SNOMED CT Induced Classifications

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1 SNOMED CT Induced Classifications Dr Jeremy Rogers IHTSDO Consultant Terminologist Principal Terminology Specialists NHS HSCIC IHTSDO Conference, Amsterdam, October 27 th 2014

2 Outline 17 th Century AnalyDcs : The old way 20 th Century AnalyDcs : The current way 21 st Century AnalyDcs : A new way?

3 17 th Century AnalyDcs A code for each thing you want to count London Bills of Mortality (1603- )

39 Months of A&E Data 12,022 disdnct SCT codes used at least once 13000 NUM 9

(NUM) 12500 12000 11500 11000 10500 10000 9500 9000 ~1300 extra attendances per

4 39 Months of A&E Data 12,022 disdnct SCT codes used at least once NUM 9 per. Mov. Avg. (NUM) ~1300 extra attendances per month by end 2011 = 10% increase Oct '08 Jan '09 Apr '09 Jul '09 Oct '09 Jan '10 Apr '10 Jul '10 Oct '10 Jan '11 Apr '11 Jul '11 Oct '11

5 Choices for aggregadon ED Dataset (39 categories) 90% of 417,211 episodes map to one of 38 ED dataset codes Low granularity High(ish) coverage.. 10% of acdvity lost to this analysis Change in Caseload Per ED Dataset diagnosis category (n Year3 n Year1 ) (Total Year3 Total Year1 )

6 ED Dataset Fixed (39 categories) Change in Caseload Per ED Dataset diagnosis category (n Year3 n Year1 ) (Total Year3 Total Year1 )

7 Outline 17 th Century AnalyDcs : The old way Pre- hoc stadc categories 20 th Century AnalyDcs : The current way Pre- hoc stadc, hierarchy of categories 21 st Century AnalyDcs : A new way?

8 20 th Century AnalyDcs A classified code for each thing you want to count

9 20 th Century AnalyDcs Aggregate over shallow, fixed monohierarchies ICD10 READ2 (or ICD10-CM) A1 A1234

Choices for aggregadon ICD 10 ICD10 L2 Fixed (224 categories) J1 K5 I4 H4 I5 L2 P5 E6 P8 G2 F5 C3 C4 Q5 D3 O9 R7 C8 O1 Q0 C7 B1 B9 V8 K9 83% of 417,211 episodes map to one of: 3,374 ICD10 codes 224

T10-T19 Fracture Per of ED Upper Dataset limb / Foreign diagnosis Bodies category 11% R00-R09 Symptoms and signs involving the circulatory and respiratory systems 9% S60-S69 Injuries to the wrist and

10 Choices for aggregadon ICD 10 ICD10 L2 Fixed (224 categories) J1 K5 I4 H4 I5 L2 P5 E6 P8 G2 F5 C3 C4 Q5 D3 O9 R7 C8 O1 Q0 C7 B1 B9 V8 K9 83% of 417,211 episodes map to one of: 3,374 ICD10 codes 224 at level 2 (A0, A1, A3 ) Medium granularity, medium coverage 1 episode in 6 lost to this analysis Change in Caseload 16% R10-R19 Symptoms and signs involving the digestive system and abdomen 13% T10-T19 Fracture Per of ED Upper Dataset limb / Foreign diagnosis Bodies category 11% R00-R09 Symptoms and signs involving the circulatory and respiratory systems 9% S60-S69 Injuries to the wrist and hand (n Year3 n Year1 ) (Total Year3 Total Year1 ) 8% T39-39 Burns, frostbite, poisonings (some) 7% S00-S09 Injuries to the head 6% I60-I69 Cerebrovascular diseases Z8 N5 M7 R2 B3 R

11 Outline 17 th Century AnalyDcs : The old way Pre- hoc stadc categories 20th Century AnalyDcs : The current way Pre- hoc stadc, hierarchy of categories 21st Century AnalyDcs : A new way?

12 21 st Century AnalyDcs? Dynamic selecdon of classes to aggregate over ICD10 READ2 (or ICD10-CM) A1 A1234

10 Diseases of the respiratory system 11 Diseases of the digestive system R50 R69 General symptoms and signs 21 Factors influencing health status and contact w 03 Diseases of the blood and blood-

complications of trauma 16 Certain conditions originating in the perinatal 04 Endocrine, nutritional and metabolic diseases 07 Diseases of the eye and adnexa T36 T50 Poisoning by drugs, medicaments

entering through n T80 T88 Complications of surgical and medical care S20 S29 Injuries to the thorax S70 S79 Injuries to the hip and thigh 06 Diseases of the nervous system S30 S39 Injuries to the

13 10 Diseases of the respiratory system 11 Diseases of the digestive system R50 R69 General symptoms and signs 21 Factors influencing health status and contact w 03 Diseases of the blood and blood- forming organs S10 S19 Injuries to the neck T51 T65 Toxic effects of substances chiefly nonmed 08 Diseases of the ear and mastoid process 14 Diseases of the genitourinary system T79 T79 Certain early complications of trauma 16 Certain conditions originating in the perinatal 04 Endocrine, nutritional and metabolic diseases 07 Diseases of the eye and adnexa T36 T50 Poisoning by drugs, medicaments and biolog T20 T25 Burns and corrosions of external body surf T13 Other injuries of lower limb, level unspecifie 12 Diseases of the skin and subcutaneous tissue T15 T19 Effects of foreign body entering through n T80 T88 Complications of surgical and medical care S20 S29 Injuries to the thorax S70 S79 Injuries to the hip and thigh 06 Diseases of the nervous system S30 S39 Injuries to the abdomen, lower back, lumba R25 R29 Symptoms and signs involving the nervous a S50 S59 Injuries to the elbow and forearm R30 R39 Symptoms and signs involving the urinary s T66 T78 Other and unspecified effects of external S80 S89 Injuries to the knee and lower leg S40 S49 Injuries to the shoulder and upper arm 09 Diseases of the circulatory system R20 R23 Symptoms and signs involving the skin and T11 Other injuries of upper limb, level unspecifie 13 Diseases of the musculoskeletal system and conn 15 Pregnancy, childbirth and the puerperium S90 S99 Injuries to the ankle and foot R40 R46 Symptoms and signs involving cognition, pe T29 T32 Burns and corrosions of multiple and unspe 05 Mental and behavioural disorders 01 Certain infectious and parasitic diseases S60 S69 Injuries to the wrist and hand S00 S09 Injuries to the head R00 R09 Symptoms and signs involving the circulato R10 R19 Symptoms and signs involving the digestive ICD10 Induced (43 categories) Change in Caseload A1 A % R10-R19 Symptoms and signs involving the digestive system and abdomen 11% R00-R09 Symptoms Per ICD and signs diagnosis involving the category circulatory and respiratory systems 7% S00-S09 Injuries to the head 9% S60-S69 Injuries to the wrist and hand 6% 01 Certain infectious and parasitic diseases (n Year3 n Year1 ) (Total Year3 Total Year1 )

14 21 st Century AnalyDcs? Dynamic inducdon of classes to aggregate over ICD10 READ2 (or ICD10-CM) CTV3 SNOMED CT A1 A1234

243796009 Situation with explicit context 406123005 Viscus structure finding 2704003 Acute disease 128139000 Inflammatory disorder 106048009 Respiratory finding 362981000 Qualifier value 125667009

125643001 Open wound 414030009 Disorder of immune structure 414027002 Disorder of haematopoietic structure 118952005 Joint finding 399986003 Disorder of body wall 3519007 Disorder of synovium

15 Situation with explicit context Viscus structure finding Acute disease Inflammatory disorder Respiratory finding Qualifier value Contusion Disorder of abdominal segment of trunk Digestive system finding Body structure Ear, nose and throat finding Disorder of lymphatic system Open wound Disorder of immune structure Disorder of haematopoietic structure Joint finding Disorder of body wall Disorder of synovium Disorder characterised by pain Ear and auditory finding Superficial injury Administrative statuses Degenerative disorder Crushing injury Finding of cellular component of blood Vestibular system finding Event Peripheral nerve finding Physical object Ulcer Finding of neck region Observable entity Pain by sensation quality Cartilage finding Cyst Hereditary disease Incised wound Disorder of soft tissue of trunk Disorder of foetus or newborn Urogenital finding Bite - wound Substance Neoplasm and/or hamartoma Finding of elbow region Mucosal finding General clinical state finding Blunt injury Mental disorder Deformity Disorder of scalp Bloodstream finding Oedema Disorder of body cavity Muscle finding Mass of body structure Concussion Disorder of endocrine system Metabolic disease Musculoskeletal pain Necrosis of anatomical site Closed wound Hypersensitivity condition Ligament finding Infectious disease Foreign body Pregnancy, childbirth and puerperium Injury of trunk Abrasion and/or friction burn Finding of pelvic region of trunk Jaundice Finding by method Finding of wrist region Musculoskeletal finding related to Disorder of nose and nasopharynx Swelling Evaluation finding Seizure related finding Eye / vision finding Finding of shoulder region Finding of back Disorder of soft tissue of limb Disorder of soft tissue of head Chronic disease Disorder of connective tissue Integumentary system finding Disorder of skeletal system Bleeding Finding reported by subject or history p Poisoning Complication Drug- related disorder Pain of head and neck region Functional finding Cardiovascular finding Vomiting Pain in limb Burn Bone finding Procedure Injury of musculoskeletal system Finding of lower limb Finding of face Disorder of digit Disorder of nervous system Finding of hand region Central nervous system finding Head and neck injury Laceration - injury Disorder of upper extremity Finding of upper trunk Soft tissue injury General finding of observation of patien Pain of truncal structure R10-R19 Symptoms and signs involving the digestive system and abdomen R00-R09 Symptoms and signs involving the circulatory and respiratory systems S00-S09 Injuries to the head S60-S69 Injuries to the wrist and hand 01 Certain infectious and parasitic diseases SNOMED CT Induced (113 categories) Pain of truncal structure General finding of observation of patient Soft tissue injury Finding of upper trunk Disorder of upper extremity Laceration - injury Head and neck injury Central nervous system finding Finding of hand region Disorder of nervous system Disorder of digit Finding of face Finding of lower limb

The invisible idiot problem << 312608009 Laceration 60 ICD-10 codes 13323 episodes (3.

upper trunk All cases : Episodes Monthly Total 118947000 Disorder of << upper 312608009 extremity Laceration NUM 6mth 312608009 Mov.

1%) 118940003 Disorder of nervous system 128597007 Disorder of 480 digit SNOMED codes 301310005 Finding of face 116312005 Finding of lower limb 921 CODES across 28858 EPISODES (6.

$125653000 Open wound of finger (disorder)** 670 episodes of 42818005 Closed fracture of navicular bone of wrist (disorder)** 621 episodes of 263196008 Fracture of radial head (disorder)**$ $phalanx of foot (disorder)** 426 episodes of 16114001 Fracture of ankle (disorder)** 379 episodes of 9468002 Closed fracture carpal bone (disorder)** 800 372 episodes of 425322008 Stab wound$ $(disorder)** 306 episodes of 208401007 Closed fracture finger metacarpal (disorder)** 200 298 episodes of 76865005 Closed fracture of distal phalanx of finger (disorder)** 294 episodes of$ 207753003 Fracture of mandible closed (disorder)** 270 0 episodes of 81102000 What s Injury of the back (disorder)** 267 episodes of 20511007 Fracture of hand (disorder)** 251 episodes of

207753003 Fracture of mandible closed (disorder)** 270 0 episodes of 81102000 What s Injury of the back (disorder)** 267 episodes of 20511007 Fracture of hand (disorder)** 251 episodes of

$of finger (disorder)** 251 episodes of 111640008 Closed fracture of radius (disorder)** 251 episodes of 342070009 Closed fracture of foot (disorder)** 240 episodes of 18171007 Fracture of$

16 The invisible idiot problem << Laceration 60 ICD-10 codes episodes (3.2%) 141 SNOMED codes episodes Pain of truncal structure SNOMED codes General finding of observation of patient Soft tissue injury Finding of upper trunk All cases : Episodes Monthly Total Disorder of << upper extremity Laceration NUM 6mth Mov. Avg Laceration << - injury Open wound Head and neck injury = Wound Central nervous system finding Finding of hand region episodes (5.1%) Disorder of nervous system Disorder of 480 digit SNOMED codes Finding of face Finding of lower limb 921 CODES across EPISODES (6.9% of all Episodes) 2629 episodes of Wound (disorder)** 1323 episodes of Foreign body (disorder)** 831 episodes of Corneal abrasion (disorder)** 786 episodes of Open wound of finger (disorder)** 670 episodes of Closed fracture of navicular bone of wrist (disorder)** 621 episodes of Fracture of radial head (disorder)** episodes of Closed fracture of distal end of radius (disorder)** 467 episodes of Incised wound (disorder)** episodes of Closed fracture of phalanx of foot (disorder)** 426 episodes of Fracture of ankle (disorder)** 379 episodes of Closed fracture carpal bone (disorder)** episodes of Stab wound (disorder)** 369 episodes of Cut of finger (disorder)** 367 episodes of Fracture of navicular bone of wrist (disorder)** episodes of Insect bite - wound (disorder)** 328 episodes of Needle stick injury (disorder)** episodes of Open wound of hand (disorder)** 321 episodes of Fractured nasal bones (disorder)** 306 episodes of Closed fracture finger metacarpal (disorder)** episodes of Closed fracture of distal phalanx of finger (disorder)** 294 episodes of Fracture of mandible closed (disorder)** episodes of What s Injury of the back (disorder)** 267 episodes of Fracture of hand (disorder)** 251 episodes of difference Crushing injury? of finger (disorder)** 251 episodes of Closed fracture of radius (disorder)** 251 episodes of Closed fracture of foot (disorder)** 240 episodes of Fracture of phalanx of finger (disorder)** 231 episodes of Open wound of thumb (disorder)** 213 episodes of Elbow fracture - closed (disorder)** 213 episodes of Elbow fracture (disorder)** Oct '08 Nov '08 Dec '08 Jan '09 Feb '09 Mar '09 Apr '09 May '09 Jun '09 Jul '09 Aug '09 Sep '09 Oct '09 Nov '09 Dec '09 Jan '10 Feb '10 Mar '10 Apr '10 May '10 Jun '10 Jul '10 Aug '10 Sep '10 Oct '10 Nov '10 Dec '10 Jan '11 Feb '11 Mar '11 Apr '11 May '11 Jun '11 Jul '11 Aug '11 Sep '11 Oct '11 Nov '11 Dec ' ICD-10 codes episodes 1061 SNOMED codes

17 Conclusion Non- stadsdcal analydcs can be done nadvely in SNOMED CT Clinical analydcs should be done nadvely in SNOMED CT?

injury poisoning and certain other (s00-t98)

1 of 13 1 injury poisoning and certain other consequences of external causes (s00-t98) ICD S T P10-P15 ( ) O70-O71 ( ) S T injuries to the head (s00-s09) injuries to the neck (s10-s19) injuries to the