By Rory Davidson

Chief Information Officer

SNOMED International’s Chief Information Officer, Rory Davidson, discusses the organization's recent introduction of community content, answering your frequently asked questions about the offering. 

Over the past year, you may have heard some discussion of how SNOMED International is moving toward enabling stakeholders to contribute to and participate in the ongoing development, maintenance and improvement of SNOMED CT, our clinical terminology. In this blog post, SNOMED International CIO Rory Davidson explains what we mean by “community content,” how it will work and how we envision the benefits it will bring to our entire community of SNOMED CT users.  

Q: What do we mean by community content?

RD:  We want to provide a more easily accessible platform and content area where the community can contribute and collaborate on globally relevant SNOMED CT content. The community content model is a way to allow other stakeholders outside of SNOMED International to be involved in adding, improving and maintaining the terminology without our being a bottleneck. We talk about it as “democratizing terminology” in that we are enabling other people to participate in developing it, and by doing so, it won’t be just an ivory tower with SNOMED International at the top.

Q: How will community content differ from national extensions?

RD: The organization presently produces the SNOMED CT International Edition and publishes it twice a year (at the end of each July and January). 

National extensions are a bit different from the International Edition release. While dependent on the SNOMED CT International Edition, national extensions allow Members to add content to SNOMED CT that would not generally be relevant outside their country, based on policy, health trends, language, etc.

You can think of a national extension as a localized layer on top of the International Edition. In contrast, community content provides somewhere to extend the core, the SNOMED CT International Edition, in a global way that is available to everybody, not just to a specific country as an extension.

The International Edition has lots of checks and balances in place to ensure quality so we can’t add to it as quickly or as dynamically as people would often prefer, and national extensions tend to be quite specific. We see community content as an area where we can share things like reference sets, maps, translations and new content domains much more easily.

This is based on our current thinking, which continues to evolve. 

Q: Can content be moved out of the community area and into the International Edition or a national extension? If so, how does that work? 

RD: In some cases, the community content area might be a staging area for content that people want to see globally that the SNOMED International team doesn’t have the capacity to add to the International Edition, or at least not that quickly. By including the content in the community content area, it’s available to everyone immediately. Once it has gone through a quality assurance process and clinical review, that content can be promoted into the International Edition, where it will then be maintained by SNOMED International. 

Q: How will quality continue to be assured with community content? 

RD: That’s the biggest challenge with this. It’s very easy to assure quality when you have a single team that is reviewing everything, but when you open it up to this collaborative approach, it becomes more challenging. It’s not just the process of ensuring quality across multiple external contributors; we also want to ensure stakeholders don’t perceive any impact to quality.

We’re still reviewing the quality assurance process but it will require steps such as ensuring contributors are qualified, either by our certification courses or by other means, to work in the community content area. We will automate the QA process as much as we can, as we do for the International Edition and the national extensions, but ultimately this is a knowledge-based product and we are depending on other people to review community content. It requires treading a fine line between ensuring there are checks and balances while supporting and facilitating the community content contribution process. 

Q: What does community content mean to Members and other stakeholders? How does it benefit them and us?

RD: It depends on the Member and the context: countries that have a large national extension, like Canada or Australia, may have global clinical content that they just haven’t been able to promote. The community content area could be where they put it, enabling other people to work with them to quality assure, maintain and use it, which means they no longer have to manage it in their extension. 

Countries that share a common language (as with French for Switzerland, Canada and Belgium, for example), can move their translation projects into the community content area, rather than each working individually on translations in their national extensions. This may be particularly useful for countries that are brand-new to SNOMED CT and that don’t have a lot of resources. 

For SNOMED International, the benefit is that we can work with clinical specialist groups and organizations, or even other standards bodies, who can manage whole areas of globally available community content that we (SNOMED International) don’t necessarily manage. That is a massive advantage for us in leveraging a wide and global knowledge base. It also means we can add new clinical domains to our clinical terminology. For example, one of the newest projects in community content is traditional medicine. Dr. Yongsheng Gao, one of our senior terminologists, has experience in that realm. He is working with a team of external experts on community content. It’s a great example of how we can work with other organizations without depending on our team to advance the work. 

Q: What kind of feedback have we received from our Members about this initiative? 

RD: I think Members can see the benefit of being able to have content globally available more quickly, because it takes time to add content to the International Edition. Community content speeds up that process of making content globally available.Members also see the flexibility community content enables and the advantages it provides, particularly in the area of translations. Non-Member countries might be more interested in becoming a SNOMED International Member when they see how community content facilitates language translation among countries that share languages. One great example of that is our Member country Kazakhstan, which speaks Kazak, but also Russian. Russian is also spoken in other countries, so if other Russian-speaking countries see there is already a translation project under way, they might be more interested in becoming a Member. 

Q: What challenges do you anticipate, if any, and how are we preparing to address them?

RD: One challenge is ensuring quality, as I spoke about earlier. The other is making sure the community content area doesn’t become the wild west and just a dumping ground. At the moment, it’s a little bit like when Apple first unveiled the App Store for iPhones: they created the apps, but they didn’t know what people would do or how they would use them. We’re creating this area and we hope people will come and propose content additions to us. Then we will be able to say, “Yes, here’s a platform where you can do this and we can help you do it,” whereas before we would have told people to work with their national extension or to get in the queue to add new content to the International Edition.

Q: Can you describe the rollout process/timeline, beginning with a soft launch? 

RD: We’re ahead of schedule – we expected to start this at the beginning of next year but we did a soft launch in February 2021. We now have a URL and a community content browser that currently hosts four projects: cancer synoptic reporting, genomics, traditional medicine and the common French translation.

The next steps are to govern what can and can’t go into the community content area with the help of our Members. Over the next 12-18 months, we’ll be improving our tooling technology platform so people will be able to get involved much more easily than they can at the moment. At the end of the day, though, the community content initiative will reflect the efforts and engagement of our stakeholders and users.

Q: How will users add to or use community content?

RD: Initially this will be guided by the Member Forum and steering committee. The process we’ve discussed with them is that someone will submit (an equivalent to) a business case and let us know what they want to do. There will be some oversight and they will have to ensure they will maintain that content. SNOMED CT is a dynamic terminology, so if the content changes, say, in six months to a year, it is going to have to be maintained, so we will need a commitment that participants will take on that responsibility.

Q: Do we have any success criteria or any expectations in terms of uptake?

RD: No; I would say the things we’ve been able to achieve with cancer synoptic reporting, traditional medicine and the common French translation project (and what we expect to be doing with the common German translation project) have demonstrated that the idea has traction. I think the criteria would be that in two to three years we have an increase in content but no decrease in quality. There may not be a lot of people involved; it may just be one organization, so it’s not driven by aspirations to specific volumes, it’s more about what will be made available to people at a global level.

This is a work in progress – we’re very open for feedback to help us make this work for the community. It’s important to note that this is not intended to be a mechanism for SNOMED International to offload work; it gives people the ability to be much more involved than they are now, whether it’s a local hospital, a project group or another standards body. We’ll provide the platform to do it and/or a way for them to use their own tools if they want to access the service.

Q: Where can people find more information? 

RD: They can find it at http://snomed.org/community-content.  Please note that a confluence account is required. Register for an account.

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