overview, benefits and how to approach implementing - robyn richards (nehta)

SNOMED CT-AU Overview, Benefits and how to approach

Implementing- Robyn Richards (NEHTA)

SNOMED CT-AU 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

SNOMED CT-AU SNOMED CT-AU

The Basics

SNOMED CT-AU SNOMED CT-AU Over 300,000 concepts that are organised into

19 top-level hierarchies

Body structureClinical findingEnvironment or geographic locationEventLinkage conceptObservable entityOrganismPharmaceutical/biologic productPhysical force

Physical objectProcedureQualifier valueRecord artefactSituation with explicit contextSocial contextSpecial conceptSpecimenStaging and scalesSubstance

SCTID: 22298006

SNOMED CT-AU SNOMED CT-AU A concept and its descriptions

Myocardialinfarction

Synonym MI - Myocardial infarctionSCTID: 1784872019Synonym Infarction of heart

SCTID: 37441018Synonym Cardiac infarctionSCTID: 37442013

Synonym Heart attackSCTID: 37443015

Fully Specified Name

Myocardial infarction (disorder)SCTID: 751689013

Preferred term Myocardial infarctionSCTID: 37436014

SNOMED CT-AU SNOMED CT-AU 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 has an attribute of Laterality Procedure has an attribute of Access

Concepts within the top-level hierarchies exist in a poly-hierarchical structure

Pneumonia

Pneumonitis Lung consolidation

Inflammatory disorder of lower respiratory tract

Disorder of lung

Disorder of lowerRespiratory system

Is AIs A

Is A Is A

Is AIs A

Is A

SNOMED CT-AU SNOMED CT-AU

Role grouping

SNOMED CT-AU SNOMED CT-AU Attributes

Viral Bronchitis

Bronchitis

Is A

Virus (organism)

Infectious process(morphologic abnormality)

Bronchial structure(body structure)

Inflammation(morphologic abnormality)

Causative agent

Pathological process

Associated morphology

Finding site

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’



Reference sets Reference sets 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

Reference set Reference set SNOMED CT

concept

Clinical finding

Cyanosis BronchitisVascular disease

Embolism

Pulmonary embolism

Bronchiolitis

Refset

Cyanosis Bronchitis

Pulmonary embolism

Bronchiolitis

Benefits

Why should we use SNOMED CT-AU?

Benefits

Why should we use SNOMED CT-AU?

Classifications and TerminologiesClassifications and Terminologies

BenefitsWhy should we use SNOMED CT-

AU?


AU? At Data Entry

Content coverage Specificity One concept with multiple descriptions

BenefitsAt Entry - Example

BenefitsAt Entry - Example

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


AU?


AU? For communication

Standard terminology across the system Unambiguous concept identification


AU?


AU? 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

For Retrieval – Example –

Viral Pneumonia For Retrieval – Example –

Viral Pneumonia Example

ICD-10-AM

Diseases of the Respiratory System

|Influenza and Pneumonia

|J12.9 – Viral Pneumonia, NEC

|J12.9 – Viral Pneumonia, unspecified

Viral Pneumonia Will return in searches relating

to

Viral Pneumonia Will return in searches relating

to SNOMED CT-AU ICD-10-AMDisorder of respiratory systemPneumoniaViral pneumonia

Infectious diseasesInflammatory disordersInfection by sites (lung etc)Viral infectionsRespiratory conditions that have had related procedures

SNOMED CT uses its hierarchies and attributes to allow retrieval queries to be written

Diseases of respiratory systemInfluenza’s and PneumoniaViral Pneumonia

ICD was developed to quantify and fund inpatient events which it will continue to do


AU?


AU? 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

How do I use SNOMED CT-AU ?


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

What is the best way to

implement? What is the best way to

implement?

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

Searching functionality - TIPS


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!!!

How do I implement now?


Options are:

Natively (with basic searching criteria)

Use Mappings ..(more on this later)



Steps to implement into a specific data element

Steps to implement Steps to implement

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

Use Cases Use Cases

Does this include medications? Does this include foods? Does this include organisms? Does this include chemicals?


Context in relation to definition


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



AMT Product/ Pharmaceutical Biologic hierarchy

‘Pepzan’‘Brolene eye drops’

Substance hierarchy‘penicillin’‘latex’

Clinical finding hierarchy‘allergy to penicillin’


Steps to implement Steps to implement 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

Steps to implement Steps to implement 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

Steps to implement Steps to implement Unpack reference sets – technical processes Use Australian language reference set Ensure searching functionality works Test it

Mapping Mapping 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

Mapping Mapping Type 1Mapping 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

Mapping Mapping Type 1Should 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 bronchitisOld termset content mapped to SNOMED CT content

Mapping Mapping

Perceived as semi-automation of traditional ICD codingMore accurately regarded as transformation

Take SNOMED CT contentFind suitable ICD candidateInclude ICD rules – NOTE INCLUDES, EXCLUDES, NOS,

NECAssign ICD-10 code for use in reporting

Type 2

CONCEPTID SNCT DESCRIPTION MAP GROUP MAP ADVICE TARGET CODE ICD DESCRIPTION

1 ALWAYS S06.90 S06.90

Intracranial injury, unspecified, without

open intracranial wound

2 ALWAYS S02.90 S02.90Fracture of skull and

facial bones, part unspecified, closed

111613008

Closed skull fracture with

intracranial injury (disorder)

Can’t find the concepts I need…

Can’t find the concepts I need…

Try under a different name or wording

Contact the service desk ([email protected])

Submit a request submission to NEHTA ([email protected])

mailto:[email protected]


[email protected]

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Thanks and any Questions?

Acknowledge challenges and the journey to implementation that we all face


overview, benefits and how to approach implementing - robyn richards (nehta)

Documents

snomed ctau attributes

snomed ctau overview

international snomed

concept id

au additions

types of attributes

preferred terms

unique text string