SNOMED CT

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SNOMED CT

• Systematized Nomenclature Of Medicine Clinical
  Terms
• ---An introduction ---

Dr Karanvir Singh MBBS, MS, FRCS (Glasgow) Chief
Medical Information Office Apollo Hospitals India
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US
UK
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Most of us own smartphones
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This is what we use them for
Now imagine the uses if you remove internet
connectivity Voice calls SMS Camera A few games
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An EMR alone is like a dumb phoneSnomed CT is
the internet of EMRs

• It connects healthcare data across all entities
• Allows very granular clinical data capture
• Provides very powerful clinical analytics
• It supports clinical decision support
• and is used in over 50 countries. It is the
  best clinical terminology system today

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Let us see how it is better than existing
healthcare coding systems

• Let us compare it with ICD-10

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More clinical terms
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Codes for Ectopic Pregnancy in ICD-10

• ICD-10 has five codes (terms) only
• Abdominal
• Tubal
• Ovarian
• Others
• Unspecified

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Terms for Ectopic pregnancy in SNOMED CT
Abdominal pregnancy Membranous pregnancy
Aborted ectopic pregnancy Mesenteric pregnancy
Angular pregnancy Mesometric pregnancy
Cervical pregnancy Miscarriage of tubal ectopic pregnancy
Combined heterotopic pregnancy Multiple pregnancy involving intrauterine pregnancy and tubal pregnancy
Combined intrauterine and ovarian pregnancy Mural pregnancy
Combined pregnancy Ovarian pregnancy
Combined tubal and intrauterine pregnancy Rudimentary horn pregnancy
Compound ectopic Ruptured ectopic pregnancy
Cornual pregnancy Ruptured tubal pregnancy
Delivery of viable fetus in abdominal pregnancy Secondary abdominal pregnancy
Fallopian pregnancy Simultaneous intrauterine and extrauterine pregnancies
Fallopian tube pregnancy Tubal abortion
Heterotopic pregnancy Tubal pregnancy
Intraligamentous pregnancy Unruptured tubal pregnancy
Intraperitoneal pregnancy Viable fetus in abdominal pregnancy
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Multiple ancestors
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Pneumonia as classified in ICD-10
Section Code Title
Infectious disorders B01.2 Varicella pneumonia
Infectious disorders B05.2 Measles complicated by pneumonia
Infectious disorders B20.6 HIV disease resulting in Pneumocystis carinii pneumonia
Diseases of respiratory system J10.0 Influenza with pneumonia, other influenza virus identified
Diseases of respiratory system J11.0 Influenza with pneumonia, virus not identified
Diseases of respiratory system J12 Viral pneumonia, not elsewhere classified
Diseases of respiratory system J13 Pneumonia due to Streptococcus pneumoniae
Diseases of respiratory system J14 Pneumonia due to Haemophilus influenzae
Diseases of respiratory system J15 Bacterial pneumonia, not elsewhere classified
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Poly-hierarchy
Disease
Infections
Lung disorders
Disorder of lung
Infectious disease
Viral disease
Lower respiratory tract infection
Viral infection
Infectious disease of lung
Viral respiratory infection
Infective pneumonia
Viral pneumonia
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ICD is running out of codes

• Since code numbers are the main stay of
  classification, and the number of diseases are
  very large in number, ICD is running out of
  codes.
• Multiple disorders are being grouped under one
  code

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ICD is running out of codes

• Since code numbers are the main stay of
  classification, and the number of diseases are
  very large in number, ICD is running out of
  codes.
• Multiple disorders are being grouped under one
  code

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Snomed CT has no limits on the codes that can be
used

• No sharing of codes by two different conditions

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Comparison of existing coding systems
Coding system ICD-10 ICD-10 PCS LOINC NANDA CPT4 SNOMED CT
Diagnosis Yes No No Partial No Yes
Procedures / operations No (except pregnancy related) Yes No No Yes Yes
Laboratory No No Yes No No Yes
Nursing No No No Yes No Yes
Special context (e.g not diabetic) No No No No No Yes
Meaning based analytics No No No No No Yes
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Will SNOMED CT replace ICD-10?

• Yes No
• Clinical modules analytics would benefit from
  SNOMED CT
• The medical records departments will continue
  ICD-10

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Let us look at the nuts bolts of SNOMED CT
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These are four different conditions (clinical
ideas)

1. Ischemic heart disease
2. Angina
3. Unstable angina
4. Myocardial infarction
5. Heart attack
6. Cardiac infarction
7. MI

Same clinical meaning (idea)
Each clinical idea is called a concept
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Each concept has a random concept number

1. Ischemic heart disease 414545008
2. Angina 194828000
3. Unstable angina 4557003
4. Myocardial infarction
5. Heart attack
6. Cardiac infarction
7. MI

Same clinical meaning (idea) 22298006
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The same concept has different translations

1. Ischemic heart disease 414545008 - cardiopatía
   isquémica
2. Angina 194828000 - angina de pecho
3. Unstable angina 4557003 - síndrome preinfarto
4. Myocardial infarction
5. Heart attack
6. Cardiac infarction
7. MI

Same clinical meaning (idea) 22298006 - infarto
de miocardio
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Independent system of classification
Concept Concept ID
Ischaemic Heart Disease 414545008
Angina 194828000
Unstable Angina 4557003
Myocardial Infarction 22298006
Heart Attack 22298006
Cardiac Infarction 22298006
MI 22298006
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Poly-hierarchy
Disease
Infections
Lung disorders
Disorder of lung
Infectious disease
Viral disease
Lower respiratory tract infection
Viral infection
Infectious disease of lung
Viral respiratory infection
Infective pneumonia
Viral pneumonia
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Thus

• Each clinical idea is a concept and has a unique
  concept number
• Each concept number has multiple terms for it
• In different languages
• There is no limit on the number of concepts.
  Hence different conditions do not have to share
  the same code
• Concepts are connected to other concepts (parents
  / children) independent of their codes multiple
  relationships
• There are other relationships also, defining
  different properties of a concept

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How do multiple relationships help?
Disorder of foot
Cellulitis of lower limb
Is a
Is a
Cellulitis of foot
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Multiple types of relationships
Disorder of foot
Cellulitis of lower limb
Is a
Is a
Cellulitis of foot
Cellulitis
Foot structure
Associated morphology
Finding site
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Disorder of foot
Cellulitis of lower limb
Is a
Is a
Cellulitis of foot
Cellulitis
Foot structure
Associated morphology
Finding site
Is a
Is a
Cellulitis of toe
Cellulitis of heel
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Disorder of foot
Cellulitis of lower limb
Is a
Is a
Cellulitis of foot
Cellulitis
Foot structure
Associated morphology
Finding site
Is a
Is a
Is a
Cellulitis
Cellulitis of toe
Toe structure
Associated morphology
Finding site
Cellulitis of heel
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Disorder of foot
Cellulitis of lower limb
Is a
Is a
Cellulitis of foot
Cellulitis
Foot structure
Associated morphology
Finding site
Is a
Is a
Is a
Is a
Cellulitis
Cellulitis of toe
Toe structure
Associated morphology
Finding site
Heel structure
Cellulitis of heel
Cellulitis
Finding site
Associated morphology
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Disorder of foot
Cellulitis of lower limb
Is a
Is a
Cellulitis of foot
Cellulitis
Foot structure
Associated morphology
Finding site
Is a
Is a
Is a
Is a
Cellulitis
Cellulitis of toe
Toe structure
Associated morphology
Finding site
Heel structure
Cellulitis of heel
Cellulitis
Finding site
Associated morphology
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List me all patients with cellulitis
Disorder of foot
Cellulitis of lower limb
Is a
Is a
Cellulitis of foot
Cellulitis
Foot structure
Associated morphology
Finding site
Is a
Is a
Is a
Is a
Cellulitis
Cellulitis of toe
Toe structure
Associated morphology
Finding site
Heel structure
Cellulitis of heel
Cellulitis
Finding site
Associated morphology
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Associated morphology Cellulitis
Cellulitis of foot
Cellulitis of foot excluding toe
Cellulitis of forearm
Cellulitis of forehead
Cellulitis of gingiva
Cellulitis of groin
Cellulitis of hand
Cellulitis of hand excluding finger
Cellulitis of head
Cellulitis of heel
Cellulitis and abscess of lower leg
Cellulitis and abscess of lower limb
Cellulitis and abscess of neck
Cellulitis and abscess of nose (external)
Cellulitis and abscess of perineum
Cellulitis and abscess of shoulder
Cellulitis and abscess of submandibular region
Cellulitis and abscess of temple region
Partial data
Conditions with the word Cellulitis within it
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Associated morphology Cellulitis
Cellulitis of foot
Cellulitis of foot excluding toe
Cellulitis of forearm
Cellulitis of forehead
Cellulitis of gingiva
Cellulitis of groin
Cellulitis of hand
Cellulitis of hand excluding finger
Cellulitis of head
Cellulitis of heel
Cellulitis and abscess of lower leg
Cellulitis and abscess of lower limb
Cellulitis and abscess of neck
Cellulitis and abscess of nose (external)
Cellulitis and abscess of perineum
Cellulitis and abscess of shoulder
Cellulitis and abscess of submandibular region
Cellulitis and abscess of temple region
Beat knee
Chronic recurrent streptoccocal erysipelas
Cutaneous erysipeloid
Disseminated cutaneous erysipeloid
Erysipelas
Erysipelas of lower limb
Erysipeloid
Facial erysipelas
Localized cutaneous erysipeloid
Ludwig's angina
Onychia of finger
Phlegmon
Postpartum AND/OR puerperal erysipelas
Recurrent erysipelas
Seal finger
Partial data
Conditions with the word Cellulitis within it
Conditions even without the word Cellulitis
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How relationships help in decision support
Pick up all cases of cerebrovascular accident for
consideration for thrombolytic therapy
Use it to identify potential cohorts for clinical
trials for a new breast cancer drug.
Warn if the patient has any type of diabetes AND
any type of kidney disease
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How is it used in a hospitals EMR?
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The hospitals EMR software
Snomed CT
Terminology services (Snomed CT)
Record services (EMR)
Patient Ram Lal, age 56, admitted with a
diagnosis of
Herni
Hernia Inguinal hernia Indirect inguinal
hernia Indirect inguinal hernia with obstruction
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Leveraging relationships
Operations on the foot
We can show all the SubType concepts of E in the
operation list of a foot surgeon
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SubTypes (All descendants)
Operations on the foot
Foot incision
Foot joint operations
Division of muscle of foot
Tenotomy of abductor hallucis muscle
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Value set binding SNOMED supplies the lists
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How will clinicians benefit from it?
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ICD-10 has very limited search no synonyms

• The doctor may search for any of these terms for
  the same diagnosis
• Renal calculus
• Renal stone
• Nephrolith
• Calculus in kidney
• Kidney stone
• Kidney calculus
• Only the term Calculus in Kidney exists in ICD-10
  
• Such issues are present with most diagnosis

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No abbreviations in ICD-10

• The doctor may search by typing
• COPD
• MI
• IHD

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ICD-10 terms are not appropriate for printing
  What the doctor wants to write What is available in ICD-10 tables prints as such
  Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease, Unspecified
  Ureterocele Other specified disorders of kidney and ureter
  Neonatal tetanus Other tetanus
  Achlorhydria Other specified diseases of stomach and duodenum
  Recurrent appendicitis Other appendicitis
  Indirect inguinal hernia Inguinal hernia
  Direct inguinal hernia Inguinal hernia
  Strangulated inguinal hernia Unilateral or unspecified inguinal hernia, with obstruction, without gangrene
  Hepatic encephalopathy Hepatic failure, not elsewhere classified
  Bird flu (H5N1) Influenza due to certain identified influenza virus
  Swine flu (H1N1). Influenza due to certain identified influenza virus
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ICD-10 codes are not appropriate for printing
  What the doctor wants to write What is available in ICD-10 tables prints as such
  Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease, Unspecified
  Ureterocele Other specified disorders of kidney and ureter
  Neonatal tetanus Other tetanus
  Achlorhydria Other specified diseases of stomach and duodenum
  Recurrent appendicitis Other appendicitis
  Indirect inguinal hernia Inguinal hernia
  Direct inguinal hernia Inguinal hernia
  Strangulated inguinal hernia Unilateral or unspecified inguinal hernia, with obstruction, without gangrene
  Hepatic encephalopathy Hepatic failure, not elsewhere classified
  Bird flu (H5N1) Influenza due to certain identified influenza virus
  Swine flu (H1N1). Influenza due to certain identified influenza virus
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Summary

• Snomed CT is the terminology that supports the
  EMR. On its own it does nothing
• It is very clinician friendly
• It is multilingual
• It allows very powerful data analytics
• It augments decision support capabilities of an
  EMR

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Questions through the THIT app please