SNOMED IS COMING: DON T PANIC! March 2018 Jo Tissier CEG Clinical Facilitator

What about local codes? How will I find the right codes? Why do we have to change? When is it going to happen? What about my templates and searches?

Objective 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!

Structured list of health terms Known as concepts Concepts are clinical thoughts we want to convey. Concepts all have a unique code

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

1 Apr 2016: last Read release no more new Read codes! 1 Apr 2018: 1 st 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

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

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

Same codes used in the Bahamas as in Redbridge

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

Polyhierarchical = more than 1 parent, Read N0... e.g: rheumatoid arthritis Arthropathies and related disorders N04.. SNOMED Rheumatoid arthritis and other inflammatory polyarthropathies N040. Rheumatoid arthritis

Read No duplications e.g CKD Stage 5 1Z14. Chronic kidney disease stage 5 Under history and symptoms AND K055. Chronic kidney disease stage 5 SNOMED

Structure is Unambiguous e.g.no headache Read SNOMED

True synonyms e.g. childhood asthma Read H330. SNOMED

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

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)

Clinical findings Procedures Body structure Observations Staging and scales And many more

Hierarchy Description Examples Clinical finding Procedure Event What phenomena is found Contains the sub-hierarchies of finding including symptoms and diseases (disorder). Important for documenting clinical disorders, symptoms and examination findings. What is being done Purposeful activities performed in the provision of health care. 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. 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. Situation with Explicit Context Pharmaceutical/ biologic product Social Context Phrases that have the context specified For example, terms about another family member, absence or has happened in the past 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. 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. Swelling of arm (finding) Normal breath sounds (finding) Headache (finding) Tired all the time (finding) Pneumonia (disorder) Depression (disorder) Biopsy of lung (procedure) Diet education (procedure) Referral to paediatrician (procedure) Review of medication (procedure) Flash flood (event) Motor vehicle accident (event) Exposure to measles virus (event) Fall (event) Death (event) Body weight (observable entity) Tumour size (observable entity) Body mass index (observable entity) Gender (observable entity), Serum bilirubin level (observable entity) Family history of stroke (situation) No nausea (situation) Referral to psychiatrist declined (situation) Suspected sepsis (situation) Both parents smoke (situation) 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) Economic status (social concept) Asian (ethnic group) Clerical supervisor (occupation) Donor (person) Thief (life style) Judaism (religion/philosophy)

No ambiguity: Dressing

Have a go!

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

Professional nurse (occupation) Night Nurse (product) Seen by nurse (finding) Informing nurse (procedure) Pulled elbow (disorder) -Nursemaids' elbow Nurse practitioner clinic (environment)

>>>> Open browser to demonstrate

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

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

Disease type 1 Disease type 1 Disease type 2 Disease type 2 Disease type 3 Disease type 3 Disease type NOS Disease type 4 Disease type NOS 625Z A/N care: social risk NOS mapped to A/N Care social risk

Holding awareness events Learning (self and NHS Digital) Reviewing templates? Reviewing searches and protocols

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 searches Label searches clearly (& add descriptions) If you keep historical claims searches, export the data and store in a folder of your choice Archive old templates, protocols, documents Review your local templates and check for NOS/NEC codes

NHS Digital SNOMED CT browser: https://termbrowser.nhs.uk/ Training materials: https://hscic.kahootz.com/connect.ti/t_c_hom e/view?objectid=301107#301107

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

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.

DON T PANIC! Remember the Millennium Bug? Did any planes drop out of the sky?

Any other questions? http://www.qmul.ac.uk/blizard/ceg/