SNOMED CT: The global perspective

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SNOMED CT The global perspective

• Professor Martin Severs on behalf of NHS
  Connecting for Health and College of American
  Pathologists

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Presentation

• What is SNOMED CT?
• What is SNOMED the standard?
• What is the SNOMED Standards Development
  Organisation SDO?
• Why do it?
• What is the current position?

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What is SNOMED CT?

• Scope of SNOMED CT UK Release Core plus UK
  local extension
• Size
• 414,808 health care concepts
• 1,084,972 descriptions
• 1,465,255 semantic relationships
• English, German and Spanish language editions
• Cross mappings (ICD-10, OPCS 4.2)
• UK Extensions (UK Admin, UK Drugs)

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SNOMED CT Principles

• Purpose
• Support clinical care of patients internationally
• Integrity
• Ensure clinical and technical integrity
• Funding
• Stable and secure governance structure

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What is SNOMED the standard?

• Documents describing the SNOMED CT standards and
  specifications
• The terminology database consisting of
• Concepts, Descriptions, Relationships
• Technical tools to support development and
  request processing

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What is SNOMED the standard?

• SNOMED allied standards
• Enabling SNOMED CT to effectively interoperate
  with other international information standards
• Implementation standards for the successful use
  of SNOMED CT, including
• Translations
• Reference implementation instructions

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The SNOMED SDO What is this about?

• An international effort to produce and enhance a
  global clinical terminology standard
• An organisation that owns supports that effort
• A set of products and services produced by that
  organisation
• Set of principles that guide decision making

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The SNOMED SDO What is this about?

• FROM
• Proprietary CAP owned
• Single enterprise
• USA placed
• License based
• Not for profit
• Business Model

• TO
• Publicly owned
• Globally and locally responsive
• Swiss placed
• Fair share subscription based
• Not for profit
• Business Model

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SNOMED Enterprise Old and New
National Centre
National Centre
National Centre
SNOMED SDO
National Centre
Current SNOMED Enterprise
National Centre
National Centre
National Centre
Open Market Activity
National Centre
National Centre
National Centre
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New SNOMED Enterprise Model
National SNOMED Centre
SNOMED SDO
National SNOMED Centre
National SNOMED Centre
Local/National Health Entities
National SNOMED Centre
Shared technology environment enables
collaboration
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SNOMED Enterprise Components

• SNOMED SDO Core
• Content necessary for international conformance
  and interoperability
• Standards and policies required to maintain the
  principles of the SSDO

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SNOMED Enterprise Components

• National Extensions
• National conformance and interoperability
• Maintain the SSDO principles
• Open Market Works
• Extend the Core and national extensions
• Subject to SSDO standards and policies

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Global Membership,Global Outlook
Representation Based on Four Global Regions
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Global Membership

• Open Membership
• All potential members are welcome
• Accessible Membership
• Minimize barriers to membership
• Involved Membership
• All members must have a voice in governance

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SNOMED SDO Structure
Harmonisation Boards
Vendor Forum
Management Board
Finance Operations Committee
Research Innovation Committee
Technical Committee
Content Committee
Support Organisation
Research Teams
Task Finish Groups
Working Groups
Working Groups
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Why a Clinical Terminology?

• Terminology use benefits the entire healthcare
  system
• Save as much as 5 of total healthcare costs
• Up to 84 Billion per year in US

Costs
Source - Walker J et al., Market Watch
200519th January10-18
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Why the SNOMED Terminology?

• Validated Product
• Leading Global Terminology
• Ready for Local Implementation
• 84 million already invested in SNOMED CT

SNOMED CT should become the Global Clinical
Terminology
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Why Adopt SNOMED CT?

• High cost and delays to develop alternatives
• Estimated cost to create an alternative
• 21 to 46 million to develop a terminology
• 7 to 8 million per year to maintain and support
• End-user costs increase as software vendors must
  support two competing terminology standards
• Development would take up to five years, delaying
  national EHR adoption

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Why Adopt SNOMED CT?

• Avoid the costs of delaying data migration
• Safe data migration will cost
• Data Conversion 375 per citizen
• Clinician Re-Training 24 per citizen
• Total cost for the UK 24,000 million

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Why Adopt SNOMED CT?

• Avoid the huge harm by avoiding data migration
• With Data Migration
• Injuries 832 / 100,000 citizens
• Deaths 20 / 100,000 citizens
• For UK Injuries 490,000 (3 of beds)
• Deaths 12,089?

? Source British Medical Journal, Jul 2004 329
15 19 (prescribing harm only)
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Why Join the SNOMED SDO?

• Costs are minimal compared to the millions to
  implement an Electronic Patient Record system
• Fees are affordable and costs are shared among
  members according to their ability to pay
• Fees will reduce as additional members join
• HIT investment risks are significantly reduced
• Protect your Healthcare IT investment now

Commercial Benefits
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Comparing Health Economiesand Estimated Fees

• Nation Health Econ. Health IT SSDO Fees
• UK 118Bn 4.7Bn 0.76m
• US 1,426Bn 40Bn 4.6m

SSDO fees will be 0.012 to 0.017 of Health IT
UK NHS budget 4 is NHS target spend
source Wanless Report Annals of Health Care
(US)
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Current Position

• Potential Charter Membership of 8 countries with
  another 3 making decisions in June 2006
• Ongoing discussions between this group and CAP
• Ongoing discussions within Europe with next
  meeting in May 2006
• Major discussion at WHO Executive in May 2006
• Determination to set up the SDO asap!

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In conclusion.

• SNOMED CT (in the NHS) will facilitate the
  sharing of electronic patient records to provide
  clinical support across all care settings
• SNOMED CT is part of the EHR solution, not part
  of the problem..................... not the
  solution

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SNOMED SDO Benefits Summary

• Create the global clinical terminology required
  for EHR implementation
• Reduce risk by joining committed partners
• Avoid the costs of terminology delay billions
  of dollars and thousands of lives
• Participate in democratic governance
• Share reducing costs on a fair share basis