Mi224 snomed santiago & herber 022715

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SNOMED CT
Alvina Pauline D. Santiago, MD
Burr Herber, RN
For MI224 under Benedict Sandejas, MD
February 28, 2015

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SNOMED CT
Jan Michael M. Herber, RN

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“Diane” Bool, DP, “Tin” Salas, F?. Snomed CT.
Powerpoint presentation
MI 224 Class, 2013-2014.

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IHTDSO.org
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_Starter
Guide_Current-en-US_INT_20141202.pdf?ok ,
http://www.ihtsdo.org

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SNOMED CT elearning
http://snomed.org/elearning
http://webarchive.nationalarchives.gov.uk/20130502102046/http://www.connect
ingforhealth.nhs.uk/elearning/snomedct/flash/

+ SNOMED CT:
Systematized Nomenclature of
Medicine: Clinical Terms

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Snomed CT: Systematized Nomenclature
of Medicine Clinical Terms
Systematic
Organized
Structured
Logical
Consistent
Nomenclature
Collection of
Names
Words
Medicine (clinical
Terms)
Relevant to
Medicine
http://ihtsdo.org/fileadmin/user_upload/doc/download/doc_StarterGuide_Current-en-US_INT_20141202.pdf?ok

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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

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

HISTORY:
• 1965: SystematizedNomenclatureof Pathology(SNOP)
• publishedbytheCollege ofAmericanPathologists(CAP)
• Morphologyandanatomy.
• 1975: SystematizedNomenclatureof Medicine (SNOMED).
• CAP expandedSNOPunderDr.RogerCote’sleadership
JMM Herber, 2015

HISTORY:
• 1979: SNOMEDII Mostwidelyadoptedversion
• 1993: SNOMED3.0 Majorexpansionandrevision
• 2000: SNOMEDRT Kaiser Permanente +CAP
Logic-basedversion
RT=referenceterminology
JMM Herber, 2015

HISTORY:
• 1980s: Read CodesV1Dr.James Read
NationalHealth Service
Clinical terminologycoding
• 1990: Read CodesV2
• 1994: Read CodesV3
ClinicalTerms V3 (CTV3)
JMM Herber, 2015

HISTORY:
• September 1998: merged CTV3 & SNOMED RT
• Three-yearprojectunderCAPownership
• January 2002: SNOMEDCTVersion 1
• 2007: IHTSDOacquiredintellectual propertyrights toall versions ofSNOMED.
SNOMED RT
(Reference
Terminology)
SNOMED CT
(Clinical
Terms)
Clinical
Terms
Version 3
(CTV3)
+ =
JMM Herber, 2015

NICE TO KNOW:
Although SNOMEDwasoriginally an acronymforSystematized NomenclatureofMedicine, IT LOST
THAT MEANING when SNOMED was combined with CTV3 in 2002. The merged product was
calledSNOMEDClinical Terms,which wasshortenedtoSNOMEDCT.
IHTSDOconsidersSNOMEDCTtobeaBRANDNAME,NOT ANACRONYM.
JMM Herber, 2015

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

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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

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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

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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

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 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

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 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

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SNOMED CT: Clinical Information
http://www.liveconsciously.com.au

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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 ,

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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

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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 ,

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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 countries
Catherinecronin.file

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

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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

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SNOMED CT:
Supporting different languages
 Multinational
 Multilingual
 Built-in framework to
manage languages and
dialects
http://images.sodahead.com

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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

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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

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Snomed CT: Hierarchies

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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

STRUCTURE:
 HIERARCHYOFCONCEPTS/ TOPLEVEL CONCEPTS
 Dressing (theactivityofputtingonclothes)
 ObservableEntity
 Dressing (thethingthatisplacedoverthewound)
 PhysicalObject
 Dressing (theactofcovering awound)
 Procedure
 Hierarchy helpsclarify themeaning ofaconcept
JMM Herber, 2015

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SNOMED CT:
Concepts & Descriptions
 Basic Unit: Concept
 Fully specified Name
 Preferred Name
 Synonyms

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Relationships
 IS-A Relationship
 Subtype
 Supertype
 Parent-child
 Attribute Relationship
 Relate 2 concepts
 Establish type of relationship
http://webarchive.nationalarchives.gov.uk/

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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

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SNOMED CT: Attributes that define
Clinical Finding Concepts

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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/syst
em/files/documents/pages/disabili
ty-codes-equipment-modification-
services-20140613.xlsx
 Emergency procedure reference
set
http://ithealthboard.health.nz/syste
m/files/documents/pages/ambulanc
e%20observation%20and%20interv
ention%20codes%2020140227.xlsx

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SNOMED CT:
Logical Model
Core Content of Terminology
Reference Sets: configuring and enhancing

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SNOMED CT: Logical Model
(Concepts)

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(Descriptions)

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(Relationships)

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(Subtype Relationships)

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(Attribute Relationships)

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(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

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Snomed CT:
Code Format/Structure

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Snomed CT: Structure
Concept ID = Snomed Clinical Term Identifier (SCTID)
6-18 digits
https://www.youtube.com/watch?v=ISfoMR4aygc&list=PL842440B7867442B7&index=1

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SNOMED CT: Compositional Grammar

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SNOMED CT: Examples
Precoordinated: represent meaning of individual concepts

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SNOMED CT: Examples
Postcoordinated: 2 or more concept identifiers

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SNOMED CT: Examples

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Comparison with other
classifications

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Snomed CT: Availability
Release Schedule
Release files and formats
Release types

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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

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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

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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

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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

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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

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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

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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

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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

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Editor's Notes