snomed is coming: don’t panic!€¦ · tumour size (observable entity) body mass index...

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March 2018 Jo Tissier CEG Clinical Facilitator SNOMED IS COMING: DON’T PANIC!

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Page 1: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

March 2018

Jo Tissier CEG Clinical Facilitator

SNOMED IS COMING:

DON’T PANIC!

Page 2: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)
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How will I find the right codes?What about local codes?

When is it going to happen?

What about my templates and searches?

Why do we have to change?

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To raise your AWARENESS of SNOMED

By the end you will leave with the knowledge of:

• Why are we changing to SNOMED and when is it happening?

• What is the structure of SNOMED?

To REASSURE You

• About searching for code concepts?

• How will this affect searches and templates

• What you can do to prepare!

Objective

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Structured list of health terms

Known as concepts

Concepts are clinical thoughts we want to convey.

Concepts all have a unique code

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Different codes used by different systems

Read codes – some are incorrect – these cannot be deleted in current system so still continue to be used

Level of detail of coding can’t be expanded to meet all new requirements

Ambiguity in concepts

Only UK based

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1 Apr 2016: last Read release – no more new Read codes!

1 Apr 2018: 1st SNOMED business rules for QOF 2018/19 – v39

1 Apr 2018: Pilots of SNOMED in primary care start – none in E. London

1 Apr 2020: SNOMED rolled out across rest of NHS

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Phase 1: by end of April. Back-end changes to support GPES extractions and GP2GP

Phase 2 testing: new code picker, templates, searches. Rolled out to a small number of practices after phase 1.

Phase 2 roll out: by Autumn. Activated in stages – not all practices at the same time

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Coding is international (used in 50+countries)

No longer will we be remembering codes – codes in SNOMED are meaningless.

Record sharing made easier - Interoperability

Deep level of detail

Comprehensive

Polyhierarchical

Precise, unambiguous, no duplications

Dynamic – wrong codes inactive

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Same codes used in the Bahamas as in Redbridge

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READ

G3 Heart Disease

G33 Angina

6A2 heart disease annual review

SNOMED

414545008 is IHD in SNOMED

194828000 is Angina

315614006 8 is IHD review

Page 13: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

Polyhierarchical = more than 1 parent, e.g: rheumatoid arthritis

ReadN0... Arthropathies and related disorders

N04.. Rheumatoid arthritis and other inflammatory polyarthropathies

N040. Rheumatoid arthritis

SNOMED

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No duplications e.g CKD Stage 5

Read

1Z14. Chronic kidney disease stage 5 –Under history and symptoms

AND

K055. Chronic kidney disease stage 5

SNOMED

Page 15: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

Structure is Unambiguous e.g.no headache

Read SNOMED

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True synonyms e.g. childhood asthma

Read

H330.

SNOMED

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One of my favourites: Dynamic –inaccurate codes deactivated e.g.

9OS1. Attends clinic A monitoring

A136. Tuberculous encephalitis or myelitis

If inactive, it will remain in the record and you will be able to search for it, but you will not be

able to record it again

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How concepts are described

• FSN (preferred): Metatarsal bone fracture (disorder)

• S (preferred): Metatarsal bone fracture

• S (acceptable): Fracture of metatarsal bone

• Parent(s): Fracture of bone of forefoot (disorder)

• Children- 5, one of which is: Closed fracture of metatarsal bone (disorder)

Page 20: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

Clinical findings

Procedures

Body structure

Observations

Staging and scales

And many more…

Page 21: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

Hierarchy Description Examples Clinical finding What phenomena is found

Contains the sub-hierarchies of finding including

symptoms and diseases (disorder). Important for

documenting clinical disorders, symptoms and

examination findings.

Swelling of arm (finding)

Normal breath sounds (finding)

Headache (finding)

Tired all the time (finding)

Pneumonia (disorder)

Depression (disorder)

Procedure What is being done

Purposeful activities performed in the provision of

health care.

Biopsy of lung (procedure) Diet education

(procedure)

Referral to paediatrician (procedure)

Review of medication (procedure)

Event What is taking place

Describes the situation around the individual at a

specific time which is relevant to their healthcare.

This does not include procedures or interventions.

Flash flood (event)

Motor vehicle accident (event)

Exposure to measles virus (event)

Fall (event)

Death (event)

Observable Entity An observation that can produce an answer or result

Terms that are used to record measurements,

readings, numerical results, etc. and always have an

associated value entry.

Body weight (observable entity)

Tumour size (observable entity)

Body mass index (observable entity)

Gender (observable entity),

Serum bilirubin level (observable entity)

Situation with

Explicit Context

Phrases that have the context specified

For example, terms about another family member,

absence or has happened in the past

Family history of stroke (situation)

No nausea (situation)

Referral to psychiatrist declined (situation)

Suspected sepsis (situation)

Both parents smoke (situation)

Pharmaceutical/

biologic product

A drug or other substance that is used to treat a

patient

This hierarchy is separate from the substance

hierarchy in order to clearly distinguish drug

products (products) from the chemical constituents

(substances) of drug products.

Tamoxifen (product)

Tramadol (product)

Paracetamol 500mg tablet (product)

Multivitamin tablet (product)

Motilium 10 tablets (McNeil Ltd) (product)

Anadin Extra soluble tablets (Wyeth

Consumer Healthcare) (product)

Social Context Non clinical demographic information Contains social

conditions and circumstances significant to

healthcare. Includes family and economic status,

ethnic and religious heritage, and life style and

occupations.

Economic status (social concept)

Asian (ethnic group)

Clerical supervisor (occupation)

Donor (person)

Thief (life style)

Judaism (religion/philosophy)

Page 22: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

No ambiguity: Dressing

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Have a go!

Page 24: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

Be clear about what you want to record (concept)

Just type (a) significant word(s)

No need to type whole words or type connectors

No need to worry about word order

You can type abbreviations

EMIS will allow you to search for Read codes

Pay attention to the FSN

Pay attention to parent and child codes

Is it a disorder? A procedure? You can use filters

Page 25: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

Professional nurse (occupation)

Night Nurse (product)

Seen by nurse (finding)

Informing nurse (procedure)

Pulled elbow (disorder) -Nursemaids' elbow

Nurse practitioner clinic (environment)

Page 26: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

>>>> Open browser to demonstrate

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>>>> Open browser to demonstrate

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You are doing this already!

More time to adapt, current tools will still work

Historical data to remain dual forever – new data for which Read codes do not exist will not be dual

Page 32: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

Mapping is a link between a Read term and a SNOMED description

Maps have been authored by NHS Digital in collaboration with the Joint GP IT Committee

All historical data has been mapped from Read to SNOMED

Page 33: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

Disease type 1

Disease type 2

Disease type 3

Disease type NOS

Disease type 1

Disease type 2

Disease type 3

Disease type 4

Disease type NOS

625Z A/N care: social risk NOS – mapped to A/N Care social risk

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Holding awareness events

Learning (self and NHS Digital)

Reviewing templates?

Reviewing searches and protocols

Page 36: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

Attend events like this Listen to webinars or read materials by HSCIC Look out for clinical system supplies updates and

news feeds Try a SNOMED browser Spring clean your system:Delete old searchesLabel searches clearly (& add descriptions)If you keep historical claims searches, export the data

and store in a folder of your choiceArchive old templates, protocols, documentsReview your local templates and check for NOS/NEC

codes

Page 37: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

NHS Digital SNOMED CT browser:

https://termbrowser.nhs.uk/

Training materials:

https://hscic.kahootz.com/connect.ti/t_c_home/view?objectId=301107#301107

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EMIS local codes will keep working exactly as they do now

Yes, you can search for inactive codes even if they are no longer available for data entry

You will still be able to attach text to codes

Page 39: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

There will be a conversion to map Read codes to the appropriate SNOMED CT codes, so you won’t need to rewrite searches, templates, concepts and protocols.

However, there are significantly more SNOMED CT codes than Read codes, so over time you might want to review and amend your searches to reflect the greater choice of codes. Also, some codes may move positions in the SNOMED CT hierarchy, which could affect search results. However, we expect the effect to be minimal, usually reflecting cases where the Read code hierarchy was incorrect.

Page 40: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

DON’T PANIC!

Remember the Millennium Bug?

Did any planes drop out of the sky?

Page 41: SNOMED IS COMING: DON’T PANIC!€¦ · Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity)

Any other questions?

http://www.qmul.ac.uk/blizard/ceg/