SNOMED CT

1. SNOMED CT Systematized Nomenclature Of Medicine – Clinical Terms ---An introduction --- Dr Karanvir Singh MBBS, MS, FRCS (Glasgow) Chief Medical Information Office Apollo Hospitals India

2. US UK

3. Most of us own smartphones…

4. This is what we use them for Now imagine the uses if you remove internet connectivity Voice calls SMS Camera A few games

5. An EMR alone is like a ‘dumb’ phoneSnomed CT is the internet of EMRs It connects healthcare data across all entities + Allows very granular clinical data capture Provides very powerful clinical analytics It supports clinical decision support … and is used in over 50 countries. It is the best clinical terminology system today

6. Let us see how it is better than existing healthcare coding systems Let us compare it with ICD-10

7. More clinical terms

8. Codes for Ectopic Pregnancy in ICD-10 • ICD-10 has five codes (terms) only • Abdominal • Tubal • Ovarian • Others • Unspecified

9. Terms for Ectopic pregnancy in SNOMED CT

10. Multiple ‘ancestors’

11. Pneumonia – as classified in ICD-10

12. Poly-hierarchy Disease Infections Lung disorders Infectious disease Disorder of lung Viral disease Lower respiratory tract infection Viral infection Infectious disease of lung Viral respiratory infection Infective pneumonia Viral pneumonia

13. ICD is running out of codes • Since code numbers are the main stay of classification, and the number of diseases are very large in number, ICD is running out of codes. • Multiple disorders are being grouped under one code

14. ICD is running out of codes • Since code numbers are the main stay of classification, and the number of diseases are very large in number, ICD is running out of codes. • Multiple disorders are being grouped under one code

15. Snomed CT has no limits on the codes that can be used No sharing of codes by two different conditions

16. Comparison of existing coding systems

17. Will SNOMED CT replace ICD-10? Yes & No • Clinical modules & analytics would benefit from SNOMED CT • The medical records departments will continue ICD-10

18. Let us look at the nuts & bolts of SNOMED CT

19. These are four different conditions (clinical ideas) • Ischemic heart disease • Angina • Unstable angina • Myocardial infarction • Heart attack • Cardiac infarction • MI Same clinical meaning (idea) Each clinical idea is called a concept

20. Each concept has a random concept number • Ischemic heart disease 414545008 • Angina 194828000 • Unstable angina 4557003 • Myocardial infarction • Heart attack • Cardiac infarction • MI Same clinical meaning (idea) 22298006

21. The same concept has different translations • Ischemic heart disease 414545008 - cardiopatíaisquémica • Angina 194828000 - angina de pecho • Unstable angina 4557003 - síndromepreinfarto • Myocardial infarction • Heart attack • Cardiac infarction • MI Same clinical meaning (idea) 22298006 - infarto de miocardio

22. Independent system of classification

23. Poly-hierarchy Disease Infections Lung disorders Infectious disease Disorder of lung Viral disease Lower respiratory tract infection Viral infection Infectious disease of lung Viral respiratory infection Infective pneumonia Viral pneumonia

24. Thus… • Each clinical idea is a concept and has a unique concept number • Each concept number has multiple terms for it • In different languages… • There is no limit on the number of concepts. Hence different conditions do not have to share the same code • Concepts are connected to other concepts (parents / children) independent of their codes – multiple relationships • There are other relationships also, defining different properties of a concept

25. How do multiple relationships help? Disorder of foot Cellulitis of lower limb Is a Is a Cellulitis of foot

26. Multiple types of relationships Disorder of foot Cellulitis of lower limb Is a Is a Cellulitis of foot Cellulitis Foot structure Associated morphology Finding site

27. Disorder of foot Cellulitis of lower limb Is a Is a Cellulitis of foot Cellulitis Foot structure Associated morphology Finding site Is a Is a Cellulitis of toe Cellulitis of heel

28. Disorder of foot Cellulitis of lower limb Is a Is a Cellulitis of foot Cellulitis Foot structure Associated morphology Finding site Is a Is a Is a Cellulitis Toe structure Cellulitis of toe Associated morphology Finding site Cellulitis of heel

29. Disorder of foot Cellulitis of lower limb Is a Is a Cellulitis of foot Cellulitis Foot structure Associated morphology Finding site Is a Is a Is a Is a Cellulitis Toe structure Cellulitis of toe Associated morphology Finding site Heel structure Cellulitis of heel Cellulitis Finding site Associated morphology

30. Disorder of foot Cellulitis of lower limb Is a Is a Cellulitis of foot Cellulitis Foot structure Associated morphology Finding site Is a Is a Is a Is a Cellulitis Toe structure Cellulitis of toe Associated morphology Finding site Heel structure Cellulitis of heel Cellulitis Finding site Associated morphology

31. List me all patients with cellulitis Disorder of foot Cellulitis of lower limb Is a Is a Cellulitis of foot Cellulitis Foot structure Associated morphology Finding site Is a Is a Is a Is a Cellulitis Toe structure Cellulitis of toe Associated morphology Finding site Heel structure Cellulitis of heel Cellulitis Finding site Associated morphology

32. Associated morphology = Cellulitis* *Partial data Conditions with the word “Cellulitis” within it

33. Associated morphology = Cellulitis* *Partial data Conditions with the word “Cellulitis” within it Conditions even without the word “Cellulitis”

34. How relationships help in decision support Pick up all cases of cerebrovascular accident for consideration for thrombolytic therapy Use it to identify potential cohorts for clinical trials for a new breast cancer drug. Warn if the patient has any type of diabetes AND any type of kidney disease

35. How is it used in a hospital’s EMR?

36. The hospital’s EMR software Snomed CT Terminology services (Snomed CT) Record services (EMR) Patient Ram Lal, age 56, admitted with a diagnosis of Herni Hernia Inguinal hernia Indirect inguinal hernia Indirect inguinal hernia with obstruction

37. Leveraging relationships Operations on the foot We can show all the SubType concepts of E in the operation list of a foot surgeon

38. SubTypes (All descendants) Operations on the foot Foot incision Foot joint operations Division of muscle of foot Tenotomy of abductor hallucis muscle

39. Value set binding: SNOMED supplies the lists

40. How will clinicians benefit from it?

41. ICD-10 has very limited search – no synonyms • The doctor may search for any of these terms for the same diagnosis • Renal calculus • Renal stone • Nephrolith • Calculus in kidney • Kidney stone • Kidney calculus • Only the term Calculus in Kidney exists in ICD-10 • Such issues are present with most diagnosis

42. No abbreviations in ICD-10 • The doctor may search by typing • COPD • MI • IHD

43. ICD-10 terms are not appropriate for printing

44. ICD-10 codes are not appropriate for printing

45. Summary • Snomed CT is the terminology that supports the EMR. On its own it does nothing • It is very clinician friendly • It is multilingual • It allows very powerful data analytics • It augments decision support capabilities of an EMR

46. Questions through the THIT app please