Forty years of SNOMED – A literature review –

1. Forty years of SNOMED – A literature review– Ronald Cornet, Nicolette de Keizer Dept. of Medical Informatics Academic Medical Center – Universiteit van Amsterdam

2. Research Background • 10 years of experience in design, implementation and maintenance of a terminological system for Reasons for Admission in Intensive Care (DICE) • Frame-based, experiments using Description Logic • Compositional • 2500 concepts, 1500 reasons for admission

3. Direct Indirect Motivation: Use of Patient Data • Documentation in the EPR/EHR • Decision support • Clinical audit • Reporting • Summaries • Administrative & management information • Epidemiology • Billing • Resource management [National Health Services – United Kingdom]

4. Motivation: Clinical Terminology • Cost reduction • Terminology use benefits entire health system • Save as much as 5% of total healthcare costs* • up to $100 Billion per year in US * Source - Walker J et al., Market Watch 2005:19th January;10-18 [Slide from Kevin Donnelly – SNOMED international]

5. Motivation: SNOMED Where is the science base for our work?

6. The science base… “Is there scientific evidence that patient care improves using SNOMED?”

7. Method • Literature review in Pubmed by 2 reviewers • Retrieve all citations containing “SNOMED” or “SNOP” • Exclude papers without English abstract • Exclude papers that do not deal with SNOP/SNOMED, e.g. authored by Snop • Analyze remaining abstracts

8. Characteristics • SNOP/SNOMED Version • Domain (e.g., cancer, cardiology) • Usage (as primary/secondary study object) • Evaluation phase (does it work, does it help, what are consequences)

9. (Cumulative) number of publications

10. Sources of publication 71 SCAMC / AMIA proceedings 41 pathology journals (22) 16 Medinfo proceedings 14 Methods of Information in Medicine 13 JAMIA 10 MIE proceedings 9 Med Inform (Lond) 9 Int J Medical Informatics 6 J Biomed Informatics 4 Biomed Sci Instrum 3 Int J Biomed Comput 3 Comput Inform Nurs 3 Comput Methods Programs Biomed <= 2 various (43 titles)

11. SNOMED versions

12. SNOMED versions

13. “Is SNOMED CT really multi-professional?” Distribution of medical domains, when mentioned in the paper

14. “Is SNOMED CT really multi-professional?”

15. Usage

16. Evaluation of SNOMED • 129 papers describe evaluation • 104 (81%) Does it work? • technical evaluation • content coverage • 25 (19%) Does it help? • retrieval of patients • aggregation of patient groups • No papers describe consequences

17. Discussion • Limited to scientific publications • No comparison to other trends / systems • SNOMED is part of the solution, not the solution itself, e.g., for Kaiser Permanente

18. Conclusions • The two largest groups of papers: • comparison of SNOMED to other TSs • theory (automatic coding, natural language processing and description logics) illustrated by (case studies with) SNOMED • Few studies are available on the usage of SNOMED in clinical practice

19. How can you improve care? • SNOMED CT contributes to • structured documentation • decision support • clinical audit • The effect of using SNOMED CT on the care process and outcome needs to be studied