W4G SNOMEDCT

SNOMED Structured electronic Records Programme : SNOMED Structured electronic Records Programme Dr Grant Kelly GP CfH Clinical Lead for SNOMED


And you? : And you? All interested(!) Some clinically grounded? Some background of data? Teaching data usage? GP/PCTs/Community only? READ codes & QoF,ICD/OPCS? ……well taught clients?


SNOMED is different : SNOMED is different SNOMED & CRS are one Almost all problems will be common At different times It isn’t a primary vs. secondary affair It must be managed


Your (eventual) clients? : Your (eventual) clients? 130,000 doctors 400,000 nurses Physios AHP’s Pharmacies Opticians Labs, etc ……… a big affair


What’s CRS? : What’s CRS? Records and systems Data handling Process alterations in care provision Continuity of care Moving decisions around Moving actions around A federating process A change process Management and control All those staff….. ……where do we start?


Slide7 : MH Partners GPs PH Trusts SS HA


Slide8 : DVLA HA SS Partners GPs CRS PH Trusts MH EPR


Why SNOMED? : Why SNOMED? Machines are thick They don’t understand what you tell them They don’t think what you want They can’t guess what you’re after They can’t cope with change They need a translator They need electronic glue SNOMED is that glue


SNOMED properties : SNOMED properties Coding and Terming Translates words into ‘live’ data Allows ordered storage/recall Allows manipulation Allows analysis Allows dissemination Grows with medicine


SNOMED vs. READ/ICD/OPCS? : SNOMED vs. READ/ICD/OPCS? Multi-axial Contextual Replicable anywhere Infinitely extensible Future-proofed Benefits clear Problems equally so


Micro scale – the consultation : Micro scale – the consultation How you enter data How you wrap it What you do with it Effects on consultation Individually recall Group recall Audit thinking POMRs Data into knowledge Knowledge into safety DECSI Disease/drug Drug/drug Disease/genetics Genetics/drugs Subtle or not so Legal points too


MACRO scale : MACRO scale Anytime, anyplace, anywhere Aggregation Disease tracking PH Hospital activities PbR Planning in the round “eMailing for Health”


SNOMED because… : SNOMED because… What matters is the structure & thinking in EPRs Terminology exists to support that Transforms consultation Transforms care, its planning and provision By way of Transmission of meaning Context wrapping ..SNOMED Structured electronic Records Programme


What does it look like? : What does it look like? Puzzling! ConceptID 22298006 FSN: Myocardial Infarction (Disorder) DescriptionID 751689013 Preferred Term: Myocardial Infarction DescriptionID 37436014 Synonym: Cardiac Infarction DescriptionID 37442013 Synonym: Heart attack DescriptionID37443015 Synonym: Infarction of Heart DescriptionID 37441018


Makeup : Makeup Codes/ID’s Fully specified name Preferred Term Synonymy Semantic composition Relationships Sub-type (hierarchies) Defining Qualifiers Context management Cross-maps


Relationships Attributes : Relationships Attributes Defining Qualifying Historical Additional 50+ Finding site Associations with Causative agent Severity Episodicity Due to Occurrence, etc


Concepts in SNOMED : Concepts in SNOMED Clinical Finding Procedure/intervention Observable entity Body structure Organism Substance Pharmaceutical/biologic product Specimen Special concept Physical object Physical force Events Environments/ geographical locations Social context Context-dependent categories Staging and scales Attribute Qualifier value


Populating screens - FSN : Populating screens - FSN dressing (oneself) dressing (e.g. a bandage) dressing (assisting the person to dress) dressing (of wound) dressing (observable entity) parent: personal care activity dressing, device (physical object) dressing patient (procedure) dressing of wound (procedure)


So how to get it down as data? : So how to get it down as data? Subsets CUI Training System design Post coordination


Why SSeRP? : Why SSeRP? Learn the lessons Make it easy for clinicians Make knowledge systematic across the enterprise Teach them first Congruent systems and people Get a uniform level Standardise where relevant


How? : How? Early Adopters Content, Function & Presentation Education & Training Subsets & datasets Primary care


What do you need? : What do you need? Systems Can term successfully Staff Who understand what they are doing And why Support services Provision Maintenance Congruence Comms The Emperor………


A business case : A business case Clinical Admin Political Local National Perpetual


Code factory : Code factory SDO Releases Congruency Updating Mapping/Back mapping Replacement Licensing Namespace handling Help Triage system? Documentation Standards Subsets Create Maintain Control/Release cycle ………….


Subsets : Subsets Systems Uptake Congruence Manageability Refinement People Socialise and educate Acceptance Work flow ISB


E & T elements : E & T elements ‘Back-office’ Pilots Notation (standard) Change advice Lead-in Reassurance ‘People’ Why & when The power of recall Audit principles Audit structures Training cascade Research


Systems : Systems UI/storage/querying/data in motion Messaging Record architecture Releases/Updates/Congruence Legacy Private Sector P-C SNOMED


Testing : Testing Interchange Uploads &Updates Retirement Backwards compatibility Language use


How do we get there? : How do we get there? Where? Roadmap Compliance levels 1-5 Text only Other coding systems + transmit +translate Cut-down pre-coord internally and for comms ‘Full’ pre-coord internally & externally Post-coord native build or specialty builds Timing & training issues Date is crucial


Primary Care : Primary Care Mixed picture! Hospitals discharges structured GP2GP between systems Increasing legacy problems NICE C&B PSIS & DM&D Hard for suppliers


Shoehorning SNOMED into legacy : Shoehorning SNOMED into legacy Inability to display terms more than 40 characters Inability to store adequate number of concepts in data tables Inability to display or navigate hierarchy Inability to deal with synonyms (more than one description) Absent or limited ability to post-coordinate Limited ability to append text Uncertainty over standard logical NHS Clinical Information Model


Strategy : Strategy Engagement Mapping issues Missing documentation Standardise term-finding Reporting changes (Clin, QMAS, QoF) DM&D and PSIS issues Attachment handling/Doc ontology E&T


Other interests : Other interests PbR Private sector Contractors Insurance industry Research Universities The non-CfH world CMO & SSDO


CMO view…. : Your work on developing and implementing System Nomenclature for Medicine — Clinical Terms (SNOMED—CT) is key to achieving the necessary standardisation of clinical terms and I agree that this is an issue that is wider than NHS Connecting for Health. I am aware that, with the approval of ministers, NHS Connecting for Health is taking action with other countries to secure SNOMED-CT as an accepted standard with the potential for wider global use for the future. It is appropriate therefore that we now tackle the issues of context to ensure that, as the standard becomes ubiquitous, we have satisfactorily addressed the issues of patient safety and usability by clinicians. CMO view….