition at the point-of-care, without interfering with the physician's ability to provide patient care.
SNOMED RT Spanish Translation Beta Test
The Spanish edition of SNOMED RT was completed. This edition was the first translation of SNOMED RT to be completed. Validation of the translation will be conducted through the end of 2001. The objective of the Spanish edition beta test for the Spanish-language edition of SNOMED RT will be to ensure the integrity of the translation.
SNOMED CT Alpha Test Conducted
An alpha test period for SNOMED CT began in late July with the release of a limited domain subset for testing and evaluation purposes. Forty-two test sites representing six countries including the U.S., U.K., Germany, Iceland, The Netherlands and Australia participated in the evaluation of file structure and content. Objectives of the alpha test were to demonstrate that SNOMED CT follows core table structure specifications and reflects U.S. and U.K. dialects, to provide developers with a data set for experimentation, and to provide clinicians with a view of data in selected domains.
Test applications included the use of SNOMED CT in clinical information systems, decision support systems, and the development of technical infrastructure tools. Three Open Dialogue Meetings scheduled for late September and October with the alpha test sites enable the sharing of findings with representatives from the College, the NHS and other test sites. The SNOMED Clinical Terms First Release is scheduled for December 2001.
CDC Grant Renewed
A number of initiatives were underway as part of the third year renewal of the CDC grant Standardized Reporting and Encoding of Surgical Pathology Reports (Grant # H75/CCH517569-02). In September, market assessments were sent to select hospital and regional or central cancer registries to determine the knowledge level of registrars regarding SNOMED. Responses were received and results tabulated. Second year follow-up assessments were mailed in December 2000 to software vendors, anatomic pathologists and laboratory directors regarding knowledge and implementation of SNOMED. Results from all assessments were presented at the Third Annual Vendor/End User Open Dialogue to be held February 23, 2002 in Chicago.
AHIMA and SNOMED Jointly Review SNOMED RT Terminology Mapping to ICD-9-CM
The American Health Information Management Association (AHIMA), the leading association of health information management professionals, and SNOMED International embarked on a joint project to study the mapping of SNOMED RT to ICD-9-CM. This project served to educate AHIMA’s members on clinical terminologies and their relationship to classification systems, and to help AHIMA assist its members in preparing for changes in health information management practice in the future.
SNOMED RT Version 1.1 Released
The update file contained more than121,000 fully specified concepts complemented by more than 190,000 terms or synonyms covering the breadth of clinical practice. The code set also consisted of over 360,000 explicitly defined relationships between terms enabling the retrieval of cases based on any of a variety of criteria (e.g., disease hierarchy, anatomic relationships). Updates reflected a special focus on nursing content incorporating new diagnosis concepts integrated into the findings, conclusions and assessments hierarchy and diagnostic concepts specific to home health care. The release of SNOMED RT version 1.1 included nursing diagnosis concepts from NANDA (North American Nursing Diagnosis Association), the Omaha System, and the Georgetown Home Health Care Classification. Future plans include the addition of nursing intervention and outcomes concepts. The drug section was updated to reflect the proprietary and non-proprietary drugs approved since November 2000. Version 1.1 includes mappings, where appropriate, to concepts in the general practice findings.
Australian Delegation Visits SNOMED
A delegation representing the Australian government participated in a wee long meeting with SNOMED staff to assess the status of SNOMED CT development and its potential impact on Australian health coding and to explore the potential to contribute expertise to the ongoing development of the terminology. The delegation identified a number of short-term initiatives in the Australian market and has assisted in encouraging the participation of a number of alpha test sites.
SNOMED Signs Contract with Australian Pathology Laboratory
The Queensland Health Pathology Service executed a license to integrate SNOMED RT into its statewide laboratory information system. All of the networked hospitals in Queensland will be able to access and use SNOMED RT to code their specimen collection, analytical testing, results interpretation, clinical consultations and research. This is the first SNOMED license in Australia.
SNOMED Coding of CAP Cancer Protocols and Checklists
A grant initiative involves the coding of the CAP cancer protocols and checklists. SNOMED coding of the more than 30 checklists from the CAP Cancer Committee’s cancer protocols is nearly complete. SNOMED coded cancer checklists will play a major role in educating vendors, pathologists, laboratory managers and cancer registrars regarding the benefits of coded structured cancer reporting.
2001 Nursing Initiatives
SNOMED nursing initiatives have been the catalyst for bringing together existing nursing terminologies for comprehensive documentation of nursing care. The expansion of nursing concepts in SNOMED RT and SNOMED CT came to fruition. The SNOMED Convergent Terminology Group for Nursing (SCTGFN) was originally charged by the SNOMED International Editorial Board with the task of developing principles, processes, and strategies for enhancing the coverage of the nursing domain in SNOMED RT.
WASPaLM Endorses SNOMED As Preferred Reference Language for Laboratory Clinicians
The World Association of Societies of Pathology and Laboratory Medicine (WASPaLM) recently endorsed SNOMED - the Systematized Nomenclature of Medicine - as the preferred clinical terminology for coding in pathology laboratories worldwide. The endorsement was voted on by the WASPaLM Bureau at its meeting in Vienna, Austria this past summer.
SNOMED RT Launched at TEPR 2000
SNOMED RT, a concept-based reference terminology, became available in wide release, providing the infrastructure for the electronic health record worldwide. It contained multiple hierarchies, more than 121,000 concepts linked to more than 190,000 synonym terms and an excess of 340,000 explicit relationships that enables one to retrieve a case based on any of a variety of criteria, as well as mapping to LOINC and ICD-9-CM codes.
CAP Accredited by ANSI
CAP was recognized by the American National Standards Institute (ANSI) as an accredited developer of standards. The first work CAP submitted for recognition was the kind of hierarchical terminology model used in SNOMED RT.
CDC Awards Grant
CAP was awarded a grant from the Centers for Disease Control and Prevention (CDC) to study current cancer terminology in SNOMED RT. This project will validate the scope and granularity of SNOMED RT in terms of electronic reporting to cancer registries.
SNOMED RT Recognized by ANA
The American Nurses Association officially recognized SNOMED RT as the clinical reference terminology to support the integrated electronic health record for nursing. This agreement represents the continued effort of CAP and the ANA to support nursing terminology efforts worldwide.
SNOMED RT to Be Combined with NHS Read Codes
CAP and the United Kingdom’s National Health Service (NHS) reached an agreement to combine SNOMED RT and the NHS Clinical Terms Version 3 (Read Codes) into a single, global health terminology. This new work, called SNOMED CT (Clinical Terms), will create the most comprehensive structure for supporting the electronic health record.
SNOMED RT Beta Test
A new generation of SNOMED, SNOMED Reference Terminology (RT) entered beta-testing by over 40 developers and healthcare enterprises. This latest version of SNOMED was developed in collaboration with the Kaiser Permanente Convergent Medical Technology (CMT) Project. SNOMED RT was designed to meet the need for a semantically unified clinical terminology for health states, disease states, pathophysiology, treatments and outcomes.
SNOMED Expands Terminology in SNOMED 3.5
SNOMED International gained 6,446 new terms, most of them in the Disease module. SNOMED 3.5 consisted of 156,965 terms and term
codes and was comprised of 12 modules. Four new microglossaries were enhanced with this new version of SNOMED: the Signs and Symptoms and Medical Observations Microglossary, the Pathology Microglossary, the Neoplasm Microglossary and the Tetratology Microglossary.
SNOMED 3.4 Provides Enhancements to SNOMED III
The most significant version of SNOMED III provided enhancements to the SNOMED nomenclature with atomic axes mapped to LOINC. In addition, 32,027 SNOMED terms were mapped to ICD-9-CM codes to facilitate health reporting and statistical analysis. SNOMED now contained more than 150,000 terms.
SNOMED Maps with LOINC Codes
SNOMED and the Logical Observation Identification, Names and Codes (LOINC) collaborated on the cross-mapping of clinical reference terminology, where the detailed names of laboratory tests provided by LOINC, were mapped to more atomic SNOMED procedure terms.
SNOMED III (SNOMED International) Introduced
The third edition of SNOMED was heralded as a work of enormous significance, providing a multi-dimensional, structured nomenclature for indexing medical diagnoses and treatments. SNOMED III was the first edition of SNOMED widely accepted within the international healthcare community and translated into several foreign languages. Its hierarchical classification of terms facilitated medical tools necessary for the coding of electronic patient records. SNOMED III contained 130,580 terms and term codes in 11 modules.
Unified Medical Language System (UMLS) Includes SNOMED
CAP and the National Library of Medicine incorporated SNOMED into the UMLS to facilitate the retrieval, transfer and integration of biomedical information from different sources.
SNOMED II (Second Edition) Gains Even More Acceptance
This second edition of SNOMED contained 44,587 records classified in six modules and was available in a two-volume set with an alphabetic index. The United Nation’s Council of International Organizations of Medical Science, Section of Pathology recognized SNOMED II as the nomenclature for clinical and anatomic pathology. It was also endorsed by the American Society of Clinical Pathologists and the Royal College of Pathologists in the United Kingdom.
Electronic Version of SNOMED Available
SNOMED was converted from print to electronic media for newly developed mainframe-based medical information systems. This facilitated the use of the tool for physicians, researchers and other healthcare professionals.
SNOMED (Systematized Nomenclature of Medicine)
Dr. Roger Coté helped extend SNOP beyond pathology, and it evolved into the Systematized Nomenclature of Medicine (SNOMED). SNOMED contained a broad array of clinical terms crossing all specialties of medicine and significantly expanded its use within healthcare environments.
SNOP (Systematized Nomenclature of Pathology)
SNOMED’s earliest origins came in the form of SNOP (Systematized Nomenclature of Pathology). SNOP was a four-axis system of terms and related codes intended to be a comprehensive and flexible tool for pathologists interested in the storage and retrieval of medical data. It was developed by the College of American Pathologists (CAP) Committee on Nomenclature and Classification of Disease, under the direction of Dr. Arthur Wells.