Whats in IT for me Why SNOMED CT is good for you

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Whats in IT for me?Why SNOMED CT is good for
you

• Dr Richard Gain
• Subset Development Project Manager
• SNOMED in Structured electronic Records Programme
• NHS Connecting for Health

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What is SNOMED CT?
A conceptual classification
A controlled clinical vocabulary
SNOMED CT is a terminological resource that can
be implemented in software applications to
represent clinically relevant information
reliably and reproducibly.
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Terminology vs. Coding scheme?

• Coding schemes categorise concepts usually
  relating to populations or groups of patients
• ICD-10
• OPCS-4
• Terminologies describe concepts related to
  individuals
• Read
• SNOMED

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So whats the problem?

• Coding done manually
• ICD and OPCS not designed for clinical noting
• Data collected to different standards
• Hospital systems not compatible
• with each other
• with Primary Care systems
• No sharing of information possible

5
Why not just use ICD10 or OPCS4?

• Language not rich enough to describe clinical
  activities such as patient assessment or delivery
  of care
• No facility to combine expressions to clarify
  meaning
• emergency thoracotomy
• recurrent IGTN left great toenail
• Updates too slow to respond to rapidly evolving
  areas of clinical practice

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Dynamic, not static

• Changing classifications is a slow and arduous
  process
• ICD9 1977
• ICD10 1992
• SNOMED CT is a dynamic terminology
• Able to respond quickly to
• Changes in the wider field of medicine
• Changes in local policy
• Individual requests for additions

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Whats wrong with free text?

• Free text can be an extremely valuable way of
  recording details about individual circumstances,
  but
• The exact meaning may be ambiguous
• It can be misinterpreted
• It cant automatically be analysed for audit or
  payment
• It cant direct care pathways
• It cant trigger automatic warnings about
  allergic reactions or interactions
• In other words, its not the best way of sharing
  information.

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Sharing information

• Different systems
• Different locations
• Different users
• One common purpose
• A single Electronic Patient Record
• Exchanging information requires
• INTEROPERABILITY

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How is the information used?
Direct care
Indirect Care
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Who benefits from electronic records?

• Clinicians
• Patients
• Carers
• Clinical coders
• Administrative staff
• Researchers
• Health service analysts

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Clinicians

• Improved continuity of care
• Improved safety and productivity
• Improved seamless working between public/private
  and primary/secondary care providers
• Improved quality in clinical audit, research and
  secondary use services

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Patients

• Improved safety
• Improved patient experience
• Improved confidence in care provided
• Improved access to care information

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Secondary users

• Improved coding accuracy
• Improved information for planning
• Improved public health research
• Change of role for coders?

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Will it understand what I mean?

• Clear descriptions of concepts
• Unambiguous terms
• Preservation of meaning after communication
• Multi-lingual
• (passes the English gt Spanish gt English test)

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Clarity

• Fully Specified Name (FSN)
• Each concept has one unique FSN intended to
  provide an unambiguous way to name a concept. It
  is not necessarily the most commonly used phrase
• Preferred Term
• Each concept has one Preferred Term to capture
  the common word or phrase used by clinicians to
  name that concept
• Synonyms
• These represent any additional terms that
  represent the same concept as the FSN

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One concept, many names

• Some of the descriptions associated with
  ConceptID 22298006
• Fully Specified Name Myocardial infarction
  (disorder)DescriptionID 751689013
• Preferred term Myocardial infarctionDescriptio
  nID 37436014
• Synonym Cardiac infarctionDescriptionID
  37442013
• Synonym Heart attackDescriptionID 37443015
• Synonym Infarction of heartDescriptionID
  37441018

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Avoiding ambiguity

• To a neurologist
• Cord compression
• means Spinal cord compression
• To a midwife
• Cord compression
• means Umbilical cord compression
• Transmission and sharing of information requires
  consistency of terminology

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Will the computer limit what I can say?

• More concepts
• 400,000 health care concepts
• More descriptions
• 1,000,000 clinical terms
• More information
• 1,500,000 semantic relationships
• Contextual modification of expressions
• possible, FH of, planned, refused, aborted etc.
  etc.

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Depth of clinical expression

• peripheral angiography
• special peripheral angiography procedures
• peripheral graft arteriogram
• femoral-femoral crossover arteriogram

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How is it organised?

• Multiple top level concepts
• E.g. Body structure
• Each with a hierarchy of concepts beneath
• Strictly organised by IS A relationships
• Index finger is a kind of Finger
• Finger is a kind of Hand part etc

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How is it constructed?

• Defining and qualifying characteristics are used
  to construct and refine a terminological model of
  medicine
• Concepts combined with Attribute-Value pairs
• Procedure with
• method excision
• site tonsillar structure
• Tonsillectomy

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How is it constructed?

• Defining and qualifying characteristics are used
  to construct and refine a terminological model of
  medicine
• Concepts combined with Attribute-Value pairs
• Procedure with
• method excision
• site both tonsils
• using laser device
• Bilateral laser tonsillectomy
• which is a kind of Tonsillectomy
• Allows computers to process medical information

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What are subsets?

• A group of things chosen for their relevance to a
  specific group of people
• Break terminology into relevant blocks
• Can be used nationally or locally synchronised
  national releases
• Do not prevent the use of the rest of SNOMED
  codes
• Searching in a subset makes it easier to find
  what youre looking for by filtering out
  irrelevant terms.

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How will it be delivered?

• Some general principles apply
• Data entry field in the record provides context
• finding diagnosis procedure
• Search for best term subsets can help here
• Add qualifiers or free text
• In well-constrained, frequently used areas
• templates / data entry forms are faster

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What are the unexpected benefits?

• Much less duplication of entry of information
• Much less time spent looking for relevant
  information
• Safety enhancement through decision support
• Enhanced mobility of data between clinicians and
  units
• More detailed performance monitoring
• Reduction in misunderstanding and possible
  litigation
• Consistent internationally recognisable research
  strings

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The long term vision

• SNOMED CT becomes the clinical coding standard
• Systems embrace the full potential of the
  standard
• (subsets, post-coordination)
• Increase in the quantity of data that is coded
• Adoption of a Common User Interface

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Are we winning?

• We will know we have succeeded when clinical
  terminologies in software are used and
  re-used,and when multiple independently
  developed medical records, decision support, and
  clinical information retrieval systems sharing
  the same information using the same terminology
  are in routine use.
• Alan Rector 2000
• Clinical Terminology Why is it so hard?

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Further information

• You can contact the SNOMED in Structured
  electronic Records Programme by sending an email
  to
• sserp_at_nhs.net
• There are still some places available at the NHS
  CFH SNOMED Conference, Quality Data, Quality
  Care here in the NEC on 6th March 2007.