SNOMED CT in the EHR Present and Future. with the patient at the heart

Transcription

1 SNOMED CT in the EHR Present and Future

2 ` SNOMED CT in the EHR Present and Future Christopher Alban, MD Epic Systems Corporation

3 Objectives Describe the use of SNOMED CT to enable decision support, analytics, and interoperability in EHRs. Evaluate the use of SNOMED CT as an interface terminology for problems and visit diagnoses. Present a possible roadmap for the use of SNOMED CT for advanced EHR functions.

4 Current Use Disclosures Our experience base Lots of customer variation Some generalizability with the the patient at at the the heart

5 Why is SNOMED Useful? Common Language Information reconciliation Hierarchical Structure for Diagnoses Logical framework for value sets Easier maintenance with the the patient at at the the heart

6 Current Use Patterns Common Language Documentation mapping of discrete elements Internal consistency within patient charts NLP extracting discrete details from note text Interoperability Other EMR Other EMR Other EMR with the the patient at at the the heart

7 Current Use Patterns Hierarchical Diagnoses Diagnosis Selection Hierarchy based searching Grouping Criteria Decision support Action based alerts Analytics Inclusion and exclusion Dynamic data presentation Problem oriented patient management Specialty views Diabetes Mellitus Maternal DM with the the patient at at the the heart

8 SNOMED-CT s limitations Clinical depth Need / expectation for post-coordination Synonomy and hierarchy problems Need for additional maps with the the patient at at the the heart

9 SNOMED-CT as an interface terminology Interface terminology vs. Reference terminology with the the patient at at the the heart

10 What Is Covered in The NLM Map Diagnoses collected from problem list of 7 health care organizations CORE problem list subset: Top 95% of those diagnoses CORE problem list subset Identified in SNOMED-CT Mapped to ICD-10-CM codes About 26% of ICD-10-CM codes covered

11 What Is Covered in The NLM Map NLM Maps Top 95% Identified or Mapped Mapped (26%) (74%) Problem List data from 7 orgs SNOMED-CT ICD-10

12 Coverage Analysis Diagnosis usage analyzed from 9 Epic customers Searched diagnoses over the last 3 years Concepts not found in NLM s map were considered as not covered

13 Diagnosis Coverage Average Missing: 18.4 %

14 Missing Diagnoses - examples Visit Diagnosis Count Routine infant or child health check Encounter for long-term (current) use of anticoagulants Routine general medical examination at a health care facility Routine gynecological examination Other screening mammogram Encounter for long-term (current) use of other medications Special screening for malignant neoplasms, colon Myalgia and myositis, unspecified Screening for unspecified condition Screening examination for pulmonary tuberculosis Screening for lipoid disorders Special screening for malignant neoplasm of prostate Preoperative examination, unspecified Screening for diabetes mellitus

15 Percentage of Diagnosis Covered by Maps Improving NLM s map How much effort would be involved in augmenting these? Percentage of Coverage Additional SNOMED concepts to be mapped

16 SNOMED-CT as an interface terminology Term Source Home grown terms and tools SNOMED-CT and NLM Maps Vendor Work to create Work to maintain Work to localize High? Low High? Low Low? Medium with the the patient at at the the heart

17 Design Ideas Problem List: Lookup & Store SNOMED concepts (restricted to those mapped by NLM) Visit Diagnosis: Lookup using SNOMED & ICD-10-CM Store only ICD-10-CM codes

18 Add Diagnosis to the Problem List Diagnosis present in NLM map

19 Add Diagnosis to the Problem List Diagnosis present in NLM map

20 Add Diagnosis to the Problem List Diagnosis present in NLM map

21 Problem List to Visit Diagnosis Diagnosis present in NLM map with one ICD code

22 Problem List to Visit Diagnosis Diagnosis present in NLM map with one ICD code *System automatically evaluates an age rule to determine the appropriate ICD code *NLM is still working on these rules

23 Add New Diagnosis to Visit Diagnosis present in NLM map with two ICD codes

24 Add New Diagnosis to Visit Diagnosis present in NLM map with two ICD codes From SNOMED

25 Add New Diagnosis to Visit Diagnosis present in NLM map with two ICD codes

26 Add New Diagnosis to Visit Diagnosis present in NLM map additional details needed for an ICD code

27 Add New Diagnosis to Visit Diagnosis present in NLM map additional details needed for an ICD code

28 Add New Diagnosis to Visit Diagnosis absent in NLM map

29 Add New Diagnosis to Visit Diagnosis absent in NLM map

30 SNOMED-CT as an interface terminology SNOMED-CT NLM Maps ICD-10 IHTSDO NLM CMS Assumptions SNOMED-CT is good enough NLM map is good enough NLM map is reversible 95% is good enough coverage Specialties? Larger organizations? MD will find ICD-10 when no map exists Expectations Release cycles coordinated Update processes timely Coordination of new and deactivated terms Localization process (term and map) with the the patient at at the the heart

31 SNOMED-CT as an interface terminology Term Source Home grown terms and tools SNOMED-CT and NLM Maps Vendor Work to create Work to maintain Work to localize High? Low High? Low Low? Medium $$$ FTE Resources with the the patient at at the the heart

32 SNOMED into the Future We think of SNOMED as a terminology, not a tool. Utilize additional SNOMED relationship types Analytics Enhanced lookups beyond diagnoses Unifying body for the terminology soup ICD around the world LOINC RxNorm Nursing terminologies with the the patient at at the the heart

33 Concluding Remarks SNOMED-CT has a lot of value Reference terminology Interoperability Continued maturation will increase its value Questions? with the the patient at at the the heart