The Ministry of Health is moving towards improved recording by district health boards of emergency department visits. For every ED patient, a record of the chief presenting complaint, any diagnosis and any procedures or investigations needs to be kept. Each of these data elements must be recorded using SNOMED CT, our standard for clinical terminology.
To enable this process we have introduced SNOMED reference sets for chief presenting complaint, diagnosis and procedure concepts in emergency care.
The three refsets can be downloaded either (1) as Excel spreadsheets from this page or (2) as part of the SNOMED NZ Edition from our SNOMED Member Licensing and Distribution Service. The files can then be loaded into any compatible ED information system.
While the SNOMED NZ Edition is our standard product, we will continue to maintain the spreadsheets as long as there is demand.
A more direct way to access the refsets is to integrate the ED information system with a terminology service that can be called in real-time as the ED visit record is created. In line with our Interoperability Roadmap, we have introduced a FHIR(R) terminology service to support this method of integration. This API for development and production purposes is available on the internet at https://snomednz.digital.health.nz/fhir.
Here are examples of using the API to query each of the three refsets (in the above order):
SNOMED International's Snowstorm terminology server is the software used. See the Snowstorm GitHub repository for more about how to use the API.
We ask that software suppliers who are not already SNOMED affiliate users to register with us to use the API.
The refsets can also be browsed online using the SNOMED refset management tool:
- NZ emergency care chief presenting complaint reference set
- NZ emergency care diagnosis reference set
- NZ emergency care procedure reference set
The National Collections Annual Maintenance Project (NCAMP) set the requirement for DHBs to implement SNOMED in their ED information systems and submit SNOMED-coded ED visit data to the National Non-Admitted Patient Collection (NNPAC).
- NCAMP 2019 introduced the change for voluntary early adopters Nelson-Marlborough DHB, Auckland DHB, Canterbury DHB and Bay of Plenty DHB. The Annual Plan Guidelines for 2019/20 asked all other DHBs to plan for adoption.
- NCAMP 2020 set the mandatory implementation date of 1 July 2021 for all DHBs.
- NCAMP 2021 affirmed the mandatory implementation date of 1 July 2021.
The Ministry is developing and making available new reports from NNPAC using the SNOMED-coded visit data.
We acknowledge the work by emergency medicine specialists at Nelson-Marlborough DHB to develop the presenting complaint and diagnosis reference sets, which have been used at Nelson and Wairau hospitals since 2013. The procedure reference set was also developed by New Zealand emergency care specialists.
The introduction of SNOMED in EDs is endorsed by the Australasian College of Emergency Medicine.