SNOMED CTAn opportunity – and a necessity

Dr Bev Nicolls

ACC

NPF

Clinical ‘coding’ and terminology systems: a brief overview. ICD• ICD-6, published in 1949, was the first to be shaped to become

suitable for morbidity reporting. The name then changed from International List of Causes of Death to International Statistical Classification of Diseases. • ICD-10 began in 1983. The latest version came into use in WHO

Member States starting in 1994. The classification system allows more than 155,000 different codes and permits tracking of many new diagnoses and procedures, a significant expansion on the 17,000 codes available in ICD-9

READ• The first version was developed in the early 1980s by Dr James Read,

a Loughborough general medical practitioner. The scheme was structured similarly to ICD-9:• Read terminology as used in New Zealand is currently owned by the

NHS in the UK, who maintain the code-sets.• BUT Read is being phased out in the UK in favour of SNOMED:• Read Version 2 in Primary Care Dec 2016• Read Version 3 April 2018• Whole of system SNOMED implementation April 2020

What is SNOMED CT ?• SNOMED Clinical Terms (CT) is a comprehensive clinical terminology for

capturing a wide range of patient information at point of care. • SNOMED was started in 1965 as a Systematized Nomenclature of Pathology

(SNOP)and evolved most recently as SNOMED CT released in 2000• It is the most comprehensive, multilingual clinical healthcare terminology in

the world. (In use in > 50 countries)• It is a resource with scientifically validated clinical content.• It enables consistent, processable representation of clinical content in

electronic health records.• It is mapped to other international standards.

SNOMED CT

….on FHIR

Fast Healthcare Interoperability

Resources

My thanks to David Hay (Product Strategist, Orion Health) for the next slides 8

Establishing the ecosystem

Terminology

Security

Identity Data

FHIR API and Resources

Conformance

FHIR – a system of standards for the communication of health ‘Resources’

Clinical - Identification - Workflow - Infrastructure - Conformance - Financial

The FHIR Service

11

Metadata Narrative(text)

ExtensionsStructured Data including SNOMED

SNOMED CT

…. continued

Where does the NZ Healthcare system fit in?• New Zealand is one of 27 member countries to the International

Health Terminology Standards Development Organisation (IHTSDO) that develops SNOMED. • The National Health IT Board has taken advice from the National

Information Clinical Leadership Group (NICLG) on the benefits of SNOMED in clinical documentation, care coordination and clinical decision support. • SNOMED creates trusted, actionable information. SNOMED is also a

tool for interoperability. • In NZ, the current status of the NHITB work programmes AND the EHR

as a goal lends itself to the introduction of SNOMED

Current main users of terminology systems:• St John: Integrating SNOMED into ePF• NZULM / NZ Formulary: SNOMED• Health One is in the early planning phase to map Read to SNOMED

and display both (initially)• GPs / Pharmacies: Pharmacodes (MIMS)• GPs: Predominantly Read (>90%)• ACC: • Primary Care; ACC injury terminology is based on Read (electronic for GP)• Secondary Care; procedure reporting is / will be ICD-10

Current main users of terminology systems:• Secondary Care:• Limited use of SNOMED in ED• DHB Output coding post event is ICD-10• ACC injury forms – paper-based Read coding• Private specialists: capacity to use Read via use of GP PMS-type systems

• Community providers: Isolated use of ICD 10, Omaha, SNOMED• National Patient Flow: Receiving data from multiple terminologies

Where do we need to be?Themes from HINZ opening addresses:Liz Schoff: The HINZ theme this year is ‘connecting’.

David Meates: To achieve a Person-centred solution we need tools, data and frameworks so that patients can connect with their health care providers and teams. We need to develop, shape and design connected systems.

Minister Coleman: We will have a single health record….hybrid best of suite approach to health information …. a single EHR from a number of smaller systems.

ACC

NPF

The clear message:• We need SNOMED to underpin an EHR particularly in the areas of:• Medicines• Clinical observations• Problem lists / diagnoses• Allergies / Alerts• Decision support tools

• SNOMED is the ‘GLUE’ that binds the clinical community together and is the platform for all clinically relevant information

The GP Clinical Terminology user:Business as usual for 2 decades.

Clinical Terminology: The power of the system:

Patient Administration System

Electronic Referral Management System

Clinical Portal / Workstation

Outpatient Assessment (FSA)

- Diagnostic Code: Inguinal Hernia 'confirmed'

- Procedure Code: Repair Inguinal Hernia

Theatre Management system:Workflow:

- Procedure Code: Repair Inguinal Hernia

GP Referral:Diagnostic Code: Inguinal Hernia 'provisional'

Waiting List Management

eReceipt and Triage

Operation:Code: Repair Inguinal

Hernia - written back to GP and Patient Medical

Record

Ward booking

AUDIT and KNOWLEDGEClinical Audit: OPD mix / conversion System Informatics for review / redesign

Post op dependencyOperation lengthDefault priorityOperating instrument tray

National Patient Flow

In summary:• Implementing SNOMED will be integral to the EHR programme. • Supported (NHS) Read code-sets will be to be phased out from

December 2016• New primary care and hospital information systems will be

SNOMED based. • National Patient Flow project is introducing SNOMED to the

referral and assessment process. • ACC and the Ministry are working together to plan the migration

to SNOMED in primary care and specialist services.

The SNOMED international community holds an annual conference which in October 2016 will be hosted in New Zealand. We are expecting over 300 delegates from around the world. This is a tremendous opportunity to showcase our health IT programme and innovative use of SNOMED.

In short:Clinical Terminology underpins the EHR across all health domains

It’s not an if… it is a when, a necessity to implement a single Clinical Terminology system at the ‘front end’ of healthcare

SNOMED is the National Health IT Board mandated Clinical Terminology system

And a last word of encouragement for Murray Milner:

Clinical Terminology underpins the EHR across all health domains

It’s not an if… it is a when, a necessity to implement a single Clinical Terminology system at the ‘front end’ of healthcare

SNOMED is the National Health IT Board mandated Clinical Terminology system

Thank you