Is SNOMED CT really multi-professional?

1
Is SNOMED CT really multi-professional?

• Anne Casey FRCN
• Editor Paediatric Nursing
• Adviser in Informatics Standards to the Royal
  College of Nursing
• Clinical Domain Lead NHS (England) Information
  Standards Board
• Chair SNOMED Content Steering Group

2
Overview

• Requirement
• What is said to be in SNOMED CT
• The Reality
• Relationship between SNOMED CT and other
  professions terminologies
• Approaches to content development

3
Multi professional working?

• Single shared assessment, integrated care
  pathways, team approaches
• mixed economy for healthcare records
• separate records for each profession
• single patient record with different sections for
  each profession
• single patient record (e.g. mental health)

4
Requirement for terminology in healthcare

• patient terminology
• nursing terminology
• medical terminology
• laboratory terminology
• physiotherapy terminology, dietetics, .
• drugs, equipment terminologies
• social care terminology
• .

5
Requirement for terminology to support
interoperability in the e-healthcare world

• Standard, multi professional terminology with
  features that support data entry, retrieval,
  messaging, maps to other terminologies /
  classifications, translation etc.

6
SNOMED CT..

• a comprehensive multi-disciplinary clinical
  terminology for use in electronic records and
  messages
• Terms are profession neutral
• e.g. NOT physiotherapy terms, nursing assessment
  terms etc
• Profession context is provided by record
  structure and/or user ID
• Professional groups can take the lead for areas
  of content
• e.g. opthalmologists eye findings, dietitians
  dietary assessment, cardiologists cardiac
  procedures, nurses care regimes

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The reality

• Content sources e.g.
• Clinical Terms Version 3 (Read Codes) included
  content from NHS clinical terms projects
  nursing, psychology, midwifery, physiotherapy,
  speech and language therapy..
• Nursing example concepts from approved nursing
  terminologies
• Evidence? few systematic reviews (expertise
  required)

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Content examples from CTV3

• Dysphagia therapy
• Environmental safety assessment
• Substance abuse prevention
• Spiritual growth
• Ability to perform fine motor function
• Weight reduction regime

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Nursing Content examples
Assessment findings nursing diagnoses e.g. altered family coping, knowledge deficit Findings hierarchy
Interventions e.g. falls prevention, eye care Procedure hierarchy
Outcome names e.g. pain level, behaviour Observable Entity hierarchy
Nursing outcome indicators (NOC) Findings hierarchy
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Relationship between SNOMED and other
terminologies

• Different terminologies have features suited to
  their different purposes....
• clinical definitions
• knowledge relationships
• classification concepts
• coding scheme suited to use in a paper system
• .

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SNOMED CT has a specific set of purposes it
doesnt do what some other terminologies do..

• Example 1. ICF
• ..describes body functions and structures,
  activities and participation - used to understand
  and measure health outcomes
• Example 2. Nursing terminologies such as NANDA
  diagnoses
• ..support the description of nursing in practice,
  education and research may include knowledge
  that supports clinical reasoning (e.g. defining
  characteristics of NANDA diagnoses)

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• NHS Scotland wishes to use ICF to assess and
  record participation of disabled children
• The concepts can be recorded using SNOMED CT e.g.
  relationships with peers, play, learning and
  applying knowledge
• Classification concepts are not in SNOMED CT
• e.g. other specified
• A map between SNOMED CT and ICF may be useful for
  statistical analyses
• The ICF contains clinical knowledge supporting
  the purpose of assessment
• The ICF model (e.g. performance and capacity
  scales) can also support system design
• The ICF definitions can support consistent use of
  terms.

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• A primary care organisation wishes to use the
  OMAHA (nursing) system to record care given to
  new mothers in the community and to support
  analysis of outcomes
• The concepts can be recorded using SNOMED CT e.g.
  knowledge about breastfeeding, community support
• OMAHA system contains clinical knowledge (e.g.
  relationship between interventions and outcomes)
  that supports the purposes
• OMAHA system model (e.g. problem rating scales)
  can support system design
• OMAHA system definitions can support consistent
  use of terms

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Either OR both?

• Where an organisation wishes to use a particular
  clinical tool such as ICF or the OMAHA system,
  the individual concepts can be represented using
  SNOMED CT content additions may be required
• The other features of the terminology are not
  held within SNOMED CT i.e. definitions, structure
  / relationships etc
• A map between SNOMED CT and the terminology /
  classification may be useful

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SNOMED CT Content development
Expert committee
System content developer
SNOMED CT
End user
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Other contributors to content development and
quality review

• Specialty lists - making implementation easier
  radiology, general practice, nursing
• Encoding of national (international?) standards
• Assessment instruments single assessment of the
  elderly, Glasgow coma scale
• Multi professional care pathways pre-operative
  assessment, asthma admission
• Shared records bowel cancer screening programme
  record, patient held diabetes record
• Etc.

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Conclusions

• SNOMED CT covers some areas for all professions
  model can accommodate all
• Mechanisms exist for increasing content
• Content additions are increasingly based on
  feedback from users needs better co-ordination
  and quality assurance
• Professions can take responsibility for quality
  of specific areas
• International specialty organisations could lead
• Snomed working groups at national levels feeding
  into international level??
• BUT the real issue for the professions is

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migration of professionals

• from unstructured, non standard, narrative
  records
• from vague, ambiguous, local terminology and
  locally adapted clinical tools
• ...from paper records

• to structured, standard records and messages
• ...to standard, defined, evidence based
  terminologies and tools
• to ICT that supports clinical workflow, decision
  making, recording and communication (and has
  standard terminology for interoperability)