▪ Background▪ SNOMED International

▪ Collaborations

▪ 2018 developments

▪ Information models

▪ Extensions

Agenda

▪ International not-for-profit association, based in the UK

▪ Owns and maintains SNOMED CT on behalf of, and in

partnership with, its member countries

▪ Funded by countries based on national wealth (GDP)

▪ Provides SNOMED CT free to use in member countries

▪ Affiliate licenses for institutions in other countries

SNOMED International

Our

Members

4

Argentina Luxembourg

Slovenia

5

What is SNOMED CT?

The world’s most comprehensive multilingual

clinical language

• A resource with comprehensive, scientifically validated clinical content

• Enables consistent representation of clinical content for processing in

electronic health records

• Maps to international standards (ICD-10, OPCS-4, GMDN, ICPC-2, LOINC, etc.)

• Used in more than fifty countries

How Does SNOMED CT Work?

• Enables the global exchange of medical

information through a codified language that

represents groups of clinical terms

• Represents clinically relevant information

consistently, reliably and comprehensively as an

integral part of producing electronic health

information.

• Provides a standardized way to represent clinical

phrases captured by the clinician and enables

machine processable semantics automatic

interpretation of those phrases.

How Does SNOMED CT Work?

SNOMED CT contains

concepts with unique

meanings and formal logic

based definitions.

It is organized into

hierarchies and represented

using 3 types of components.

▪ International release (6 monthly – January and July)

▪ Extension (dependent on the international release)

▪ Subset (reference sets)▪ Defined set of SNOMED CT terms based on specific

requirements

▪ Release files▪ Concept, Descriptions, Relationships

▪ Ontology▪ Classified view of the concepts included in the release

▪ Supported by a defined concept model (attributes)

SNOMED CT

Our Focus on Quality

SNOMED International key collaborations

▪ WHO – ensuring linkage between SNOMED CT and WHO

classifications – ICD-10, ICD-11, ICD-O, (ICF)

▪ HL7 – ensuring appropriate use of SNOMED CT in HL7 v2, v3, CDA

and FHIR

▪ ICN – Linking SNOMED CT to ICNP

▪ DICOM – SNOMED CT set used globally in DICOM Digital Imaging

standard

▪ ISO TC 216 Health Informatics – contributing to development based

on SNOMED CT requirements to interoperate

▪ ADA - alignment between SNOMED CT and SNODENT

▪ GS1- Linking SNOMED CT and GTINs (bar coded information on

medicinal products)

▪ WONCA - general/family practice subset and maps to ICPC2

. . . and many more

Purpose

To enable users to utilise SNOMED CT interoperably with other information standards, all

have agreed joint deliverables

▪ Content

▪ Quality assurance/clean up of

existing content

▪ Drugs – implementation of new

drugs model

▪ Creation of content and

development of maps to EDQM

and UCUM

▪ Substances – update and

refinement of existing content

▪ Orphanet – continuation of

content developm,ent and

crteation of linkage table

▪ ICD-11 – creation of content,

and development of supporting

m,apping products

▪ Technical

▪ Support for Description

logic changes within

SNOMED CT

▪ Development and roll-out

of batch template authoring

▪ Continued roll-out of

Managed Service

▪ Support for the content

quality assurance clean up

▪ General support for content

enhancement activities

2018 developments

▪ Customer relations

▪ Four new counties in the

process of joining SNOMED

International

▪ Roadmap for mobile health,

consumer health research and

big data/analytics

▪ Genomics

▪ Alignment of SNOMED CT

with HPO

▪ Pilot site(s)

▪ Implementation maturity matrix

▪ Vendor maturity matrix

▪ Development of SNOMED In

Action web portal

▪ Education

▪ Development of clinical

pathway

▪ Development of materials

to support vendors – e.g.

“Why implement SNOMED

CT?”, “Where do I start?”

▪ Development of guidance

documentation, for

example “SNOMED CT In

FHIR terminology

services”, and “Migrating

systems to SNOMED CT”

▪ Support the increase

globally of available

SNOMED CT expertise

2018 developments

The interoperability challenge

General practice

Ambulance/Emergency services

Hospitals

Allied health professions

Pathology

Diagnostic imaging

Specialists

Pharmacists

Patient

record“I have breathing problems sometimes”

“I am an asthmatic”

“I have asthma attacks”

“I am diagnosed with respiratory disease”

▪ Retrieval and reuse may miss similar information

represented in different structure/terminology

combinations

▪ For example, representing Family history of asthma▪ A ‘family history’ check list with ‘asthma’ marked ‘yes’

▪ A ‘family history’ section referring to the SNOMED CT concept

‘asthma’

▪ A record entry referring to the ‘family history of asthma’ using a

single SNOMED CT concept

▪ A record entry containing a SNOMED CT expression such as

‘family history : associated finding = asthma’

▪ A record entry containing the SNOMED CT concept ‘asthma’

associated to a ‘family member’ by an information model

▪ A patient record recording the information using ICD-10

Same information represented in

different ways

▪ Statements in EHR‟s ▪ Electronic health record is made up of a series of clinical assertions

▪ Codes are the values for fields/slots in the information

model ▪ Codes from the terminology fill in some or all of the statement body

▪ Information model determines the fields/slots that are available

▪ Coordination required to avoid gaps and overlaps

between: ▪ Terminology model

▪ Information model

Where does SNOMED CT go in the

EHR?

Types of Information Models

Information models

Clinical Models

Document specifications

Document encodings

Use case

driven +

business

requirements

System/platfo

rm driven

CONCEPTUAL

LOGICAL

IMPLEMENTABLE

CARE SUMMARY CDA (XML)

PRESCRIPTION (HL7 V2)

NURSING HANDOVER FHIR

DISCHARGE SUMMARY

CARE PLAN

CLINICAL NOTE

PARTICIPATION

NURSING

ASSESSMENTADVERSE REACTION

PROBLEM DIAGNOSISPROCEDURE

ASSESSMENT SCORE

▪ Terminologies

▪ SNOMED CT

▪ LOINC

▪ RxNORM

▪ AMT

▪ Classifications

▪ ICD-9CM

▪ ICD-10

▪ ICD-10CM, AM etc

▪ ICPC-2

▪ ICNP

▪ NIC, NOC, NANDA

▪ Messaging

▪ HL7 (V2, CDA, FHIR)

▪ Content Modelling

▪ Clinical Archetypes (CEN

13606)

▪ openEHR

▪ CIMI

Information standards (examples)

What are SNOMED CT national

extensions ?

SNOMED CT

International

Release

National

Extension

Dependency

on the

international

release

National release

(International

Release plus

national extension)

What are SNOMED CT local extensions

?

National release

(International

Release plus

national extension)

SN

OM

ED

EX

TE

NS

ION

S

Dependency on

the release

(maybe either

national or

international)

▪ SNOMED CT Identifiers

▪ Called “SCTIDs”

▪ Allow for a part of the code to identify a Namespace

▪ A namespace is controlled by an organization other than SNOMED

International

▪ A namespace can be allocated to any organization with a SNOMED CT

license (national or affiliates)

▪ Extensions should add content that is not required in the

international release

▪ Realm-specific content:▪ Multnomah County (Oregon) jail cell number

▪ Leave granted under the Mental Health Act 1983 (England and Wales)

▪ Should consider the need/requirement for an extension before

committing to building/maintaining one

▪ SNOMED CT is missing content ?▪ Request new code additions through NRC ?

▪ Clear of statement of requirements and justification

A word about extensions . . . .

▪ Interoperability

▪ Primary use of SNOMED CT is to support interoperability

▪ Extension content at a vendor/organizational level can put interoperability at risk

(codes travelling outside the organization cannot be understood)

▪ National extension – standardizes terminology across Belgium

▪ Extensions are useful to develop specific content (such as metadata) required by

a system

▪ Systems in place to ensure local extension content does not travel outside native

system

▪ Dangers of duplication

▪ SNOMED CT has a large amount of content. Adding new content requires

checks to ensure no duplication

▪ Two codes used with the same meaning can be anything from inconvenient to

clinical risk

▪ Maintenance commitment

▪ Authoring of SNOMED CT content in an extension

▪ Reconciliation of extension content, with the new international or national release

(every 6 months)

▪ DO YOU REALLY WANT TO DO THIS ?

Local extensions – things to consider