1 / 24

Experience Implementing SNOMED-CT

Experience Implementing SNOMED-CT. Chris Wroe. Overview. Experience to date Term Subsets Term Search What is being worked on (SNOMED-CT in the data lifecycle. Data entry. Data storage and messaging. Data analysis. Experience - subsets. SNOMED-CT is a reference terminology –

jemima-young
Download Presentation

Experience Implementing SNOMED-CT

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Experience Implementing SNOMED-CT Chris Wroe Training Course Title

  2. Overview • Experience to date • Term Subsets • Term Search • What is being worked on (SNOMED-CT in the data lifecycle Data entry Data storage and messaging Data analysis

  3. Experience - subsets • SNOMED-CT is a reference terminology – • large and covers most aspects of medicine • Any one clinical context requires far fewer terms • Subsets important • Content • Surgical procedure subsets for operating theatre applications • Diagnosis subsets, Primary care relevant subsets • Allergies and alerts subsets • Software • Need the ability to restrict selection to a particular subset

  4. Anatomy Disorder Procedure

  5. Procedures only

  6. Usability of term search • Aiming for minimal impact on documentation time • Searching for a term to add to the record must be straightforward and fast • Balance of brevity, sensitivity and specificity

  7. Brevity • Sensitivity • Selectivity Key search features Unordered start of word search within phrase • Responsive – users wont have the time to page through multiple pages of results

  8. Usability of term browsing • Recording for clinical care should allow term to be recorded at whatever level of detail necessary • Need for browsing to more general or more specific terms. • SNOMED-CT hierarchy designed to be machine interpretable • Need for navigation subsets to apply a recognisable table of contents view onto SNOMED-CT for a specific context

  9. More recognisable hierarchy

  10. Current work & issues in using SNOMED-CT in the clinical data lifecycle1: Data entry

  11. Entering a SNOMED-CT term • Always ask when and for what purpose? • Supporting interoperability is key • Several mechanisms to enter from a controlled list of terms • In primary care a great deal of experience • In secondary care/ mental health, community health less experience. • Why general practitioners use computers and hospital doctors do not-Part 1 & 2: T Benson - 2002 , BMJ

  12. What happens when a user cannot find a term? Term triage • It is there in the subset but user could not find it • It isn’t in the subset but is in SNOMED-CT • The concept is in SNOMED-CT but the required synonymous term is not present • It isn’t in SNOMED-CT but could be expressed using postcoordination • It isn’t in SNOMED-CT and would need a new concept

  13. End user solution: Up terming • Up terming. Choose a more general term, flag it as incompletely captured and enter the additional information in free text • Issues: Hierarchy not supported in all applications

  14. Background solution : New term request • Report missing term to Cluster/ National/ International level. • Issues: Life cycle for changes

  15. Solution 3: end user extension • Allow user to postcoordinate where possible • Issues: Post coordinated data entry not supported by all applications

  16. SNOMED-CT in forms

  17. Assessment forms • SNOMED-CT is a reference terminology • Context can reduce verbosity • Family history of ischemic heart disease (297242006) • Interface terminology products often have additional context specific information of the form • ‘If you picked this symptom these are the likely diagnosis terms you may want to choose from’

  18. Storage

  19. Applications often store information as key/values reflecting the question & answer on the form Model of use Were enzymes elevated? = yes Model of meaning Raised cardiac enzyme or marker (finding) - 405740000 Important to have access to both Storage

  20. Message out Oophrectomy (83152002 ) laterality (272741003 ) right (24028007) Message in Right Oophrectomy (302376006 ) Left Oophorectomy | Right Storage and messaging with postcoordination Application Procedure | Laterality Oophorectomy |Right hl

  21. SNOMED-CT and analysis

  22. Analysis • Reporting, audit, decision support rules all depend on detecting general cases (asthma) from specific information in records. • Solutions • Enumerate all specific terms that are relevant Stable but time consuming (mild asthma, moderate asthma…) • Use the SNOMED-CT hierarchy Changes over time (asthma and its descendants)

  23. Endoscopic procedure Approach endoscopic approach Analysis and postcoordination Repair of hernia of abdominal wall Is -a Incisional hernia repair • Solution • Either add more report criteria to look for both existing endoscopic procedures in SNOMED-CT or procedures further qualified with this concept • Or use specialist software to infer these additional hierarchical relationships.

  24. Conclusion • Have to keep the whole clinical data lifecycle in mind when implementing SNOMED-CT • A fair number of work areas upstream and downstream of messaging to get interoperable data

More Related