SNOMED CT

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Explains how SNOMED CT connected to internet of EMRs and related to healthcare. For more information visit: http://www.transformhealth-it.org/

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SNOMED CT:

SNOMED CT S ystematized N omenclature O f M edicine – C linical T erms ---An introduction --- Dr Karanvir Singh MBBS, MS, FRCS (Glasgow) Chief Medical Information Office Apollo Hospitals India 1

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2 US UK

Most of us own smartphones…:

Most of us own smartphones… 3

Slide4:

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

An EMR alone is like a ‘dumb’ phone Snomed CT is the internet of EMRs:

An EMR alone is like a ‘dumb’ phone Snomed 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 5

Let us see how it is better than existing healthcare coding systems:

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

More clinical terms:

More clinical terms 7

Codes for Ectopic Pregnancy in ICD-10 :

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

Terms for Ectopic pregnancy in SNOMED CT :

Terms for Ectopic pregnancy in SNOMED CT Abdominal pregnancy Membranous pregnancy Aborted ectopic pregnancy Mesenteric pregnancy Angular pregnancy Mesometric pregnancy Cervical pregnancy Miscarriage of tubal ectopic pregnancy Combined heterotopic pregnancy Multiple pregnancy involving intrauterine pregnancy and tubal pregnancy Combined intrauterine and ovarian pregnancy Mural pregnancy Combined pregnancy Ovarian pregnancy Combined tubal and intrauterine pregnancy Rudimentary horn pregnancy Compound ectopic Ruptured ectopic pregnancy Cornual pregnancy Ruptured tubal pregnancy Delivery of viable fetus in abdominal pregnancy Secondary abdominal pregnancy Fallopian pregnancy Simultaneous intrauterine and extrauterine pregnancies Fallopian tube pregnancy Tubal abortion Heterotopic pregnancy Tubal pregnancy Intraligamentous pregnancy Unruptured tubal pregnancy Intraperitoneal pregnancy Viable fetus in abdominal pregnancy 9

Multiple ‘ancestors’:

Multiple ‘ancestors’ 10

Pneumonia – as classified in ICD-10 :

P neumonia – as classified in ICD-10 Section Code Title Infectious disorders B01.2 Varicella pneumonia Infectious disorders B05.2 Measles complicated by pneumonia Infectious disorders B20.6 HIV disease resulting in Pneumocystis carinii pneumonia Diseases of respiratory system J10.0 Influenza with pneumonia , other influenza virus identified Diseases of respiratory system J11.0 Influenza with pneumonia , virus not identified Diseases of respiratory system J12 Viral pneumonia , not elsewhere classified Diseases of respiratory system J13 Pneumonia due to Streptococcus pneumoniae Diseases of respiratory system J14 Pneumonia due to Haemophilus influenzae Diseases of respiratory system J15 Bacterial pneumonia , not elsewhere classified 11

Poly-hierarchy:

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

ICD is running out of codes:

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 13

ICD is running out of codes:

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

Snomed CT has no limits on the codes that can be used:

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

Comparison of existing coding systems:

Comparison of existing coding systems Coding system ICD-10 ICD-10 PCS LOINC NANDA CPT4 SNOMED CT Diagnosis Yes No No Partial No Yes Procedures / operations No (except pregnancy related) Yes No No Yes Yes Laboratory No No Yes No No Yes Nursing No No No Yes No Yes Special context ( e.g not diabetic ) No No No No No Yes Meaning based analytics No No No No No Yes 16

Will SNOMED CT replace ICD-10?:

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

Let us look at the nuts & bolts of SNOMED CT:

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

These are four different conditions (clinical ideas):

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

Each concept has a random concept number:

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 20

The same concept has different translations:

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

Independent system of classification:

Independent system of classification Concept Concept ID Ischaemic Heart Disease 414545008 Angina 194828000 Unstable Angina 4557003 Myocardial Infarction 22298006 Heart Attack 22298006 Cardiac Infarction 22298006 MI 22298006 22

Poly-hierarchy:

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

Thus…:

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 24

How do multiple relationships help?:

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

Multiple types of relationships:

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

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

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

Slide29:

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

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

List me all patients with cellulitis:

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

Associated morphology = Cellulitis*:

Associated morphology = Cellulitis* 32 Cellulitis of foot Cellulitis of foot excluding toe Cellulitis of forearm Cellulitis of forehead Cellulitis of gingiva Cellulitis of groin Cellulitis of hand Cellulitis of hand excluding finger Cellulitis of head Cellulitis of heel Cellulitis and abscess of lower leg Cellulitis and abscess of lower limb Cellulitis and abscess of neck Cellulitis and abscess of nose (external) Cellulitis and abscess of perineum Cellulitis and abscess of shoulder Cellulitis and abscess of submandibular region Cellulitis and abscess of temple region Conditions with the word “Cellulitis” within it *Partial data

Associated morphology = Cellulitis*:

Associated morphology = Cellulitis* 33 Cellulitis of foot Cellulitis of foot excluding toe Cellulitis of forearm Cellulitis of forehead Cellulitis of gingiva Cellulitis of groin Cellulitis of hand Cellulitis of hand excluding finger Cellulitis of head Cellulitis of heel Cellulitis and abscess of lower leg Cellulitis and abscess of lower limb Cellulitis and abscess of neck Cellulitis and abscess of nose (external) Cellulitis and abscess of perineum Cellulitis and abscess of shoulder Cellulitis and abscess of submandibular region Cellulitis and abscess of temple region Beat knee Chronic recurrent streptoccocal erysipelas Cutaneous erysipeloid Disseminated cutaneous erysipeloid Erysipelas Erysipelas of lower limb Erysipeloid Facial erysipelas Localized cutaneous erysipeloid Ludwig's angina Onychia of finger Phlegmon Postpartum AND/OR puerperal erysipelas Recurrent erysipelas Seal finger Conditions with the word “Cellulitis” within it Conditions even without the word “Cellulitis” *Partial data

How relationships help in decision support :

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 34

How is it used in a hospital’s EMR?:

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

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

Leveraging relationships:

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

SubTypes (All descendants):

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

Value set binding: SNOMED supplies the lists:

Value set binding: SNOMED supplies the lists 39

How will clinicians benefit from it?:

How will clinicians benefit from it? 40

ICD-10 has very limited search – no synonyms:

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

No abbreviations in ICD-10 :

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

ICD-10 terms are not appropriate for printing:

ICD-10 terms are not appropriate for printing   What the doctor wants to write What is available in ICD-10 tables – prints as such   Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease, Unspecified   Ureterocele Other specified disorders of kidney and ureter   Neonatal tetanus Other tetanus   Achlorhydria Other specified diseases of stomach and duodenum   Recurrent appendicitis Other appendicitis   Indirect inguinal hernia Inguinal hernia   Direct inguinal hernia Inguinal hernia   Strangulated inguinal hernia Unilateral or unspecified inguinal hernia, with obstruction, without gangrene   Hepatic encephalopathy Hepatic failure, not elsewhere classified   Bird flu (H5N1) Influenza due to certain identified influenza virus   Swine flu (H1N1). Influenza due to certain identified influenza virus

ICD-10 codes are not appropriate for printing:

ICD-10 codes are not appropriate for printing   What the doctor wants to write What is available in ICD-10 tables – prints as such   Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease, Unspecified   Ureterocele Other specified disorders of kidney and ureter   Neonatal tetanus Other tetanus   Achlorhydria Other specified diseases of stomach and duodenum   Recurrent appendicitis Other appendicitis   Indirect inguinal hernia Inguinal hernia   Direct inguinal hernia Inguinal hernia   Strangulated inguinal hernia Unilateral or unspecified inguinal hernia, with obstruction, without gangrene   Hepatic encephalopathy Hepatic failure, not elsewhere classified   Bird flu (H5N1) Influenza due to certain identified influenza virus   Swine flu (H1N1). Influenza due to certain identified influenza virus

Summary:

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 45

Questions through the THIT app please:

Questions through the THIT app please 46

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