Introduction to SNOMED CT Why SNOMED CT Features

Introduction to SNOMED CT Why SNOMED CT? Features, Examples of Use & Benefits Monday 16 th November, 10. 30 – 11. 30 Presented by Jo Oakes (Jo. Oakes@hscic. gov. uk) 1

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.

Interoperable With an agreed structure data can be passed from one system to another Patient visits GP y ar m um GP s o e rg ed t a h n sc tur i D re re GP fer m ra ak l to es Tr us t To achieve this we need to use structured records and a structured terminology SNOMED CT Discharge Summary (may contain SNOMED CT) Using Choose & Book to make the referral l is a r er g f e n r r usi T o f n ded D C o as cor ME e R re NO S Di ag rec nosi s SN orde of p OM d u ati ED sin ent CT g Clinician treats Patient

SNOMED CT • The chosen terminology for the NHS England GP’s Laboratories Community SNOMED CT A&E Acute Mental Health 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 Terminologies are designed to be used by clinically relevant data related to Terminologies clinicians in their recording of data in a patient individuals and their care. Provides a standard vocabulary of clinical terms. record. Classifications are intended for population statistics and analysis. Maps between SNOMED CT and the classifications are provided as part of • categorise episodes of care into the national products to support classification populations or groups of patients according to specific business rules Classifications coding. and support epidemiology, payment, population monitoring

Any Questions Please 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 Clinical Findings Causes of Disease Procedures • • Disease and deformity – scar Symptoms – difficulty breathing Social – finding of walking aid use Examination findings – tachycardia • Forces – pressure change • Events – road traffic accident • Organisms – herpes simplex virus • • Laboratory Therapy Clinical Investigation Surgical procedure

SNOMED CT Content Anatomy Observations Products • Normal – knee joint • Abnormal – ganglion cyst • Lesions – bony callus • Vital signs – blood pressure • Body product observable – colour of urine • Values - present • Drugs – paracetamol • Substances – latex • Devices – bedpan

Sitting Blood pressure Lung von Recklinghausen's bone disease Clinical ‘ideas’ are Concepts in the terminology inflammation mild moderate finger ischaemic infection severe acute angina toe bacterial cough exertional viral phlegm

A Concept Codes and descriptions Relationships Is a Attributes Qualifiers & values

A Concept in SNOMED CT Preferred Term: Heart Disease Synonym: Cardiopathy Synonym: Disorder of Heart Synonym: Morbus Cordis Synonym: Cardiac Disorder Synonym: Cardiac Diseases Synonym: Heart Diseases Heart disease (disorder) 56265001 Relationships Is a cardiac finding Is a disorder of mediastinum Is a disorder of cardiovascular system Finding site heart structure Severity Episodicity Courses

Disease Infectious disease Disorder by body site Infection by site Disorder of trunk Disorder of thorax Bacterial infectious disease Respiratory tract infection Bacterial infection by site Disorder of lung Lower respiratory tract infection Lung consolidation Pneumonia Bacterial respiratory infection Infectious disease of lung Infective pneumonia Bacterial lower respiratory infection Bacterial pneumonia

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 Questions Please 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 Action Click 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

Communication – “Connect all” Seamless transfer - coded information to be electronically communicated - without mapping Translated into different languages: Spanish, French, Swedish, Danish. . . Work starting in Lithuanian, Polish

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

Learn more about SNOMED CT Visit: Training and Resources on UKTC website e. Learning future webinars SNOMED CT NHS network Documentation Case studies

Any Questions Please put yourself on mute when not talking. Many Thanks