background extensions · 2018-04-03 · • maps to international standards (icd-10, opcs-4, gmdn,...
TRANSCRIPT
▪ Background▪ SNOMED International
▪ Collaborations
▪ 2018 developments
▪ Information models
▪ Extensions
Agenda
▪ 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
SNOMED International
Our
Members
4
Argentina Luxembourg
Slovenia
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
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.
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.
▪ 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)
SNOMED CT
Our Focus on Quality
SNOMED International key collaborations
▪ 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
Purpose
To enable users to utilise SNOMED CT interoperably with other information standards, all
have agreed joint deliverables
▪ 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
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
2018 developments
The interoperability challenge
General practice
Ambulance/Emergency services
Hospitals
Allied health professions
Pathology
Diagnostic imaging
Specialists
Pharmacists
Patient
record“I have breathing problems sometimes”
“I am an asthmatic”
“I have asthma attacks”
“I am diagnosed with respiratory disease”
▪ 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
Same information represented in
different ways
▪ 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
Where does SNOMED CT go in the
EHR?
Types of Information Models
Information models
Clinical Models
Document specifications
Document encodings
Use case
driven +
business
requirements
System/platfo
rm driven
CONCEPTUAL
LOGICAL
IMPLEMENTABLE
CARE SUMMARY CDA (XML)
PRESCRIPTION (HL7 V2)
NURSING HANDOVER FHIR
DISCHARGE SUMMARY
CARE PLAN
CLINICAL NOTE
PARTICIPATION
NURSING
ASSESSMENTADVERSE REACTION
PROBLEM DIAGNOSISPROCEDURE
ASSESSMENT SCORE
▪ 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
Information standards (examples)
What are SNOMED CT national
extensions ?
SNOMED CT
International
Release
National
Extension
Dependency
on the
international
release
National release
(International
Release plus
national extension)
What are SNOMED CT local extensions
?
National release
(International
Release plus
national extension)
SN
OM
ED
EX
TE
NS
ION
S
Dependency on
the release
(maybe either
national or
international)
▪ 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
A word about extensions . . . .
▪ 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 ?
Local extensions – things to consider