The Canadian Medicines Terminology (CMT) is a SNOMED CT suite of artefacts, created by Canada Health Infoway to support the creation of a Canadian SNOMED CT Drug Extension. CMT provides the foundation for clear and precise identification of medicinal products commonly used in the treatment of human patients across Canada. The different medicinal product concepts can be integrated into clinical information systems to support a wide range of use cases, enhancing the accuracy and efficiency of patient care, and improving cross-jurisdictional compatibility in data sharing.

The CMT encompasses the Canadian SNOMED CT drug model based on the Canadian-specific requirements, the medicinal product concepts, the data transformation process, the mapping rules and principles, the tooling enhancements, the customized modelling templates, and modelling editorial guidelines for representing complex drug products.

Scope

This is a multi-phase project, based on a phased approach to standardize Canadian drug data using SNOMED CT. Starting from Phase 0 with the establishment of editorial guidelines and foundational tables, each subsequent phase - covering different types of drug products - will use these consistent rules for modeling, clinical requirements, and validation.

Phases 1 to 4 introduce specific product types (from single-ingredient oral solids to complex, multi-component drugs), each standardized with SNOMED CT’s editorial and modeling rules. This consistency ensures that drug data for various formulations and ingredients aligns across all provincial health systems to ensure interoperability. Currently, the project completion date for phase 4 is March 31, 2026.

The current scope excludes:

• vaccines
• immunoglobulin products
• radiopharmaceutical products
• natural health products
• veterinary products
• disinfectant products
• devices

The following table provides the details for each phase for the CMT development.

Phase 0: Definition of Model, Tools, and Scope

Status: COMPLETED

Deliverables:

• Define the model structure, tooling requirements, and project scope.

Scope:

• Oral tablets and capsules with one ingredient and one component.
• Initial setup of the CMT Canadian SNOMED CT Drug model for simple products.
• DPD (Drug Product Database) products are included, excluding any packaging requirements.

Phase 1: Tooling and End-to-End Workflow for Oral Tablets and Capsules

Status: COMPLETED May 31, 2025

Deliverables:

• Create a tooling workflow for oral tablets and capsules products.
• Approximately 6,000 Trade Clinical Drugs (TCDs).

Scope:

• Focus on simple products with single components in oral tablet and capsule forms, without packaging.
• Phase 2 requirements confirmation and documentation development
• Tooling requirements confirmation and development for Phase 2
• Documentation development: Editorial guidelines, mapping process, authoring process, release notes
• Inclusion of DPD-marked products designated for human use.

• From DPD extract
• Status = “Marketed”
• Class = “Human
• Route = “Oral”
• Dose form = “Capsule”, “Tablet” variations
• Not a vaccine or immunoglobulin product
• Not in NVC (National Vaccine Catalogue)
• “VACCINE” or “IMMUNOGLOBULIN” not in ATC term
• “VACCINE”, “IMMUNOGLOBULIN”, “STRAIN” or “VIRUS” not in ingredient name
• Single component (1 type of unit of presentation)
• Single ingredient (1 active ingredient)
• CMT classes VMP, VMPF, VCD, TMP, TMPF, TCD only

Phase 2: Tooling Support for Single-Component Drugs (Non-Parenteral)

Status: In progress

Deliverables:

• Expand tooling support to cover all single-component, non-parenteral drugs.
• Increase the CMT content by approximately 2,600 TCDs.

Scope:

• Integration of remaining single products without packaging into the CMT model.
• Coverage of single-component drugs, focusing on human drugs marked by DPD.

Phase 3: Tooling for Parenteral Products (Single Component)

Status: Pending Phase 2 completion

Deliverables:

• Add tooling support for parenteral, single-component products.
• Expand CMT content to include approximately 2,000 TCDs.

Scope:

• Focus on single-component injections, such as biologicals.
• Include multi-component drugs within the CMT model, covering all active ingredients.
• Ensure DPD coverage for all classes of human drugs.

Phase 4: Tooling for Multi-Component Drugs

Status: Pending Phase 3 completion

Deliverables:

• Develop tooling support for multi-component drugs, including complex products with packaging.
• Increase the CMT content to approximately 400 TCDs.

Scope:

• Inclusion of multi-component drugs with specific packaging requirements.
• Preparation for future requirements, such as cancelled products, agents, and radiopharmaceuticals.

The overarching approach

The Canadian Drug model design is based on SNOMED International’s standardized national drug extension model, with additional Canadian enhancements to support Canadian-specific requirements. This is an essential enabler for supporting both national and international semantic interoperability, consistency, and data sharing across jurisdictions, addressing both global and Canadian healthcare requirements. Here’s how the alignment is achieved:

1. International Compatibility
   • The structure and concept definitions are based on the SNOMED CT International terminology model, which provides a robust framework for representing medicinal products.
   • Use cases include compatibility with the IDMP (Identification of Medicinal Products) model, facilitating global regulatory and clinical data exchange.
   • The SNOMED CT framework supports international interoperability for patient care and cross-border healthcare data sharing, such as through standardized patient summaries.
2. National Adaptation for Canada
   • While based on the international model, the SNOMED CT Canadian Edition includes specific modifications to meet the regulatory and clinical needs of Canadian healthcare, as outlined in the SNOMED CT Canadian Drug Extension.
   • Concepts are adapted to reflect Canadian healthcare practices and regulatory requirements (e.g., the Drug Product Database (DPD) mapping and compatibility with Canadian health data standards).
   • This adaptation ensures that the hierarchy can serve as a national medicinal product terminology, meeting the specific needs of Canadian healthcare providers while supporting data compatibility and consistency.

Data Sources

The Drug Product Database (DPD) is the CMT’s source data for the drugs authorized for sale by Health Canada. The DPD is updated nightly and includes:

• availability of the drug in Canada
• product monograph (PM) for human drugs
• labels for animal drugs (which is out of scope for the CMT project)

Generic drug manufacturers must update their PM to ensure it aligns with the Canadian Reference Product. The Product Monograph Brand Safety Updates table provides updates on safety information in PMs of brand name pharmaceutical drug products.

Data processing

The online mapping tool developed and hosted by SNOMED international, Snap2SNOMED, is used to author and maintain simple maps from DPD data source to SNOMED CT Canadian concepts. The maps are designed to define key drug attributes such as substances, pharmaceutical dose forms, strength units (numerator and denominator), units of presentation, product names, suppliers, and containers. The results of the listing maps are served as building blocks in the construction of the drug concepts.

The following maps are currently being developed and maintained for phase 1:

List of Maps for data preparation

1. DPD (Drug Product database) to SNOMED CT- CA Substance Map
2. DPD to SNOMED CT- CA Pharmaceutical Dose Form Map
3. DPD to SNOMED CT- CA Strength Numerator Units Map
4. DPD to SNOMED CT- CA Strength Denominator Units Map
5. DPD to SNOMED CT- CA Strength Units of Presentation Map
6. DPD to SNOMED CT- CA Route of Administration Map
7. DPD to SNOMED CT- CA Supplier Map
8. DPD to SNOMED CT- CA Basic Dose Forms to Units of Presentation Map