1. SNOMED CT Webinar 3 Tom Seabury http://www.networks.nhs.uk/nhs-networks/snomed-ct/about-us 26 th September 2011 at 15:00-16:00, repeated on 29th September at 10:30-11:30 NHS Data Standards and Products

2. Welcome Useful links: UKTC website - http://www.nhscfh.nhs.uk/uktchttp://www.nhscfh.nhs.uk/uktc Email for Data Standards help desk – datastandards@nhs.netdatastandards@nhs.net NHS Networks – network name: SNOMED CT http://www.networks.nhs.uk/ http://www.networks.nhs.uk/

3. Resources to support implementation

4. Topic areas Implementation types and approaches Access to existing SNOMED CT content and related products Resources relating to change in content Training, Roles and Competences, the SNOMED CT community DIY and Free-to-use tools, content and research

5. Implementation Types Three major class of implementation identified by IHTSDO in their documentation on SNOMED CT are: Clinical records Knowledge representation Aggregation and analysis

6. Implementation Approaches A variety of implementation strategies are commonly encountered and are demonstrably credible. These include: Introduction to restricted domains in a system but in great depth e.g. medications records in a hospital system Phased introduction starting with substitution into the data entry process in place of an existing terminology scheme Parallel use of SNOMED CT along with either a legacy terminology or a dedicated interface terminology deployed at the user interface

7. Topic areas Implementation types and approaches Access to existing SNOMED CT content and related products Resources relating to change in content Training, Roles and Competences, the SNOMED CT community DIY and Free-to-use tools, content and research

8. Subsets in the UK Edition UK Edition – Concepts – Descriptions – Relationships – Sets

9. Subset detail – nationally distributed subsets

10. UKTC Subset Register http://termrequest.connectingforhealth.nhs.uk/registry/subset

11. Cross maps (I) Anticipated uses for cross maps – To suggest or allocate classification codes – To allow one-time migration of existing data between systems – To support some level of data ‘round-trip’ with minimal loss – no loss? – Not assumed to be automated e.g. where exacting and specific coding policy is paramount (provider reimbursements)

12. Cross maps (II) Particular uses of cross maps SNOMED CT to ICD10 & OPCS-4 in secondary care Suggested maps offered to clinical coders Where SNOMED CT is the target terminology such as allergies data in a summary care record

13. Cross maps (III) Data migration maps Inter-terminology, inter-edition, inter-release, DI imaging map from NICIP (interim) to SNOMED CT Supporting the needs expressed by suppliers and NHS For GP2GP For preparation SCRs from non-SNOMED CT records

14. Cross-map release schedules General case: Maps are released alongside each successive release of each of the schemes e.g. – SNOMED CT six monthly release has up-to date maps – OPCS each release comes with the up-to-date map from SNOMED CT

15. Tools for Mapping Proprietary codes scheme can be mapped to SNOMED CT (with a set of caveats on scope, information models and editorial policy) UKTC can offer guidance for those seeking to do this Good practise Past practise Known and avoidable pitfalls IHTSDO tools for mapping (schedule for release of tool)

16. Questions

17. Topic areas Implementation types and approaches Access to existing SNOMED CT content and related products Resources relating to change in content Training, Roles and Competences, the SNOMED CT community DIY and Free-to-use tools, content and research

18. Change to SNOMED CT content SNOMED CT is relatively dynamic More change compared to Read More frequent changes than classifications Less dynamic than the drugs data

19. SNOMED CT changes: Changes to Concepts New Changed +/- inactive (quite a few ‘flavours’ of change) Changes to descriptions Changes to Subsets or Cross Maps Subset versioning – policy documentation link Mapping updates

20. SNOMED CT changes: Inactive concepts Quality management requires continuous improvement of its content New implementation initiatives – refinements of content Healthcare advances between each SNOMED CT release

21. Cascades of change Changes to the concepts Changes to things which have used the inactive or concepts Subsets Queries ‘Bindings’ Cross maps

22. Resources for changed content National subsets – maintained for you in line with published policy – re-distributed on each release A table of potential substitute concept(s) – (progressing from technical preview) Planned or proposed – Further tools to assist – simple countermeasures for inactive content

23. Overall counts of inactive concepts

24. History Mechanism Past practice (Andrew Jones, NHS London) Simple move from UK Extension to Core ‘Replaced by’

25. History Mechanism Removal of Duplicates ‘Same as’

26. History Mechanism Removal of Ambiguous concepts

27. Sample Data sample data from Technical Preview Crown copyright 2011

28. Topic areas Implementation types and approaches Access to existing SNOMED CT content and related products Resources relating to change in content Training, Roles and Competences, the SNOMED CT community DIY and Free-to-use tools, content and research

29. Training and Education Materials For a general audience: UKTC – Brochures – eLearning – Training (via a variety of providers including us) – UK release documentation (descriptive) – Case Studies

30. Brochures http://www.connectingforhealth.nhs.uk/systemsandser vices/data/uktc/snomed/training

31. eLearning Link (viaTRUD) http://www.connectingforhealth.nhs.uk/systemsandservices/icd/informspec/etd/el earning/nhselearning/snomedct http://www.connectingforhealth.nhs.uk/systemsandservices/icd/informspec/etd/el earning/nhselearning/snomedct intended audience end user introductory and descriptive supportive for application training

33. Training and Education Materials For the more technical audience UKTC – Where-to-start guide – Subset Policy document IHTSDO materials – User Guide – the standard itself (TIG, TRG)

34. UK Where-to-start document An approachable guide to resources An introduction to a range of approaches and techniques http://www.isb.nhs.uk/documents/isb-0034/amd-26- 2006/wheretostart.pdf Migration roadmap.. how to swap out any one terminology for another whilst satisfying all the clinical safety processes at the same time as also maintaining business continuity for reporting during the switchover and after

35. How accessible is it all? 1000+ pages of IHTSDO standards documentation Pre-digested for you in our where-to-start guide Support for you to get to the most important points is the business of the implementation team

36. IHTSDO Materials Established key documents SNOMED CT User Guide Technical Reference Guide Technical Implementation Guide Future Competences and Roles

37. Typical Roles and Competences IHTSDO are drafting some guidance on Roles and competencies associated with implementation activity ? – Application developer – Requirements analyst – Solution architect – Subject matter expert (clinical & technical)

38. Typical Roles and Competences Competences? User experience design – point of care Adaption of technology to ways of working - product deployment Database design Clinical data migration and information governance Message and ‘interoperability’ design Design of clinically appropriate sets, filters and reports Mapping and binding to existing models and data Distinct roles are not pre-se separate employees!

39. SNOMED CT Community Implementation Forums – Implementation Forum – GP Supplier Special interest Group – IHTSDO Special Interest Groups and collaboration space – IHTSDO Affiliate forum Editorial – UKTC Edition Committee – Domain specific engagement e.g. Nat Lab catalogue pathology - governance and Specialist groups

40. Questions

41. Topic areas Implementation types and approaches Access to existing SNOMED CT content and related products Resources relating to change in content Training, Roles and Competences, the SNOMED CT community DIY and Free-to-use tools, content and research

42. SNOMED CT Tools How to request changes Subset tool options – UKTC working with IHTSDO to develop free to use set tools for the Release Format 2 formalism: Refsets – Existing commercially available tools can be used for formal Release Format 1 : Subsets – UKTC policy document sets out much detail on policy practicalities – Implementation team can assist in your orientation

43. Portal for request submission

45. SNOfyre Demonstrator software – complex reporting – SNOMED CT specific – Free to access and investigate, open source – Links > to follow – What you may want to refer to it for:- – Proof of concept for utility of compositional coded records Query and reporting using SNOMED CT Advanced SNOMED CT query capability demonstrated

46. SNOfyre Industry dissemination early 2011 Report of pre-coordination test No fundamental challenges to our initial findings Get involved or actively review

47. SNOfyre http://code.google.com/p/snofyre/

48. NHS Common User Interface Programme of developing guidance and standards for EHR interfaces Some guidance on SNOMED CT – ‘Single concept matching’ – codification of free text entry – Medications – Allergies and ADRs

49. CURIO (I) A collaborative research project by the team from UCL and the from NHS Data Standards Development of a technical environment and framework to facilitate exploration of challenges around implementing Common User Interface components and SNOMED CT Sharing of CURIO tools for CUI and SNOMED CT, licensed under Apache 2: implement key GUI functionality that is required to develop implementations of CUI specifications open source components developed in Adobe Flex.

50. CURIO (II) http://forge.tactix4.net/gf/project/curio/wiki/ Gives life to the guidance by example http://www.youtube.com/user/CurioOpenSource#p/f Example demonstration of the tool for ‘Single Concept Matching’ http://www.youtube.com/user/CurioOpenSource#p/f/11/6skB6q Cj8CM

52. Lexicon of words used in UK Terms Most recent addition to the products released by UKTC Carefully curated from the words used in all active UK Edition descriptions e.g. for data entry spell-check

53. IHTSDO Lexical Resources Member Exchange

54. Questions

55. Please take time to complete the Evaluation to help us improve current provision and identify additional webinars. UKTC website - http://www.nhscfh.nhs.uk/uktchttp://www.nhscfh.nhs.uk/uktc Data Standards help desk – datastandards@nhs.netdatastandards@nhs.net SNOMED CT Network: http://www.networks.nhs.uk/http://www.networks.nhs.uk/ dm+d: http://www.dmd.nhs.uk/snomed_links/index.htmlhttp://www.dmd.nhs.uk/snomed_links/index.html