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Mental Health : An introduction to SNOMED CT

Mental Health : An introduction to SNOMED CT. presented by Ian Spiers Advanced Terminologist. Housekeeping. Please keep yourself on mute unless you want to ask a question You can ask questions either through chat or taking yourself off mute

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Mental Health : An introduction to SNOMED CT

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  1. Mental Health : An introduction to SNOMED CT presented by Ian SpiersAdvanced Terminologist

  2. Housekeeping • Please keep yourself on mute unless you want to ask a question • You can ask questions either through chat or taking yourself off mute • There will be opportunities to ask questions at the end of each section, but please ask if there is something said you do not understand. • The slides are available, you will receive an email with details after the presentation

  3. What is SNOMED CT ? Why SNOMED CT ? Brief overview of SNOMED CT fundamentals SNOMED CT Content – Using Browser Classifications and SNOMED CT Subsets (Refsets) Useful Information on SNOMED CT What is covered in this presentation

  4. What is SNOMED CT? • A national and international vocabulary of ‘Clinical phrases’ for electronic systems • Used for recording information in relation to the direct care of the patient • Has structure useful for system functionality • Is different to a classification (e.g. ICD-10) • Examples: • Depression • Thoughts of self harm • Cognitive behavioral therapy • Referral to mental health team • Body weight • Serum lithium level • No speech problem • Family history: Schizophrenia • Suspected drug abuse

  5. Why SNOMED CT - Interoperability • Reduce Burden • Improve care

  6. Why SNOMED CT - Benefits

  7. SNOMED CT the standard • SNOMED CT • National standard under the Health and Social Care Act 2012 • Single clinical terminology to support direct management of care • International Standard • DHSC : The future of healthcare: our vision for digital, data and technology in health and care • Key themes : Standards and Interoperability SNOMED CT

  8. Implementation Dates • By April 2018: • GP service providers must adopt SNOMED CT • By April 2020: • Secondary Care • Acute Care • Mental Health • Community systems • Dentistry • And … other systems used in the direct management of care • Social Care is in scope of the standard but there are currently no required implementation dates

  9. SNOMED CT SNOMED Use – Where are we now ? SNOMED CT IN MENTAL HEALTH website

  10. Where are we now? • Systems that support SNOMED CT: • Cerner Millennium • Lorenzo • Rio • MediTech • AllScripts • SystmOne • EMIS Web (in final stages) • DocMan • Advance Health • Apollo • OpenEyes … and more

  11. Data returns requiring SNOMED CT • Yellow card • MHSDS • ECDS • COSD • CSDS • QOF • GP Enhanced services Any new or updated dataset will have to use SNOMED CT

  12. Fundamentals of SNOMED CT Brief Overview

  13. Structure of SNOMED CT • Over 700,000 clinical concepts • Broad coverage, all professions, all specialities • Structured into 19 hierarchies • Concepts are organised in a logical structure way to help analysis

  14. SNOMED CT Content

  15. SNOMED CT Content

  16. Building blocks of SNOMED CT • SNOMED CT has three key building blocks - concepts - descriptions - relationships

  17. Concept ID 22298006 Concepts and descriptions • (FSN) Fully specified name • (PT) Preferred term • (S) Acceptable synonyms Concept ID 13746004 Descriptions (Terms) FSN Bipolar disorder (disorder) 739182010 PT Bipolar disorder 23447014 S Bipolar affective disorder 2839307017 S MDI - Manic-depressive illness 1221013017 S Manic-depressive illness 1221012010 S Manic-depressive psychosis 1221011015

  18. Relationships Concepts are linked to other concepts in 2 different ways Is-A Relationship Attribute Relationship More specific

  19. Is-A Relationships 128293007 35489007 Chronic mental disorder Parent Concepts Depressive disorder Is A Is A Concept ID 192080009 Chronic depression (disorder) ChildConcept

  20. Attribute Relationships Organic mental disorder is A Dementia Drug or medicament Brain structure is A Finding site causative agent Drug-induced dementia

  21. Building blocks of SNOMED CT In summary: • Concepts are clinical thoughts we wish to convey • Descriptions are different ways of expressing a clinical thought • Relationships tell us how the concepts link together and also provide more information about a concept

  22. Any Questions ? Further Questions : Helpdesk information.standards@nhs.net

  23. SNOMED CT Browsers Browsers : A way to see SNOMED CT data Many browsers available : SNOMED International Website includes SNOMED International Browser Suggested Browser for UK : NHS Digital SNOMED CT online browser termbrowser.nhs.uk The EPR may also have a SNOMED browser Looking at SNOMED CT data: use a browser

  24. NHS Digital SNOMED CT online browser

  25. NHS Digital SNOMED CT online browser

  26. NHS Digital SNOMED CT online browser 19 Hierarchies

  27. Search tips

  28. Search tips • Type what you want to say …

  29. Search for concepts Searching using Hierarchy Searching by Term Searching by ID Looking at SNOMED CT data in a browser

  30. Lets Explore • NHS Digital Browser • Searching using hierarchies

  31. Lets Explore Search for terms in the following hierarchies: • Disorder/Finding • Procedure • Situation • Observable

  32. Finding / Disorder Concepts The clinical finding concepts - represent diagnosis and symptoms/findings Depressive disorder (disorder) Schizophrenia (disorder) Chronic paranoid psychosis (disorder) Mild anxiety (finding) Panic attack (finding) At Risk Mental State for psychosis (finding) Thoughts of self harm (finding)

  33. Procedure Concepts The procedure concepts - represent activities performed in the provision of health care Procedures Review of medication (procedure) Lithium measurement (procedure) Physical restraint (procedure) Assessment using DIALOG patient rated outcome measure (procedure) Referral to mental health team (procedure) Lifestyle education regarding diet (procedure) Smoking cessation education (procedure) Cognitive - behaviour therapy (regime/therapy)

  34. Observable entity Concepts The observable concepts - Represents a question or assessment which requires an answer or result Observable – Gender (observable entity) Ideal body weight (observable entity) Serum clozapine level (observable entity) Health of the nation outcome scale for children and adolescents score (observable entity)

  35. Situation concepts Default context : Procedures and Findings Refers to patient of record (Subject of record) Occurring now or at a specified time (Current or specified time) Finding is actually present (Known present) Procedure has actually occurred (Done) Situation concepts - represents concepts in which the clinical context is specified as part of the definition of the concept itself. For example, when the conditions are absent or in the past or relate to someone other than the subject of the record

  36. Situation Concepts Situation History of depression (situation) No history of psychiatric disorder (situation) Family history of autism (situation) No family history of Parkinson's disease (situation) Smoking cessation advice declined (situation) Planned food restriction (situation) Euphoria absent (situation) Suspected alcohol abuse (situation)

  37. Concept ID 22298006 Searching by ID Concept ID 13746004 Descriptions (Terms) FSN Bipolar disorder (disorder) 739182010 PT Bipolar disorder 23447014 S Bipolar affective disorder 2839307017 S MDI - Manic-depressive illness 1221013017 S Manic-depressive illness 1221012010 S Manic-depressive psychosis 1221011015

  38. Overview of efficient searchingTerm searching + “walking” hierarchy up/down or downUnderstanding main hierarchiesUsing browser filters to limit search returns Key Message

  39. Classifications and Terminology • Classifications (ICD-10, OPCS-4) • Used to report after the event • Used to capture episode of care • Focused on what we want to ‘count’ • Terminology • Vocabulary for an electronic record • Focused on what we want to record at point of care • Not just procedures and diagnosis

  40. Classifications and Terminology ICD-10

  41. Classifications and Terminology 4926007 |Schizophrenia in remission (disorder)| 191542003 |Catatonic schizophrenia (disorder)| 111483008 |Catatonic schizophrenia in remission (disorder)| ICD-10 F20.2 Catatonic schizophrenia 35489007 |Depressive disorder (disorder)| 128293007 |Chronic mental disorder (disorder)| 192080009 |Chronic depression (disorder)| ICD-10 F32.8 Other depressive episodes

  42. Classifications and Terminology ICD-10 F43.0 Acute stress reaction F03.X Unspecified dementia

  43. Subsets (Reference sets) • It is often desirable to restrict the SNOMED CT concepts available • A subset is ‘smaller set of SNOMED CT’ that meets a particular requirement(s) • A SNOMED CT subset can be a group of concepts, descriptions or relationships • Over 300 nationally released subsets https://dd4c.hscic.gov.uk/dd4c Subset

  44. Useful Information on SNOMED CTFurther education, presentations, case studies and documentation on websiteNew SNOMED website for Mental health Requesting new content or changes to SNOMED CTRequest Submission Portal Further Information

  45. Any Questions ? Further Questions : Helpdesk snomedmentalhealth@nhs.net, information.standards@nhs.net

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