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SNOMED CTAn opportunity – and a necessity
Dr Bev Nicolls
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ACC
NPF
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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
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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
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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.
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SNOMED CT
….on FHIR
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Fast Healthcare Interoperability
Resources
My thanks to David Hay (Product Strategist, Orion Health) for the next slides 8
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Establishing the ecosystem
Terminology
Security
Identity Data
FHIR API and Resources
Conformance
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FHIR – a system of standards for the communication of health ‘Resources’
Clinical - Identification - Workflow - Infrastructure - Conformance - Financial
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The FHIR Service
11
Metadata Narrative(text)
ExtensionsStructured Data including SNOMED
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SNOMED CT
…. continued
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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
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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
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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
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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.
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ACC
NPF
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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
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The GP Clinical Terminology user:Business as usual for 2 decades.
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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
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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.
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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.
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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:
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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