mi224 snomed santiago & herber 022715
TRANSCRIPT
+
SNOMED CT
Alvina Pauline D. Santiago, MD
Burr Herber, RN
For MI224 under Benedict Sandejas, MD
February 28, 2015
+IHTDSO.orghttp://ihtsdo.org/fileadmin/user_upload/doc/download/doc_Starter
Guide_Current-en-US_INT_20141202.pdf?ok ,
http://www.ihtsdo.org
+SNOMED CT elearninghttp://snomed.org/elearning
http://webarchive.nationalarchives.gov.uk/20130502102046/http://www.connect
ingforhealth.nhs.uk/elearning/snomedct/flash/
+Snomed CT: Systematized Nomenclature
of Medicine Clinical Terms
Systematic
Organized
Structured
Logical
Consistent
Nomenclature
Collection of
Names
Words
Medicine (clinical
Terms)
Relevant to
Medicine
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+SNOMED CT
Most comprehensive, multilingual clinical healthcare
terminology in the world.
Is a resource with comprehensive, scientifically validated
clinical content.
Enables consistent, processable representation of clinical
content in electronic health records.
Is mapped to other international standards.
http://www.ihtsdo.org/snomed-ct/what-is-snomed-ct/history-of-snomed-ct
+SNOMED CT
May be used to represent clinical information consistently,
reliably, comprehensibly as part of producing electronic health
information
Provides standardized way of representing clinical phrases
Clinically validated, semantically rich, controlled vocabulary
Benefits patients and clinicians, individual as well as population
as it supports evidence-based care
http://www.ihtsdo.org/snomed-ct/what-is-snomed-ct/history-of-snomed-ct
HISTORY:
• 1965: Systematized Nomenclature of Pathology (SNOP)
• published by the College of American Pathologists (CAP)• Morphology and anatomy.
• 1975: Systematized Nomenclature of Medicine (SNOMED).
• CAP expanded SNOP under Dr. Roger Cote’s leadership
JMM Herber, 2015
HISTORY:
• 1979: SNOMED II Most widely adopted version
• 1993: SNOMED 3.0 Major expansion and revision
• 2000: SNOMED RT Kaiser Permanente + CAPLogic-based version
RT=reference terminology
JMM Herber, 2015
HISTORY:
• 1980s: Read Codes V1Dr. James Read National Health ServiceClinical terminology coding
• 1990: Read Codes V2
• 1994: Read Codes V3Clinical Terms V3 (CTV3)
JMM Herber, 2015
HISTORY:
• September 1998: merged CTV3 & SNOMED RT• Three-year project under CAP ownership
• January 2002: SNOMED CT Version 1
• 2007: IHTSDO acquired intellectual property rights to all versions of SNOMED.
SNOMED RT
(Reference
Terminology)
SNOMED CT
(Clinical
Terms)
Clinical
Terms
Version 3
(CTV3)
+ =
JMM Herber, 2015
NICE TO KNOW:
Although SNOMED was originally an acronym for Systematized Nomenclature of Medicine, IT LOSTTHAT MEANING when SNOMED was combined with CTV3 in 2002. The merged product wascalled SNOMED Clinical Terms, which was shortened to SNOMED CT.
IHTSDO considers SNOMED CT to be a BRAND NAME, NOT AN ACRONYM.
JMM Herber, 2015
+Snomed CT: Structure
https://www.youtube.com/watch?v=ISfoMR4aygc&list=PL842440B7867442B7&index=1
+Benefits of Electronic Record
Reduced storage cost
Can be accessed by multiple
users, at multiple sites,
simultaneously
Can be transferred quickly
Internet connection?
Legible (not necessarily
understandable)
http://www.drexel.edu
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_Sta
rterGuide_Current-en-US_INT_20141202.pdf?ok
+Benefits of a structured record
Display logical progression of
clinical data
Retrieve clinical data based on
situation or author
Allows clinical data to be
transmitted longitudinally on
patient’s record
Improve continuity of care
Reduce medical error
Decrease duplicate data
entry
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+Benefits of SNOMED CT:
Clinical Terminology
Controlled vocabulary
Ability to search records for
clinical information
ID patients who match a set
of criteria
Provision of decision
support
Terms correctly understood
by everyone
Adequate searches,
adequate data, reliable “first”
event
Retrieval of patients more
reliable
Real time Clinical Decision
Support System (CDSS)
easier to use/apply
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+Benefits of SNOMED CT:
Clinical Terminology
Public Health Monitoring
Outcome Analysis
Performance Analysis
Population level
Proactive
Disease Outbreaks
Good evidence base for
CPG, PPP
Performance related
Fit to Practice
Adherence to CPG, PPP
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+Benefits of SNOMED CT:
Clinical Terminology
Consistent terminology across all care
domains
Allows precise recording of clinical
information
& retroactive data retrieval for research,
management and interventions
SNOMED CT is a developing international
standard
Many languages but same code
Interoperable
http://blog.lionbridge.com
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuid
e_Current-en-US_INT_20141202.pdf?ok
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+Key Determinants of full benefit
Record structure: stores similar info consistently
Ease of data entry: constrain data
Communication: interface retain clinical content structure & coding to
allow receiving system to reuse information based on SNOMED CT
Record storage & indexing optimize semantics used in SNOMED CT
Retrieval: display clinical records with critical information
Real time and batch decision support
Analysis of data for various purposes
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: Lessons
Reusability requires consistent structured representation
Otherwise, overlaps and conflicts between structure and clinical
terms = ambiguous and conflicting interpretations
For information reuse, queries should be formulated taking into
account information structure and coding.
Human inconsistencies: constrain data entry
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+SNOMED CT: Challenges
Diversity of views related to structure of
clinical information
Overlap between models and terminology
Different views on application design
Different requirements for collection of
information
Different views on record structures and
data entry methods
http://mocostudent.org
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+Snomed CT: Features
Most Comprehensive, multilingual
Healthcare clinical terminology
Scientifically validated clinical content
Enables consistent, processable
representation of clinical content in eHR
Mapped to international standards
Used in more than 50 countriesCatherinecronin.file
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok ,
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: Characteristics
Comprehensive
Scalable
Flexible
Maps work to provide explicit
links to health related
classifications and coding
schemes, e.g. statistical
classifications such as ICD-9-
CM, ICD-10, and ICD-O3.
http://jessicachivers.com
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+SNOMED CT:
Supporting different languages
Multinational
Multilingual
Built-in framework to
manage languages and
dialects
http://images.sodahead.com
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+SNOMED CT: Languages
US English
UK English
Spanish
Danish
Swedish
Canadian French (Partial)
Lithuanian (Partial)
Further translations by IHTDSO Members ongoing http://st.depositphotos.com
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+SNOMED CT: Basic Structure
Concepts: clinical meaning organized into hierarchies
Hierarchies groups to organize concepts
Description: link appropriate human readable terms to concepts
Fully specified name
Preferred name
Synonyms
Relationships
Connection between concepts
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
STRUCTURE:
CONCEPT
A single unit of thought or idea with a distinct clinical
meaning.
Unique clinical phrases
Formal logic-based definitions
Identified by a unique numeric identifier that NEVER
CHANGES , which is the Concept ID
Made up of string of digits 6-18 in length, 8-9 on average
Never deleted but may be retired.
JMM Herber, 2015
+SNOMED CT: Top Level Concepts
(Major branch of hierarchy)
CLINICAL FINDING: e.g., |asthma|, |normal breath sounds|
result of clinical observation, assessment or judgment
Includes normal and abnormal clinical state
Includes concept used to represent diagnosis
PROCEDURE: e.g., |appendectomy|, |physiotherapy|
Activities performed in providing health care
Included invasive procedures, administration of medicine, imaging, education, therapies, administrative procedure
SITUATION WITH EXPLICIT CONTENT: e.g. |endoscopy arranged|, |past history of myocardial infarction|
Represents concepts in which the clinical context is specified as part of the definition of the concept itself
Presence or absence of a condition
May be current or in the past
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+SNOMED CT: Top Level Concepts
(Major branch of hierarchy)
OBSERVABLE ENTITY: e.g., |Systolic BP|, |iris color|,
|gender|
Question or assessment which can produce an answer or result
BODY STRUCTURE: e.g., |mitral valve|, |adenosarcoma|
Normal or abnormal anatomical structure
SUBSTANCE: e.g., |methane|, |insulin|, |albumin|
General substances
Chemical constituents of pharmaceutical/biological product
PHARMACEUTICAL/BIOLOGICAL PRODUCT: e.g.,
|amoxicillin 250mg cap|, |paracetamol+codeine tab|
Drug product
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+SNOMED CT: Top Level Concepts
(Major branch of hierarchy)
SPECIMEN: e.g., |Urine Specimen|, |Prostate biopsy specimen|
Entities obtained for examination or analysis
SPECIAL CONCEPT: e.g., |alternative medicine poisoning|, |navigational concept|
Do not play a part in the formal logic of the concept
May be useful for specific cases
PHYSICAL OBJECT: e.g., |implant device|, |automobile|
Man-made or natural object
PHYSICAL FORCE: e.g., |radiation|, |alternating current|
Physical forces that can play a role as mechanisms of injury
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+SNOMED CT: Top Level Concepts
(Major branch of hierarchy)
EVENT: e.g., |flood|, |earthquake|
Occurrences excluding procedures and interventions
SOCIAL CONTEXT: e.g., |occupation|, |religious belief|
Social conditions and circumstances significant to health care
STAGING & SCALES: e.g., |Glasgow coma scale|
Assessment scales and tumor staging systems
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+SNOMED CT: Top Level Concepts
(Major branch of hierarchy)
QUALIFIER VALUE: e.g, |left|. |abnormal result|, |severe|
Values for some SNOMED CT attributes not subtypes of other top
level concepts
RECORD ARTIFACT: e.g., |patient held record|, |family history
section|, |record entry|
Content created for providing others with record events or state of
affairs
SNOMED CT MODEL COMPONENT
Technical metadata supporting SNOMED CT release
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
STRUCTURE:
HIERARCHY OF CONCEPTS / TOP LEVEL CONCEPTS
Dressing (the activity of putting on clothes) Observable Entity
Dressing (the thing that is placed over the wound) Physical Object
Dressing (the act of covering a wound) Procedure
Hierarchy helps clarify the meaning of a concept
JMM Herber, 2015
+SNOMED CT:
Concepts & Descriptions
Basic Unit: Concept
Fully specified Name
Preferred Name
Synonyms
http://webarchive.nationalarchives.gov.uk
+Relationships
IS-A Relationship
Subtype
Supertype
Parent-child
Attribute Relationship
Relate 2 concepts
Establish type of relationship
http://webarchive.nationalarchives.gov.uk/
+SNOMED CT: Relationships
Is-a relationships define
hierarchy of concepts
Every relationship has a unique
numeric relationship builder
Pneumonia
is a
Infective pneumonia
is an
Bacterial Pneumonia
+SNOMED CT: Attributes that define
Clinical Finding Concepts
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: Attributes that define
Clinical Finding Concepts
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: Attributes that define
Clinical Finding Concepts
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: Attributes that define
Clinical Finding Concepts
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT:
Reference Sets (Refsets)
Flexible
Support for customization and
enhancements
Language preferences
Mapping from, or to other code
systems
Every reference set has a
unique numeric concept
identifier
Disability reference set
http://ithealthboard.health.nz/system/files/documents/pages/disability-codes-equipment-modification-services-20140613.xlsx
Emergency procedure reference set
http://ithealthboard.health.nz/system/files/documents/pages/ambulance%20observation%20and%20intervention%20codes%2020140227.xlsx
+SNOMED CT: Logical Model
(Concepts)
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: Logical Model
(Descriptions)
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: Logical Model
(Relationships)
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: Logical Model
(Subtype Relationships)
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: Logical Model
(Attribute Relationships)
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: Logical Model
(Reference Sets)
Language & dialect preferences
Subsets of components that are included or excluded
Value sets of concepts limiting content
Frequently asked description or concepts
Structuring & ordering of lists & hierarchies
Maps to or from other code systems http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
http://sostranslatorchat.com
+Snomed CT: StructureConcept ID = Snomed Clinical Term Identifier (SCTID)
6-18 digits
https://www.youtube.com/watch?v=ISfoMR4aygc&list=PL842440B7867442B7&index=1
+SNOMED CT: Compositional Grammar
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: Compositional Grammar
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: ExamplesPrecoordinated: represent meaning of individual concepts
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: ExamplesPrecoordinated: represent meaning of individual concepts
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: ExamplesPostcoordinated: 2 or more concept identifiers
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: ExamplesPostcoordinated: 2 or more concept identifiers
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: ExamplesPostcoordinated: 2 or more concept identifiers
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: Examples
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok ,
+SNOMED CT: Availability
Distributed to IHTDSO Members and Affiliate licensees as a set
of downloadable files
Regular updates available
IHTDSO members pay fees based on national wealth
Affiliate licensees not charged in Member country
Licensing free for poorest countries and certain approved
public-good use
Low cost per institution charges
+SNOMED CT Products & Services(IHTDSO Members with Affiliate License)
SNOMED CT Terminology
Derivative Works that help in uptake and use of SNOMED CT, including reference sets that support
Subsets of SNOMED CT
Language or dialect preference
Maps to other code classifications
Other metadata to support use of components
Implementation guidance
Access to services for requests for changes, additions, documentation
Participation in global IHTDSO collaboration
http://www.seap.es
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok
+SNOMED CT: release schedule
International editions
Twice a year
31st Jan
31st July
National Extensions
Full release:
contains every version of
every component
Delta release:
only versions created or
inactivated since previous
release
Snapshot release:
Most recent version of every
component at time of
snapshot
+Member Countries: (> 20)
Australia
Belgium
Brunei
Canada
Chile
Czech
Republic
Denmark
Estonia
Hong Kong
Iceland
India
Israel
Lithuania
Malaysia
Malta
Netherlands
New Zealand
Portugal
Singapore
Slovak Republic
Republic of
Slovenia
Spain
Sweden
United Kingdom
United States
Uruguay
http://www.ihtsdo.org/members/
And >5000 licenses to individuals & organizations
+SNOMED CT PHILIPPINES
Is Philippines a Member country?
Are there affiliate licensees?
Multiple languages and dialects
Does third world PH qualify for FREE?
Poor country
Public good use
http://upload.wikimedia.org/wikipedia/commons/2/28/Philippine_judicial_regions
.PNG
+SNOMED CT: PHILIPPINES
Regions of Philippines (geographic location) {223761002 , SNOMED-CT }
Parent/Child (Relationship Type)
Bohol (geographic location) {223762009 , SNOMED-CT } Cebu (geographic location) {223763004 , SNOMED-CT } Leyte (geographic location) {223764005 , SNOMED-CT } Luzon (geographic location) {223765006 , SNOMED-CT } Masbate (geographic location) {223766007 , SNOMED-CT } Mindanao (geographic location) {223767003 , SNOMED-CT } Mindoro (geographic location) {223768008 , SNOMED-CT } Negros (geographic location) {223769000 , SNOMED-CT } Palawan (geographic location) {223770004 , SNOMED-CT } Panay (geographic location) {223771000 , SNOMED-CT } Samar (geographic location) {223772007 , SNOMED-CT }
http://phinvads.cdc.gov/vads/http:/phinvads.cdc.gov/vads/ViewCodeSystemConcept.action?oid=2.16.840.1.113883.6.96&code=22376
1002
+References
Snomed CT Starter Guide December
2014.http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu
rrent-en-US_INT_20141202.pdf?ok , Accessed February 9, 2015.
Snomed CT eLearning.
http://webarchive.nationalarchives.gov.uk/20130502102046/http://connectingforh
ealth.nhs.uk/elearning/snomedct/html/
http://webarchive.nationalarchives.gov.uk/20130502102046/http://www.connectin
gforhealth.nhs.uk/elearning/snomedct/flash/
SNOMED CT. A User Guide for General Practice. (2012). Crown Copyright.
Retrieved from
http://systems.hscic.gov.uk/data/uktc/training/snmdct_gp_userg.pdf, Accessed
Feb 20, 2015
+References
“Diane” Bool, DP, “Tin” Salas, F?. Snomed CT. Powerpoint presentation given
at MI 224 Class, first semester, 2014-2015.
Nehta Snomed CT Basics, Parts 1-6.
https://www.youtube.com/watch?v=jcohuHGjLLk&index=2&list=PL842440B78674
42B7&spfreload=1
What is SNOMED CT? IHTSDO. http://www.ihtsdo.org/snomed-ct/what-is-
snomed-ct/history-of-snomed-ct. Accessed February 26, 2015