Agenda. Background SNOMED International Collaborations developments Information models Extensions

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2 Agenda Background SNOMED International Collaborations 2018 developments Information models Extensions

3 SNOMED International International not-for-profit association, based in the UK Owns and maintains SNOMED CT on behalf of, and in partnership with, its member countries Funded by countries based on national wealth (GDP) Provides SNOMED CT free to use in member countries Affiliate licenses for institutions in other countries

4 Our Members Argentina Luxembourg Slovenia 4

5 What is SNOMED CT? The world s most comprehensive multilingual clinical language A resource with comprehensive, scientifically validated clinical content Enables consistent representation of clinical content for processing in electronic health records Maps to international standards (ICD-10, OPCS-4, GMDN, ICPC-2, LOINC, etc.) Used in more than fifty countries 5

6 How Does SNOMED CT Work? Enables the global exchange of medical information through a codified language that represents groups of clinical terms Represents clinically relevant information consistently, reliably and comprehensively as an integral part of producing electronic health information. Provides a standardized way to represent clinical phrases captured by the clinician and enables machine processable semantics automatic interpretation of those phrases.

7 How Does SNOMED CT Work? SNOMED CT contains concepts with unique meanings and formal logic based definitions. It is organized into hierarchies and represented using 3 types of components.

8 SNOMED CT International release (6 monthly January and July) Extension (dependent on the international release) Subset (reference sets) Defined set of SNOMED CT terms based on specific requirements Release files Concept, Descriptions, Relationships Ontology Classified view of the concepts included in the release Supported by a defined concept model (attributes)

9 Our Focus on Quality

10 SNOMED International key collaborations Purpose To enable users to utilise SNOMED CT interoperably with other information standards, all have agreed joint deliverables WHO ensuring linkage between SNOMED CT and WHO classifications ICD-10, ICD-11, ICD-O, (ICF) HL7 ensuring appropriate use of SNOMED CT in HL7 v2, v3, CDA and FHIR ICN Linking SNOMED CT to ICNP DICOM SNOMED CT set used globally in DICOM Digital Imaging standard ISO TC 216 Health Informatics contributing to development based on SNOMED CT requirements to interoperate ADA - alignment between SNOMED CT and SNODENT GS1- Linking SNOMED CT and GTINs (bar coded information on medicinal products) WONCA - general/family practice subset and maps to ICPC2... and many more

11 2018 developments Content Quality assurance/clean up of existing content Drugs implementation of new drugs model Creation of content and development of maps to EDQM and UCUM Substances update and refinement of existing content Orphanet continuation of content developm,ent and crteation of linkage table ICD-11 creation of content, and development of supporting m,apping products Technical Support for Description logic changes within SNOMED CT Development and roll-out of batch template authoring Continued roll-out of Managed Service Support for the content quality assurance clean up General support for content enhancement activities

12 2018 developments Customer relations Four new counties in the process of joining SNOMED International Roadmap for mobile health, consumer health research and big data/analytics Genomics Alignment of SNOMED CT with HPO Pilot site(s) Implementation maturity matrix Vendor maturity matrix Development of SNOMED In Action web portal Education Development of clinical pathway Development of materials to support vendors e.g. Why implement SNOMED CT?, Where do I start? Development of guidance documentation, for example SNOMED CT In FHIR terminology services, and Migrating systems to SNOMED CT Support the increase globally of available SNOMED CT expertise

13 The interoperability challenge General practice Pharmacists Ambulance/Emergency services Specialists Patient record I have breathing problems sometimes I am an asthmatic I have asthma attacks I am diagnosed with respiratory disease Hospitals Diagnostic imaging Allied health professions Pathology

14 Same information represented in different ways Retrieval and reuse may miss similar information represented in different structure/terminology combinations For example, representing Family history of asthma A family history check list with asthma marked yes A family history section referring to the SNOMED CT concept asthma A record entry referring to the family history of asthma using a single SNOMED CT concept A record entry containing a SNOMED CT expression such as family history : associated finding = asthma A record entry containing the SNOMED CT concept asthma associated to a family member by an information model A patient record recording the information using ICD-10

15 Where does SNOMED CT go in the EHR? Statements in EHR s Electronic health record is made up of a series of clinical assertions Codes are the values for fields/slots in the information model Codes from the terminology fill in some or all of the statement body Information model determines the fields/slots that are available Coordination required to avoid gaps and overlaps between: Terminology model Information model

16 Types of Information Models

17 Information models CONCEPTUAL PARTICIPATION Clinical Models PROCEDURE PROBLEM DIAGNOSIS NURSING ASSESSMENT LOGICAL ADVERSE REACTION Document specifications ASSESSMENT SCORE Use case driven + business requirements DISCHARGE SUMMARY CLINICAL NOTE CARE PLAN IMPLEMENTABLE Document encodings System/platfo rm driven CARE SUMMARY CDA (XML) NURSING HANDOVER FHIR PRESCRIPTION (HL7 V2)

18 Information standards (examples) Terminologies SNOMED CT LOINC RxNORM AMT Classifications ICD-9CM ICD-10 ICD-10CM, AM etc ICPC-2 ICNP NIC, NOC, NANDA Messaging HL7 (V2, CDA, FHIR) Content Modelling Clinical Archetypes (CEN 13606) openehr CIMI

19 What are SNOMED CT national extensions? SNOMED CT International Release Dependency on the international release National release (International Release plus national extension) National Extension

20 What are SNOMED CT local extensions? Dependency on the release (maybe either national or international) SNOMED EXTENSIONS National release (International Release plus national extension)

21 A word about extensions.... SNOMED CT Identifiers Called SCTIDs Allow for a part of the code to identify a Namespace A namespace is controlled by an organization other than SNOMED International A namespace can be allocated to any organization with a SNOMED CT license (national or affiliates) Extensions should add content that is not required in the international release Realm-specific content: Multnomah County (Oregon) jail cell number Leave granted under the Mental Health Act 1983 (England and Wales) Should consider the need/requirement for an extension before committing to building/maintaining one SNOMED CT is missing content? Request new code additions through NRC? Clear of statement of requirements and justification

22 Local extensions things to consider Interoperability Primary use of SNOMED CT is to support interoperability Extension content at a vendor/organizational level can put interoperability at risk (codes travelling outside the organization cannot be understood) National extension standardizes terminology across Belgium Extensions are useful to develop specific content (such as metadata) required by a system Systems in place to ensure local extension content does not travel outside native system Dangers of duplication SNOMED CT has a large amount of content. Adding new content requires checks to ensure no duplication Two codes used with the same meaning can be anything from inconvenient to clinical risk Maintenance commitment Authoring of SNOMED CT content in an extension Reconciliation of extension content, with the new international or national release (every 6 months) DO YOU REALLY WANT TO DO THIS?