SNOMED CT implementation in primary care UK

Sly Saint

Sly Saint

Senior Member (Voting Rights)
"
Why primary care needs to migrate to SNOMED CT
Two versions of clinical codes (Read v2 and CTV3) currently exist in General Practice. Not all GP systems use the same coding system.

Parts of the Read code vocabulary are full and new codes have been allocated to unrelated areas. This makes analysis more difficult.

The NHS needs a single clinical terminology, for clinical data to be exchanged accurately and consistently across all care settings. This will allow better patient care and improve how clinical data can be analysed and reported on.

SNOMED CT is an international clinical terminology. It will allow the UK to take part in more effective research and analysis of health information, to support national and global health care improvements."

"
When SNOMED CT is being implemented
SNOMED CT will go live in general practice care in a phased approach from April 2018.

The phased approach will:

  • enable systems to preserve both SNOMED CT and Read Codes for a period of time to support the transition and implementation planning
  • ensure national specifications that are provided in SNOMED CT can be supported while suppliers roll-out their solutions
  • ensure that new clinical content for general practice that is released in SNOMED CT can be recorded and processed by all end users during the implementation
The deployment rollout will commence with pilot sites for the four principal clinical system suppliers, EMIS, TPP, Vision and Microtest. This will commence from April 2018 with a phased roll-out approach ensuring year-end processes can be completed prior to implementation. "

more here:
https://digital.nhs.uk/SNOMED-CT-implementation-in-primary-care

for background:
https://www.snomed.org/snomed-ct/what-is-snomed-ct/history-of-snomed-ct

see also for other countries:
https://www.snomedinaction.org/

Fullscreen capture 28012018 125022.jpg
https://snomedbrowser.com/Codes/Details/52702003

note the Mild/Moderate/Severe CFS "This is a UK specific concept"
 
Sly Saint said:
"
Why primary care needs to migrate to SNOMED CT
Two versions of clinical codes (Read v2 and CTV3) currently exist in General Practice. Not all GP systems use the same coding system.

Parts of the Read code vocabulary are full and new codes have been allocated to unrelated areas. This makes analysis more difficult.

The NHS needs a single clinical terminology, for clinical data to be exchanged accurately and consistently across all care settings. This will allow better patient care and improve how clinical data can be analysed and reported on.

SNOMED CT is an international clinical terminology. It will allow the UK to take part in more effective research and analysis of health information, to support national and global health care improvements."

"
When SNOMED CT is being implemented
SNOMED CT will go live in general practice care in a phased approach from April 2018.

The phased approach will:

  • enable systems to preserve both SNOMED CT and Read Codes for a period of time to support the transition and implementation planning
  • ensure national specifications that are provided in SNOMED CT can be supported while suppliers roll-out their solutions
  • ensure that new clinical content for general practice that is released in SNOMED CT can be recorded and processed by all end users during the implementation
The deployment rollout will commence with pilot sites for the four principal clinical system suppliers, EMIS, TPP, Vision and Microtest. This will commence from April 2018 with a phased roll-out approach ensuring year-end processes can be completed prior to implementation. "

more here:
https://digital.nhs.uk/SNOMED-CT-implementation-in-primary-care

for background:
https://www.snomed.org/snomed-ct/what-is-snomed-ct/history-of-snomed-ct

see also for other countries:
https://www.snomedinaction.org/

View attachment 1551
https://snomedbrowser.com/Codes/Details/52702003

note the Mild/Moderate/Severe CFS "This is a UK specific concept"
Click to expand...
URGENT REQUESR. Any updates on this?
 
Not sure what specific updates you are looking for, but SNOMED CT is now the mandated terminology system for use at the point of care across primary care and secondary care settings (though some GP practices are still using a mixture of the now retired Read Codes (CTv3) and SNOMED CT codes).

The most recent version of the SNOMED CT UK Extension can be accessed here:

https://termbrowser.nhs.uk/?perspec...gRefset=999001261000000100,999000691000001104


Click on the "Details" tab for the "National Health Service realm language reference set (clinical part)" Reference set. All the terms in the Reference set, ie "Preferred Term" and "Acceptable Terms", are cross mapped to ICD-10's G93.3 and all terms listed are searchable via the Search function.


See also: https://digital.nhs.uk/services/terminology-and-classifications/snomed-ct

(...)

National requirements for SNOMED CT
All NHS healthcare providers in England must now use SNOMED CT for capturing clinical terms within electronic patient record systems. Northern Ireland, Scotland and Wales also have programmes of work underway in relation to SNOMED CT; each devolved nation should be consulted for relevant details.

The use of SNOMED CT is a National Information Standard, and therefore a contractual requirement; further details can be obtained in the SNOMED CT Information Standards Notice. The user guide in the Release section of the standard provides useful information.
 
See slide #19 of NHS presentation: "Clinical Coding for non coders" for how SNOMED CT and ICD-10 are used for clinical records and data reporting and the different purposes they serve:

https://slideplayer.com/slide/13283348/

Slide #19:

coding-for-non-coders.png
 
Unlike ICD-10 and ICD-11, in which diagnostic terms are arranged within organ or body system chapters, SNOMED CT "Concept" terms are assigned under multiple "Parents".

This is the full Parent list for 52702003 Chronic fatigue syndrome and its Synonyms terms:

https://termbrowser.nhs.uk/?perspec...gRefset=999001261000000100,999000691000001104

upload_2024-6-11_12-22-49.png

Note also that the three Children terms:

  • Mild chronic fatigue syndrome (disorder)
  • Moderate chronic fatigue syndrome (disorder)
  • Severe chronic fatigue syndrome (disorder)
which are exclusive to the UK extension and don't appear in the International version or in any of the other national extensions, are also coded for:

377181000000104 | Mild chronic fatigue syndrome (disorder)
377171000000101 | Moderate chronic fatigue syndrome (disorder)
377161000000108 | Severe chronic fatigue syndrome (disorder)

but it's not known whether or to what extent these Concept codes for Mild, Moderate or Severe are being used in secondary or primary care and if so, what criteria are being used to differentiate between the three severities.


Note: SNOMED CT includes terminology other than disease terms and terms are categorised as "(disorder)" or "(finding)" or "(procedure)" etc.

More on Disorders and Findings here:

https://confluence.ihtsdotools.org/display/DOCEG/Clinical+Finding+and+Disorder

https://confluence.ihtsdotools.org/display/DOCEG/Clinical+Finding+and+Disorder+Naming+Conventions
 
Last edited:
Dx Revision Watch said:
Unlike ICD-10 and ICD-11, in which diagnostic terms are arranged within organ or body system chapters, SNOMED CT "Concept" terms are assigned under multiple "Parents".

This is the full Parent list for 52702003 Chronic fatigue syndrome and its Synonyms terms:

https://termbrowser.nhs.uk/?perspec...gRefset=999001261000000100,999000691000001104

View attachment 22006

Note also that the three Children terms:

  • Mild chronic fatigue syndrome (disorder)
  • Moderate chronic fatigue syndrome (disorder)
  • Severe chronic fatigue syndrome (disorder)
which are exclusive to the UK extension and don't appear in the International version or in any of the other national extensions, are also coded for:

377181000000104 | Mild chronic fatigue syndrome (disorder)
377171000000101 | Moderate chronic fatigue syndrome (disorder)
377161000000108 | Severe chronic fatigue syndrome (disorder)

but it's not known whether or to what extent these Concept codes for Mild, Moderate or Severe are being used in secondary or primary care and if so, what criteria are being used to differentiate between the three severities.
Click to expand...


I wonder if these codes will feed into the PROMS being developed given that PROMS are for clinical use. Given the mish mash of questionnaires to date , and the somewhat idiosyncratic severity questions, this could be problematic for many at the moderate/ severe interface.
 
Note also that "Postviral fatigue syndrome" has been separately coded for in SNOMED CT since the Countess of Mar's correspondence with SNOMED CT UK managers in 2015. (No rationale for this specific decision appears to be provided within the 2015 correspondence.)

Prior to July 2015,
Postviral fatigue syndrome had been listed under Children to Chronic fatigue syndrome.

The SNOMED CT Concept code for Postviral fatigue syndrome is:

https://termbrowser.nhs.uk/?perspec...gRefset=999001261000000100,999000691000001104

51771007 | Postviral fatigue syndrome (disorder)

Its Parents are:

Clinical finding (finding)
> Disease (disorder)
> Sequelae of disorders (disorder)
> Post-infectious disorder (disorder)
> Disorder following viral disease (disorder)


It remains cross mapped to ICD-10's G93.3.
 
May be of interest where GP practices using SystmOne for electronic medical records are still coding using the now retired Read CTv3 code system:

https://support.ardens.org.uk/support/solutions/articles/31000147413-snomed-ct-codes


Also:

NHS page discussing transition to SNOMED CT, advantages of SNOMED CT over the now retired Read (CTv3) Code system and also mentions facility built into some EMR systems for "dual coding" using Read Codes and SNOMED CT:

NHS England: Clinical coding – SNOMED CT Version 1.2, 1 May 2023:

https://england.nhs.uk/long-read/clinical-coding-snomed-ct/

Extract:

upload_2024-6-12_21-50-18.png


My understanding is that the mapping tables from Read (CTv3) to SNOMED CT UK Edition are a licensed product and not readily accessible online.

However, if you search for a SNOMED CT term using the public browser ( https://termbrowser.nhs.uk/? ) then click on "Classification Map" (which you will find underneath the "Summary" and "Details" tabs) it will display the ICD-10 map code; and if you look under the "Refsets" tab, it will give the Read (CTv3) mapping code under heading: "Simple Map Refset name".
 
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