Fire and Ice - SNOMED for CORE strength - John Fountain
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Transcript of Fire and Ice - SNOMED for CORE strength - John Fountain
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SNOMED CTClinically Oriented Record Entry
CORE
Dr John S Fountain
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SNOMED CT(Systematized Nomenclature of Medicine – Clinical Terms)
SNOMED Clinical Terms (SNOMED CT) is the most comprehensive, multilingual clinical healthcare terminology (ontology) in the world.
SNOMED CT can be used to represent clinical information in a coded form, with the level of expressivity appropriate for clinical documentation, and also with extensive support for meaning based retrieval, analysis and reporting.
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SNOMED CT(Systematized Nomenclature of Medicine – Clinical Terms)
SNOMED Clinical Terms (SNOMED CT) is the most comprehensive, multilingual clinical healthcare terminology (ontology) in the world.
It contains in excess of 400,000 clinical concepts (clinical thoughts) each identified by human readable descriptions (over 1.2 million). These concepts can be:• Translated into a range of languages• Mapped to existing classification systems
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Difficulties with Data Exchange
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Difficulties with Data Exchange
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This provides effective access to information required for decision support and consistent reporting and analysis.
Patients benefit from the use of SNOMED CT because it improves the recording of EHR information and facilitates better communication, leading to improvements in the quality of care.
SNOMED CT(Systematized Nomenclature of Medicine – Clinical Terms)
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The Health Information Standards Organisation (HISO) has endorsed the use of SNOMED CT as the clinical terminology to be used across the health and disability sector in New Zealand.
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Great, what now?
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There is a clear need for effective bedside clinical decision support
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The challenge is not in developing an effective Clinical Decision Support tool, which by definition:
• Is integrated into clinical workflow rather than a separate log-in or screen;
• Provides recommendations for care, not just assessments; and• Provides CDS at the point of care.1
It is in designing a clinical user interface to allow effective data collection to support decision-making.
1. Adapted from:Kawamoto K et al. Improving clinical practice using clinical support systems: a systematic review of trials to identify features critical to success. British Medical Journal 2005; 330 (7494): 765
Clinically Oriented Record Entry - CORE
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The critical first step is the efficient and effective collection of data. Without this, SNOMED CT implementations:
• Will not deliver on promises, or• Will squander healthcare dollars, or• Will impede clinical care and patient outcomes, or• All of the above
Clinically Oriented Record Entry - CORE
Clinically Oriented Record Entry - CORE
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Search / Input Functionality
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A reference set (or ‘refset’) is a mechanism used to refer to a set of SNOMED CT components and to add customised information to these components. Refsets can be used for many purposes, including representing subset of concepts, descriptions or relationships, language and dialect preferences, maps to and from other code systems, ordered lists, navigation hierarchies and aggregated hierarchies.
Reference Sets
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Reference Sets
Ambulance
• Ambulance electronic patient report form (ePRF)• Emergency observations and interventions refset
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Reference Sets
Ambulance
• Ambulance electronic patient report form (ePRF)• Emergency observations and interventions refset
Emergency Departments
• Emergency Department at a Glance (EDaaG )• Emergency care refset
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Refsets are good for such devices as:
• Pick lists• Drop downs• Short (or relatively short) searchable lists
They are a good mechanism to emulate systems currently available for data collection, but which may not adequately or appropriately code data.
Reference Sets
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But, refsets may negate the full potential of SNOMED CT by exposing users to only a small subset of the full ontology:
• Terms not within the refset may not be (easily) available• The granularity of data input is reduced • Such systems may persist for long periods without being
updated• Desired clinical concepts may not be available in SNOMED CT
Reference Sets
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A set of terminology components and derivatives that add to and are dependent on the SNOMED CT International Edition, and are created, structured, maintained and distributed in accordance with SNOMED CT specifications and guidelines.
Extension / National Extension
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SNOMED CT International
Extension
Extension / National Extension
A set of terminology components and derivatives that add to and are dependent on the SNOMED CT International Edition, and are created, structured, maintained and distributed in accordance with SNOMED CT specifications and guidelines.
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SNOMED CT International
Extension / National Extension
A set of terminology components and derivatives that add to and are dependent on the SNOMED CT International Edition, and are created, structured, maintained and distributed in accordance with SNOMED CT specifications and guidelines.
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New Zealand Medicines Terminology
SNOMED CT International
Extension / National Extension
A set of terminology components and derivatives that add to and are dependent on the SNOMED CT International Edition, and are created, structured, maintained and distributed in accordance with SNOMED CT specifications and guidelines.
SNOMED CT International
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• Body structure• Clinical finding• Environment or geographical
location• Event• Linkage concept• Observable entity• Organism• Pharmaceutical / biologic product• Physical force• Physical object• Procedure• Qualifier value• Record artifact• Situation with explicit context• Social context• Special concept• Specimen• Staging and scales• Substance
SNOMED CT HIERARCHIESConcepts are organized into top-level
hierarchies
Hierarchy Search
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Searching within a specific hierarchy rather than the entire ontology
Hierarchy Search
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Hierarchy Search
Term Hierarchy Number Descriptors
“Tibia” All
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Hierarchy Search
Term Hierarchy Number Descriptors
“Tibia” All 1,304 Tibia Tibia Part
Tibia VaraTibia VeinTibia X-rayDistal TibiaTibial NerveEntire TibiaTibial BraceTibial VesselTibial Insert
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Hierarchy Search
Term Hierarchy Number Descriptors
“Tibia” All 1,304Body Structure 373 Tibia
Tibial VeinDistal TibiaTibial NerveEntire TibiaTibial VesselTibial ArteryShaft of TibiaTibial PlateauTibial Plafond
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Hierarchy Search
Term Hierarchy Number Descriptors
“Tibia” All 1,304Body Structure 373Procedure 390 Tibial X-ray
Biopsy of TibiaTibial AngiogramTibial OsteotomyDivision of TibiaIncision of TibiaGrafting of Tibia
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Hierarchy Search
Term Hierarchy Number Descriptors
“Tibia” All 1,304Body Structure 373Procedure 390Disorder 403 Tibia Vara
Injury of TibiaUnossified TibiaSarcoma of TibiaFracture of TibiaTibial NeuropathyAgenesis of TibiaNeoplasm of Tibia
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Hierarchical lists can be ranked by likelihood of occurrence‘Common things happen commonly’
Therefore when looking at disorders the list is more practical when reordered:
Hierarchy Search
Tibia VaraInjury of TibiaUnossified TibiaSarcoma of TibiaFracture of TibiaTibial NeuropathyAgenesis of TibiaNeoplasm of Tibia
Injury of TibiaFracture of TibiaTibial NeuropathyNeoplasm of TibiaSarcoma of TibiaTibia VaraUnossified TibiaAgenesis of Tibia
Becomes
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SNOMED CT expressions are a structured combination of one or more concept identifiers used to represent a clinical idea in a logical manner that is computer processable.
There are:
• Precoordinated expressions
• Postcoordinated expressions
Expressions
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SNOMED CT expressions are a structured combination of one or more concept identifiers used to represent a clinical idea in a logical manner that is computer processable.
There are:
• Precoordinated expressions
• Are single concept identifiers that represent the meaning of individual concepts which are predefined in SNOMED CT
• Postcoordinated expressions
Expressions
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Acute otitis media
Disorder of the ear
Acute inflammatory disease
Otitis media
Sudden onset AND/OR short duration
Acute inflammation
Middle ear structure
Is a(attribute)
Is a(attribute)
Is a(attribute)
Finding site(attribute)
Clinical course(attribute)
Associated morphology(attribute)
3110003
Precoordination
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SNOMED CT expressions are a structured combination of one or more concept identifiers used to represent a clinical idea in a logical manner that is computer processable.
There are:
• Precoordinated expressions
• Are single concept identifiers that represent the meaning of individual concepts which are predefined in SNOMED CT
• Postcoordinated expressions
Expressions
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SNOMED CT expressions are a structured combination of one or more concept identifiers used to represent a clinical idea in a logical manner that is computer processable.
There are:
• Precoordinated expressions
• Are single concept identifiers that represent the meaning of individual concepts which are predefined in SNOMED CT
• Postcoordinated expressions
• Expressions that contain two or more concept identifiers adding more detail to the meaning of a single concept.
Expressions
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Fracture of lower limb
Bone structure of tibia
Fracture
Injury of tibia
Associated morphology(attribute)
Finding site(attribute)
Is a(attribute)
Is a(attribute)
Fracture of tibia
Precoordination
31978002
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Fracture of tibia
Postcoordination
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Bone structure of tibiaFinding site(attribute)
Postcoordination
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Bone structure of tibia
FractureAssociated morphology(attribute)
Finding site(attribute)
Postcoordination
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Bone structure of tibia
FractureAssociated morphology(attribute)
Finding site(attribute)
Fracture of tibia
Postcoordination
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Fracture of lower limb
Bone structure of tibia
Fracture
Injury of tibia
Associated morphology(attribute)
Finding site(attribute)
Is a(attribute)
Is a(attribute)
Fracture of tibia 31978002
Postcoordination
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Working diagnosis
Investigation
Medication
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Working diagnosis
Muscles
Skeletal
Organ
Skin
Investigation
Medication
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Working diagnosis Skeletal
Investigation
Medication
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Working diagnosis Skeletal
Left tibiaInvestigation
Medication
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Working diagnosis Skeletal
Fracture
Neuropathy
Osteomyelitis
Left tibiaInvestigation
Medication
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Working diagnosis Skeletal
Fracture
Left tibiaInvestigation
Medication
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Working diagnosis Fracture left tibia
Investigation
Medication
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Working diagnosis Fracture left tibia X-ray
CT scan
MRI
Investigation
Medication
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Working diagnosis Fracture left tibia
Investigation
Medication
X-ray
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Working diagnosis Fracture left tibia
Investigation
Medication
X-ray
Pain
Antiemetic
Fluids
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Working diagnosis
Investigation
Medication
X-ray Morphine
Tramadol
Oxycodone
Codeine
Paracetamol
PainFracture left tibia
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Working diagnosis
Investigation
Medication
X-ray Dose
Route
Time
Morphine
Morphine
Fracture left tibia
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Working diagnosis
Investigation
Medication
X-ray Dose
5 mg
10 mg
15 mg
Morphine
Morphine
20 mg
Fracture left tibia
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Working diagnosis
Investigation
Medication
X-ray Dose
Route
Time
Morphine
Morphine 10mg
Fracture left tibia
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Working diagnosis
Investigation
Medication
X-ray Dose
Route
PO
SC
Morphine
Morphine 10mg
IM
IV
Fracture left tibia
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Working diagnosis
Investigation
Medication
X-ray Dose
Route
Time
Morphine
Morphine 10mg IV
Fracture left tibia
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Working diagnosis
Investigation
Medication
X-ray Dose
Route
Time
STAT
Morphine
Morphine 10mg IV
PRN
Hourly
2Hourly
Fracture left tibia
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Working diagnosis
Investigation
Medication
X-ray
Morphine 10mg IV STAT
Pain
Antiemetic
Fluids
Fracture left tibia
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Implementation Exemplar
Develop a circumscribed, achievable example of SNOMED CT implementation which:
• Collects meaningful data/information• Supports clinical decision making• Can be efficiently and effectively used in the clinical
environment• Is scalable• Can be proven to improve clinical practice / patient outcome
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SNOMED CTClinically Oriented Record Entry
CORE
Dr John S Fountain