The SNOMED CT Operational Challenge

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• The SNOMED CT Operational Challenge
• Ian Kerr
• SNOMED CT Business Change Lead
• Karen Hillier-Smith
• SNOMED CT Sub-set Lead

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The SNOMED CT Operational Challenge

• Process in Use to assist SNOMED CT functionality
  in Lorenzo
• Awareness Education
• Requirements Terminology Binding
• Deployment

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The SNOMED CT Operational Challenge

• What is SNOMED CT?

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The SNOMED CT Operational Challenge

• SNOMED CT (Systematized Nomenclature of
  Medicine-Clinical Terms) is considered to be the
  most comprehensive, multilingual clinical
  healthcare terminology in the world
• A clinical terminology is a structured collection
  of descriptive terms for use in clinical practice
  using plain clinical English
• These terms describe the care and treatment of
  patients and cover areas like diagnoses,
  symptoms, surgical procedures, treatments and
  drugs.
• Fully machine processable

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The SNOMED CT Operational Challenge

• Interprets and standardises
• Includes multiple categories and sub-branches
  (sub-sets)
• Diagnoses
• Interventions
• Procedures
• Therapies, etc

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The SNOMED CT Operational Challenge

• Why SNOMED?

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The SNOMED CT Operational Challenge

• The success of the National Programmes is
  dependent upon users speaking a common language
  when communicating.
• A common language will
• Minimise differing interpretations of
  information
• Reduce risk of error with a corresponding
  increase in patient safety
• Without this National Programmes WILL NOT WORK

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The SNOMED CT Operational Challenge

• Benefits
• Audit Clinical Audit provision, what you
  need in the form that you need it
• Clinical databases/research
• Epidemiology
• Public health
• Long term conditions Ability to extract on wide
  or narrow parameters, any relevant clinical
  information with the confidence that it
  conforms to National Standards
• Clinical communication Enforces a standard in
  clinical notation that can be interpreted by
  any Clinician
• Decision support National Standards for Diagnosis
  (within Clinical Term) and Treatment etc
• Improved Clinical Noting Application (supporting
  SNOMED) will ensure t hat notes are presented
  in a common format
• Patient Safety Reduces chance of misreading
  diagnosis and treatment

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The SNOMED CT Operational Challenge

• How is SNOMED to be delivered?

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• The SNOMED CT Operational Challenge

Record update points
Paper Based Record
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The SNOMED CT Operational Challenge
SNOMED at the Core of the record
Record Update points
CRS Implementation
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The SNOMED CT Operational Challenge

• What might the SNOMED screens look like?

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The SNOMED CT Operational Challenge
SNOMED SFS
Drop down list from SNOMED
Screenshots from LORENZO are courtesy of iSOFT -
An IBA Health Group Company
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The SNOMED CT Operational Challenge
Screenshots from LORENZO are courtesy of iSOFT -
An IBA Health Group Company
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The SNOMED CT Operational Challenge
Screenshots from LORENZO are courtesy of iSOFT -
An IBA Health Group Company
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The SNOMED CT Operational Challenge
Uses context based subsets for search identified
by note headings
Screenshots from LORENZO are courtesy of iSOFT -
An IBA Health Group Company
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The SNOMED CT Operational Challenge

• Education
• Health Organisations know the change they face
• Clinicians know the change they face
• Standards
• National
• Local
• Functionality
• Richness
• Reporting
• Development Path

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The SNOMED CT Operational Challenge

• The Way Forward
• Education
• Change Process (Burden of change must be reduced
  by systems)
• Reporting (Search stratagems and capabilities)

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The SNOMED CT Operational Challenge

• SNOMED CT is not aclinical records structure,it
  is the building blocksfrom which
  structuredclinical records can be built

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Workflow Diagram Terminology Binding
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SNOMED CT The Operational Challenge Part Two
The SNOMED CT Operational Challenge

• Karen Hillier-Smith
• SNOMED CT Subset Lead

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The SNOMED CT Operational Challenge

• Terminology binding (noun) an instance of a link
  between a terminology component and an
  information model artefact.
• Example
• A set of coded values that may be applied to a
  particular attribute in an information model. The
  set may be expressed either explicitly at the
  interface, or as a definitional constraint or
  rule.
• Terminology binding (verb) the process or action
  of making one or more terminology bindings.
• Example
• Assigning a set of coded values or a definitional
  constraint/rule to a field in an information
  model to express the range of possible meanings
  that can be expressed within that field.

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The SNOMED CT Operational Challenge

• The phrase 'term binding' is not correct as it
  can be misleading. The binding is to the
  Terminology product
• The target of Terminology binding should never be
  a term on its own but instead links to the
  SNOMED CT reference data by which the chosen term
  is defined by
• The content of Terminology-binding should be
  driven by data retrieval and business
  requirements

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The SNOMED CT Operational Challenge
Search Tools
USER INTERFACE
HIDDEN REFERENCE TERMINOLOGY
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The SNOMED CT Operational Challenge

• Use Case 1 Wound Care
• Dressing
• Reason for Referral
• Referral to

Opsite Opsite Plus Mepore Tegaderm Pharmapore Hype
rfix
Pick List
Data Type
Referral to school nurse Referral to paediatric
dietitian Referral to psychologist Referral to
GP Referral to paediatrician Referral to
community paediatrician Referral to CAMHS
team Referral to speech and language
therapy Referral to social worker Referral to
health visitor Referral to paediatric
cardiologist Referral to paediatric
gastroenterologist Referral to paediatric
neurologist Referral to paediatric
oncologist Referral to psychiatrist Referral
to child and adolescent psychiatrist Referral to
dental surgeon Referral to ophthalmologist Refe
rral to community drug and alcohol team Referral
to education service Referral to paediatric
dermatology service Referral to mental health
team Referral to paediatric neurology
service Referral to occupational therapy
service Referral to orthotics service Referral
to physiotherapy service Referral to
gastroenterologist
Specialty Type
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The SNOMED CT Operational Challenge

• Use Case 2 Tracheostomy Care
• Diagnosis / Problem
• Catheter used
• Skin Condition

Specialty Type or Data Type
Tendertip Unomedical Pennine
Pick List
Skin healthy Macerated skin Fragile skin Dry
skin Scaly skin Oedematous skin
Pick List
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The SNOMED CT Operational Challenge
SNOMED CT in Lorenzo Regional Care-Release 1
Dr Richard Gain SME CFH Deployment Support Team
for NME region
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The SNOMED CT Operational Challenge

• Lorenzo Regional Care Release 1
• Utilises subsets of SNOMED CT
• defined lists of concepts related to a theme
• Input methods
• Medipad for clinical noting
• tag key words for coding
• Search For - Select
• a SNOMED CT browsable structure
• Clinical Data Capture form fields (with SCT
  mappings)
• no direct user contact with SNOMED CT

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Tips 1 Requirements
The SNOMED CT Operational Challenge

• Clinical Data Capture forms and Pick Lists are
  ideal for unique processes i.e. within Diabetes,
  Heart monitoring
• Areas like Emergency Care or General Surgery may
  be less constrained in choice and thus may
  require additional training for users.
• Ask clinical coders what information would be
  helpful to them, and also look at national and
  local reporting requirements.
• Try to identify clinical areas where there are
  opportunities to collect more useful or more
  accurate information to improve patient care.

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Tips 2 Method
The SNOMED CT Operational Challenge

• Analyse what elements influence the decision
  points along the clinical pathway
• Design data collection forms to ensure
  information is captured at the right level of
  detail
• Think carefully about what to code, e.g.
  whether to code an aggregated assessment outcome,
  e.g. a Waterlow score, or whether to code the
  individual scores
• Code data where there is a clear purpose for it
  (analysis, decision support, etc)

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Tips 3 Realising Benefits
The SNOMED CT Operational Challenge

• It is important to recognise that the person
  entering the information is not always the one
  who will benefit from it
• The aim is also to collect information only once
  and re-use it appropriately e.g. when
  transferring clinical history onto request forms
• Ensure that all system users will see (or at
  least hear about) the realised benefits of having
  effectively coded records.

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Thankyouwww.ihtsdo.orgwww.connectingforhealth
.nhs.uk/systemsandservices/data/snomed
The SNOMED CT Operational Challenge