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About SNOMED CT

About SNOMED CT. 40 year old medical terminology 322,544 concepts (and growing) Attempting an ‘in situ’ migration to EL+ And ‘seamless’ deployment into an industry based on enumerated classifications 18-country international effort, $9.3M annually. SNOMED CT in UK. Many secondary care sites

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About SNOMED CT

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  1. About SNOMED CT • 40 year old medical terminology • 322,544 concepts (and growing) • Attempting an ‘in situ’ migration to EL+ • And ‘seamless’ deployment into an industry based on enumerated classifications • 18-country international effort, $9.3M annually

  2. SNOMED CT in UK • Many secondary care sites • Some primary care • 13,353,775 Summary Care Records • 33M Choose & Book referrals • Electronic TFR of prescriptions • Soon: Radiology & Pathology messaging

  3. Issues • Change management • Migration from/integration with legacy systems • Changes in SNOMED CT itself • Death by 1,000 mutual dependencies • Implementation skills • User interfaces (or, data repair) • Tools • Time to load & classify • Content refactoring • ‘Linkage’ to external resources • Business case

  4. SNOMED CT39 months @ a busy UK A&E Department • One ‘reason for encounter’ code per completed visit • 408,823 coded episodes • 39 months (Oct 2008 – Dec 2011) • 12,323 distinct codes selected at least once • 8,387 not coded (or uncodable?) = 1 in 50 episodes • 20-50% miscoding rate

  5. Relative code use

  6. 7.8% ‘Ontology-driven’ miscoding…

  7. Miscoding examples 1097 Temperature 246508008|Temperature (attribute)| • Drug used 246488008|Drug used (attribute)| 373 ETOH - Alcohol intake 160573003|Alcohol intake (observable entity)| 136 Nasogastric tube 17102003|Nasogastric tube, device (physical object)| 82 Catheter 19923001|Catheter, device (physical object)| 78 Dressing 37898001|Dressing, device (physical object)| 110 53570002|Removal of foreign body from eye (procedure)| 83 172828005|Removal of foreign body from nose (procedure)| 43 172278002|Removal of foreign body from eyelid (procedure)| 293 82576008|Retained foreign body in eye (disorder)| 166 74699008|Foreign body in nose (disorder) 7 25012008|Retained foreign body of eyelid (disorder)|

  8. Variable Data Quality • 23% of 74 abdominal aortic aneurysms miscoded as a Drug Trade Family (9192101000001100 AAA (product)); AAA make sore throat spray(and not much else) • 25% of 939 stabbing victims miscoded as a qualifier value (‘stabbing sensation quality’, as in heart attack) • 33% of 3771 patients with some form of high temperature miscoded as either an attribute, or a physical force • 38% of 1101 failed consultations (patient left the department, or did not attend an appointment) miscoded as either a laterality (left) or as deoxyribonucleic acid (DNA = Did Not Attend) • 44% of 575 patient attending with a fish bone stuck in their throat miscoded as the bone itself (7661006|Fish bone (substance)|) • 49% of 5,062 alcohol-related attendances miscoded as either the substance (alcohol, ethyl alcohol) or just feeling elated/intoxicated but not necessarily involving alcohol intake at all

  9. Not all bad news:Admissions for sickle cell • Clinical impression • ‘They stop coming once they get older; most of the attendances will be in the 15-20 age group’ • Clinical lore • Cold weather triggers attacks‘People with sickle cell disease should try to avoid any potential triggers for a sickle cell crisis as much a possible. For example: try to keep warm in cold weather, try to avoid becoming dehydrated and take precautions if you undergo extreme exercise’(patient.co.uk) • Clinical Data…???

  10. WINTER 2008-9 But: We could probably have got this particular result using ICD. Overall, is the ontology (as implemented) helping or hindering primary data capture and secondary data analysis?

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