Is SNOMED CT really multi-professional?

Is SNOMED CT really multi-professional? Anne Casey FRCN Editor Paediatric Nursing Adviser in Informatics Standards to the Royal College of Nursing Clinical Domain Lead NHS (England) Information Standards Board Chair SNOMED Content Steering Group

Overview • Requirement • What is said to be in SNOMED CT • The Reality • Relationship between SNOMED CT and other professions’ terminologies • Approaches to content development

Multi professional working? • Single shared assessment, integrated care pathways, team approaches • ‘mixed economy’ for healthcare records • separate records for each profession • single patient record with different sections for each profession • single patient record (e.g. mental health)

Requirement for terminology in healthcare • patient terminology • nursing terminology • medical terminology • laboratory terminology • physiotherapy terminology, dietetics, …. • drugs, equipment terminologies • social care terminology • …….

Requirement for terminology to support interoperability in the e-healthcare world • Standard, multi professional terminology with features that support data entry, retrieval, messaging, maps to other terminologies / classifications, translation etc.

SNOMED CT….. • ‘a comprehensive multi-disciplinary clinical terminology for use in electronic records and messages’ • Terms are ‘profession neutral’ • e.g. NOT physiotherapy terms, nursing assessment terms etc • Profession context is provided by record structure and/or user ID • Professional groups can take the lead for areas of content • e.g. opthalmologists: eye findings, dietitians: dietary assessment, cardiologists: cardiac procedures, nurses: care regimes

The reality… • Content sources e.g. • Clinical Terms Version 3 (Read Codes) included content from NHS clinical terms projects: nursing, psychology, midwifery, physiotherapy, speech and language therapy….. • Nursing example: concepts from approved nursing terminologies • Evidence? few systematic reviews (expertise required)

Content examples – from CTV3 • Dysphagia therapy • Environmental safety assessment • Substance abuse prevention • Spiritual growth • Ability to perform fine motor function • Weight reduction regime

Nursing Content examples

Relationship between SNOMED and other terminologies Different terminologies have features suited to their different purposes.... • clinical definitions • ‘knowledge’ relationships • classification concepts • coding scheme suited to use in a paper system • ….

SNOMED CT has a specific set of purposes – it doesn’t do what some other terminologies do.. Example 1. ICF • ..describes body functions and structures, activities and participation - used to understand and measure health outcomes Example 2. Nursing terminologies such as NANDA diagnoses • ..support the description of nursing in practice, education and research; may include knowledge that supports clinical reasoning (e.g. defining characteristics of NANDA diagnoses)

NHS Scotland wishes to use ICF to assess and record participation of disabled children • The concepts can be recorded using SNOMED CT e.g. relationships with peers, play, learning and applying knowledge • Classification concepts are not in SNOMED CT • e.g. other specified • A map between SNOMED CT and ICF may be useful for statistical analyses • The ICF contains clinical knowledge supporting the purpose of assessment • The ICF model (e.g. performance and capacity scales) can also support system design • The ICF definitions can support consistent use of terms.

A primary care organisation wishes to use the OMAHA (nursing) system to record care given to new mothers in the community and to support analysis of outcomes • The concepts can be recorded using SNOMED CT e.g. knowledge about breastfeeding, community support • OMAHA system contains clinical knowledge (e.g. relationship between interventions and outcomes) that supports the purposes • OMAHA system model (e.g. problem rating scales) can support system design • OMAHA system definitions can support consistent use of terms

Either OR both? • Where an organisation wishes to use a particular clinical tool such as ICF or the OMAHA system, the individual concepts can be represented using SNOMED CT – content additions may be required • The other features of the terminology are not held within SNOMED CT i.e. definitions, structure / relationships etc • A map between SNOMED CT and the terminology / classification may be useful

SNOMED CT Content development Expert committee System content developer SNOMED CT End user

Other contributors to content development and quality review • Specialty lists - making implementation easier: radiology, general practice, nursing • Encoding of national (international?) standards • Assessment instruments: single assessment of the elderly, Glasgow coma scale • Multi professional care pathways: pre-operative assessment, asthma admission • Shared records: bowel cancer screening programme record, patient held diabetes record • Etc.

Conclusions • SNOMED CT covers some areas for all professions – model can accommodate all • Mechanisms exist for increasing content • Content additions are increasingly based on feedback from users – needs better co-ordination and quality assurance • Professions can take responsibility for quality of specific areas • International specialty organisations could lead • Snomed working groups at national levels feeding into international level?? • BUT the real issue for the professions is…

…from unstructured, non standard, narrative records …from vague, ambiguous, local terminology and locally adapted clinical tools ...from paper records …to structured, standard records and messages ...to standard, defined, evidence based terminologies and tools …to ICT that supports clinical workflow, decision making, recording and communication (and has standard terminology for interoperability) migration of professionals…

Is SNOMED CT really multi-professional?