Post on 25-Jul-2016
description
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SNOMED CTSystematized Nomenclature Of Medicine – Clinical Terms
---An introduction ---Dr Karanvir Singh
MBBS, MS, FRCS (Glasgow)Chief Medical Information Office
Apollo HospitalsIndia
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Systematized Nomenclature of Pathology (SNOP)
1965 CAP
Broad clinical terms included (SNOMED)1975 CAP
Logic basedSNOMED-RT2000 CAP
Read codes1980s NHS UK
Read codes v3Clinical Terms v3
CTV31990s NHS UK
SNOMED-CT2007 IHTSDO
India became a member of the IHTSDO2014
SNOMED-CT2002CAP
NHS UK
US UK
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Most of us own smartphones…
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Now imagine the uses if you remove internet connectivity
Voice callsSMSCameraA few games
This is what we use them for
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An EMR alone is like a ‘dumb’ phoneSnomed CT is the internet of EMRsIt connects healthcare data across all entities
+Allows very granular clinical data captureProvides very powerful clinical analyticsIt supports clinical decision support
… and is used in over 50 countries. It is the best clinical terminology system today
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Let us see how it is better than existing healthcare coding systemsLet us compare it with ICD-10
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More clinical terms
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Codes for Ectopic Pregnancy in ICD-10 • ICD-10 has five codes (terms) only• Abdominal• Tubal• Ovarian • Others• Unspecified
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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
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Multiple ‘ancestors’
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Pneumonia – as classified in ICD-10
Section Code TitleInfectious 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
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Viral pneumonia
Infectious disease of lung
Lower respiratory tract infection
Disorder of lung
Disease
Viral infection
Infective pneumoniaViral respiratory
infection
Viral disease
Infectious disease
Poly-hierarchyLu
ng d
isor
ders
Infe
ction
s
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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
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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
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Snomed CT has no limits on the codes that can be usedNo sharing of codes by two different conditions
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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
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Will SNOMED CT replace ICD-10?Yes & No
• Clinical modules & analytics would benefit from SNOMED CT
• The medical records departments will continue ICD-10
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Let us look at the nuts & bolts of SNOMED CT
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These are four different conditions (clinical ideas)
1. Ischemic heart disease2. Angina3. Unstable angina4. Myocardial infarction5. Heart attack6. Cardiac infarction7. MI
Same clinical meaning (idea)
Each clinical idea is called a concept
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Each concept has a random concept number
1. Ischemic heart disease 414545008
2. Angina 194828000
3. Unstable angina 4557003
4. Myocardial infarction5. Heart attack6. Cardiac infarction7. MI
Same clinical meaning (idea) 22298006
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The same concept has different translations
1. Ischemic heart disease 414545008 - cardiopatía isquémica
2. Angina 194828000 - angina de pecho
3. Unstable angina 4557003 - síndrome preinfarto
4. Myocardial infarction5. Heart attack6. Cardiac infarction7. MI
Same clinical meaning (idea) 22298006 - infarto de miocardio
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Independent system of classificationConcept Concept IDIschaemic Heart Disease 414545008Angina 194828000Unstable Angina 4557003Myocardial Infarction 22298006Heart Attack 22298006Cardiac Infarction 22298006MI 22298006
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Viral pneumonia
Infectious disease of lung
Lower respiratory tract infection
Disorder of lung
Disease
Viral infection
Infective pneumoniaViral respiratory
infection
Viral disease
Infectious disease
Poly-hierarchyLu
ng d
isor
ders
Infe
ction
s
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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
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How do multiple relationships help?
Cellulitis of foot
Disorder of foot
Cellulitis of lower limb
Is aIs a
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Multiple types of relationships
Cellulitis of foot
Disorder of foot
Cellulitis of lower limb
CellulitisFoot structure
Is aIs a
Associated morphologyFinding site
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Cellulitis of foot
Disorder of foot
Cellulitis of lower limb
CellulitisFoot structure
Is aIs a
Associated morphologyFinding site
Cellulitis of toe
Cellulitis of heel
Is a
Is a
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Cellulitis of foot
Disorder of foot
Cellulitis of lower limb
CellulitisFoot structure
Is aIs a
Associated morphologyFinding site
Cellulitis of toe
Cellulitis of heel
Is aIs a
Toe structureFinding
site
CellulitisAssociated morphology
Is a
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Cellulitis of foot
Disorder of foot
Cellulitis of lower limb
CellulitisFoot structure
Is aIs a
Associated morphologyFinding site
Cellulitis of toe
Cellulitis of heel
Is aIs a
Toe structureFinding
site
Heel structureFinding
site
CellulitisAssociated morphology
CellulitisAssociated morphology
Is aIs a
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Cellulitis of foot
Disorder of foot
Cellulitis of lower limb
CellulitisFoot structure
Is aIs a
Associated morphologyFinding site
Cellulitis of toe
Cellulitis of heel
Is aIs a
Toe structureFinding
site
Heel structureFinding
site
CellulitisAssociated morphology
CellulitisAssociated morphology
Is aIs a
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Cellulitis of foot
Disorder of foot
Cellulitis of lower limb
CellulitisFoot structure
Is aIs a
Associated morphologyFinding site
Cellulitis of toe
Cellulitis of heel
Is aIs a
Toe structureFinding
site
Heel structureFinding
site
CellulitisAssociated morphology
CellulitisAssociated morphology
List me all patients with cellulitis
Is aIs a
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Associated morphology = Cellulitis*Cellulitis of footCellulitis of foot excluding toeCellulitis of forearmCellulitis of foreheadCellulitis of gingivaCellulitis of groinCellulitis of handCellulitis of hand excluding fingerCellulitis of headCellulitis of heelCellulitis and abscess of lower legCellulitis and abscess of lower limbCellulitis and abscess of neckCellulitis and abscess of nose (external)Cellulitis and abscess of perineumCellulitis and abscess of shoulderCellulitis and abscess of submandibular regionCellulitis and abscess of temple region
Conditions with the word “Cellulitis” within it
*Partial data
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Associated morphology = Cellulitis*Cellulitis of footCellulitis of foot excluding toeCellulitis of forearmCellulitis of foreheadCellulitis of gingivaCellulitis of groinCellulitis of handCellulitis of hand excluding fingerCellulitis of headCellulitis of heelCellulitis and abscess of lower legCellulitis and abscess of lower limbCellulitis and abscess of neckCellulitis and abscess of nose (external)Cellulitis and abscess of perineumCellulitis and abscess of shoulderCellulitis and abscess of submandibular regionCellulitis and abscess of temple region
Beat kneeChronic recurrent streptoccocal erysipelasCutaneous erysipeloidDisseminated cutaneous erysipeloidErysipelasErysipelas of lower limbErysipeloidFacial erysipelasLocalized cutaneous erysipeloidLudwig's anginaOnychia of fingerPhlegmonPostpartum AND/OR puerperal erysipelasRecurrent erysipelasSeal finger
Conditions with the word “Cellulitis” within it Conditions even without the word “Cellulitis”
*Partial data
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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
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How is it used in a hospital’s EMR?
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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 HerniHerniaInguinal herniaIndirect inguinal herniaIndirect inguinal hernia with obstruction
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Leveraging relationshipsWe can show all the SubType concepts of E in the operation list of a foot surgeon
Operations on the foot
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SubTypes (All descendants)Operations on the foot
Foot joint operations
Foot incision
Division of muscle of
foot
Tenotomy of abductor hallucis muscle
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Value set binding: SNOMED supplies the lists
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How will clinicians benefit from it?
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 • The doctor may search by typing• COPD• MI• IHD
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 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
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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
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Questions through the THIT app please