SNOMED CT
Systematized Nomenclature Of Medicine – Clinical Terms
---An introduction ---
Dr Karanvir Singh
MBBS, MS, FRCS (Glasgow)
Chief Medical Information Office
Apollo Hospitals
India
1
US
UK
1965
Systematized
Nomenclature of
Pathology (SNOP)
CAP
1975
Broad clinical terms
included (SNOMED)
CAP
2000
Logic based
SNOMED-RT
CAP
1980s
Read codes
NHS UK
1990s
Read codes v3
Clinical Terms v3
CTV3
NHS UK
CAP
2002
SNOMED-CT
NHS UK
2007
SNOMED-CT
2014
India became a member
of the IHTSDO
IHTSDO
2
Most of us own smartphones…
3
This is what we use them for
Now imagine the
uses if you remove
internet connectivity
Voice calls
SMS
Camera
A few games
4
An EMR alone is like a ‘dumb’ phone
Snomed CT is the internet of EMRs
It connects healthcare data across all entities
+
Allows very granular clinical data capture
Provides very powerful clinical analytics
It supports clinical decision support
… and is used in over 50 countries. It is the best clinical terminology system today
5
Let us see how it is better than existing
healthcare coding systems
Let us compare it with ICD-10
6
More clinical terms
7
Codes for Ectopic Pregnancy in ICD-10
• ICD-10 has five codes (terms) only
•
•
•
•
•
Abdominal
Tubal
Ovarian
Others
Unspecified
8
Terms for Ectopic pregnancy in SNOMED CT
Abdominal pregnancy
Membranous pregnancy
Aborted ectopic pregnancy
Mesenteric pregnancy
Angular pregnancy
Mesometric pregnancy
Cervical pregnancy
Miscarriage of tubal ectopic pregnancy
Combined heterotopic pregnancy
Multiple pregnancy involving intrauterine pregnancy and
tubal pregnancy
Combined intrauterine and ovarian pregnancy
Mural pregnancy
Combined pregnancy
Ovarian pregnancy
Combined tubal and intrauterine pregnancy
Rudimentary horn pregnancy
Compound ectopic
Ruptured ectopic pregnancy
Cornual pregnancy
Ruptured tubal pregnancy
Delivery of viable fetus in abdominal pregnancy
Secondary abdominal pregnancy
Fallopian pregnancy
Simultaneous intrauterine and extrauterine pregnancies
Fallopian tube pregnancy
Tubal abortion
Heterotopic pregnancy
Tubal pregnancy
Intraligamentous pregnancy
Unruptured tubal pregnancy
Intraperitoneal pregnancy
Viable fetus in abdominal pregnancy
9
Multiple ‘ancestors’
10
Pneumonia – as classified in ICD-10
Section
Code
Title
Infectious disorders
B01.2
Varicella pneumonia
Infectious disorders
B05.2
Measles complicated by pneumonia
Infectious disorders
B20.6
HIV disease resulting in Pneumocystis carinii pneumonia
Diseases of respiratory system
J10.0
Influenza with pneumonia, other influenza virus identified
Diseases of respiratory system
J11.0
Influenza with pneumonia, virus not identified
Diseases of respiratory system
J12
Viral pneumonia, not elsewhere classified
Diseases of respiratory system
J13
Pneumonia due to Streptococcus pneumoniae
Diseases of respiratory system
J14
Pneumonia due to Haemophilus influenzae
Diseases of respiratory system
J15
Bacterial pneumonia, not elsewhere classified
11
Poly-hierarchy
Disorder of lung
Infectious disease
Lower respiratory tract
infection
Viral disease
Infectious disease of
lung
Viral infection
Infections
Lung disorders
Disease
Viral respiratory
infection
Infective pneumonia
Viral pneumonia
12
ICD is running out of codes
• Since code numbers are the main stay of classification, and the
number of diseases are very large in number, ICD is running out of
codes.
• Multiple disorders are being grouped under one code
13
ICD is running out of codes
• Since code numbers are the main stay of classification, and the
number of diseases are very large in number, ICD is running out of
codes.
• Multiple disorders are being grouped under one code
14
Snomed CT has no limits on the codes that
can be used
No sharing of codes by two different conditions
15
Comparison of existing coding systems
Coding
system
ICD-10
ICD-10 PCS
LOINC
NANDA
CPT4
SNOMED CT
Yes
No
No
Partial
No
Yes
pregnancy
related)
Yes
No
No
Yes
Yes
Laboratory
No
No
Yes
No
No
Yes
Nursing
No
No
No
Yes
No
Yes
Special
context (e.g
not diabetic)
No
No
No
No
No
Yes
Meaning
based
analytics
No
No
No
No
No
Yes
Diagnosis
Procedures /
operations
No (except
16
Will SNOMED CT replace ICD-10?
Yes & No
• Clinical modules & analytics would benefit from SNOMED CT
• The medical records departments will continue ICD-10
17
Let us look at the nuts & bolts of SNOMED CT
18
These are four different conditions (clinical ideas)
1.
2.
3.
4.
5.
6.
7.
Ischemic heart disease
Angina
Unstable angina
Myocardial infarction
Heart attack
Cardiac infarction
MI
Same clinical meaning (idea)
Each clinical idea is called a concept
19
Each concept has a random concept number
1.
2.
3.
4.
5.
6.
7.
Ischemic heart disease 414545008
Angina 194828000
Unstable angina 4557003
Myocardial infarction
Heart attack
Same clinical meaning (idea) 22298006
Cardiac infarction
MI
20
The same concept has different translations
1.
2.
3.
4.
5.
6.
7.
Ischemic heart disease 414545008 - cardiopatía isquémica
Angina 194828000 - angina de pecho
Unstable angina 4557003 - síndrome preinfarto
Myocardial infarction
Heart attack
Same clinical meaning (idea) 22298006 infarto de miocardio
Cardiac infarction
MI
21
Independent system of classification
Concept
Ischaemic Heart Disease
Angina
Unstable Angina
Myocardial Infarction
Heart Attack
Cardiac Infarction
MI
Concept ID
414545008
194828000
4557003
22298006
22298006
22298006
22298006
22
Poly-hierarchy
Disorder of lung
Infectious disease
Lower respiratory tract
infection
Viral disease
Infectious disease of
lung
Viral infection
Infections
Lung disorders
Disease
Viral respiratory
infection
Infective pneumonia
Viral pneumonia
23
Thus…
• Each clinical idea is a concept and has a unique concept number
• Each concept number has multiple terms for it
• In different languages…
• There is no limit on the number of concepts. Hence different
conditions do not have to share the same code
• Concepts are connected to other concepts (parents / children)
independent of their codes – multiple relationships
• There are other relationships also, defining different properties of a
concept
24
How do multiple relationships help?
Disorder of
foot
Cellulitis of
lower limb
Is a
Is a
Cellulitis of
foot
25
Multiple types of relationships
Disorder of
foot
Cellulitis of
lower limb
Is a
Is a
Foot structure
Finding site
Cellulitis of
foot
Associated morphology
Cellulitis
26
Disorder of
foot
Cellulitis of
lower limb
Is a
Is a
Foot structure
Finding site
Cellulitis of
foot
Associated morphology
Cellulitis
Is a
Is a
Cellulitis of toe
Cellulitis of
heel
27
Disorder of
foot
Cellulitis of
lower limb
Is a
Is a
Foot structure
Finding site
Cellulitis of
foot
Is a
Is a
Toe structure
Cellulitis of toe
Finding
site
Associated morphology
Cellulitis
Is a
Associated morphology
Cellulitis of
heel
Cellulitis
28
Disorder of
foot
Cellulitis of
lower limb
Is a
Is a
Foot structure
Is a
Finding site
Is a
Toe structure
Cellulitis of
foot
Is a
Cellulitis of toe
Finding
site
Associated morphology
Cellulitis
Is a
Associated morphology
Heel structure
Finding
site
Cellulitis of
heel
Cellulitis
Associated
morphology
Cellulitis
29
Disorder of
foot
Cellulitis of
lower limb
Is a
Is a
Foot structure
Is a
Finding site
Is a
Toe structure
Cellulitis of
foot
Is a
Cellulitis of toe
Finding
site
Associated morphology
Cellulitis
Is a
Associated morphology
Heel structure
Finding
site
Cellulitis of
heel
Cellulitis
Associated
morphology
Cellulitis
30
List me all patients with cellulitis
Disorder of
foot
Cellulitis of
lower limb
Is a
Is a
Foot structure
Is a
Finding site
Is a
Toe structure
Cellulitis of
foot
Is a
Cellulitis of toe
Finding
site
Associated morphology
Cellulitis
Is a
Associated morphology
Heel structure
Finding
site
Cellulitis of
heel
Cellulitis
Associated
morphology
Cellulitis
31
Associated morphology = Cellulitis*
Cellulitis of foot
Cellulitis of foot excluding toe
Cellulitis of forearm
Cellulitis of forehead
Cellulitis of gingiva
Cellulitis of groin
Cellulitis of hand
Cellulitis of hand excluding finger
Cellulitis of head
Cellulitis of heel
Cellulitis and abscess of lower leg
Cellulitis and abscess of lower limb
Cellulitis and abscess of neck
Cellulitis and abscess of nose (external)
Cellulitis and abscess of perineum
Cellulitis and abscess of shoulder
Cellulitis and abscess of submandibular region
Cellulitis and abscess of temple region
*Partial data
Conditions with the word “Cellulitis” within it
32
Associated morphology = Cellulitis*
Cellulitis of foot
Cellulitis of foot excluding toe
Cellulitis of forearm
Cellulitis of forehead
Cellulitis of gingiva
Cellulitis of groin
Cellulitis of hand
Cellulitis of hand excluding finger
Cellulitis of head
Cellulitis of heel
Cellulitis and abscess of lower leg
Cellulitis and abscess of lower limb
Cellulitis and abscess of neck
Cellulitis and abscess of nose (external)
Cellulitis and abscess of perineum
Cellulitis and abscess of shoulder
Cellulitis and abscess of submandibular region
Cellulitis and abscess of temple region
Conditions with the word “Cellulitis” within it
Beat knee
Chronic recurrent streptoccocal erysipelas
Cutaneous erysipeloid
Disseminated cutaneous erysipeloid
Erysipelas
Erysipelas of lower limb
Erysipeloid
Facial erysipelas
Localized cutaneous erysipeloid
Ludwig's angina
Onychia of finger
Phlegmon
Postpartum AND/OR puerperal erysipelas
Recurrent erysipelas
Seal finger
*Partial data
Conditions even without the word “Cellulitis”
33
How relationships help in decision support
Pick up all cases of
cerebrovascular accident for
consideration for
thrombolytic therapy
Use it to identify
potential cohorts for
clinical trials for a new
breast cancer drug.
Warn if the patient has any type
of diabetes AND any type of
kidney disease
34
How is it used in a hospital’s EMR?
35
The hospital’s EMR software
Record services (EMR)
Patient Ram Lal, age 56, admitted with a diagnosis of
Snomed CT
Terminology services (Snomed CT)
Herni
Hernia
Inguinal hernia
Indirect inguinal hernia
Indirect inguinal hernia with obstruction
36
Leveraging relationships
We can show all
the SubType
concepts of E in
the operation list
of a foot surgeon
Operations
on the foot
37
SubTypes (All descendants)
Operations
on the foot
Foot
incision
Division of
muscle of
foot
Foot joint
operations
Tenotomy of
abductor
hallucis muscle
38
Value set binding: SNOMED supplies the lists
39
How will clinicians benefit from it?
40
ICD-10 has very limited search – no synonyms
• The doctor may search for any of these terms for the same diagnosis
•
•
•
•
•
•
Renal calculus
Renal stone
Nephrolith
Calculus in kidney
Kidney stone
Kidney calculus
• Only the term Calculus in Kidney exists in ICD-10
• Such issues are present with most diagnosis
No abbreviations in ICD-10
• The doctor may search by typing
• COPD
• MI
• IHD
ICD-10 terms are not appropriate for printing
What the doctor wants to write
What is available in ICD-10 tables – prints as such
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease, Unspecified
Ureterocele
Other specified disorders of kidney and ureter
Neonatal tetanus
Other tetanus
Achlorhydria
Other specified diseases of stomach and duodenum
Recurrent appendicitis
Other appendicitis
Indirect inguinal hernia
Inguinal hernia
Direct inguinal hernia
Inguinal hernia
Strangulated inguinal hernia
Hepatic encephalopathy
Unilateral or unspecified inguinal hernia, with obstruction,
without gangrene
Hepatic failure, not elsewhere classified
Bird flu (H5N1)
Influenza due to certain identified influenza virus
Swine flu (H1N1).
Influenza due to certain identified influenza virus
ICD-10 codes are not appropriate for printing
What the doctor wants to write
What is available in ICD-10 tables – prints as such
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease, Unspecified
Ureterocele
Other specified disorders of kidney and ureter
Neonatal tetanus
Other tetanus
Achlorhydria
Other specified diseases of stomach and duodenum
Recurrent appendicitis
Other appendicitis
Indirect inguinal hernia
Inguinal hernia
Direct inguinal hernia
Inguinal hernia
Strangulated inguinal hernia
Hepatic encephalopathy
Unilateral or unspecified inguinal hernia, with obstruction,
without gangrene
Hepatic failure, not elsewhere classified
Bird flu (H5N1)
Influenza due to certain identified influenza virus
Swine flu (H1N1).
Influenza due to certain identified influenza virus
Summary
• Snomed CT is the terminology that supports the EMR. On its own it
does nothing
• It is very clinician friendly
• It is multilingual
• It allows very powerful data analytics
• It augments decision support capabilities of an EMR
45
Questions through the THIT app please
46