2026-05-28: DEUSG Virtual

Cross-Border Terminology Alignment Challenges

Melanie, a pharmacist at the National Health Authority of Cyprus and EP leader for cross-border services implementation, raised a practical challenge regarding terminology alignment for route of administration across European countries. She noted that while Cyprus aligns with EDQM standard terms, other countries use SNOMED CT or different terminology systems, potentially creating interoperability challenges for cross-border data exchange. Melanie suggested developing a mapping between EDQM and SNOMED CT for route of administration to address these challenges, particularly in preparation for upcoming EHDS implementation requirements.

Healthcare Standards Route Mapping Challenges

The group discussed challenges with mapping routes of administration between different healthcare standards, particularly focusing on SNOMED CT and EDQM. Alejandro explained that while the current work provides mappings to forms, there are ongoing discussions about how dose forms and routes differ in definition, noting that Australia uses routes to define clinical drugs while SNOMED uses dose forms. The discussion revealed that different countries use varying standards, with Ireland using SNOMED exclusively, and that some data may be missing when exchanging e-prescriptions between systems using different standards.

Intended Site vs Route of Administration

Guillermo explained the concept of intended site from EDQM, which is used more for regulatory purposes than electronic prescriptions, and discussed how it differs from routes of administration. Yongsheng clarified that while intended site and route of administration codes are similar, they serve different purposes - intended site for modeling medicinal products and route of administration for modeling procedures. The team explored possibilities of merging these two code systems but decided against it due to potential concerns about safety and pharmaceutical standards.

Medication Administration Sites and Routes

Alejandro demonstrated different medication dose forms and explained the distinction between intended site and route of administration, noting that intended site is more specific than route of administration. CY clarified that intended site is more specific than route of administration since a medication can have multiple administration routes but only one intended site. Karen and Stuart agreed that while the terms are similar, the actual use cases differ significantly, with Stuart emphasizing that there's no direct one-to-one link between dose form, intended site, and actual route of administration in clinical practice.

Route Administration Mapping Discussion

Shane proposed creating a forum post after the call to gather input on route administration mapping requirements from countries using EQR and SNOMED systems. Guillermo confirmed that mapping would not be problematic as coverage is largely consistent, with only a few routes of administration varying between systems. The discussion focused on how different administration methods (intravenous, intramuscular, intrathecal) are not definitional for products, with Guillermo explaining that while some countries may accept different forms, this complexity is being addressed through previous multi-component discussions.

EDQM-SNOMED CT Mapping Discussion

The group discussed mapping between EDQM and SNOMED CT systems for route administration, with CY confirming that mapping EDQM's approximately 160 terms to SNOMED CT concepts would not be difficult. Stuart clarified that veterinary-only routes like beak dipping would be excluded from the mapping. Alejandro provided an update on a draft implementation guide for the drug model, noting that feedback is still welcome and the document will be released in its first version during May. The next meeting will focus on non-terminating strength rounding and developing a standardized approach across countries.

Hydrated Ingredients Classification Approach

Guillermo discussed a long-standing issue with supporting hydrated ingredients in the SNOMED International core, noting that some countries cannot classify real clinical drugs with hydrated substances due to international law classification challenges. The team agreed on a technical approach involving property chains and creating attributes to enable proper classification, with Young having completed a proof of concept in Protege. Yongsheng raised a concern about the difference between treating hydrated substances as subtypes versus siblings in the property hierarchy, which could impact attribute inheritance, and requested further discussion to finalize the approach before promoting attributes to the international core.

Substance Modeling Attributes Updates

The group discussed updates on substance modeling attributes and dose forms. Guillermo explained that new attributes for substance relationships would be introduced as a plug-and-play option for countries wanting to implement them, without forcing mandatory adoption. Yongsheng provided updates on substance-linked organisms and DOS forms after transformation, noting plans to introduce new attributes for modeling DOS forms and that Administrative Orders Form would only be used for pharmaceutical medicinal products aligned with IDMP. The team also addressed concerns about clinical drug duplicates in SNOMED CT International Edition, with Elizabeth raising questions about mapping challenges between national drug dictionaries and SNOMED CT, particularly regarding different dose forms like injection versus infusion.