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SNOMED CT Implementation Approaches

National Resource Centre for EHR Standards (NRCeS)

C-DAC, Pune

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• SNOMED CT is a powerful modern clinical terminology⁻ Comprehensive scope and support for detailed information

⁻ A code system providing standard representation of clinical meanings

⁻ A global reference terminology with multilingual term support

⁻ A polyhierarchy with ontological features that enable inference

• SNOMED CT is designed for use in electronic health records⁻ On its own SNOMED CT does nothing!

• SNOMED CT is a component that delivers value when implemented as partof an electronic health record

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SNOMED CT with no Health Record



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• Making health records electronic

⁻ A significant step forward

⁻ Improves communication

⁻ Increases availability of relevant information

… but it is only a partial solution; the real challenge is …

• Making health records meaningful

⁻ Identifying significant facts in oceans of data

⁻ Enabling effective meaning-based retrieval

⁻ Linking the EHR to authoritative clinical knowledge

• SNOMED CT represents clinical information meaningfully as part of a well-designed EHR

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Health Records with no SNOMED CT



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• STRATEGIC BENEFITS– Staying Competitive and Relevant to the Market

– Selling into International Markets

– Meeting Clinician Expectations

– Supporting Standards

– Retaining Existing Customers

• PRACTICAL BENEFITS– Common Terminology

– Ease of Adoption

– Enhanced User Interfaces

– Enhanced Analytics

– Using Clinical Data to Meet External ReportingRequirements

– Integration of Third Party Products

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Benefits to Vendors: why implement SNOMED CT



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• SNOMED CT can be integrated as:

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Integration Approaches



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EHR System Design

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• Benefits

⁻ Patient data may be integrated froma variety of structured andunstructured sources, includinghospital health record systems andmobile devices

⁻ Patient data coded in a consistentway can be used for analytics,querying, decision support ordisplaying to the user

⁻ Correlations between data fromdisparate sources can be made usingSNOMED CT’s defining relationships

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A Reference Terminology for Data Integration



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• Benefits

⁻ Supports research and analysis in a localsystem or shared data warehouse

⁻ Supports use of SNOMED CT for analysisand reporting

⁻ For identification of cohorts of patientsfor research studies

⁻ For exploration of data in support ofclinical process review

⁻ To improve the user experience oflongitudinal record review

⁻ Zero or minimal disruption to run-timeprocesses

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An Indexing System for Data Retrieval



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• Benefits

• No change to terms that clinicians areused to seeing in the user interface

• Patient data stored using SNOMED CTconcepts

• Communication using shared meaning

• Can utilize internationally developedmappings such as the mappings to ICD-9and ICD-10

• SNOMED CT is available for direct use inelectronic communications

• Standardized integration with decisionsupport rules

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A Code System for Clinical Data in the EHR



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• Benefits

• Standardized descriptions in the userinterface

• No mapping required between interfaceterms and codes stored in patient record

• Supports enhanced techniques for dataentry, search and display e.g. searchingover synonyms of the same concept

• Patient data stored using SNOMED CTconcepts

• Readily available master reference datae.g. allergen list

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An Interface Terminology For EHR Data Entry



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• Benefits

• Supports the use of SNOMED CT for analysis andreporting purposes, such as:

• To improve the user experience

• For exploration of data in support of clinical processreview

• For identification of patients for research studies

• Can utilize internationally developed mappingssuch as the mappings to ICD-9 and ICD-10

• Standardized descriptions in the user interface

• Patient data stored using SNOMED CT concepts

• Communication using shared meaning

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For Simple Aggregation And Analysis of Data



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• Benefits

• This system combines all thebenefits identified for the precedingapproaches.

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Full Use of SNOMED CT



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• Include SNOMED CT data for Storing clinical records

• Mapping from existing data entry templates or message templates to aSNOMED CT equivalent

• Introduction of SNOMED CT into the suite of data entry tools

• Propagating SNOMED CT changes as part of scheduled productmaintenance

• Introducing SNOMED CT into the payload of electronic messages

• Migrating clinical records between systems

• Replicating existing reports or other outputs but with SNOMED CT

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Enhancing EHR Design with SNOMED CT



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DATA ENTRY USING SNOMED CT

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Constrain searches by Concept and Description status



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Constrain searches by super type ancestors (e.g. Disease)



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Constrain search to avoid multiple hits on the same concept



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Order shortest matching terms first



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Order preferred term matches before synonyms



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Distinguish identical terms of different concepts



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• World Health Organization classifications: ICD-10

– Develop and assure maps and links between SNOMED CT and WHO Classificationslike SNOMED CT to ICD-9-CM and SNOMED CT to ICD-10 maps

• LOINC (Logical Observation Identifiers Names and Codes)

– One result of this will be alignment of the attributes of laboratory tests. This willenable LOINC and SNOMED CT to be used together in a consistent andinteroperable manner.

• Clinical Information Modelling Initiative (CIMI)

• HL7 message standards, CDA and FHIR

– Enabling effective use of SNOMED CT in HL7 message

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Using SNOMED CT with other standards



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• Careful planning and understanding key objectives

• Ease and effectiveness of data entry and display

• Consistent representation of stored clinical information

• Methods and approach to effective communication

• Optimisation of retrieval, analysis and reuse

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Key to Successful Integration of SNOMED CT



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• Annaswamy Mudaliar General Hospital,Bangalore (HealthStore HIS developed by CSoftTechnologies Pvt. Ltd.)

• eHealth Kerala Project (JK Technologies)

• Death Note Form, AIIMS New Delhi (AIIMS)

• Hyderabad, Telangana (Generation 5 eSushrut)

– District Hospital, Kingkoti

– Area Hospital, Malakpet

– Gandhi Hospital, Secunderabad

– NIMS Panjagutta

• HealthQik

• eHospital (NIC Tripura) – in-progress

• Manorama Infosolution Pvt. Ltd. – in-progress

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SNOMED in Action

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Sept-Dec 2014 Jan-Dec 2015 Jan-Dec 2016 Jan-Dec 2017 Jan-Dec 2018 Jan-April 2019

SNOMED CT Implementation Status

IN-PLANNING IN-PROGRESS IMPLEMENTED



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• Vendor Introduction to SNOMED CT

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References

https://confluence.ihtsdotools.org/display/DOCVENDOR?preview=/33491725/33491726/doc_VendorIntroduction_Current-en-US_INT_20161011.pdf



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Thank [email protected]

Documents

Click to edit Master title style CT... · EHR System Design 6. Click to edit Master title style •Click to edit Master text styles ... clinical process review ⁻ To improve the