Clinical terminology integration within COSD

Why are we integrating clinical terminologies within COSD?

The data set can benefit significantly from implementing clinical terminologies within the data model:

• using SNOMED CT to capture outcome measures can reduce the need for individual tables for each measure
• a single table can capture multiple measures using a common structure
• the data set can respond more quickly to changes in clinical practice and information requirements
• terminology is updated at regular intervals and the data set automatically can capture the latest terms without the need for changing the data set through the DAPB process
• all NHS healthcare providers in England must now use SNOMED CT for capturing clinical terms within electronic patient record systems
• the use of SNOMED CT simplifies exchanging clinical information between systems

It is important to note that there is limited use of SNOMED CT within COSD, however this will be reviewed and may capture more clinical terminology within future versions.

SNOMED CT is the standard clinical terminology for the NHS to support recording of clinical information, in a way that supports data management and analysis to support patient care, while enabling data extraction and data exchange.

SNOMED CT provides a comprehensive set of clinical phrases or terms; this is called a terminology. SNOMED CT is much more than just a set of clinical phrases, for example it also includes groups with relationships between terms. It is the most comprehensive international terminology currently available and can be used across all care settings and all clinical domains.

SNOMED CT is managed and maintained internationally by SNOMED International and in the UK by the UK National Release Centre (part of NHS England).

Find out more about the UK National Release Centre on the NHS Digital website.

SNOMED CT is specified as the single terminology to be used across the health system. Find out more about SNOMED CT and the Personalised Health and Care 2020 policy paper on the GOV.UK website.

As the NHS moves to paperless, and the aspiration to exchange data electronically across the NHS, it is critical that all systems share the same clinical vocabulary. If every system uses its own vocabulary then interoperability is reduced to simply moving readable documents around the system and clinicians having to repeatedly transcribe data they need to be within their system, thus introducing errors.

The use of an international terminology enables system suppliers to design their system to a common terminology that can be implemented with less country specialisation across a number of countries. The last few years has seen a shift by suppliers from developing country specific solutions to global solutions with local configuration.

More information about SNOMED CT can be found on the NHS Digital website - this includes information about the following.

Licensing:

• the UK is a SNOMED International member country
• use of SNOMED CT in the UK is free; however, the use of SNOMED CT does require a license
• SNOMED CT licensing enquiries can be sent to [email protected]

Training:

• NHS England offer a range of ways for individuals to learn more about SNOMED CT and its uses
• NHS England provide a number of training and education resources about SNOMED CT, including an overview of SNOMED CT, pre-recorded webinars, case studies, brochures and technical guidance
• for system suppliers, you may also be interested in the more technical guidance provided through the recorded webinars

NHS England have developed a SNOMED CT Browser that can be accessed online.

The NHS England SNOMED CT Browser provides ways to browser and search the SNOMED CT UK Edition. The SNOMED CT UK Edition is currently released twice per year and consists of the International Edition plus the UK-specific content provided within the UK Clinical Extension and UK Drug Extension including maps to ICD-10 and OPCS-4.

This is for use in the UK only.

A list of the SNOMED CT releases contained in the browser is maintained and can be viewed on the NHS England website. The Browser is provided by NHS England to anyone for reference purposes. The interface and REST APIs are not to be used as part of production systems in health care settings.

The following provides a useful guide on how to use termbrowser, when searching for SNOMED CT codes: 

• go to this termbrowser website
• click the ‘Go Browsing’ button
• click ‘Search’
• enter the known ID or start typing the term required and all available concepts and reference sets will appear below

Now select one of the search results - on the right will be the concept ID and information for the item you have selected

If this is a reference set - select the members tab from the right-hand window to view all member concepts and their ID’s

When searching for a diagnosis, ensure that you use the (disorder) hierarchy, which will be in brackets at the end of the 'Fully Specified Name' field.

For example, if you search for ‘Breast Cancer’ a long list of available types of breast cancer diagnoses will appear for you to choose as follows:

You can select the more granular level from the children list (on the right) and then cross reference your diagnosis by using the ‘Classification Map’ to ICD10.

For example, if you select ‘Malignant neoplasm of breast (disorder)’ the classification map will show three ICD10 codes:

When searching for procedures, it is important that you only use the (procedure) hierarchy, which will be in brackets at the end of the 'Fully Specified Name' field.

For example, you could search for mastectomy and a long list of available types of mastectomy will appear for you to choose as follows:

You can select the more granular level from the children list (on the right) and then cross reference your diagnosis by using the ‘Classification Map’ to OPCS.

For example, if you select ‘Simple mastectomy of left breast (procedure)’ the classification map will show all associated OPCS codes as follows: