Introduction to SNOMED CT

Why SNOMED CT? Features, Examples of Use & BenefitsMonday 16th November, 10.30 – 11.30

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Presented byJo Oakes (Jo.Oakes@hscic.gov.uk)

WHY SNOMED CT?

Electronic Patient Records

Quality Healthcare requires effective communications

Effective communications need a common language and a common structure for humans AND for computers

SNOMED CT allows clinical data to be recorded in a human recognisable and a computer recognisable way

Why SNOMED CT?

• SNOMED CT has been selected and approved as the terminology to be adopted by the NHS in England. It is the most comprehensive international terminology currently available and can be used across all care settings and all clinical domains.

Discharge Summary(may contain SNOMED CT)

Interoperable

SNOMED CT

Patient visits GP

Using Choose & Bookto make the referral

Clinician treats

Patient

Discharge summary

returned to GPGP makes

referral to Trust

Reason for referra

l is

recorded using

SNOMED CT

Diagnosis of patient

recorded using

SNOMED CT

With an agreed structure data can be passed

from one system to another

To achieve this we need to use

structured records and a

structured terminology

SNOMED CT

• The chosen terminology for the NHS England

SNOMED CT

GP’s

Community

Acute

Mental Health

A&E

Laboratories

Use of Synonyms helps cater for different expressions with the same meaning

‘Coding’ in the NHS

• Clinical phrases that are recorded in a patient record (EPR) and capture clinically relevant data related to individuals and their care. Provides a standard vocabulary of clinical terms.

Terminologies

• categorise episodes of care into populations or groups of patients according to specific business rules and support epidemiology, payment, population monitoring

Classifications

Terminologies are designed to be used by clinicians in their recording of data in a patient

record. Classifications are intended for population statistics and analysis.  Maps between SNOMED CT and the classifications are provided as part of

the national products to support classification coding.

Any QuestionsPlease put yourself on mute when not talking. Many Thanks

SNOMED CT

SNOMED CT – What is it?

• SNOMED CT is a clinical terminology

Systematized Nomenclature of Medicine (Clinical Terms)

SNOMED CT – What is it?

• SNOMED CT is a clinical terminology

Systematized Nomenclature of Medicine (Clinical Terms)

• Collection of names and words

SNOMED CT – What is it?

• SNOMED CT is a clinical terminology

Systematized Nomenclature of Medicine (Clinical Terms)

• Collection of names and words• Relevant to the field of medicine

SNOMED CT – What is it?

• SNOMED CT is a clinical terminology

Systematized Nomenclature of Medicine (Clinical Terms)

• Collection of names and words• Relevant to the field of medicine• Organised in a structured and logically consistent

manner

SNOMED CT – What is it?

• SNOMED CT is a clinical terminology

Systematized Nomenclature of Medicine (Clinical Terms)

• Collection of names and words• Relevant to the field of medicine• Organised in a structured and logically consistent

manner

More ‘like’ a thesaurus than just a coding scheme

SNOMED CT Content

• Disease and deformity – scar• Symptoms – difficulty breathing• Social – finding of walking aid use• Examination findings – tachycardia

Clinical Findings

• Forces – pressure change• Events – road traffic accident• Organisms – herpes simplex virus

Causes of Disease

• Laboratory• Therapy• Clinical Investigation• Surgical procedure

Procedures

SNOMED CT Content

• Normal – knee joint• Abnormal – ganglion cyst• Lesions – bony callus

Anatomy

• Vital signs – blood pressure• Body product observable – colour of urine• Values - present

Observations

• Drugs – paracetamol • Substances – latex • Devices – bedpan

Products

Clinical ‘ideas’ are Concepts in the terminology

mild

moderate

severeacute

Blood pressure

exertionalangina

ischaemic

cough bacterial

viral

finger

toe

phlegm

infection

inflammation

Lung

Sitting Blood pressure

von Recklinghausen's bone disease

Codes and descriptions

Relationships

Is a Attributes Qualifiers & values

A Concept

Heart disease (disorder) 56265001

Relationships

Is a cardiac finding

Is a disorder of mediastinum

Is a disorder of cardiovascular

system

Finding site heart

structure

SeverityEpisodicityCourses

Preferred Term: Heart DiseaseSynonym: CardiopathySynonym: Disorder of HeartSynonym: Morbus CordisSynonym: Cardiac DisorderSynonym: Cardiac DiseasesSynonym: Heart Diseases

A Concept in SNOMED CT

Bacterial pneumonia

Infective pneumonia Bacterial lower respiratory infection

Pneumonia Infectious disease of lung

Disease

Lower respiratory tract infection

Lung consolidation

Disorder of lung

Disorder of thorax

Disorder of trunk

Disorder by body site

Respiratory tract infection

Infection by site

Infectious disease

Bacterial respiratory infection

Bacterial infection by site

Bacterial infectious disease

Subsets

What is a SUBSET?• SNOMED CT is extensive – it is supporting a

common vocabulary for all healthcare specialisms, and all healthcare professionals, as well as keeping up to date with current practice

• A subset is ‘smaller set of SNOMED CT ‘ that meets a particular requirement

• A SNOMED CT subset can be a group of concepts, descriptions or relationships chosen for relevance under certain conditions or in certain contexts

Subsets

Why SUBSETS?• It is often desirable to constrain the SNOMED

CT concepts available to a subset, say to help faster data entry – so for example, all possible performed procedures in a radiology department or a theatre department

Subsets

HOW APPLICATIONS USE SUBSETS

• Supports easier navigation• Can be used to limit to specific SNOMED CT

codes• Can act like a ‘favourites’ for the end user• Can be used nationally or locally –

synchronised national releases• Access to subsets may be role based

Current Subsets Examples

Allergens Diagnosis

Laterality Radiology procedures

Browser Demo

• Examples of concepts in a browser

Any QuestionsPlease put yourself on mute when not talking. Many Thanks

EXAMPLES OF USE

Success with SNOMED CT

Things are normally in the singular, e.g. eye not eyes

When searching don’t always use full words, e.g. diab would return both diabetic and diabetes

Don’t enter words like “and”, “to” and “the”

Success with SNOMED CT

Use techniques similar to how you currently search the internet and medical publications

Search for significant words and don’t worry about the order, e.g. implant lumbar cath would return implantation of lumbar epidural catheter

Try common abbreviations, e.g. PID for prolapsed intervertebral disc

What’s Recorded?

Examples of patient information that are currently recorded using SNOMED CT include:• Diagnoses – e.g. Crohn’s Disease• Procedures – e.g. colonoscopy with biopsy• Allergies – e.g. metronidazole• Symptoms – e.g. abdominal pain• Drugs – e.g. prednisolone

What the Clinician Sees

Crohn’s Disease

34000006

Decision to Admit

If it is decided to admit a patient in A&E, a structured form is completed with details of the speciality referred to and treatment required. When these are recorded in SNOMED CT they can be sent electronically to the GP so they are kept informed of key information about their patients.

Allergies/ADRs

The recording of Allergies and Adverse Reactions can be critical for the effective care of a patient. Ensuring these are clearly recorded for use by other clinicians is an ideal use of SNOMED CT.

Discharge Summary

Once the intervention has been completed a discharge summary is returned to the GP and may contain SNOMED CT terms that could be taken straight into the GP system

SNOMED CT in Action

• The following sections contain screen shots from applications that use SNOMED CT

• We are grateful for their kind permission to use these as without them it is sometimes difficult to envisage what SNOMED CT looks like in use

MOORFIELDS EYE HOSPITAL – OPEN EYES SOFTWARE

SNOMED CT in ActionClick on the drop down list to see a list of common diagnoses which are all SNOMED CT terms

SNOMED CT in Action

Diagnosis can be selected from a list of common diagnoses which are all SNOMED CT terms

SNOMED CT in Action

Alternatively type in what you are looking for and a list of SNOMED CT terms containing the text will appear

SNOMED CT in Action

The same can be done for procedures, select from a list of commonly used procedures which are all SNOMED CT terms

SNOMED CT in Action

You can also type in the procedure you are looking for and the list that appears will all be SNOMED CT terms

NHS E-REFERRAL SERVICE

Making an Appointment

• GPs can use e-Referral to make appointments for their patients who can then make their decision based on choices such as ease of travel or nearest location

SNOMED CT in Action

The Clinical Term is selected from a list of SNOMED CT terms

SNOMED CT in Action

Type in the term to be searched for

SNOMED CT in Action

A list of terms appears

SNOMED CT in Action

The selected term is shown below with its parents and children

SNOMED CT in Action

Select the required term

SNOMED CT in Action

The selected term then appears in the Clinical Term box

CSC LORENZO

Type in what you are looking for and then click on the search button

Select the required term

Select certainty from the drop down list

Find the term you require

Select severity from the drop down list

Select severity from the drop down list

The body site then needs to be selected

Type in the body site and click to search for it

Select body site from the list displayed

Select laterality from the drop down list

Select laterality from the drop down list

Click on add to add the body site

Click on Finish to complete save

Start to type the procedure you are looking for

Click on the search button to display the procedures

Click to use the advanced search

Children of the term are displayed allowing you to select a more detailed term

Select the term to display even more detailed terms

Further terms are displayed

Select the required term

Click on Finish to add it to the record

The other fields can be completed in the same way as for diagnosis

Click on Finish to complete save

SNOMED CT in Applications

• SNOMED CT has been implemented in many applications and as has been shown in the previous slides should not make things complicated

• Clinicians should just see terms they are familiar with using and not even realise they are SNOMED CT terms

BENEFITS OF SNOMED CT

Across Professions

Across different specialisms: orthopaedics, cardiology, renal, microbiology, histopathology ...

Across primary, secondary, community, social care, mental health

Synonyms – same concept said in different ways to support cross discipline working

Seamless transfer - coded information to be electronically communicated - without mapping

Translated into different languages: Spanish, French, Swedish, Danish ... Work starting in Lithuanian, Polish

Communication – “Connect all”

International

Suppliers in different countries using the same terminology

Potential for improved functionality of systems as supporting just one terminology

Collaborative effort: more cost effective

Links with other international standards – eg. World Health Organisation

How can I look at SNOMED CT?

• There are various free to use browsers available on the market. Details of those that support the UK Edition of SNOMED CT can be found in the UKTC:

• http://www.hscic.gov.uk

eLearning

future webinars

SNOMED CT NHS network

Documentation

Case studies

Learn more about SNOMED CT Visit: Training and Resources on UKTC website

Any QuestionsPlease put yourself on mute when not talking. Many Thanks