Frequently Asked Question

Sometimes a clinician will not find the concept he/she is looking for even though it exists in the value set and is translated in the Belgian languages, simply because he/she don't look for it using the right term. This is called a lack of expressivity in the target (specialized) language.

As immediate solution to the problem, you can teach the clinician which term he/she can use to find the desired concept. However, though one must insists on banishing slang from the EHR, the clinicians should always have the opportunity to find easily the concept he/she desires, if only by adding search terms to this concept.

Search terms are terms that, as their name indicates, allow you to find a concept, but that will not be actually used to capture this clinical notion in the EHR document/file. Search terms are not true acceptable synonyms in the SNOMED CT sense of the term and they are not constrained as strictly by the SNOMED CT editorial rules regarding word order, spelling or homonymy.

Whether you want to add true acceptable synonyms or just search terms, you can do it four ways:

1- You add them yourself only in your EHR/flat file. Though this approach is seducing because it offers an immediate patch to your local problem we do not recommand it for several reasons. First, maintenance. Anything you create in SNOMED CT you must then maintain. Any additional synonyms you add locally to an official refset will be lost at the next official update unless you devise a way to add them as recurrent metadata you can link back to that concept when you do your official update. Second, there is the question of economy of scale. It is quite likely that if your practionner find an synonym useful, others will too. It is the essence of the CSCT to try to avoid needless duplication of efforts between the hospitals by mutualising the resources.

2- You add it at EHR vendor level if the vendor manages the dictionaries for you.

3- You request addition of this synonym/search term at CSCT level, using the content modification request template of the CSCT Knowledge and Support Center. At the moment the CSCT doesn't publish yet it's own SNOMED CT extension (but this might change base on demand). However, where the CSCT publishes the flat file value set like for the AllergyIntolerance care set causative agent, the CSCT can publish intermediate and/or urgent release updates, which will then be available for the whole CSCT community. Valid acceptable synonym added by the CSCT to one of its released flat file will be proposed in batch at regular intervals to the Belgian NRC for inclusion in the official Belgian extension. The timing of publication of such intermediate releases will be subject to the amount of requests received, their impact on clinical data capture and the priorities fixed by the CSCT Board and General Assembly.

4- You request addition of the acceptable synonym at Belgian extension level directly to the Belgian NRC using the SNOMED CT management portal. Depending on availability and the moment of the request submission, you may expect your synonym to appear in the next Belgian release (15th of March/15th of September).

Please note that requesting a synonym doesn't mean necessarily getting that synonym as there are editorial rules to follow, especially rules against homonymy and eponyms. However there is always the solution of adding a special "interface terms" language refset containing search terms, which the CSCT tools allow.