1. Mapping from antecedent SNOMED to SNOMED CT in Histopathology and Cellular Pathology IHTSDO Business Meeting, London April 2016 Presented by Jeremy Rogers and Deborah Drake, UKTC HSCIC

2. Background Work began by the UK Terminology Centre in order to try support the move from antecedent versions of SNOMED to SNOMED CT (helpdesk enquiries to information standards) The move from older versions affects –Laboratories adopting SNOMED CT (e.g. cellular / histopathology domains) –Suppliers trying to embed SNOMED CT into new Laboratory Information Management Systems (LIMS) –Secondary care systems –Cancer Outcomes and Services Dataset –Royal College of Pathology and reporting standards –Other systems which secondary report e.g. cervical cytopathology, bowel cancer screening –Other clinical domains (e.g. microbiology)

3. Current coverage of mapping to SNOMED CT 3 International (IHTSDO) mapping files do exist already but…. –‘Product’ has not been maintained –Becoming more out of date as time passes –Contains a number of non-SNOMED CT mapped items No current single source of truth / clinical validated version for mappings available Various mappings currently done locally and nationally without reference to mapping files / a standard

4. Criteria to go to a Technical preview product 1 Utility –At least 4 laboratories so far with similar needs and 1 created their own mapping product (NB early adopters / moving to SNOMED CT) –Other enquiries being received from independent laboratories and secondary users –Evidence RC Path in the same solution space for Bowel screening & dataset specifications Quality –Computed as a derivative of mapping resources (Quality Assured by IHTSDO*) –Coverage of mapping on next slide –*NB known map errors from ambiguous content 4

5. Legacy coding schemes & SNOMED CT maps 5 LEGACY VERSION TOTAL No. CODES No. MAPPED to SNOMED CT No. NOT MAPPED to SNOMED CT SNOMED 2 42,58440,475 (95%)2,109 SNOMED 2+ 117,58024,787 (21.1%)92,793 SNOMED 3 98,77985,910 (87%)12,869 SNOMED 3.5 110,79296,686 (87.3%)14,106 SNOMED RT 132,517118,592 (89.5%)13,925 SNOMED 2+ = SNOMED 2 extended by enumerating all the codes implied by means of a legitimate code digit swap or addition.

6. Technical preview product criteria 2 Capability –Current draft (technical preview) product already exists –Legitimate ? Capability for further Quality Assurance resourcing –Clinical support from Pathologists gaining traction –Will possibly be brought into the NLMC ‘suite’ in the future –Creation of a standard to map reduces local lab, supplier and duplication of burden to move to SNOMED CT –Improves standardisation in migration to SNOMED CT from various legacy products Safety –Probably less unsafe than alternative –Centralisation of risk; risk mitigation as per other maps also validated* locally on migration – *note local clinical validation still required –Guidance documentation will be provided helping improve methodology / support –Professional engagement on preferred delivery format and Quality Assurance –Reduces local duplicity of mapping to a different map from other data sources –Helps enable move to SNOMED CT from unsupported, less safe coding schemes –Increased clinical engagement and understanding of a complex issue –Standard file formats 6

7. Legacy coding in laboratory LIMS CODE ORIGINLAB 1LAB 2LAB 3LAB 4 SNOMED 2 00 43,700 SNOMED 3.5 2,2151,63412,45116 SNOMED RT 31,1486611 ICD-O 0 119 0 15 UNKNOWN 55,266797 TOTAL 2,2238,16712,5283,839 TOTAL MAPABBLE TO SNOMED CT 2,197 (99%) 2,738 (33%) 12,396 (99%) 3,563 (92%) 7 Collectively the labs map to a superset of 11,323 SNOMED CT codes 563 codes or legacy equivalent used in all 4 labs Analysis of original data and its origins required before mapping to SNOMED CT

8. Unique code use by based LIMS in same labs No OF UNIQUE CODESPERCENTAGE OF TOTAL LAB 160728 % LAB 277228 % LAB 3672054 % LAB 486224 % 8 Current coding appears a mixture of legacy coding and bespoke local requirements Appears a coding drift over time from standard coding structures / scope creep of local coding requirements Not all coding in LIMS is necessarily clinical (e.g. some administrative) There are also national secondary data collections dependent on LIMS data (e.g. COSD; RC Pathology datasets, other national collections)

9. Requirement for UK maps to SNOMED CT To create one single source of truth for national UK mappings Could be clinically adopted / validated / maintained with HSCIC support Based around current usage but also current national standard reporting Decrease mapping variability (& potential coding mismatching) –Which could eventually increase interoperability and standardisation Aid migration to SNOMED CT from legacy coding schemes going out of licence Aid to increase the adoption, understanding and use of the recommended standard clinical terminology SNOMED CT Potential to decrease overall burden to the NHS 9

10. File format and future development opportunity File distributed via TRUD –Currently following product development lifecycle procedure –Simple human readable format – other file types can be blocked by Firewalls making download difficult –Status = technical preview –Supporting documentation – maybe with a case study example later Could be eventually be adopted as part of the NLMC / ‘suite’ of standards for pathology Could be built on to help standardise consistent code use in these and other affected pathology domains

11. What have we found so far? ChallengesOpportunities Improved Standardisation Increased clinical involvement and knowledge Increased co-operation with suppliers, clinicians and secondary data collections Increased engagement and promotion of SNOMED CT Reliance on legacy code schemes Scale of change required nationally and timescales Localisation of standards

12. The possible future of the mapping product UK requirements Other NRC requirements IHTSDO maintenance of standard antecedent mapping product

13. Questions? 13