1. SNOMED CT Denise Downs Knowledge Management & Education Lead Data Standards, Technology Office Department of Health Informatics Directorate

2. © Crown Copyright 2010 Why a terminology? Common vocabulary across the UK required for data communication SNOMED CT is the NHS mandated terminology for clinical and data interoperability Applications such as Summary Care Record, Choose and Book, ePrescribing use SCT for recording clinical data (DM&D part of SCT release) New messaging requirements such as microbiology requests and results will use SCT With a common terminology other ‘services’ such as NICE, NHS Evidence, Map of Medicine... all looking to tag using SCT

3. © Crown Copyright 2010 Why SNOMED CT? (SCT) Current coding systems not scalable, maintainable, or accurately used – and content dated o eg. 587 terms in ICD in relation to accident caused by a pedal cycle o Only something like 3000 terms used in any one year V12.24 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities V31.22 Occupant of three-wheeled motor vehicle injured in collision with pedal cycle, person on outside of vehicle, nontraffic accident, while working for income W65.40 Drowning and submersion while in bath-tub, street and highway, while engaged in sports activity X35.44 Victim of volcanic eruption, street and highway, while resting, sleeping, eating or engaging in other vital activities V12.24 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities V31.22 Occupant of three-wheeled motor vehicle injured in collision with pedal cycle, person on outside of vehicle, nontraffic accident, while working for income W65.40 Drowning and submersion while in bath-tub, street and highway, while engaged in sports activity X35.44 Victim of volcanic eruption, street and highway, while resting, sleeping, eating or engaging in other vital activities

4. © Crown Copyright 2010 Why SNOMED CT? (cont) International o 12 countries collaboratively developing and growing o Includes USA, Canada, Australia o Also non English speaking, and being translated Rich terminology not just list of codes o Provides for more sophisticated searching, reporting, investigation

5. © Crown Copyright 2010 Optometry and SNOMED CT There is a large amount of content relevant to Optometry in SCT – needs verifying by Optometry domain experts Descriptions may need enriching to support optometry – remember SCT is international, concept is unique but can have additional descriptions May need some new concepts adding – there is a request mechanism

6. © Crown Copyright 2010 SCT Submission request process There is a request process for new concepts to be added to SCT You need to register on the site It is helpful for these to be well formed requests https://www.uktcregistration.nss.cfh.nhs.uk/requests/myRequests.jsf

7. © Crown Copyright 2010 Subsets SCT contains over 500,000 terms – not all relevant to Optometry Subsets ‘hold’ concepts within SCT that are relevant to a particular specialism – ie most regular used vocabulary – can be used within software to support pick lists etc on forms Subsets usually developed by a group; sometimes brought together through a Royal College or Association; to provide an area domain subset used by all suppliers within that domain Development of Subsets – ideally via ‘rules’ – as SCT is not static

8. © Crown Copyright 2010 Some considerations: Patient Identification - and how to make referrals into the NHS, checking medications of own patients if required What is required ‘outside’ immediate practice as well as within eg. Accepting referrals, government required statistics, care pathways (diabetes), reporting....

9. © Crown Copyright 2010 Next Steps... Identify use cases.... what to record, why, what messages needed to go out of system and what will be received Undertake analysis - requirement for structured data, messages indicates record in SCT, data for re-use is prime candidate for SCT coding - and hence need for SCT usually ‘drops out’ of analysis – free text in systems usually for data not to be re-used Agree commonality for shared data elements in data model, consult other work such as LRA Subsets – do as collaboration and share, identify owner and need to keep subset current as new concepts added (why rules help) Take account of existing research and work – both locally and internationally that can inform eg diabetic retinopathy