SNOMED CT

Denise DownsKnowledge Management & Education Lead

Data Standards, Technology Office

Department of Health Informatics Directorate

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Why a terminology?

Common vocabulary across the UK required for data communication

SNOMED CT is the NHS mandated terminology for clinical and data interoperability

Applications such as Summary Care Record, Choose and Book, ePrescribing use SCT for recording clinical data (DM&D part of SCT release)

New messaging requirements such as microbiology requests and results will use SCT

With a common terminology other ‘services’ such as NICE, NHS Evidence, Map of Medicine ... all looking to tag using SCT

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Why SNOMED CT?(SCT)

• Current coding systems not scalable, maintainable, or accurately used – and content datedo eg. 587 terms in ICD in relation to accident caused by a pedal

cycleo Only something like 3000 terms used in any one year

•V12.24 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

•V31.22 Occupant of three-wheeled motor vehicle injured in collision with pedal cycle, person on outside of vehicle, nontraffic accident, while working for income

•W65.40 Drowning and submersion while in bath-tub, street and highway, while engaged in sports activity

•X35.44 Victim of volcanic eruption, street and highway, while resting, sleeping, eating or engaging in other vital activities

•V12.24 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

•V31.22 Occupant of three-wheeled motor vehicle injured in collision with pedal cycle, person on outside of vehicle, nontraffic accident, while working for income

•W65.40 Drowning and submersion while in bath-tub, street and highway, while engaged in sports activity

•X35.44 Victim of volcanic eruption, street and highway, while resting, sleeping, eating or engaging in other vital activities

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Why SNOMED CT?(cont)

• International o 12 countries collaboratively developing and growingo Includes USA, Canada, Australia o Also non English speaking, and being translated

• Rich terminology not just list of codeso Provides for more sophisticated searching, reporting,

investigation

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Optometry and SNOMED CT

There is a large amount of content relevant to Optometry in SCT – needs verifying by Optometry domain experts

Descriptions may need enriching to support optometry – remember SCT is international, concept is unique but can have additional descriptions

May need some new concepts adding – there is a request mechanism

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SCT Submission request process

There is a request process for new concepts to be added to SCT

You need to register on the site

It is helpful for these to be well formed requests

https://www.uktcregistration.nss.cfh.nhs.uk/requests/myRequests.jsf

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Subsets

SCT contains over 500,000 terms – not all relevant to Optometry

Subsets ‘hold’ concepts within SCT that are relevant to a particular specialism – ie most regular used vocabulary – can be used within software to support pick lists etc on forms

Subsets usually developed by a group; sometimes brought together through a Royal College or Association; to provide an area domain subset used by all suppliers within that domain

Development of Subsets – ideally via ‘rules’ – as SCT is not static

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Some considerations:

Patient Identification - and how to make referrals into the NHS, checking medications of own patients if required

What is required ‘outside’ immediate practice as well as within

eg. Accepting referrals, government required statistics, care pathways (diabetes), reporting ....

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Next Steps ...Identify use cases .... what to record, why, what messages needed to

go out of system and what will be received

Undertake analysis - requirement for structured data, messages indicates record in SCT, data for re-use is prime candidate for SCT coding - and hence need for SCT usually ‘drops out’ of analysis – free text in systems usually for data not to be re-used

Agree commonality for shared data elements in data model, consult other work such as LRA

Subsets – do as collaboration and share, identify owner and need to keep subset current as new concepts added (why rules help)

Take account of existing research and work – both locally and internationally that can inform eg diabetic retinopathy