Overview, Benefits and how to approach Implementing - Robyn Richards (NEHTA)
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Transcript of 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 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 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’
Pre and Post-coordination
Pre and Post-coordination
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
BenefitsWhy should we use SNOMED CT-
AU?
BenefitsWhy should we use SNOMED CT-
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
BenefitsWhy should we use SNOMED CT-
AU?
BenefitsWhy should we use SNOMED CT-
AU? For communication
Standard terminology across the system Unambiguous concept identification
BenefitsWhy should we use SNOMED CT-
AU?
BenefitsWhy should we use SNOMED CT-
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
BenefitsWhy should we use SNOMED CT-
AU?
BenefitsWhy should we use SNOMED CT-
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 ?
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
How do I use SNOMED CT-AU ?
How do I use SNOMED CT-AU ?
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
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
Searching functionality - TIPS
Searching functionality - TIPS
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?
How do I implement now?
Options are:
Natively (with basic searching criteria)
Use Mappings ..(more on this later)
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?
Adverse reaction substance: Substance that is responsible for a reaction in a patient
Context in relation to definition
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
Context in relation to definition
Context in relation to definition
AMT Product/ Pharmaceutical Biologic hierarchy
‘Pepzan’‘Brolene eye drops’
Substance hierarchy‘penicillin’‘latex’
Clinical finding hierarchy‘allergy to penicillin’
Adverse reaction substance: Substance that is responsible for a reaction in a patient
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])
Click icon to add picture
Thanks and any Questions?
Acknowledge challenges and the journey to implementation that we all face