The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters over a lifetime in any care delivery setting which includes patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, radiology reports, etc.; and can be accessed instantly and securely by authorized users.
The Electronic Medical Record (EMR) is an electronic record of patient health information generated by one or more encounters in a particular health care facility/delivery setting which includes patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports; and can be accessed instantly and securely by authorized users from that healthcare facility.
EMR is not accessible by other healthcare facility.
EHRs are patient centric and comprise of longitudinal patient health record which can be accessed across healthcare facilities. EHR is a collection of all EMRs.
EMRs are healthcare provider centric and comprise of episodic patient health information accessible within a healthcare facility.
National Resource Centre for EHR Standards (NRCeS) is a single point of contact for assistance in developing, implementing and using EHR standards in India. NRCeS provides the knowledge base for EHR Standards and associated resources and facilitates acceptance of and adherence to EHR standards.
Ministry of Health & Family Welfare (MoHFW), Govt. of India has established a Centre of Excellence named as National Resource Centre for EHR Standards (NRCeS) at C-DAC, Pune to accelerate and promote adoption of EHR standards in India.
To know the recommended healthcare IT Standards for India, refer EHR Standards for India v2 (2016)
SNOMED Clinical Terms (SNOMED CT) is the most comprehensive, multilingual clinical healthcare terminology in the world. It is owned, maintained, and distributed by the SNOMED International, United Kingdom. It is a widely used terminology and contains comprehensive active concepts with unique meanings and formal logic-based definitions organized into hierarchies.
Incorporation of such a comprehensive terminology in EHR requires understanding of the underlying concept model, various levels at which clinical information can be effectively represented, and cross-mapping to other international vocabulary standards
SNOMED CT provides a standardised, core terminology for EHR. When implemented in software, SNOMED CT represents clinically relevant information consistently, reliably, and comprehensively as an integral part of the EHR. It provides a standardized way to represent clinical phrases captured by the clinician and enables automatic interpretation of these. Use of an EHR improves communication and increases the availability of relevant information.
If clinical information is stored in ways that allow meaning-based retrieval, the benefits are greatly increased. The added benefits range from availability of more easily accessible and complete information regarding medical history, illnesses, treatments, laboratory results, etc., increased opportunities for real time decision support, improved patient outcomes and treatment. It can also facilitate research and analysis based on coded information from clinical IT systems.
SNOMED International is an international not-for-profit organization based in United Kingdom.
SNOMED International is a product and service organization. It owns and administers the rights to SNOMED CT and related terminology standards. The SNOMED International is responsible for ongoing maintenance, development, quality assurance, and distribution of SNOMED CT.
SNOMED International is an association governed by a General Assembly that contains one representative of each of its national Members. Currently 30 countries are members of SNOMED International.
The SNOMED International Members pay a fee, based on national wealth, to the SNOMED International which gives them the right to a seat on the General Assembly. SNOMED International does not charge Affiliate Licensees for use of the SNOMED CT International Edition within Member countries.
SNOMED International members undertake a range of activities related to their involvement in the SNOMED International and their role in distributing, extending and supporting the use of SNOMED CT in their country. The Organisation or agency that coordinates this role in each country is referred to as a NRC.
NRC provide a single point of contact for communications with SNOMED International and other SNOMED International Members. Within their own countries, NRCs manage the use of SNOMED CT and communicate with a range of stakeholders, including SNOMED CT Affiliate Licensees, healthcare institutions, clinical groups and end users.
The Ministry of Health and Family Welfare (MoH&FW) has designated C-DAC, Pune to run the NRC for distribution and management of SNOMED CT within India.
India became a member country of SNOMED International in April 2014.
SNOMED CT content can be browsed using freely available online browsers
1. SNOMED International SNOMED CT Browser
2. C-DAC's CSNOFinder
Reference sets (Refsets) are a flexible standard approach used by SNOMED CT to support a variety of requirements for customization and enhancement of SNOMED CT.
These are purpose, domain or utilization specific SNOMED CT codes targeted towards one or more medical domain. E.g. Refset for Opthalmology.
These also include the representation of subsets, language preferences for use of particular terms and mapping from or to other code systems. Every reference set has a unique numeric concept identifier.
NRCeS will be publishing refsets relevant in India in phases. Requirements may also be submitted to NRCeS for new refset development and publication. Vendors, clinicians and researchers are encouraged to submit refsets prepared by them for consideration as nationwide standard.
07 SNOMED CT Preview Refsets for commonly found diseases on which National Health Programs are run by the Ministry of Health and Family Welfare (MoHFW), Government of India have been released.
SNOMED International's SNOMED CT Starter Guide is a good place to begin with. Thereafter more technical and advanced features of SNOMED CT can be studied in the Technical Implementation Guide.
For more details, refer SNOMED CT Standards section of our website.
SNOMED CT code set access is available after getting Affiliate License from
1. NRCeS for use within the jurisdiction of India
2. SNOMED International for international use
Affiliate licensees have to report usage for the period declared during Affiliate registration. The usage has to be reported before the declared period ends
Usage of SNOMED CT requires license. This license is called as Affiliate License. The Affiliate License is in accordance with the Affiliate License Agreement.
For more details, refer the SNOMED CT Standards section of our website.
The end users who use the SNOMED CT enabled software (or service) developed by Affiliate licensees need a sublicense to use SNOMED CT content.
Each system deployment requires a sub-license. Sublicense is issued based on number and type of systems that have been deployed.
Yes you still need to procure license for SNOMED CT as it is an intellectual property of SNOMED International and there are certain terms and conditions for usage of SNOMED CT as mentioned in Affiliate License Agreement.
For more details, refer Get SNOMED CT section of SNOMED International website.
MLDS is provided by SNOMED International for organizations and individuals to request use and access to the International Release of SNOMED CT for use in non-Member countries.
NRCeS agreed upon to use the same tool for licensing so the users from India are also redirected to MLDS.
The different types of Affiliate License Agreements are:
Offered for the use of SNOMED CT by vendors/developers/users.
Offered to encourage the use of SNOMED CT in research that contributes to broadening the collective understanding and knowledgebase.
The qualifying research project requires formal approval from SNOMED International.
Offered for charitable use. The product/service requires formal approval from SNOMED International.
For more details, refer Get SNOMED CT section of SNOMED International website.
Yes, an Affiliate License is required for use of SNOMED CT in India. The Ministry of Health and Family Welfare (MoH&FW), Government of India has made SNOMED CT freely available for all use within India.
Yes. An Affiliate License is required for use of SNOMED CT in India.
Yes. The Affiliate Licensee should ensure the software is sublicensed to end user.
For more details, refer Affiliate License Agreement.
For shipping/selling a software in other country you may require an affiliate license from that country. Contact NRC of that country for licensing details.
Yes. If the SNOMED CT enabled application/program (including web-based application) or mobile app is deployable in India, usable within India, or in a closed network within India, the Affiliate License issued by NRCeS would suffice. Licensee has responsibility to ensure that sub-licenses or general use meets this criteria.
In case the web-based or mobile application is deployed outside India or may have users outside India, then a special International Affiliate License need to be obtained from SNOMED International. For this purpose, please raise appropriate request through MLDS