Introduction
To provide better
and cost effective patient care, one needs to exchange healthcare information.
For this to happen seamlessly, there is a dire need of Standards that
facilitate this interoperability 1,2. A Standard denotes the ability
of two or more systems or components to exchange information (structural or
syntactic interoperability) and to (meaningfully) use the information that has
been exchanged (functional or semantic interoperability). For semantic
interoperability and getting better insights into clinical data, SNOMED CT is
preferred.
SNOMED CT, is
accepted as the global common language for clinical terms, otherwise known as a
Clinical Terminology System. SNOMED CT based clinical information benefits
individual patients and clinicians as well as populations while supporting
evidence-based care. SNOMED CT enables the full benefits of EHRs to be achieved
by supporting both clinical data capture, and the effective retrieval and reuse
of clinical information. Therefore, SNOMED-CT enabled EHR systems can lead to
better informed and analyzed patient outcomes.
Earlier Efforts
Earlier, the use
of a common list of SNOMED CT concepts was thought to maximize data
interoperability among institutions. However, local problem list vocabularies
often needed to be expanded to satisfy specific user needs. Users had to check
to see if SNOMED CT contains terminology for concepts they need to fulfill
their local requirements and use case. The UMLS Terminology Services (UTS) from
the National Library of Medicine (NLM) 3, USA, includes a SNOMED CT
browser that may be used for this purpose. The SNOMED CT Browser is available
through the SNOMED CT menu of the UTS.
If needed
concepts are not found in the terminology, users are encouraged to submit them
for inclusion in the US Extension of SNOMED CT. To submit a new nursing problem
concept, one can go to U.S. SNOMED CT Content Request System (USCRS).
Additional assistance on submitting requests can be found on the USCRS User
Guide page. This is how the link to the Nursing Problem List concepts is
maintained and divergence of problem list vocabularies can be minimized.
Institutions that use their own problem list vocabularies are encouraged to map
them to SNOMED CT with a focus on the Nursing Problem List concepts to
facilitate data interoperability.
Recent Happenings
The 2020
agreement 4 between SNOMED International and the International
Council of Nurses (ICN) highlights the clinical work of nursing. The ICN is a
federation of more than 130 national nurses’ associations worldwide. Under the
agreement, the International Classification for Nursing Practice (ICNP) will be
incorporated into SNOMED CT, which has more than 350,000 active concepts, and
SNOMED International will manage, produce and release the ICNP on behalf of
ICN, which will maintain governance and ownership of the ICNP content.
National and
international stakeholders that use SNOMED CT can seamlessly integrate ICNP
concepts into their SNOMED CT-enabled EHRs or electronic health records. The
countries that presently use both ICNP and SNOMED CT will no longer need to
engage in mapping activities between these two code systems. The agreement
coincides with the World Health Organization (WHO) declaring 2020 as the Year
of the Nurse and Midwife, and it also builds on SNOMED International’s
commitment to global interoperability as part of the Joint Initiative Council
for Global Health Informatics Standardization.
This
collaboration has advanced interoperability, and also supported disease
surveillance in real time. ICNP concepts represent the practice of 20 million
nursing professionals worldwide. Interoperability is more than just health
information systems exchanging information. It also means that EHR systems can
exchange data with unambiguous, shared meaning and that the clinicians who
document and interpret those concepts can then understand and utilize them in
the same way across practices and clinical settings, transcending geographical
and time barriers.
With ICNP, one
can measure nursing-related indicators; then use that information to improve
global, national and regional health care systems; and use that data to produce
scientific evidence that will inform health system transformation for enabling global
health.
COVID-19 pandemic
has renewed the international focus on public health infrastructure and
measures, and globally health care agencies are re-investing in community-based
nursing activities including prevention, surveillance and immunization. The
relationship between ICNP and SNOMED CT makes it possible for reporting of
COVID-19 public health surveillance at regional, national and international
levels. As nurses do the bulk of sample collection, this partnership could
enable public health officials to have access to near real-time testing data
that has been reliably documented by regulated health professionals, as well as
subsequent additional analyses about nursing care. More significantly, the
improvements in patient outcomes and the ability to meet the health needs of
patients are possible through integrated health and social care systems.
Conclusions
and Way Forward
While efforts are ongoing to ensure adequate coverage of
nursing in SNOMED CT, there have been no studies indicating the use of SNOMED
CT in nursing practice. The authors 5 recommend for achieving the
widespread collection of interoperable SNOMED CT coded nursing data in clinical
applications to evaluate nursing’s impact on patient outcomes. This is the
right time to encourage the advocacy and use of SNOMED CT for enhancing the
quality of nursing services.
References
1. Sarbadhikari SN, The Role of Standards
for Digital Health and Health Information Management, JBCR, 2019, 6(1):1: https://jbcr.net.in/JBCR-VOL-6-issue-1-2019-20/current-issues-volume-VI-issue-1-1.html
2. Sarbadhikari SN, Health Data
Analytics and clinical terminology systems like SNOMED CT, https://supten.blogspot.com/2020/03/terminology-standards-for-health.html
3. National
Library of Medicine, Nursing Problem List Subset of SNOMED CT, https://www.nlm.nih.gov/research/umls/Snomed/nursing_problemlist_subset.html
4. Davison K and Kuru K, Integration
of ICNP into SNOMED CT brings voice to nursing practice, https://www.snomed.org/news-and-events/articles/integration-ICNP-SNOMEDCT-brings-voice-to-nursing
5. Junglyun Kim, Tamara G.R. Macieira,
Sarah L. Meyer, Margaret Ansell (Maggie), Ragnhildur I. Bjarnadottir (Raga),
Madison B. Smith, Sandra Wolfe Citty, Denise M. Schentrup, Rose Marie Nealis,
Gail M. Keenan, Towards implementing SNOMED CT in nursing practice: A scoping
review, International Journal of Medical Informatics, 2020, 134: 103045, https://doi.org/10.1016/j.ijmedinf.2019.104035
