1. SNOMED CT Afzal Chaudhry anc35@cam.ac.uk Renal Association Terminology Committee anc35@cam.ac.uk

2. Thanks to Denise Downs (denise.downs@hscic.gov.uk) Ed Cheetham (ed.cheetham@hscic.gov.uk

3. Coding…. John Graunt (1620-74) Bills of Mortality - predicted onset of bubonic plague © Gresham College, London from UKTC snomed_beginners_nhs_elearning_2.0.1_20120903000001

4. Classification vs. Terminology Classification – System of arranging terms of a particular type into logical groups of ‘like’ entities – Structural framework for statistical information – Good for: audit, business planning, epidemiology – ICD-10 “Struck by a turtle” – “Contact with other non-venomous reptiles” – W59.22XA / XD / XS

5. Classification vs. Terminology Terminology – Phrases used by an expert to record information – Organised as collections – Captures relationships and linkages between concepts

6. SNOMED CT

9. Classification vs. Terminology Terminology – Phrases used by an expert to record information – Organised as collections – Captures relationships and linkages between concepts – SNOMED CT “Bruised nose from a collision with an Asiatic box turtle” – 60897004 | contusion of nose | 42752001 | due to | 217883006 | accidental collision with moving object | 246075003 | causative agent | 31067007 | Asiatic box turtle |

10. Classification vs. Terminology Classification – ICD-10 “Struck by a turtle” V00-Y99 External causes of morbidity W50-W64 Exposure to animate mechanical forces W59Contact with other non-venomous reptiles W59.2Contact with turtles W59.22Struck by turtle W59.22XA initial encounter W59.22XD subsequent encounter W59.22XSsequela

11. Classification vs. Terminology Terminology – Phrases used by an expert to record information – Organised as collections – Captures relationships and linkages between concepts – SNOMED CT “Bruised nose from a collision with an Asiatic box turtle” – 60897004 | contusion of nose | 42752001 | due to | 217883006 | accidental collision with moving object | 246075003 | causative agent | 31067007 | Asiatic box turtle |

12. SNOMED CT Systematized Nomenclature of Medicine Clinical Terms Clinical terminology = meaningful SNOMED CT – Record clinical details of individuals in EPRs – Supports data transfer between systems – Supports clinical decision making – Supports record based analysis UKRDC

13. Information Standards Notice: The standard applies to: Healthcare professionals providing care to patients receiving NHS care in England. All NHS staff interacting with patients should use SNOMED CT to record and exchange coded clinical information. Other stakeholders who may be required to use SNOMED CT will include staff at any other organisation that delivers care on behalf of the NHS. This may include public health, social care, health related services delivered in the education sector, as well as the independent sector. The standard may be used to support clinical management of the patient in the following ways: In messages that are used to transfer patient related data from one system to another. Patient Summaries including Discharge summary. Problem lists. Allergy Lists and Allergy Management. Clinical Documentation. Order Communication and Results reporting. Care Plans; in particular for clinical content that will be transferred between systems. Keyword lists for metadata in care pathways, research documents, evidence based content. Information Strategy: 3.58 At the moment different areas of the health and care system use different coding terminologies – this means that information cannot flow around the system well, and the way data and terminologies are described is often inconsistent. Reducing the number of inconsistent or incompatible terminologies from 2015 (via the ‘route-map’) will allow better integration between systems and across health and social care, and better information to support care and improvement of care. In due course, for patient care purposes, all relevant systems should use the same terminology to exchange coded information; SNOMED CT, adapted to fit all necessary uses, is the appropriate terminology to base this on. Similarly, to allow drugs to be consistently referenced, systems will consistently use the electronic drugs dictionary (dm+d). Action: The NHS Commissioning Board will lead and coordinate work on developing commissioning data sets (the main data collection from secondary care) to allow data returns in SNOMED CT from April 2014. Return to Diagram SNOMED CT preferred NHS terminology from 1/4/2015

14. Renal Subset 400,000+ concepts in SNOMED CT Renal subset – First defined April 2011 – 630+ items – mainly primary diagnoses “Kidney finding” concept – 1100 data items Quality control process to start Oct 2011

15. Quality Control WRONG

16. Quality Control

17. Documentation Clinical Documentation & Generic Record Standards standards for: – structure & content of patient records – hospital referral letters – inpatient clerking – handover communications – discharge summaries – outpatient letters http://www.infostandards.org/dd4c/professional-record-standards/scscpr/ http://www.rcplondon.ac.uk/sites/default/files/standards-for-the-clinical- structure-and-content-of-patient-records.pdf

18. Documentation

19. Semantic Control Is this true? Yes & No

20. Why is it useful? - Snofyre https://code.google.com/p/snofyre/

21. Guidelines for Implementation UK Renal Data Collaboration – BAPN, RADAR, RIXG, RPV, SRR & UKRR SNOMED CT requirements in a Renal EPR for suppliers – Thanks to Denise Downs from HSCIC http://www.rixg.org.uk/j/index.php?option=com_rokdownloads&view =file&task=download&id=43:snomed-ct-requirements-in-a-renal-epr- for-suppliers-v07