Perspectives on Data Analysis and SNOMED CT

David MarkwellHead of Education – IHTSDO

History 1992

History 1992-19931992-­‐3:• MIQUEST  designed  

and  tested• Read  codes  used  in

RFA    accredited  GP  systems

1992:• Windows  3.1  and  

MAC  OS  7• Only  26  reliable  

internet  servers  in  the  world

History 1994-19961994-­‐6MIQUEST  piloted  and  used  in  small  scale  projects1996Reports  on  slow  adoption  of  Read  Version  3  (NHS  Clinical  Terms).

1994:First  widely  available  web  browser

History 1997-20001997-­‐9:MIQUEST  used  widely  in  CHDGP  project1999:Decision  to  merge  NHS  CTV3  with  SNOMED2000PRIMIS  Formed

2000:Millennium  Bug  fails  to  materialise!!  

History 2001-20162001-­‐3• GP2GP  development  

and  pilot  testing2002:• SNOMED  CT  Released2006-­‐7:• GP2GP  implemented2007:• IHTSDO  formed  by  9  

Member  countries  and  takes  ownership  of  SNOMED  CT

IHTSDO  Today

2016:• IHTSDO  has  28  Member  countries  and  has  moved  to  London

IHTSDO

aka.  SNOMED  International

▪ An  International  not-­for-­profit  association▪ Owned  by  National  Members▪ Governed  by  General  Assembly  of  its  Members▪ Funded  by  countries  based  on  national  wealth

▪ Small  central  office  in  London▪ Globally  distributed  staff  (approximately  40)▪ All  staff  work  primarily  from  home  offices

▪ Maintains  and  delivers  SNOMED  CT▪ Licenses  the  terminology  to  registered  Affiliates▪ Does  not  charge  for  use  in  Member  countries▪ Low-­cost  annual  charges  for  institutions  in  other  countries

Internat ional Heal th TerminologyStandards Development Organisation

Role  of  SNOMED  International  (IHTSDO)

▪ Develops,  maintains,  licenses  and  distributes  the  SNOMED  CT  International  Edition  

▪ Delivers  SNOMED  CT  related  services  including  …▪ Software  Tools  and  Services

▪ To  facilitate  terminology  development,  translation,  reference  set  management,  licensing  and  distribution

▪ Education  and  Product  Support  Services▪ E-­Learning  Courses  – Foundation,  Implementation  &  Content▪ Specifications  and  guidance  documents  for  implementers▪ Product  support  helpdesk

▪ Customer  Relations  and  Collaboration▪ Supporting  Members  and  encouraging  prospective  Members▪ Engaging  with  system  vendors  ▪ Working  with  other  Standards  bodies

Features  of  SNOMED  CT

▪ Comprehensive  appropriately  detailed  coverage  ▪ Broad  clinical  scope

▪ Logic  based  definitions▪ Supporting  computable  semantics  and  meaning-­based  retrieval

▪ Concept  centric  multilingual  design  ▪ Enabling  effective  translation  of  clinical  ideas

▪ Support  for  extensions▪ Meets  national  and  local  priorities  as  part  of  a  global  terminology

▪ Robust  versioning▪ Component  permanence  and  full  history  tracking

These  and  other  features  set  SNOMED  CT  apart  as  the  leading  global  clinical  terminology

Why  isn’t  SNOMED  CT  Simple  -­ Like  the  Read  Codes?

‘Everything  should  be  made  as  simple  as  possible,  but  no  simpler.’

Albert  Einstein

▪ Clinical  ideas  are  complex  and  interrelated▪ Clinical   terminology  needs  to  be  able  to  represent  this  inherent  complexity▪ …  but  it  should  be  simple  to  use  

SNOMED  CT  as  an  EHR  System  Component

▪ On  its  own  SNOMED  CT  does  nothing!▪ It  is  a  terminology  -­ a  code  system  -­ that  is  logically  designed  to  offer  a  computer-­processable  representation  of  clinical  ideas

▪ Within  a  well-­designed   EHR  system  ▪ SNOMED  CT  delivers  benefits  by  enabling  meaning-­based  retrieval  and  analysis

▪ SNOMED  CT  enabled  EHR  systems  should▪ Have  user  interfaces  that  simplify  capture  of  clinical   ideas▪ Store  clinical  data  using  SNOMED  CT  codes  in  records  that  consistently  represent  context▪ Harness  the  logical  design  of  SNOMED  CT  to  deliver  effective  meaning-­based  retrieval▪ Meet  clinical   requirements  for  sharing  information  using  SNOMED  CT  as  the  common  clinical  terminology

Analytics  Overview

Discovery  &  communication  of  meaningful  patterns  in  data▪ May  describe,  predict  and  improve  clinical  performance▪ May  recommend  action  or  guide  decision  making▪ Scope:

▪ Individual  patient  ▪ Individual  healthcare  worker▪ Patient  groups  /  cohorts▪ Enterprise  groups▪ Geographic  groups

▪ Substrate:▪ Structured  documents  using  SNOMED  CT▪ Structured  documents  using  other  coding  systems▪ Unstructured  free  text  documents▪ ‘Big  data’

Analytics  Techniques  using  SNOMED  CT

▪ Querying  SNOMED  CT  coded  clinical  data  using  its  machine-­processable   concept  definitions▪ Mapping  clinical  data  captured  using  other  code  systems  into  SNOMED  CT,  as  a  common  reference  terminology  for  analysis▪ Analysing  free  text  with  Natural  Language  Processing  tools  using  SNOMED  CT  as  a  resource  for  interpretation  and  analysis▪ Mapping  coded  clinical  data  from  SNOMED  CT  to  a  classification,   to  enable  statistical  analysis

▪ Broad  domain  coverage▪ Enables  queries  across  disciplines,  specialties  and  domains

▪ Robust  versioning  ▪ Helps  to  manage  queries  over  longitudinal  health  records

▪ Localisation  mechanisms  ▪ Allow  queries  to  be  applied  to  data  from  different  countries,  dialects,  regions  &  applications

▪ International▪ Enables  queries,  subsets,  rules  and  maps  to  be  shared  and  reused  between  countries

SNOMED  CT  Benefits  for  Analytics

PRIMIS  and  SNOMED  CT  areNatural  Partners  in  Primary  Care  and  Analytics

▪ PRIMIS  is  based  on  standard  ways  to  express  clinical  queries  that  can  be  interpreted  by  different  systems▪ PRIMIS  has  extensive  experience  working  with  clinical  information  codes  using  various  versions  of  the  Read  Codes

▪ SNOMED  CT  is  a  standard  way  to  represent  clinical  meaning  within  records  stored  in  different  systems▪ SNOMED  CT  is  substantially  based  on  and  well  aligned  with  the  Read  Codes  and  is  a  natural  evolutionary  step  forward  for  vendors  and  uses  of  UK  GP  systems

Learn More aboutSNOMED CT

▪ IHTSDO Website

▪ www.ihtsdo.org▪ SNOMED CT Browser

▪ http://snomed.org/browser▪ SNOMED CT E-Learning Services

▪ http://snomed.org/elearning▪ SNOMED CT Documentation

▪ http://snomed.org/doc▪ SNOMED CT Analytics Report

▪ http://snomed.org/analytics

Find out how SNOMED CTis being used

▪ SNOMED In Action:

▪ http://snomedinaction.org▪ Expo Presentations:

▪ http://snomed.org/expo/index▪ Attend the SNOMED CT Expo

▪ http://snomedexpo.org

Thank you for your attention …

Any  Questions?