SNOMED CT in the NHS Care Records Service

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SNOMED CT in the NHS Care Records Service

• Paul Frosdick, Head of Clinical Coding
• Ian Arrowsmith, Clinical Terminology Lead
• NHS Connecting for Health, Technology Office
• Thursday 30th March 2006

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Outline

• Strategic position and boundaries
• Roles and responsibilities of a National Release
  Centre
• Challenges
• Subsets
• Distribution
• Questions.

3
Outline

• Strategic position and boundaries
• Roles and responsibilities of a National Release
  Centre
• Challenges
• Subsets
• Distribution
• Questions.

4
Strategic position and boundaries
Anonymised and pseudonymised reporting
Demographic details
Clinical details
QMAS
Choose and Book
Personal Spine Information Service
Person Demographic Service
Secondary Uses Service
EPS
Transaction Messaging Spine
Family Practice
Child Health
Health Space
Maternity
Labs
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Strategic position and boundaries
Anonymised and pseudonymised reporting
Demographic details
Clinical details
QMAS
Choose and Book
Personal Spine Information Service
Person Demographic Service
Secondary Uses Service
EPS
Clinical payload SNOMED CT and NHS dmd
Transaction Messaging Spine
Family Practice
Child Health
Health Space
Maternity
Labs
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Strategic position and boundaries
Anonymised and pseudonymised reporting
Demographic details
Clinical details
Clinical payload SNOMED CT and NHS dmd
QMAS
Choose and Book
Personal Spine Information Service
Person Demographic Service
Secondary Uses Service
EPS
Transaction Messaging Spine
Family Practice
Child Health
Health Space
Maternity
Labs
7
Strategic position and boundaries
Anonymised and pseudonymised reporting
Demographic details
Clinical details
QMAS
Choose and Book
Personal Spine Information Service
Person Demographic Service
Secondary Uses Service
EPS
Transaction Messaging Spine
Clinical payload SNOMED CT and NHS dmd
Family Practice
Child Health
Health Space
Maternity
Labs
8
Strategic position and boundaries
Anonymised and pseudonymised reporting
Demographic details
Clinical details
QMAS
Choose and Book
Personal Spine Information Service
Person Demographic Service
Secondary Uses Service
EPS
Transaction Messaging Spine
Family Practice
Child Health
Health Space
Maternity
Labs
9
Outline

• Strategic position and boundaries
• Roles and responsibilities of a National Release
  Centre
• Challenges
• Subsets
• Distribution
• Questions.

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Roles and responsibilities of a NRC
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Role of a NRC
Suppliers Embed/use codes within systems
design and interface messages

• National Release Centre
• Governance,
• Creation,
• Maintenance,
• Distribution
• Guidance

Systems deployed
Users feedback to suppliers any problems
Suppliers verify if problem is with their
systems or codes need changing?
Where coding systems require to be updated
Via LSP/NPfIT helpdesks
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Role of a NRC
Suppliers Embed/use codes within systems
design and interface messages

• National Admin codes (NACS)
• ICD/OPCS
• Read
• NHS Data Dictionary
• Spine Directory Service (SDS)
• dmd
• SNOMED CT

• National Release Centre
• Governance,
• Creation,
• Maintenance,
• Distribution
• Guidance

Systems deployed
Users feedback to suppliers any problems
Suppliers verify if problem is with their
systems or codes need changing?
Where coding systems require to be updated
Via LSP/NPfIT helpdesks
13
Outline

• Strategic position and boundaries
• Roles and responsibilities of a National Release
  Centre
• Challenges
• Subsets
• Distribution
• Questions.

14
Challenges boundaries

• National Release Centre
• Governance,
• Creation,
• Maintenance,
• Distribution
• Guidance

• There are lots of them!
• NRC cannot do everything
• NRC can identify what needs to be done
• Expertise required across boundaries.

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Challenges boundaries

• National Release Centre
• Governance,
• Creation,
• Maintenance,
• Distribution
• Guidance

Masters
Project Leads
Local Leads
Practicing Clinicians
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Challenges subset management

• National Release Centre
• Governance,
• Creation,
• Maintenance,
• Distribution
• Guidance

• There are lots of them!
• NRC cannot do everything
• NRC can identify what needs to be done
• Expertise required across boundaries.

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Challenges subset management

• National Release Centre
• Governance,
• Creation,
• Maintenance,
• Distribution
• Guidance

A subset is for life, not just for Christmas
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Challenges data quality

• National Release Centre
• Governance,
• Creation,
• Maintenance,
• Distribution
• Guidance

• Particularly relevant to the guidance boundary..

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Challenges data quality

• National Release Centre
• Governance,
• Creation,
• Maintenance,
• Distribution
• Guidance

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Challenges data quality

• National Release Centre
• Governance,
• Creation,
• Maintenance,
• Distribution
• Guidance

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Challenges data product choice

• National Release Centre
• Governance,
• Creation,
• Maintenance,
• Distribution
• Guidance

• National Admin codes (NACS)
• ICD/OPCS
• Read
• NHS Data Dictionary
• Spine Directory Service (SDS)
• dmd
• SNOMED CT

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Outline

• Strategic position and boundaries
• Roles and responsibilities of a National Release
  Centre
• Challenges
• Subsets
• Distribution
• Questions.

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Subsets - Approach

• Central supervision/overview
• Delegation/devolution of responsibility
• Dissemination of best practice
• Non-duplication of effort
• Provision of appropriate
• Tools
• Processes
• Resources
• Training

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Permissions/rights

• National administrator responsible for setting up
  users with their appropriate permissions at the
  National level for the following roles
• (other/replacement) National Administrators,
• National Subset Editors,
• National Subset reviewers,
• Cluster administrators
• Cluster Administrator responsible for setting up
  users with their appropriate permissions in the
  Cluster for the following roles
• Replacement Cluster Administrators,
• Cluster Subset Editors,
• Cluster Subset reviewer
• Cluster subset editors
• should have minimal administrative rights and the
  facility to assign reviewers/further editors to
  their own particular subset(s) TBC (including
  extra-cluster)

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On-going management

• Must be in line with release cycle
• Local subsets
• Managed locally
• National informal subsets
• Managed by owner/creator or representative body
• National formal subsets
• Formal management to address nature and dynamism
• Formal processes and structures
• Appropriate stakeholders
• ISB approval

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Technical provision

• Ref set mechanism
• Component history
• Other component types inc expressions
• Tools
• SNOMED CT subset editor
• Carecom subset editing environment
• Health Language Inc
• QA rules
• Distribution
• Cluster namespace identifier allocated by NHS CfH

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Namespaces

• Sub-allocated by NHS CfH
• Unit of allocation for live use cluster
• Only to be used for subsets, additional
  descriptions and navigational concepts
• Cluster responsible officer

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Outline

• Strategic position and boundaries
• Roles and responsibilities of a National Release
  Centre
• Challenges
• Subsets
• Distribution
• Questions.

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Terminology Reference data Update Distribution -
TRUD

• Electronic distribution
• Improved security
• Defined relative responsibilities
• Agreed service levels
• Acknowledged delivery
• Facility for out of cycle/ad hoc releases
• Exception handling

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Distribution end points

• Company / organisation with a registered and
  approved requirement to receive reference data
  supplied by the TRUD service, and to distribute
  that data on to their end points
• Currently
• LSPs/NASP
• Third party suppliers
• Future
• Community pharmacy suppliers ?
• Existing system suppliers ?

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Operations

• Subscriber Registration
• Subscriber Notification of Terminology Reference
  Data Available for Download
• TRUD Service Notification and Initial Validation
• Subscriber Login
• Subscriber Download
• Subscriber Logout
• Subscriber Processes Reference Data
• TRUD Service Go Live Notification

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Release sub-packs

• Currently
• SNOMED CT UK Sub-pack
• dmd Sub-pack
• Read Code Sub-pack
• LE Backup Sub-pack
• LE RTS Cache Sub-pack
• CLUE Browser Data Sub-pack
• Future
• Organisation codes
• FDBE drug decision support rules
• Medic to Medic Map of Medicine

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Thank you

• For further information contact
• Datastandards_at_cfh.nhs.uk
• Or visit
• http//www.connectingforhealth.nhs.uk/technical/st
  andards/snomed

www.connectingforhealth.nhs.uk/technical/standards
datastandards_at_cfh.nhs.uk