Post on 02-Apr-2020
March 2018
Jo Tissier CEG Clinical Facilitator
SNOMED IS COMING:
DON’T PANIC!
How will I find the right codes?What about local codes?
When is it going to happen?
What about my templates and searches?
Why do we have to change?
To raise your AWARENESS of SNOMED
By the end you will leave with the knowledge of:
• Why are we changing to SNOMED and when is it happening?
• What is the structure of SNOMED?
To REASSURE You
• About searching for code concepts?
• How will this affect searches and templates
• What you can do to prepare!
Objective
Structured list of health terms
Known as concepts
Concepts are clinical thoughts we want to convey.
Concepts all have a unique code
Different codes used by different systems
Read codes – some are incorrect – these cannot be deleted in current system so still continue to be used
Level of detail of coding can’t be expanded to meet all new requirements
Ambiguity in concepts
Only UK based
1 Apr 2016: last Read release – no more new Read codes!
1 Apr 2018: 1st SNOMED business rules for QOF 2018/19 – v39
1 Apr 2018: Pilots of SNOMED in primary care start – none in E. London
1 Apr 2020: SNOMED rolled out across rest of NHS
Phase 1: by end of April. Back-end changes to support GPES extractions and GP2GP
Phase 2 testing: new code picker, templates, searches. Rolled out to a small number of practices after phase 1.
Phase 2 roll out: by Autumn. Activated in stages – not all practices at the same time
Coding is international (used in 50+countries)
No longer will we be remembering codes – codes in SNOMED are meaningless.
Record sharing made easier - Interoperability
Deep level of detail
Comprehensive
Polyhierarchical
Precise, unambiguous, no duplications
Dynamic – wrong codes inactive
Same codes used in the Bahamas as in Redbridge
READ
G3 Heart Disease
G33 Angina
6A2 heart disease annual review
SNOMED
414545008 is IHD in SNOMED
194828000 is Angina
315614006 8 is IHD review
Polyhierarchical = more than 1 parent, e.g: rheumatoid arthritis
ReadN0... Arthropathies and related disorders
N04.. Rheumatoid arthritis and other inflammatory polyarthropathies
N040. Rheumatoid arthritis
SNOMED
No duplications e.g CKD Stage 5
Read
1Z14. Chronic kidney disease stage 5 –Under history and symptoms
AND
K055. Chronic kidney disease stage 5
SNOMED
Structure is Unambiguous e.g.no headache
Read SNOMED
True synonyms e.g. childhood asthma
Read
H330.
SNOMED
One of my favourites: Dynamic –inaccurate codes deactivated e.g.
9OS1. Attends clinic A monitoring
A136. Tuberculous encephalitis or myelitis
If inactive, it will remain in the record and you will be able to search for it, but you will not be
able to record it again
How concepts are described
• FSN (preferred): Metatarsal bone fracture (disorder)
• S (preferred): Metatarsal bone fracture
• S (acceptable): Fracture of metatarsal bone
• Parent(s): Fracture of bone of forefoot (disorder)
• Children- 5, one of which is: Closed fracture of metatarsal bone (disorder)
Clinical findings
Procedures
Body structure
Observations
Staging and scales
And many more…
Hierarchy Description Examples Clinical finding What phenomena is found
Contains the sub-hierarchies of finding including
symptoms and diseases (disorder). Important for
documenting clinical disorders, symptoms and
examination findings.
Swelling of arm (finding)
Normal breath sounds (finding)
Headache (finding)
Tired all the time (finding)
Pneumonia (disorder)
Depression (disorder)
Procedure What is being done
Purposeful activities performed in the provision of
health care.
Biopsy of lung (procedure) Diet education
(procedure)
Referral to paediatrician (procedure)
Review of medication (procedure)
Event What is taking place
Describes the situation around the individual at a
specific time which is relevant to their healthcare.
This does not include procedures or interventions.
Flash flood (event)
Motor vehicle accident (event)
Exposure to measles virus (event)
Fall (event)
Death (event)
Observable Entity An observation that can produce an answer or result
Terms that are used to record measurements,
readings, numerical results, etc. and always have an
associated value entry.
Body weight (observable entity)
Tumour size (observable entity)
Body mass index (observable entity)
Gender (observable entity),
Serum bilirubin level (observable entity)
Situation with
Explicit Context
Phrases that have the context specified
For example, terms about another family member,
absence or has happened in the past
Family history of stroke (situation)
No nausea (situation)
Referral to psychiatrist declined (situation)
Suspected sepsis (situation)
Both parents smoke (situation)
Pharmaceutical/
biologic product
A drug or other substance that is used to treat a
patient
This hierarchy is separate from the substance
hierarchy in order to clearly distinguish drug
products (products) from the chemical constituents
(substances) of drug products.
Tamoxifen (product)
Tramadol (product)
Paracetamol 500mg tablet (product)
Multivitamin tablet (product)
Motilium 10 tablets (McNeil Ltd) (product)
Anadin Extra soluble tablets (Wyeth
Consumer Healthcare) (product)
Social Context Non clinical demographic information Contains social
conditions and circumstances significant to
healthcare. Includes family and economic status,
ethnic and religious heritage, and life style and
occupations.
Economic status (social concept)
Asian (ethnic group)
Clerical supervisor (occupation)
Donor (person)
Thief (life style)
Judaism (religion/philosophy)
No ambiguity: Dressing
Have a go!
Be clear about what you want to record (concept)
Just type (a) significant word(s)
No need to type whole words or type connectors
No need to worry about word order
You can type abbreviations
EMIS will allow you to search for Read codes
Pay attention to the FSN
Pay attention to parent and child codes
Is it a disorder? A procedure? You can use filters
Professional nurse (occupation)
Night Nurse (product)
Seen by nurse (finding)
Informing nurse (procedure)
Pulled elbow (disorder) -Nursemaids' elbow
Nurse practitioner clinic (environment)
>>>> Open browser to demonstrate
>>>> Open browser to demonstrate
You are doing this already!
More time to adapt, current tools will still work
Historical data to remain dual forever – new data for which Read codes do not exist will not be dual
Mapping is a link between a Read term and a SNOMED description
Maps have been authored by NHS Digital in collaboration with the Joint GP IT Committee
All historical data has been mapped from Read to SNOMED
Disease type 1
Disease type 2
Disease type 3
Disease type NOS
Disease type 1
Disease type 2
Disease type 3
Disease type 4
Disease type NOS
625Z A/N care: social risk NOS – mapped to A/N Care social risk
Holding awareness events
Learning (self and NHS Digital)
Reviewing templates?
Reviewing searches and protocols
Attend events like this Listen to webinars or read materials by HSCIC Look out for clinical system supplies updates and
news feeds Try a SNOMED browser Spring clean your system:Delete old searchesLabel searches clearly (& add descriptions)If you keep historical claims searches, export the data
and store in a folder of your choiceArchive old templates, protocols, documentsReview your local templates and check for NOS/NEC
codes
NHS Digital SNOMED CT browser:
https://termbrowser.nhs.uk/
Training materials:
https://hscic.kahootz.com/connect.ti/t_c_home/view?objectId=301107#301107
EMIS local codes will keep working exactly as they do now
Yes, you can search for inactive codes even if they are no longer available for data entry
You will still be able to attach text to codes
There will be a conversion to map Read codes to the appropriate SNOMED CT codes, so you won’t need to rewrite searches, templates, concepts and protocols.
However, there are significantly more SNOMED CT codes than Read codes, so over time you might want to review and amend your searches to reflect the greater choice of codes. Also, some codes may move positions in the SNOMED CT hierarchy, which could affect search results. However, we expect the effect to be minimal, usually reflecting cases where the Read code hierarchy was incorrect.
DON’T PANIC!
Remember the Millennium Bug?
Did any planes drop out of the sky?