Understanding the SNOMED CT Coding system used in Indian Healthcare system

Ministry of Health & Family Welfare (MoH&FW) had notified the EHR standards for India way back in 2013. As a part fof these standards SNOMED- CT (Systematized Nomenclature for Medicine-Clinical Terms) was developed by the International Health Terminology Standards Development Organization-(IHTSDO). About 27 countries are members of IHTSDO but the terminolog is used in more than 50 countries. India became a member in April 2014.

India has obtained a “Country license” for SNOMED-CT and it is available free of cost to vendors/developers/clinical entities in India. (Ref : Circular dated 4th April 2014). The circular also urged all States/UTs to adopt EHR standards in all e-health applications.

SNOMED CT (distributed by the International Health Terminology Standards Development Organization-IHTSDO.) currently contains more than 300,000 medical concepts, divided into hierarchies such as body structure, clinical findings, geographic location and pharmaceutical/biological product etc. Each concept is represented by an individual number and several concepts can be used simultaneously to describe a complex condition.

The numerical reference system to represent medical concepts, SNOMED CT provides a standard by which medical conditions and symptoms can be referred, eliminates the confusion that may result from the use of regional or colloquial terms and also facilitates the exchange of clinical information among disparate health care providers and electronic medical records (EMR) systems.

SNOMED CT consists of four primary core components:

1.Concept Codes – numerical codes that identify clinical terms, primitive or defined, organized in hierarchies
2.Descriptions – textual descriptions of Concept Codes
3.Relationships – relationships between Concept Codes that have a related meaning
4. Reference Sets – used to group Concepts or Descriptions into sets, including reference sets and cross-maps to other classifications and standards

Concepts are further described by various clinical terms or phrases, called Descriptions, which are divided into Fully Specified Names (FSNs), Preferred Terms (PTs), and Synonyms.

SNOMED CT is a clinical terminology designed to capture and represent patient data for clinical purposes. Industry also uses the International Statistical Classification of Diseases and Related Health Problems (ICD) which is an internationally used medical classification system; which is used to assign diagnostic and, in some national modifications, procedural codes in order to produce coded data for statistical analysis, epidemiology, reimbursement and resource allocation.

Both systems use standardized definitions and form a common medical language used within electronic health record (EHR) systems. SNOMED CT enables information input into an EHR system during the course of patient care, while ICD facilitates information retrieval, or output, for secondary data purposes.

SNOMED CT is used in a number of different ways, some of which are:

-It captures clinical information at the level of detail needed for the provision of healthcare
-Through sharing data it can reduce the need to repeat health history at each new encounter with a healthcare professional
-Information can be recorded by different people in different locations and combined into simple information views within the patient record
-Use of a common terminology decreases the potential for differing interpretation of information
-Electronic recording in a common way reduces errors and can help to ensure completeness in recording all relevant data
-Standardised information makes analysis easier, supporting quality, cost effective practice, research and future clinical guideline development
-A clinical terminology allows a health care provider to identify patients based on specified coded information, and more effectively manage screening, treatment and follow up

SNOMED-CT is used in the second stage of meaningful use definition under HITECH Act. Even in the US, health care providers are complaining of the practical difficulties in implemnting the standards for recording patient care information. However, certain mapping techniques between SNOMED-CT and ICD 10 have been developed and are reportedly being used.

Along with SNOMED-CT and ICD codes, we also have HL7 standards and ANSI standards for medical encounter /transaaction recording and data transmission making the coding aspects of ealth care industtry reasonably complex.

These coding systems should be of interest to all IT companies engaged in the domain of health care including the several star ups that are now in India with services in the Health cared industry through mobile apps. This will also apply to wearables and cloud storage organizations and naturally for medical coding agencies.

It is not clear if the Indian Health cared industry which is not exposed to HIPAA is now anywhere near adopting these medical coding standards in full. Once the HDPSA becomes operative, the initial thrust in the industry would be on this aspect of implementation since non compliance to these standards would lead to a Y2K type of situation.

However, it appears that the sources for employee training in these areas in India are limited and needs to be attended to by the MoH before HDPSA kicks in.

Presently, SNOMED CT related documents can be obtained in India from the National Release Center 

CDAC has also dveloped a Toolkit for SNOMED CT which is available here.

It is time for the industry to review its software and embedded system software in health care industry to be compliant with these codes where necessary.

Naavi

For More Information on SNOMED CT Codes refer here:

Also refer National Health Portal India for further information

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