• The Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) Ontology includes “a Core terminology of over 364,000 health care concepts with unique meanings and formal logic—based definitions organized into hierarchies. As of January 2005, the fully populated table with unique descriptions for each concept contains more than 984,000 descriptions. Approximately 1.45 million semantic relationships exist to enable reliability and consistency of data retrieval. It is available in English, Spanish and German language editions.”
• The primary goal is to advance “patient care through the delivery of a dynamic and sustainable, scientifically validated terminology and infrastructure that enables clinicians, researchers and patients to share health care knowledge worldwide, across clinical specialties and sites of care.”
• National government agreements with NLM (UMLS Metathesaurus) and NPfIT (UK)
• Primary concept hierarchies include clinical findings, procedures, body structure, etc. These are linked by IS-A and attribute (such as associated morphology, body structure—part of…) relationships.

• SNOMED International: College of American Pathologists (CAP); clinical content experts; medical informatics experts; United Kingdom's National Health Service representatives; liaisons from clinical specialties and government agencies; professional medical translators, editors and validators; physicians and nurses; a Scientific Director; and external stakeholders.http://www.snomed.org/about/organization.html
• Working groups also exist for various components (e.g., Mapping or Nursing).
• UMLS links contains the active core content of SNOMED CT

Primary citation:

SNOMED International [http://www.snomed.org/]

• Core content includes the concepts table, descriptions table, relationships table, history table, an ICD-9-CM mapping, and the Technical Reference Guide. Can map to other medical terminologies and classification systems already in use.
• Over 366,170 concepts with unique meanings and formal logic-based definitions organized into 18 hierarchies (see end of sheet for entire table). http://www.snomed.org/snomedct/documents/July05_CT_FactSheet.pdf
• Contains more than 993,420 English language descriptions or synonyms for flexibility in expressing clinical concepts. For example:Concept Fully Specified Name=Pain in throat (finding) à Associated Descriptions= Sore throat, Throat pain, Pain in pharynx, Throat discomfort, Pharyngeal pain, Throat soreness
• Approximately 1.46 million semantic relationships:
  • IS-A (within single hierarchy)
  • Attribute relationships (connects concepts in different hierarchies; see end for full table): e.g., Disorder & Finding; Body Structure; Context; Measurement Procedures; Procedure' Specimen; Additional attributes
• It is meant to be complementary to LOINC (Logical Observations Identifiers, Names, Codes), another clinical terminology important for laboratory test orders and results.

"As an American National Standards Institute (ANSI) approved standards developer, the College of American Pathologists has committed to a review process that incorporates ANSI's minimum due process requirements. Recognition of the SNOMED CT structure as an approved ANSI standard was received on September 30, 2003."

The SNOMED CT development process incorporates the efforts of a team of internal and external modelers. A documented scientific process is followed that focuses on understandability, reproducibility and usefulness. Content is defined and reviewed by multiple clinician editors, with additional experts being consulted as necessary to review the scientific integrity of the content.

The quality control process is continuously supplemented by feedback from users. Parallel to domain specialist review, U.S. and U.K. editors continue to review the content and are actively making adjustments and refinements as needed.

Expert Input: The College of American Pathologists (CAP); clinical content experts; medical informatics experts from the U.S. and the United Kingdom 's National Health Service; professional medical translators, editors and validators; physicians; and nurses. These individuals bring expertise in national and international standards, medical informatics, software development and implementation, database licensing, biotechnology, clinical and academic medicine, managed care, laboratory medicine, pharmacy, nursing, education and database services.

Working Groups: An open terminology development process supports working groups providing input about the direction of the terminology to a detailed review of specific nomenclature domains.

Essentially used in human healthcare fields:

• “Electronic medical records, ICU monitoring, clinical decision support, medical research studies, clinical trials, computerized physician order entry, disease surveillance, image indexing and consumer health information services. Beyond electronic medical records, the terminology is used for physician ordering of drugs and lab tests, genomic databases, telemedicine, public health reporting, and clinical research. Sharing of data will increase the accuracy of clinical documentation, facilitate clinical decision support, and improve patient safety and enhance clinical outcomes.”
• “SNOMED CT will help structure and computerize the medical record, reducing the variability in the way data is captured, encoded and used for clinical care of patients and medical research.   For patients, that means that doctors and other care providers are more likely to have information about a patient's medical history, illnesses, treatments, and laboratory results at their fingertips, whenever it is needed. A care provider can more easily send to and receive electronic information from another health care practitioner to deliver the best patient care possible.” 

An example in Radiology/Imaging: “imaging-related content provides broad representation of the procedures, drugs (such as contrast materials), anatomical structures, and findings specific to clinical imaging.… Through SNOMED's collaboration with DICOM (Digital Imaging and Communication in Medicine), and to an increasing degree with RSNA (Radiologic Society of North America), we are working toward a single, convergent, widely accepted terminology representing the imaging domain. SNOMED hosts the quarterly Structured Reporting Working Group meetings of DICOM. As terminology content is added to the DICOM standard, it also added to SNOMED.”

• Single contrast barium enema (procedure)
  Defining characteristics
  • Imaging (action)
  • Large intestinal structure (body structure)
  • Barium sulfate (substance)
• Filling defect (finding)
• Malignant tumor of colon (disorder) 
  Defining characteristics
  • Malignant tumor (disorder)
  • Malignant neoplasm of primary, secondary, or uncertain origin (morphology)
  • Colon structure (body structure)

A. Within a Test Bed: 
Potentially provides 1) an anatomical term set for the human body, esp. the brain (Body Structure concept hierarchy); 2) clinical assessment terms for human psychiatric conditions (Staging and Scales concept hierarchy); and potential source of disorders terminology with links to anatomical terms (Disorder and Finding/Associated Morphology).

B. Across Test-Beds: 
Items in A will be relevant to both morph and function BIRN, and can be set up similarly (with first reviews to incorporate schizophrenia and Alzheimer's disease related terms). The anatomical terms and disorders may be relevant to matching with mouse BIRN.