Transcript SNOMED CT-AU: Robyn Richards
Overview, Benefits and how to approach Implementing - Robyn Richards (NEHTA)
Australian extension of the international SNOMED CT Allows us to add to and ensure the content is applicable for Australia Contains all international content plus any Au additions or changes Australian Medicines Terminology
The Basics
Over 300,000 concepts that are organised into 19 top-level hierarchies Body structure Clinical finding Environment or geographic location Event Linkage concept Observable entity Organism Pharmaceutical/biologic product Physical force Physical object Procedure Qualifier value Record artefact Situation with explicit context Social context Special concept Specimen Staging and scales Substance
A concept and its descriptions
SCTID: 22298006
Myocardial infarction
Fully Specified Name Myocardial infarction (disorder) SCTID: 751689013 Preferred term Myocardial infarction SCTID: 37436014 MI - Myocardial infarction
Synonym Synonym Synonym Synonym
SCTID: 37442013 Heart attack SCTID: 37443015
Attributes Over 60 types of attributes These ‘link’ concepts together to provide definitions
Most important Attribute is the IS-A
The use of IS-A attribute forms the hierarchies parents-children; types-subtypes; subsumption inheritance
Other attributes
are used to form lateral links between or across hierarchies
Body Structure Procedure
has an attribute of has an attribute of
Laterality Access
Concepts within the top-level hierarchies exist in a poly-hierarchical structure Disorder of lower Respiratory system Is A Inflammatory disorder of lower respiratory tract Is A Disorder of lung Is A Is A Is A Pneumonitis Lung consolidation Is A Is A Pneumonia
Attributes Bronchitis Is A
Viral Bronchitis
Causative agent Virus (organism) Pathological process Infectious process (morphologic abnormality) Associated morphology Inflammation (morphologic abnormality) Finding site Role grouping Bronchial structure (body structure)
Pre and Post-coordination
Pre and post coordination are the names given to how you approach representing clinical expressions in a record Pre coordination encapsulates all the information to convey meaning in a single code Post coordination encapsulates meaning in a series of attribute value pairs associated with a concept.
Pre and Post-coordination
Pre coordinated example ◦ One concept conveys all the required meaning ◦ E.g.
31978002 ‘Fracture of tibia’ Post coordinated expression ◦ E.g.
31978002: 272741003 = 7771000 ‘Fracture of tibia: laterality = left’
Group or subset of concepts from SNOMED CT used for a specific purpose Implementation tools used to provide a smaller set of concepts for implementation in a specific section of a record There are other uses for reference sets such as annotation and navigation references sets, but these are the most common at the moment
Refset SNOMED CT concept Clinical finding Vascular disease Embolism Pulmonary embolism
At Data Entry
Content coverage Specificity One concept with multiple descriptions
SNOMED CT Five concepts ICD-10-AM One code | 29774004 Vascular myelopathy | | 432249006 Infarction of spinal cord | | 39134007 Haematomyelia | | 65605001 Oedema of spinal cord | | 83982007 subacute necrotic myelopathy | G95.1 Vascular myelopathies Includes: Acute infarction of spinal cord Haematomyelia Oedema of spinal cord Subacute necrotic myelopathy
For communication
Standard terminology across the system Unambiguous concept identification
For Retrieval
Can utilise all SNOMED CT features to assist with retrieval for planning, reporting, research Standard terminology ensures ‘apples are compared with apples’ no matter where data sourced from This is where the power of SNOMED CT can really be realised
Example ICD-10-AM Diseases of the Respiratory System | Influenza and Pneumonia | J12.9 – Viral Pneumonia, NEC | J12.9 – Viral Pneumonia, unspecified
SNOMED CT-AU Disorder of respiratory system Pneumonia Viral pneumonia Infectious diseases Inflammatory disorders Infection by sites (lung etc) Viral infections Respiratory conditions that have had related procedures ICD-10-AM Diseases of respiratory system Influenza’s and Pneumonia Viral Pneumonia SNOMED CT uses its hierarchies and attributes to allow retrieval queries to be written ICD was developed to quantify and fund inpatient events which it will continue to do
Longer term
Used with decision support Drive evidence based medicine Drive clinical process improvement Facilitate knowledge management
Many of these benefits are for the future
In order to reap the benefits we need to get SNOMED CT into systems NOW
It is not a standalone solution It needs to be deployed IN a clinical software application SNOMED CT is one part of an EHR product The other half is the clinical application itself and its information model
Information models define the data entry boxes (names) Terminology defines the values which can be selected and recorded within those boxes (values) Diagnosis:
Viral Pneumonia
Information model Terminology
Natively – get SNOMED CT into the backend of clinical systems Need to find a balance between using reference sets to isolate content or using searching functionality Recommend reduce dependence on reference sets and mappings by improving Searching Functionality
Only provide search results for current concepts Don’t return Fully Specified Names Use the Australian Language Reference Set to extract relevant descriptions (US spellings out) Use ‘contains any word’ parameters rather than ‘starts with’ Ensure frequently selected concepts return to the top of the search results list Do Not provide pick lists if there are more than ~8 to choose from
Provide options to browse the hierarchy around a selected concept Utilise indexing tables The better the searching functionality, the larger your reference set can be without affecting usability Realise that improvements here may take some time to implement – but this is definitely the way to go!!!
Options are:
Natively (with basic searching criteria)
Use Mappings ..(more on this later)
Steps to implement into a specific data element
Understand your information model data element ◦ ◦ ◦ ◦ What is the definition of the data element?
What use cases does it need to cover?
Where in the record is it used?
What other data elements sit next to it?
Adverse reaction substance: Substance that is responsible for a reaction in a patient Adverse reaction manifestation: Reaction experienced by patient Adverse reaction type: The type of reaction determined by the clinician
Adverse reaction substance: Substance that is responsible for a reaction in a patient Does this include medications?
Does this include foods?
Does this include organisms?
Does this include chemicals?
Understand the context of the information that will be captured in the data element ◦ Often relates to the SNOMED CT top-level hierarchies: Clinical finding Specimen Observable entity Procedure Organism Substance Event Social Context Pharmaceutical or Australian Medicines Terminology Product Body Structure Situation with explicit context
Adverse reaction substance: Substance that is responsible for a reaction in a patient AMT Product/ Pharmaceutical Biologic hierarchy ‘Pepzan’ ‘Brolene eye drops’ Substance hierarchy ‘penicillin’ ‘latex’ Clinical finding hierarchy ‘allergy to penicillin’
Identify terminology content Get to know the SNOMED CT hierarchies and where different kinds of concepts can be found Search based on your use cases Are there any existing codesets you can use as a source list Identify content that is NOT valid as well as what is Document the reasoning used for your decisions Identify if any existing reference sets can be used or cut down
Build your reference set Methods will vary based on tools NEHTA CTI methods include Source data method Attribute method Concept enumeration method Simple inclusion method More information can be found in the ‘Development approach for reference sets’ document in the SNOMED CT-AU Release
Unpack reference sets – technical processes Use Australian language reference set Ensure searching functionality works Test it
Two distinct types 1. From local terms and codesets
TO
SNOMED CT 2.
FROM
SNOMED CT to other instruments (ICD for eg) Different purposes Different methods Different outcomes
Type 1 Mapping codesets to SNOMED CT are - Prone to information loss - Expensive to build and - Require ongoing maintenance and review - Recommend the use of a mapping as a migration tool
Type 1 Should be regarded as
migration
Take the old termset content Map it once, properly, to SNOMED CT content (RefSet?) And then ‘switch’ to the SNOMED CT for continued use Similar approach to the upgrade and switch over from: Analogue to digital television signal service Leaded to unleaded to E10 petrol For instance: Emergency Department Reference Set Example: 1234 | Chronic bronchitis
migrates to
63480004 | Chronic bronchitis Old termset content mapped to SNOMED CT content
Type 2 Perceived as semi-automation of traditional ICD coding More accurately regarded as transformation Take SNOMED CT content Find suitable ICD candidate Include ICD rules – NOTE INCLUDES, EXCLUDES, NOS, NEC Assign ICD-10 code for use in reporting
CONCEPTID
111613008
SNCT DESCRIPTION
Closed skull fracture with intracranial injury (disorder)
MAP GROUP
1 2
MAP ADVICE
ALWAYS S06.90
ALWAYS S02.90
TARGET CODE
S06.90
S02.90
ICD DESCRIPTION Intracranial injury
, unspecified, without open intracranial wound
Fracture
of
skull
and facial bones, part unspecified,
closed
Try under a different name or wording Contact the service desk (
[email protected]
) Submit a request submission to NEHTA (
[email protected]
)
Acknowledge challenges and the journey to implementation that we all face