Snomed ct - empowering clinicians
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SNOMED CT is a clinical terminology system that allows clinicians to precisely document clinical thoughts. It consists of over 1 million medical terms and concepts related to health and healthcare. SNOMED CT supports natural language use by clinicians and precise documentation of clinical observations for purposes like clinical decision support and healthcare analytics. The terminology can represent clinical thoughts through both pre-coordinated and post-coordinated expressions while keeping the machine-readable expressions hidden from users.
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Snomed ct - empowering clinicians
- 1. SNOMED CT – EMPOWERING CLINICIANSDr SB Bhattacharyya MBBS, MBA, FCGP Member, National EHR Standardisation Committee, MoH&FW, GoI Member, Health Informatics Sectional Committee, MHD 17, BIS Hony. State Secretary (2015), IMA Haryana President (2010 – 2011), IAMI
- 2. SNOMED CT ■ SNOMED CT is a semantically interoperable polyhierarchical subtype multi-lexical clinical terminology system that is able to deliver robust benefits to the health care services. ■ SNOMED CT is a reference terminology for clinical terms and consists of terms used in health and health care. Dr SB Bhattacharyya© 2
- 3. Why SNOMED CT? ■ Natural language for end-users – Doctors – Dentists – Nurses – Paramedics ■ Since clinical documentation systems document the clinical thoughts of the observers, a concept-based system works best, not a term-based or classification-based one ■ For clinical analytics, evidence based medicine, clinical decision support, etc., the correct idea is vital, not a prefixed term Dr SB Bhattacharyya© 3
- 4. Advantages for Clinicians ■ Users get to choose the terms that they are most comfortable with in their own language/dialect ■ Users can express their clinical thoughts very precisely using expressions Dr SB Bhattacharyya© 4
- 5. SNOMED CT Components – Core ■ Concepts – Concept Ids – meaningless machine-processable numbers ■ Descriptions (Terms) – Human-processable terms ■ Relationships – Between concepts: source to destination Dr SB Bhattacharyya© 5
- 6. SNOMED CT Terms ■ Fully Specified Name (FSN) – identified by having the term suffixed by its top-level hierarchy enclosed in parenthesis thus - “(disorder)”, “(body structure)”, “(procedure)”, etc. ■ Preferred Term (PT) ■ Acceptable (Terms) – synonyms Dr SB Bhattacharyya© 6
- 7. SNOMED CT Logical Model Dr SB Bhattacharyya© 7
- 8. SNOMED CT Relationships Infective pneumonia (disorder) Lung (body structure) Infection (disorder)Respiratory disease (disorder) Virus (organism) Viral pneumonia (disorder) Dr SB Bhattacharyya© 8
- 9. SNOMED CT Relationships (schematic) Dr SB Bhattacharyya© 9
- 10. SNOMED CT – Attribute Value-Range DOMAIN (hierarchy) ATTRIBUTE RANGE (concept of hierarchy) << This concept or one of its descendants | Clinical finding | | FINDING SITE | << 442083009 | Anatomical or acquired body structure | | Body structure | | LATERALITY | < 182353008 |Side| < Descendants only. Not the concept itself Dr SB Bhattacharyya© 10
- 11. The clinical thoughts are expressed using SNOMED CT Dr SB Bhattacharyya© 11
- 12. SNOMED CT Expressions ■ Pre-coordinated – Coordination already done : composed before-the-fact – Through its ~ 1 million terms, most thoughts can be expressed using just this ■ Post-coordinated – Coordination done on-the-fly by the users choosing various rules-based alternatives: composed after-the-fact – Required intermittently, especially when the thought is a complex one and requires further refinement or qualification or combination with other terms Dr SB Bhattacharyya© 12
- 13. Expressions ■ The actual “code” of SNOMED CT and consists of either – ConceptId only 102556003 or – ConceptId | Description (Term) | 102556003 | pain in upper limb | ■ Needs to adhere to compositional grammar rules and expression constraint syntax ■ Never to be seen by any user, clinician or otherwise, ever Dr SB Bhattacharyya© 13
- 14. Clinicians need to work only with the terms that number more than one million… Dr SB Bhattacharyya© 14
- 15. Clinical Thought ■ Viral pneumonia Dr SB Bhattacharyya© 15
- 16. What the Clinicians gets to see… ■ Pain in upper limb Dr SB Bhattacharyya© 16
- 17. What the Machine works with… ■ 75570004 Dr SB Bhattacharyya© 17
- 18. Clinical Thought ■ Family history of hypertension Dr SB Bhattacharyya© 18
- 19. Requires Post-coordinated Expression This thought includes two separate concepts : 1. Family history 2. Hypertension These need be combined, the following postcoordinated expression needs to be created as below and used to represent this family history – 281666001 | family history of disorder | : 246090004 | associated finding | = 38341003 | hypertension | This can also be written as – 281666001 : 246090004 = 38341003 Dr SB Bhattacharyya© 19
- 20. What the Clinicians gets to choose from (list created by combining two separate SNOMED CT terms)… ■ Family History of Disorder : BP - High Blood Pressure ■ Family History of Disorder : BP+ - Hypertension ■ Family History of Disorder : HBP - High Blood Pressure ■ Family History of Disorder : High Blood Pressure ■ Family History of Disorder : High Blood Pressure Disorder ■ Family History of Disorder : HT - Hypertension ■ Family History of Disorder : HTN - Hypertension ■ Family History of Disorder : Hypertension ■ Family History of Disorder : Hypertensive Disorder ■ Family History of Disorder : Hypertensive Disorder, Systemic Arterial ■ Family History of Disorder : Hypertensive Vascular Degeneration ■ Family History of Disorder : Hypertensive Vascular Disease ■ Family History of Disorder : Systemic Arterial Hypertension Dr SB Bhattacharyya© 20
- 21. What the Machine Works with… ■ 281666001 : 246090004 = 38341003 Dr SB Bhattacharyya© 21
- 22. Comments On SNOMED CT Expressions ■ NOT to be seen by any user ever ■ Akin to stuff that are handled by the machine far away from any user’s eyes, like HL7 messages that appear as but are never ever seen by any system user: MSH|^~&|GHH LAB|ELAB-3|GHH OE|BLDG4|200202150930||ORU^R01|CNTRL-3456|P|2.4<cr> PID|||555-44-4444||EVERYWOMAN^EVE^E^^^^L|JONES|19620320|F|||153 FERNWOOD DR.^ ^STATESVILLE^OH^35292||(206)3345232|(206)752-121||||AC555444444||67- A4335^OH^20030520<cr> OBR|1|845439^GHH OE|1045813^GHH LAB|15545^GLUCOSE|||200202150730||||||||| 555-55-5555^PRIMARY^PATRICIA P^^^^MD^^|||||||||F||||||444-44- 4444^HIPPOCRATES^HOWARD H^^^^MD<cr> OBX|1|SN|1554-5^GLUCOSE^POST 12H CFST:MCNC:PT:SER/PLAS:QN||^182|mg/dl|70_105|H|||F<cr> Dr SB Bhattacharyya© 22
- 23. Impact on Analytics ■ SNOMED CT has concept-based polyhierarchical structure based on a formal description logic and ability to support multiple languages ■ These permit broad aggregation of clinical observations, context- based interpretation of data, testing whether a particular observation is equivalent to or subsumed by some predefined set of clinical observations ■ Its multi-lingual nature permits queries to be made in any language without worrying about the language used in the record Dr SB Bhattacharyya© 23
- 24. Impact on Analytics ■ Ability to code all parts of a clinical record permits all data to be analysed to discover clinical knowledge in them ■ Point-of-care Analytics, Population Analytics, Observational Clinical Research, Semantic Search are all possible now Dr SB Bhattacharyya© 24
- 25. Observations On SNOMED CT ■ Not a piece of software, only a part of it ■ Akin to a gear-box of a car – on its own does nothing, when placed properly and used judiciously, it helps deliver quite a punch ■ A terminology coding system that greatly helps in automating various clinical processes including record-keeping, diagnostics, treatment planning, clinical decision support, clinical data analytics, services billing, health surveillance, etc. ■ Can code all parts of a clinical document covering terms ranging from abscess to zygote and aspects from reason for visit to outcome ■ Empower care providers to deliver best-of-possible care through the use of analytics and machine learning Dr SB Bhattacharyya© 25
- 26. Note that ICD / LOINC ≠ SNOMED CT ICD / LOINC ■ A meaning-based classification system where the literal meaning of the term used is taken into consideration ■ Useful for reporting purposes ■ Code system for medical records department SNOMED CT ■ A concept-based terminology system where the meaning of the concept behind the term is taken into consideration ■ Useful for clinical decision support and analytics, besides reporting ■ Code system for care providers Dr SB Bhattacharyya© 26
- 27. References ■ Images are all courtesy IHTSDO, used with their kind permission ■ Matter generally based on “Introduction to SNOMED CT” by Dr SB Bhattacharyya Dr SB Bhattacharyya© 27
- 28. Introduction to SNOMED CT by Dr SB Bhattacharyya available at ■ http://www.amazon.com/Introduction-SNOMED-CT-S-B- Bhattacharyya/dp/9812878939/ref=sr_1_1?ie=UTF8&qid=1453269681&sr=8- 1&keywords=introduction+to+snomed+ct – hardcopy only ■ http://www.amazon.in/Introduction-SNOMED-CT-2016- Bhattacharyya/dp/9812878939/ref=sr_1_1?ie=UTF8&qid=1453269722&sr=8- 1&keywords=introduction+to+snomed+ct – hardcopy only ■ http://www.springer.com/gp/book/9789812878939 – ebook and hardcopy ■ http://link.springer.com/book/10.1007/978-981-287-895-3 – chapter-wise online access only Dr SB Bhattacharyya© 28
- 30. Dr SB Bhattacharyya© 30 Thanks!