SNOMED CT and Nursing

 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