Mi224 snomed santiago & herber 022715

+

SNOMED CT

Alvina Pauline D. Santiago, MD

Burr Herber, RN

For MI224 under Benedict Sandejas, MD

February 28, 2015

+

SNOMED CTJan Michael M. Herber, RN

+

“Diane” Bool, DP, “Tin” Salas, F?. Snomed CT.

Powerpoint presentation

MI 224 Class, 2013-2014.

+

SNOMED CT: Introduction

+IHTDSO.orghttp://ihtsdo.org/fileadmin/user_upload/doc/download/doc_Starter

Guide_Current-en-US_INT_20141202.pdf?ok ,

http://www.ihtsdo.org

http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok

+SNOMED CT elearninghttp://snomed.org/elearning

http://webarchive.nationalarchives.gov.uk/20130502102046/http://www.connect

ingforhealth.nhs.uk/elearning/snomedct/flash/

http://webarchive.nationalarchives.gov.uk/20130502102046/http:/www.connectingforhealth.nhs.uk/elearning/snomedct/flash/

+ SNOMED CT:

Systematized Nomenclature of

Medicine: Clinical Terms

+Snomed CT: Systematized Nomenclature

of Medicine Clinical Terms

Systematic

Organized

Structured

Logical

Consistent

Nomenclature

Collection of

Names

Words

Medicine (clinical

Terms)

Relevant to

Medicine



+SNOMED CT

Most comprehensive, multilingual clinical healthcare

terminology in the world.

Is a resource with comprehensive, scientifically validated

clinical content.

Enables consistent, processable representation of clinical

content in electronic health records.

Is mapped to other international standards.

http://www.ihtsdo.org/snomed-ct/what-is-snomed-ct/history-of-snomed-ct


+SNOMED CT

May be used to represent clinical information consistently,

reliably, comprehensibly as part of producing electronic health

information

Provides standardized way of representing clinical phrases

Clinically validated, semantically rich, controlled vocabulary

Benefits patients and clinicians, individual as well as population

as it supports evidence-based care



+

SNOMED CT: History

HISTORY:

• 1965: Systematized Nomenclature of Pathology (SNOP)

• published by the College of American Pathologists (CAP)• Morphology and anatomy.

• 1975: Systematized Nomenclature of Medicine (SNOMED).

• CAP expanded SNOP under Dr. Roger Cote’s leadership

JMM Herber, 2015

HISTORY:

• 1979: SNOMED II Most widely adopted version

• 1993: SNOMED 3.0 Major expansion and revision

• 2000: SNOMED RT Kaiser Permanente + CAPLogic-based version

RT=reference terminology

JMM Herber, 2015

HISTORY:

• 1980s: Read Codes V1Dr. James Read National Health ServiceClinical terminology coding

• 1990: Read Codes V2

• 1994: Read Codes V3Clinical Terms V3 (CTV3)

JMM Herber, 2015

HISTORY:

• September 1998: merged CTV3 & SNOMED RT• Three-year project under CAP ownership

• January 2002: SNOMED CT Version 1

• 2007: IHTSDO acquired intellectual property rights to all versions of SNOMED.

SNOMED RT

(Reference

Terminology)

SNOMED CT

(Clinical

Terms)

Clinical

Terms

Version 3

(CTV3)

+ =

JMM Herber, 2015

NICE TO KNOW:

Although SNOMED was originally an acronym for Systematized Nomenclature of Medicine, IT LOSTTHAT MEANING when SNOMED was combined with CTV3 in 2002. The merged product wascalled SNOMED Clinical Terms, which was shortened to SNOMED CT.

IHTSDO considers SNOMED CT to be a BRAND NAME, NOT AN ACRONYM.

JMM Herber, 2015

+

+Snomed CT: Structure

https://www.youtube.com/watch?v=ISfoMR4aygc&list=PL842440B7867442B7&index=1


+

SNOMED CT: Benefits

+Benefits of Electronic Record

Reduced storage cost

Can be accessed by multiple

users, at multiple sites,

simultaneously

Can be transferred quickly

Internet connection?

Legible (not necessarily

understandable)

http://www.drexel.edu

http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_Sta

rterGuide_Current-en-US_INT_20141202.pdf?ok


+Benefits of a structured record

Display logical progression of

clinical data

Retrieve clinical data based on

situation or author

Allows clinical data to be

transmitted longitudinally on

patient’s record

Improve continuity of care

Reduce medical error

Decrease duplicate data

entry



+Benefits of SNOMED CT:

Clinical Terminology

Controlled vocabulary

Ability to search records for

clinical information

ID patients who match a set

of criteria

Provision of decision

support

Terms correctly understood

by everyone

Adequate searches,

adequate data, reliable “first”

event

Retrieval of patients more

reliable

Real time Clinical Decision

Support System (CDSS)

easier to use/apply





Public Health Monitoring

Outcome Analysis

Performance Analysis

Population level

Proactive

Disease Outbreaks

Good evidence base for

CPG, PPP

Performance related

Fit to Practice

Adherence to CPG, PPP





Consistent terminology across all care

domains

Allows precise recording of clinical

information

& retroactive data retrieval for research,

management and interventions

SNOMED CT is a developing international

standard

Many languages but same code

Interoperable

http://blog.lionbridge.com

http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuid

e_Current-en-US_INT_20141202.pdf?ok


http://webarchive.nationalarchives.gov.uk

+SNOMED CT: Clinical Information

http://www.liveconsciously.com.au



+Key Determinants of full benefit

Record structure: stores similar info consistently

Ease of data entry: constrain data

Communication: interface retain clinical content structure & coding to

allow receiving system to reuse information based on SNOMED CT

Record storage & indexing optimize semantics used in SNOMED CT

Retrieval: display clinical records with critical information

Real time and batch decision support

Analysis of data for various purposes

http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok ,


+SNOMED CT: Lessons

Reusability requires consistent structured representation

Otherwise, overlaps and conflicts between structure and clinical

terms = ambiguous and conflicting interpretations

For information reuse, queries should be formulated taking into

account information structure and coding.

Human inconsistencies: constrain data entry



+SNOMED CT: Challenges

Diversity of views related to structure of

clinical information

Overlap between models and terminology

Different views on application design

Different requirements for collection of

information

Different views on record structures and

data entry methods

http://mocostudent.org

http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu

rrent-en-US_INT_20141202.pdf?ok ,


+

SNOMED CT: Features

+Snomed CT: Features

Most Comprehensive, multilingual

Healthcare clinical terminology

Scientifically validated clinical content

Enables consistent, processable

representation of clinical content in eHR

Mapped to international standards

Used in more than 50 countriesCatherinecronin.file







+SNOMED CT: Characteristics

Comprehensive

Scalable

Flexible

Maps work to provide explicit

links to health related

classifications and coding

schemes, e.g. statistical

classifications such as ICD-9-

CM, ICD-10, and ICD-O3.

http://jessicachivers.com



+SNOMED CT:

Supporting different languages

Multinational

Multilingual

Built-in framework to

manage languages and

dialects

http://images.sodahead.com



+SNOMED CT: Languages

US English

UK English

Spanish

Danish

Swedish

Canadian French (Partial)

Lithuanian (Partial)

Further translations by IHTDSO Members ongoing http://st.depositphotos.com



+SNOMED CT:

Basics

+SNOMED CT: Basic Structure

Concepts: clinical meaning organized into hierarchies

Hierarchies groups to organize concepts

Description: link appropriate human readable terms to concepts

Fully specified name

Preferred name

Synonyms

Relationships

Connection between concepts



STRUCTURE:

CONCEPT

A single unit of thought or idea with a distinct clinical

meaning.

Unique clinical phrases

Formal logic-based definitions

Identified by a unique numeric identifier that NEVER

CHANGES , which is the Concept ID

Made up of string of digits 6-18 in length, 8-9 on average

Never deleted but may be retired.

JMM Herber, 2015

+Snomed CT: Hierarchies


+SNOMED CT: Top Level Concepts

(Major branch of hierarchy)

CLINICAL FINDING: e.g., |asthma|, |normal breath sounds|

result of clinical observation, assessment or judgment

Includes normal and abnormal clinical state

Includes concept used to represent diagnosis

PROCEDURE: e.g., |appendectomy|, |physiotherapy|

Activities performed in providing health care

Included invasive procedures, administration of medicine, imaging, education, therapies, administrative procedure

SITUATION WITH EXPLICIT CONTENT: e.g. |endoscopy arranged|, |past history of myocardial infarction|

Represents concepts in which the clinical context is specified as part of the definition of the concept itself

Presence or absence of a condition

May be current or in the past





OBSERVABLE ENTITY: e.g., |Systolic BP|, |iris color|,

|gender|

Question or assessment which can produce an answer or result

BODY STRUCTURE: e.g., |mitral valve|, |adenosarcoma|

Normal or abnormal anatomical structure

SUBSTANCE: e.g., |methane|, |insulin|, |albumin|

General substances

Chemical constituents of pharmaceutical/biological product

PHARMACEUTICAL/BIOLOGICAL PRODUCT: e.g.,

|amoxicillin 250mg cap|, |paracetamol+codeine tab|

Drug product





SPECIMEN: e.g., |Urine Specimen|, |Prostate biopsy specimen|

Entities obtained for examination or analysis

SPECIAL CONCEPT: e.g., |alternative medicine poisoning|, |navigational concept|

Do not play a part in the formal logic of the concept

May be useful for specific cases

PHYSICAL OBJECT: e.g., |implant device|, |automobile|

Man-made or natural object

PHYSICAL FORCE: e.g., |radiation|, |alternating current|

Physical forces that can play a role as mechanisms of injury





EVENT: e.g., |flood|, |earthquake|

Occurrences excluding procedures and interventions

SOCIAL CONTEXT: e.g., |occupation|, |religious belief|

Social conditions and circumstances significant to health care

STAGING & SCALES: e.g., |Glasgow coma scale|

Assessment scales and tumor staging systems





QUALIFIER VALUE: e.g, |left|. |abnormal result|, |severe|

Values for some SNOMED CT attributes not subtypes of other top

level concepts

RECORD ARTIFACT: e.g., |patient held record|, |family history

section|, |record entry|

Content created for providing others with record events or state of

affairs

SNOMED CT MODEL COMPONENT

Technical metadata supporting SNOMED CT release



STRUCTURE:

HIERARCHY OF CONCEPTS / TOP LEVEL CONCEPTS

Dressing (the activity of putting on clothes) Observable Entity

Dressing (the thing that is placed over the wound) Physical Object

Dressing (the act of covering a wound) Procedure

Hierarchy helps clarify the meaning of a concept

JMM Herber, 2015

+SNOMED CT:

Concepts & Descriptions

Basic Unit: Concept

Fully specified Name

Preferred Name

Synonyms


+

+

+

+

+Relationships

IS-A Relationship

Subtype

Supertype

Parent-child

Attribute Relationship

Relate 2 concepts

Establish type of relationship

http://webarchive.nationalarchives.gov.uk/

http://webarchive.nationalarchives.gov.uk/

+SNOMED CT: Relationships

Is-a relationships define

hierarchy of concepts

Every relationship has a unique

numeric relationship builder

Pneumonia

is a

Infective pneumonia

is an

Bacterial Pneumonia

+

+

+SNOMED CT: Attributes that define

Clinical Finding Concepts





































+

+

+SNOMED CT:

Reference Sets (Refsets)

Flexible

Support for customization and

enhancements

Language preferences

Mapping from, or to other code

systems

Every reference set has a

unique numeric concept

identifier

Disability reference set

http://ithealthboard.health.nz/system/files/documents/pages/disability-codes-equipment-modification-services-20140613.xlsx

Emergency procedure reference set

http://ithealthboard.health.nz/system/files/documents/pages/ambulance%20observation%20and%20intervention%20codes%2020140227.xlsx

http://ithealthboard.health.nz/system/files/documents/pages/disability-codes-equipment-modification-services-20140613.xlsx

http://ithealthboard.health.nz/system/files/documents/pages/ambulance observation and intervention codes 20140227.xlsx

+SNOMED CT:

Logical ModelCore Content of Terminology

Reference Sets: configuring and enhancing

+SNOMED CT: Logical Model

(Concepts)





(Descriptions)





(Relationships)





(Subtype Relationships)





(Attribute Relationships)





(Reference Sets)

Language & dialect preferences

Subsets of components that are included or excluded

Value sets of concepts limiting content

Frequently asked description or concepts

Structuring & ordering of lists & hierarchies

Maps to or from other code systems http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu


http://sostranslatorchat.com


+Snomed CT:

Code Format/Structure

+Snomed CT: StructureConcept ID = Snomed Clinical Term Identifier (SCTID)

6-18 digits



+SNOMED CT: Compositional Grammar




+SNOMED CT: Compositional Grammar




+

Snomed CT: Code Samples

+

+

+SNOMED CT: ExamplesPrecoordinated: represent meaning of individual concepts




+SNOMED CT: ExamplesPrecoordinated: represent meaning of individual concepts




+SNOMED CT: ExamplesPostcoordinated: 2 or more concept identifiers












+SNOMED CT: Examples




+

+Comparison with other

classifications

COMPARISONS:

JMM Herber, 2015

+

Snomed CT: AvailabilityRelease Schedule

Release files and formats

Release types

+SNOMED CT: Availability

Distributed to IHTDSO Members and Affiliate licensees as a set

of downloadable files

Regular updates available

IHTDSO members pay fees based on national wealth

Affiliate licensees not charged in Member country

Licensing free for poorest countries and certain approved

public-good use

Low cost per institution charges

http://www.ihtsdo.org/snomed-ct/get-snomed-ct

http://www.ihtsdo.org/snomed-ct/get-snomed-ct

+SNOMED CT Products & Services(IHTDSO Members with Affiliate License)

SNOMED CT Terminology

Derivative Works that help in uptake and use of SNOMED CT, including reference sets that support

Subsets of SNOMED CT

Language or dialect preference

Maps to other code classifications

Other metadata to support use of components

Implementation guidance

Access to services for requests for changes, additions, documentation

Participation in global IHTDSO collaboration

http://www.seap.es



+SNOMED CT: release schedule

International editions

Twice a year

31st Jan

31st July

National Extensions

Full release:

contains every version of

every component

Delta release:

only versions created or

inactivated since previous

release

Snapshot release:

Most recent version of every

component at time of

snapshot

AVAILABILITY:

CURRENTLY USED IN MORE THAN 50 COUNTRIES

JMM Herber, 2015

+Member Countries: (> 20)

Australia

Belgium

Brunei

Canada

Chile

Czech

Republic

Denmark

Estonia

Hong Kong

Iceland

India

Israel

Lithuania

Malaysia

Malta

Netherlands

New Zealand

Portugal

Singapore

Slovak Republic

Republic of

Slovenia

Spain

Sweden

United Kingdom

United States

Uruguay

http://www.ihtsdo.org/members/

And >5000 licenses to individuals & organizations

http://www.ihtsdo.org/members/

+SNOMED CT PHILIPPINES

Is Philippines a Member country?

Are there affiliate licensees?

Multiple languages and dialects

Does third world PH qualify for FREE?

Poor country

Public good use

http://upload.wikimedia.org/wikipedia/commons/2/28/Philippine_judicial_regions

.PNG

http://upload.wikimedia.org/wikipedia/commons/2/28/Philippine_judicial_regions.PNG

+SNOMED CT: PHILIPPINES

Regions of Philippines (geographic location) {223761002 , SNOMED-CT }

Parent/Child (Relationship Type)

Bohol (geographic location) {223762009 , SNOMED-CT } Cebu (geographic location) {223763004 , SNOMED-CT } Leyte (geographic location) {223764005 , SNOMED-CT } Luzon (geographic location) {223765006 , SNOMED-CT } Masbate (geographic location) {223766007 , SNOMED-CT } Mindanao (geographic location) {223767003 , SNOMED-CT } Mindoro (geographic location) {223768008 , SNOMED-CT } Negros (geographic location) {223769000 , SNOMED-CT } Palawan (geographic location) {223770004 , SNOMED-CT } Panay (geographic location) {223771000 , SNOMED-CT } Samar (geographic location) {223772007 , SNOMED-CT }

http://phinvads.cdc.gov/vads/http:/phinvads.cdc.gov/vads/ViewCodeSystemConcept.action?oid=2.16.840.1.113883.6.96&code=22376

1002













+

References

+References

Snomed CT Starter Guide December

2014.http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Cu

rrent-en-US_INT_20141202.pdf?ok , Accessed February 9, 2015.

Snomed CT eLearning.

http://webarchive.nationalarchives.gov.uk/20130502102046/http://connectingforh

ealth.nhs.uk/elearning/snomedct/html/

http://webarchive.nationalarchives.gov.uk/20130502102046/http://www.connectin

gforhealth.nhs.uk/elearning/snomedct/flash/

SNOMED CT. A User Guide for General Practice. (2012). Crown Copyright.

Retrieved from

http://systems.hscic.gov.uk/data/uktc/training/snmdct_gp_userg.pdf, Accessed

Feb 20, 2015


http://webarchive.nationalarchives.gov.uk/20130502102046/http:/connectingforhealth.nhs.uk/elearning/snomedct/html/

http://webarchive.nationalarchives.gov.uk/20130502102046/http:/www.connectingforhealth.nhs.uk/elearning/snomedct/flash/

http://systems.hscic.gov.uk/data/uktc/training/snmdct_gp_userg.pdf

+References

“Diane” Bool, DP, “Tin” Salas, F?. Snomed CT. Powerpoint presentation given

at MI 224 Class, first semester, 2014-2015.

Nehta Snomed CT Basics, Parts 1-6.

https://www.youtube.com/watch?v=jcohuHGjLLk&index=2&list=PL842440B78674

42B7&spfreload=1

What is SNOMED CT? IHTSDO. http://www.ihtsdo.org/snomed-ct/what-is-

snomed-ct/history-of-snomed-ct. Accessed February 26, 2015

https://www.youtube.com/watch?v=jcohuHGjLLk&index=2&list=PL842440B7867442B7&spfreload=1


Mi224 snomed santiago & herber 022715

Health & Medicine

versions of snomed

snomed ctmay

snomed iimost

snomed clinical terms

snomed ct version

clinical terms snomed

snomed ct elearninghttp

snomed ctjan michael