1. SNOMED CT A Technologist’s Perspective Gaur Sunder Principal Technical Officer & Incharge, National Release Center VC&BA, C-DAC, Pune

2. SNOMED CT Origin A controlled coded clinical terminology for use in Electronic Health Records – Developed in the USA and the UK by College of American Pathologists in USA National Health Service in the UK Design based on – Identified user requirements – Practical experience – Scientific principles established in peer reviewed publications First released in 2002 All rights and administration transferred for the public good to IHTSDO in 2007 Earlier Systematized Nomenclature for Medicine (SNOMED) – Clinical Terms (CT), now simply SNOMET Clinical Terms

3. IHTSDO IHTSDO: International Health Terminology Standards Development Organization Maintains and delivers SNOMED CT – Licensed to registered Affiliates – IHTSDO does not charge for use in Member countries – Low-cost licenses for institutions in other countries Free in lowest income countries Fee waivers for approved research and “Public Good” uses An International not-for-profit standard development organization – Owned by Nations as Members – Governed by General Assembly of its Members

4. Worldwide Presence Currently 27 countries are Members of IHTSDO The clinical terminology is used in more than 50 countries India became a member in April 2014 Represented by e-Governance Division, Ministry of Health & Family Welfare, Government of India Interim National Release Center (NRC) created at C-DAC, Pune in September 2014

5. Design Benefits of SNOMED CT Comprehensive clinical scope – Reduces need to support multiple code systems – Common framework for consistent retrieval and processing Logical definitions – Allow clinically relevant meaning-based retrieval Optional post-coordination – Combining codes to add detail and specificity – Increases scope without ‘combinatorial explosion’ of codes Updates and versioning – Regular updates to International Release (six-monthly) – Support for incremental updates – Full historical view of all previous versions of SNOMED CT

6. SNOMED CT – Comprehensive Scope It is the richest vocabulary available to describe clinical findings, diseases, procedures etc. Contains more than 365,000 concepts, almost 1 million descriptions and nearly one and a half million relationships. SNOMED CT aims at transmitting all concepts that have been expressed throughout history in the healthcare domain, unambiguously SNOMED CT concepts are divided into 19 hierarchies

7. SNOMED CT Design Every coded concept is linked to related concepts – Multi-axial subtype hierarchy (‘is a’ relationships) – Logical definitions (attribute relationships)

8. SNOMED CT Basic Components Concepts – A “concept” is a clinical idea identified by a unique numeric identifier (ConceptID) that never changes – Concepts are represented by a unique human-readable Fully Specified Name (FSN) Descriptions – Concept descriptions are human readable terms or names assigned to a SNOMED CT concept – Descriptions are of two types Fully Specified Name (FSN) Synonym – Descriptions can be Preferred or Acceptable according to the language dialect used Relationships – Relationships link concepts in SNOMED CT

9. SNOMED CT Expressions Precoordinated Expression – Representation of a clinical meaning using a single concept identifier is referred to as a precoordinated expression Postcoordinated Expression – Representation of a clinical meaning using a combination of two or more concept identifiers is referred to as postcoordination

10. SNOMED CT Additional Components Subsets & Reference Sets – A SNOMED CT subset is a set of Concepts, Descriptions, or Relationships from the international edition that is appropriate to deployment to support particular requirements of implementation Extensions – The International Edition contains the core content of SNOMED CT. – Extensions can be added to the International Edition to meet specific national or local needs Cross Maps – Mapping of concepts to other international standards and classifications such as ICD or LOINC

11. Technical Views A SNOMED CT Affiliate License is required to obtain the release files SNOMED CT International Release Files are released biannually (in Jan and July) Three release file types exists: – Snapshot: containing the current version of every component – Full: containing the complete history of every component – Delta: containing only the additions and changes since the previous release The snapshot type is recommended to use in applications All release files are UTF-8 encoded tab-delimited text files Data in these files need to be imported in relevant tables in database

12. Integration Approaches SNOMED CT can be integrated as: A code systemTo store clinical information An interface terminology To capture and display clinical information An indexing systemTo retrieve clinical information A common terminologyTo communicate in a meaningful way To integrate heterogeneous data A dictionaryTo query, analyze and report To link health records to knowledge resources

13. Usage in Software - Search

14. Usage in Software – Data Entry

15. Use in Practice Clinical ideas are complex and interrelated – A form of representation that captures this inherent complexity is essential SNOMED CT – Provides comprehensive coverage of a broad clinical scope – Is designed based on practical experience & scientific principles – Adds value with a concept model that locates clinical ideas relative to one another in a way that supports computable semantics enabling meaning- based retrieval – Clinicians need to remember the codes as only the descriptions are relevant Well-engineered EHR systems using SNOMED CT – Provide user interfaces that simplify capture of clinical ideas – Share information taking advantage of the global terminology – Harness the logical design of the terminology to deliver effective meaning- based retrieval

16. EHR Benefits of SNOMED CT Enhancing the care of individual patients: – Display of appropriate information – Guideline and decision support integration – Communicating and sharing relevant information Enhancing the care of populations of patients: – Epidemiology monitoring and reporting – Research into the causes and management of diseases Supporting cost-effective delivery of care: – Guidelines to minimize the risk of costly errors – Reducing duplication of investigation and interventions – Auditing the delivery of clinical services – Planning service delivery based on emerging health trends

17. India Updates 74 Affiliate Licensees issued in first year 06 Workshops / trainings Conducted More trainings focused on clinical use and implementations planned Check official website of India NRC at https://www.snomedctnrc.in

18. Thank You nrc-help@cdac.in info@snomedctnrc.in