SNOMED CT-A technologist's Perspective

1
SNOMED CTA Technologists Perspective

• Gaur Sunder
• Principal Technical Officer Incharge, National
  Release Center
• VCBA, C-DAC, Pune

2
SNOMED CT Origin

• A controlled coded clinical terminology for use
  in Electronic Health Records
• Developed in the USA and the UK by
• College of American Pathologists in USA
• National Health Service in the UK
• Design based on
• Identified user requirements
• Practical experience
• Scientific principles established in peer
  reviewed publications
• First released in 2002
• All rights and administration transferred for the
  public good to IHTSDO in 2007
• Earlier Systematized Nomenclature for Medicine
  (SNOMED) Clinical Terms (CT), now simply SNOMET
  Clinical Terms

3
IHTSDO

• IHTSDO International Health Terminology
  Standards Development Organization
• Maintains and delivers SNOMED CT
• Licensed to registered Affiliates
• IHTSDO does not charge for use in Member
  countries
• Low-cost licenses for institutions in other
  countries
• Free in lowest income countries
• Fee waivers for approved research and Public
  Good uses
• An International not-for-profit standard
  development organization
• Owned by Nations as Members
• Governed by General Assembly of its Members

4
Worldwide Presence

• Currently 27 countries are Members of IHTSDO
• The clinical terminology is used in more than 50
  countries
• India became a member in April 2014
• Represented by e-Governance Division, Ministry of
  Health Family Welfare, Government of India
• Interim National Release Center (NRC) created at
  C-DAC, Pune in September 2014

5
Design Benefits of SNOMED CT

• Comprehensive clinical scope
• Reduces need to support multiple code systems
• Common framework for consistent retrieval and
  processing
• Logical definitions
• Allow clinically relevant meaning-based retrieval
• Optional post-coordination
• Combining codes to add detail and specificity
• Increases scope without combinatorial explosion
  of codes
• Updates and versioning
• Regular updates to International Release
  (six-monthly)
• Support for incremental updates
• Full historical view of all previous versions of
  SNOMED CT

6
SNOMED CT Comprehensive Scope

• It is the richest vocabulary available to
  describe clinical findings, diseases, procedures
  etc.
• Contains more than 365,000 concepts, almost 1
  million descriptions and nearly one and a half
  million relationships.
• SNOMED CT aims at transmitting all concepts that
  have been expressed throughout history in the
  healthcare domain, unambiguously
• SNOMED CT concepts are divided into 19 hierarchies

7
SNOMED CT Design

• Every coded concept is linked to related concepts
• Multi-axial subtype hierarchy (is a
  relationships)
• Logical definitions (attribute relationships)

8
SNOMED CT Basic Components

• Concepts
• A concept is a clinical idea identified by a
  unique numeric identifier (ConceptID) that never
  changes
• Concepts are represented by a unique
  human-readable Fully Specified Name (FSN)
• Descriptions
• Concept descriptions are human readable terms or
  names assigned to a SNOMED CT concept
• Descriptions are of two types
• Fully Specified Name (FSN)
• Synonym
• Descriptions can be Preferred or Acceptable
  according to the language dialect used
• Relationships
• Relationships link concepts in SNOMED CT

9
SNOMED CT Expressions

• Precoordinated Expression
• Representation of a clinical meaning using a
  single concept identifier is referred to as a
  precoordinated expression
• Postcoordinated Expression
• Representation of a clinical meaning using a
  combination of two or more concept identifiers is
  referred to as postcoordination

10
SNOMED CT Additional Components

• Subsets Reference Sets
• A SNOMED CT subset is a set of  Concepts,
  Descriptions, or Relationships from the
  international edition that is appropriate to
  deployment to support particular requirements of
  implementation
• Extensions
• The International Edition contains the core
  content of SNOMED CT.
• Extensions can be added to the International
  Edition to meet specific national or local needs
• Cross Maps
• Mapping of concepts to other international
  standards and classifications such as ICD or
  LOINC

11
Technical Views

• A SNOMED CT Affiliate License is required to
  obtain the release files
• SNOMED CT International Release Files are
  released biannually (in Jan and July)
• Three release file types exists
• Snapshot containing the current version of every
  component
• Full containing the complete history of every
  component
• Delta containing only the additions and changes
  since the previous release
• The snapshot type is recommended to use in
  applications
• All release files are UTF-8 encoded tab-delimited
  text files
• Data in these files need to be imported in
  relevant tables in database

12
Integration Approaches

• SNOMED CT can be integrated as

A code system To store clinical information
An interface terminology To capture and display clinical information
An indexing system To retrieve clinical information
A common terminology To communicate in a meaningful way To integrate heterogeneous data
A dictionary To query, analyze and report To link health records to knowledge resources
13
Usage in Software - Search
14
Usage in Software Data Entry
15
Use in Practice

• Clinical ideas are complex and interrelated
• A form of representation that captures this
  inherent complexity is essential
• SNOMED CT
• Provides comprehensive coverage of a broad
  clinical scope
• Is designed based on practical experience
  scientific principles
• Adds value with a concept model that locates
  clinical ideas relative to one another in a way
  that supports computable semantics enabling
  meaning-based retrieval
• Clinicians need to remember the codes as only the
  descriptions are relevant
• Well-engineered EHR systems using SNOMED CT
• Provide user interfaces that simplify capture of
  clinical ideas
• Share information taking advantage of the global
  terminology
• Harness the logical design of the terminology to
  deliver effective meaning-based retrieval

16
EHR Benefits of SNOMED CT

• Enhancing the care of individual patients
• Display of appropriate information
• Guideline and decision support integration
• Communicating and sharing relevant information
• Enhancing the care of populations of patients
• Epidemiology monitoring and reporting
• Research into the causes and management of
  diseases
• Supporting cost-effective delivery of care
• Guidelines to minimize the risk of costly errors
• Reducing duplication of investigation and
  interventions
• Auditing the delivery of clinical services
• Planning service delivery based on emerging
  health trends

17
India Updates

• 74 Affiliate Licensees issued in first year
• 06 Workshops / trainings Conducted
• More trainings focused on clinical use and
  implementations planned
• Check official website of India NRC at
  https//www.snomedctnrc.in

18
Thank You

• nrc-help_at_cdac.in info_at_snomedctnrc.in