SNOMED CT is endorsed by the Ministry of Health as an information standard for the health and disability sector, supporting the smart system theme of the New Zealand Health Strategy.
District health boards (DHBs) are implementing SNOMED CT as a requirement with all new investment in clinical information systems. Primary health organisations (PHO) are also seeing the advantages and implementing SNOMED CT in new and upgraded systems. Nationally, SNOMED CT will be the key information standard for the planned single electronic health record system.
Pilot projects around the country are showing the benefits to care coordination, clinical decision support and interoperability that SNOMED CT makes possible:
- St John Ambulance's electronic patient report form
- Nelson-Marlborough DHB's emergency department at a glance information system
- New Zealand Universal List of Medicines (NZULM)
- Midlands Health Network's new multi-practice, multi-specialty patient management system
- South Island Patient Information and Communication System (SIPICS)
SNOMED CT is an emerging standard for laboratory and radiology orders and results, referrals and clinical assessments. SNOMED CT resources are being developed for the many health specialties within the scope of the National Patient Flow (NPF) project, which is about tracking the patient journey. For example, a strategic principle of the New Zealand Cancer Health Information Strategy is to use SNOMED CT to capture better information about the patient’s condition and their treatment.
In the context of the single electronic health record, SNOMED CT will be used to represent medications, health issues, allergies and adverse reactions, test results and care plans as core personal health information.
In the near future a project will begin to migrate from Read codes to SNOMED CT in primary care for better information in personal injury claims and medical certificates. The Ministry of Health, Ministry of Social Development and Accident Compensation Corporation are working together on this initiative.
Migrating from Read codes to SNOMED CT
Read Codes have been used since the 1990s by health providers and government agencies to capture information about patients in primary care medical records, injury claims, medical certificates and system performance measure statistics. Read codes have been important but they are now superseded by SNOMED CT.
SNOMED CT completely replaces Read codes as the clinical terminology standard for personal health information. Using SNOMED CT terms to describe health issues, impact on life and interventions will enable new levels of care coordination and clinical decision support, benefitting patients and health providers. Information created this way is actionable and supports social investment.
The first district health boards and primary health organisations are now migrating their systems from Read codes to SNOMED CT. The Ministry of Health and other key agencies are working together to support and accelerate this process. The Ministry is making available the mapping tables that will enable health providers and their industry partners to perform migration.
With the necessary resources in place, the Ministry of Health and the other key agencies are developing and will be consulting on a timetable for migration from Read codes to SNOMED CT.
SNOMED CT use in New Zealand
The following video features clinicians from the Nelson Marlborough DHB - Dr Tom Morton, Dr Andrew Munro, Dr Bev Nicolls and nurse Suzanne Addison - sharing their experience using SNOMED CT, the clinical terminology standard endorsed for use in the New Zealand health and disability sector.
Title:SNOMED CT use in New Zealand
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SNOMED CT logo and tagline – The global language of healthcare.
[Dr Tom Morton] We’ve been using SNOMED CT since 2013. SNOMED CT was a relatively easy choice. It came with fairly good recommendations from other users. It also had an emergency department reference set, which was particularly appealing and as a result of that we were able to get our hands on that refset and have a good look at it prior to implementing. And that had certain advantages. We could see straight away the terms that were covered off were in fact very appropriate for use in our emergency department, and it was a natural fit with the types of patients and the diagnoses we were making.
[Dr Andrew Munro] SNOMED allows me to use my clinical judgement as freely as I had before it existed. It’s a coding system that sits in the background.
[Tom Morton] The only way to capture a presenting complaint is to be to use the SNOMED refset. And then all diagnoses we’re capturing that are done on completion of the patient journey in the emergency department, at the point that we know the diagnosis, that’s getting converted over - the presenting complaint - to a SNOMED diagnostic code.
[Andrew Munro] This is really just scratching the surface of the use of SNOMED. It’s intuitive, it has an intelligence behind it, and its real advantage is that people can come to the emergency department - clinicians who are new to the emergency department - and sit in front of the screen and carry on as usual.
[Tom Morton] We’re capturing every single diagnosis that is made from our patient population that is entering the emergency department. And that is all 100 percent SNOMED coded.
[Suzanne Addison] We’ve been finding using SNOMED through ED at a Glance very useful for us. It’s a lot more precise than probably what we used to do before, which was using a whiteboard system and waiting for the pre-printed charts to come out. So being able to have those fields populated by SNOMED and having the correct terminology there, it’s big advances for the department, I think. Often you just need to type in three or four letters and then it will come up with a list.
[Dr Bev Nicolls] In GP records the clinical terminology we use - which is the Read code that will be superseded by SNOMED - we use it for coding all the patient diagnoses, especially the major ones like heart disease and asthma, chronic obstructive pulmonary disease. And we have to use it for ACC forms because ACC requests that.
[Tom Morton] The Read codes that come with ACC are fairly limited in their ability to fully describe the illness, the injuries that our patients sustain. SNOMED is far more precise and so we often have problems translating our diagnosis to an acceptable Read code that can capture that accurately.
[Bev Nicolls] Read is no longer supported, so the main problem with Read is that we no longer have codes that we need for modern medicine. So coronary angioplasty with a stent is not included in Read.
[Tom Morton] What we’ve done to enable clinicians to maximise the ability to find the diagnoses they’re after is to put some smart technology into our information system that allows clinicians to search for the term that they’re looking for very precisely. And to do this really it takes minimal keystrokes. I’ve got nothing but high recommendation for swapping over to SNOMED. In terms of the ability to find the diagnosis you’re looking for I believe SNOMED is unparalleled. It is very, very easy to choose the appropriate term. It gets away from using woolly terms that don’t describe what you’re seeing, and we’ve found it to be universally excellent.
[Bev Nicolls] It’s part of if they want to type in atrial fibrillation as a diagnosis the SNOMED term pops up. It’s easy to use. It’s probably quicker than typing atrial fibrillation is to put in AF, click on the clinical terminology. So that gives them power to do things quickly. It gives them power to audit what they do.
[Suzanne Addison] For instance, the number of people presenting with a headache. And then, with a diagnosis, matching it up to see how many have migraines, how many have subarachnoid haemorrhages, and how many maybe it’s just a simple headache. So it’ll end up being the information that we have, we can use it a lot more for audit purposes, research and maybe implementing some new pathways and things that we need.
[Bev Nicolls] National Patient Flow, that captures the patient journey, I think is a fantastic process that’s being run that will be of huge benefit to patients, tracking them through the system. And actually picking up the ability to track patients who are not running smoothly through the system. And clinical terminology is a way of tagging the patient’s diagnosis, any extra problems.
[Andrew Munro] It will enable us to produce decision support based around clinical terminology. It’s an international language, which means that we are able to do a tremendous amount of research.
[Bev Nicolls] St John has incorporated SNOMED into their systems. The New Zealand Formulary uses SNOMED based codes.
[Tom Morton] In terms of future improvements, one of the biggest areas is actually going to be liaising with St John ambulance service, and we’re hoping to see their SNOMED code, which they are now using, pre-populate our own ED information system so that we’re actually all talking the same language.
[Suzanne Addison] It really has just made life so much easier. It’s quick, it’s simple to use, it finds the right terminology.
[Andrew Munro] Overall very positive, nobody seems to have negative experiences with it. It’s a seamless system.
[Suzanne Addison] Speed up processes and make them a lot more efficient. And also give the patient a more accurate patient record because the right data will be collected and it will be coded correctly. And that’s something that could be carried with the patient wherever they go.
[Bev Nicolls] It’s about a partnership and an evolution, and I think it’s a really exciting time. I think there’ll be huge power for the clinicians and they’ll get a lot of benefit from using it.