Updates on status of ICD-11 and changes to other classification and terminology systems

You will find a CTV3 to SNOMED CT mapping tool here:

READ CTV3 to SNOMED CT MAPPING LOOKUP (APRIL 2018):

https://hscic.kahootz.com/connect.ti/t_c_home/view?objectId=407556


Scroll to the bottom of the landing page to:

Actions

This link will pull up a search form into which you can insert either a CTV3 or a SNOMED CT concept term name or search via a concept ID code.


There are three Read CTV3 specifiers for Mild; Moderate; or Severe chronic fatigue syndrome.

These are assigned unique CTV3 codes and are mapped to the unique SNOMED CT ConceptIDs for the three CFS severities that are exclusive to the UK extension. That is, they have different codes to the SNOMED CT "Fully specified name" for CFS (which is 52702003).

CTV3 ConceptID: F2860
CTV3 TermID: YasQy
CTV3 Term30: Mild chronic fatigue syndrome
SNOMED CT ConceptID: 377181000000104

CTV3 ConceptID: F2861
CTV3 TermID: YasQz
CTV3 Term30: Moderate chronic fatigue syndrome
SNOMED CT ConceptID: 377171000000101

CTV3 ConceptID: F2862
CTV3 TermID: YasR0
CTV3 Term30: Severe chronic fatigue syndrome
SNOMED CT ConceptID: 377161000000108


As far as I can see, only Chronic fatigue syndrome has three severity option codes in Read CTV3.

That is, there do not appear to be CTV3 severity option terms or codes specifically associated with the terms Myalgic encephalomyelitis or Postviral fatigue syndrome.

Note that there are several different Read CTV3 codes associated with the terms Myalgic encephalomyelitis and Postviral fatigue syndrome but all three terms, CFS, ME and PVFS, are mapped to

SNOMED CT ConceptID: 52702003 Chronic fatigue syndrome (disorder).


Prior to July 2015, Postviral fatigue syndrome had been listed in SNOMED CT under Children to 52702003 Chronic fatigue syndrome. I don't have access to archived earlier releases of SNOMED CT so I cannot confirm whether there had been a specific code for Postviral fatigue syndrome as a Child of CFS, or whether it took the same code as CFS (i.e. 52702003).

In July 2015, the SNOMED CT terminology managers moved PVFS under new parents so it no longer displayed as a Child under CFS. Its new parents became:

Post-infectious disorder (disorder)
> Post-viral disorder (disorder)

It has the SNOMED CT ConceptID: 51771007.


In the READ CTV3 to SNOMED CT MAPPING LOOKUP (APRIL 2018) some of the various CTV3 codes associated with Postviral fatigue syndrome map to the CFS code:

SNOMED CT ConceptID: 52702003

but some map to the code that Postviral fatigue syndrome has in its more recent location, which is:

SNOMED CT ConceptID: 51771007.


As I mentioned in my previous post, all the SNOMED CT Chronic fatigue syndrome and Synonym terms plus PVFS map to ICD-10 G93.3 and the three severity codes specific to the SNOMED CT UK Edition also map to G93.3.
 
Last edited:
This document is worth a skim:

Ed: My highlighting.

http://www.baps.org.uk/content/uplo...nicians-interested-in-developing-SNOMED-1.pdf

Royal College of Paediatrics and Child Health


RCPCH: “How-to” guide for clinicians interested in developing SNOMED-CT concepts

Extracts:

(...)

Dr Andy Spencer (former Chair of the Informatics for Quality Committee) hosted an RCPCH webinar on 23 March 2018, which explained why it is important for clinicians to get involved with the development of SNOMED-CT concepts. It is recommended that development of the terminology sets is clinically-led to accurately represent concepts that will be used in practice. You can access the webinar and presentation slides on RCPCH Compass.

(...)

What is driving adoption of SNOMED-CT and when will it be introduced?

The National Information Board document 'Personalised Health and Care 2020: A Framework for Action' recommends the move to a single terminology – SNOMED-CT - for the direct care of an individual across all care settings in England. In England, SNOMED-CT will be implemented across Primary Care settings from April 2018. No new Read codes can be requested and system suppliers have migration plans in place. Secondary Care, Acute Care, Mental Health, Community systems, Dentistry and other systems used in the direct management of care of an individual must use SNOMED-CT as the clinical terminology from 1 April 2020.

Some systems and / or providers already allow for SNOMED-CT concepts to be captured – these can be found online through SNOMED in action. Once terminologies have been agreed and a detailed explanatory glossary produced, clinicians will only need to capture the agreed terms, whose SNOMED-CT concepts will flow ‘behind the scenes’ and be used for all the purposes that previous coding systems fulfilled, e.g. ICD-10, HRG, PBR etc. Individual domains of use may choose to have clinical audits and national reports using SNOMED-CT concepts, this should minimise the burden for reporting organisations. Areas that have already been considered are the areas where novel therapies are commonly unavailable or grouped under ‘Not elsewhere classified’.

Will the concepts be the same for primary and secondary care? And will they be the same for adult and children’s services?

The goal is for the same concepts to be used across all levels of health care and in all settings, to allow for accurate comparisons and analyses. SNOMED-CT is to be the coding terminology for the NHS as a whole, not just for doctors. If the concept is the same, it should be the same for everyone, there will be some uniquely paediatric conditions but generally unless the real world has named them differently they are not different in SNOMED-CT. Specialty groups are encouraged to communicate with primary care and adult services to develop concepts appropriately and consistently. Terminologists in the Department of Health can assist in signposting specialty groups to terminology glossaries that have already been developed by other disciplines, for example, dietetics, to ensure ‘read across’ and save duplication of effort. Social care is also within the scope of SNOMED-CT, but the timescales are more fluid at present.

(...)

Is there an implementation plan for SNOMED-CT in the devolved nations?

The devolved nations are actively involved in SNOMED-CT appraisal and adoption, although there are no clearly published timelines. However, it is essential that there is agreement amongst clinicians across all parts of the UK about which concepts to use, so that sub-populations can be accurately compared across all of the UK. If there is UK-wide agreement amongst clinicians about the concepts to be used, this can be made clear in the metadata, which is available online.

(...)

What happens to SNOMED-CT concepts once they are added to the electronic record?

Reporting of diagnostic and healthcare terms that are captured by Community Services at the point of care has been mandated since October 2015 to the Children and Young People’s Health Services dataset (CYPHS). This evolved into the all-age Community Services Data Set (CSDS) in October 2017. Data from all publicly funded Community Services should be reported to the CSDS. The more clinicians who report such data, the more comprehensive the analyses can be. Ultimately, once all clinicians are capturing data at all points of care, it will be possible for reports to be created that describe population health, including variations.

Once concepts are entered by the clinician into the electronic record, the data team can extract the SNOMED-CT concepts and report them each month to NHS Digital. NHS Digital then produces reports back to Trusts and to Clinical Commissioning Groups.

Are we continuing to use ICD10?

There are no plans for the ICD classification to disappear, certainly in the short to medium term. ICD-11 implementation plans are underway; however, it is anticipated that as more records are electronic, more efficient ways to map to the classifications will be developed.

ICD-10 is a disease classification system. The equivalent SNOMED-CT concepts can be mapped, but will only make up part of the SNOMED-CT glossary of concepts. Specialty groups should identify the ICD-10 codes that reflect their SNOMED-CT diagnostic concepts and are encouraged to identify or develop relevant SNOMED-CT concepts that describe the wider needs of their patients also.

(...)

How can I get involved?

RCPCH specialty groups are currently working to produce SNOMED-CT concepts relevant to their special interest. Different groups are at different stages in the development of concepts. The first step to get involved is to contact your special interest group and get involved in their work. These specialty groups may wish to consider examining and/or working with adult equivalent groups or looking at primary care queries for Quality and Outcomes Framework (QOF). These may help find the right areas of SNOMED-CT, even if you then need to focus on your area.

Current specialty / special interest groups working with RCPCH:

(...)

Paediatric Chronic Fatigue Syndrome / MR [sic]* Special Interest Group

Ed: Given that the letter"R" is next to "E" on a keyboard I think the above is likely a typo.

Full document in attachment
 

Attachments

It's M.E. Linda said:
Another couple of thoughts please @Dx Revision Watch ?

Should we all try to check our Summary Care Records with our GP surgery to see how we PwME have been classified?
Click to expand...


I am a carer not an ME patient, myself, but if I were a patient, I would want to know what was recorded in my SCR, especially since so many clinical settings have access to the SCR (unless you opt out), including some pharmacists (with your permission).

Although SNOMED CT became mandatory for use in primary care from 01 April, there is a transition period during which there will be dual coding of Read CTV3 and SNOMED CT codes in primary care (see posts #103 and #109 for for more information and timescales). I don't know to what extent codes are included in the SCR, in addition to a diagnostic concept term.

Incidentally, there is a page here: https://digital.nhs.uk/services/summary-care-records-scr/additional-information-in-scr

about GPs adding additional information to the SRC, which may be worth scrutinizing.

Also a sample Summary Care Record created via TTP SystmOne (which is the system my own practice uses):

https://digital.nhs.uk/binaries/content/assets/legacy/pdf/7/f/example_scr_tpp.pdf

This is interesting and I'll put it in a stand alone post as well. It lists diagnostic terms but not explicit codes.

and, at some point in the future, would this mean that the NHS would be able to provide a more accurate update of how many patients have M.E. in England? (Wales, Scotland, N.I, whole UK - sorry it gets very confusing when certain medical matters are devolved throughout the union, and others are not)
Click to expand...

The adoption of SNOMED CT across all NHS settings by 2020 should in theory lead to more accurate and consistent reporting and data analysis.

Apologies if this is naive questioning, brain is not having a good week, I’m afraid. Thank you for all your hard work on these classifications- in the old days it would have been something I would have enjoyed, these days, it is far too complicated
Click to expand...

You are welcome, M.E. Linda.
 
Last edited:
Dx Revision Watch said:
....but if I were a patient, I would want to know what was recorded in my SCR,

The adoption of SNOMED CT across all NHS settings by 2020 should in theory lead to more accurate and consistent reporting and collection of data.
Click to expand...

Thank you so much @Dx Revision Watch for all this information.

I will read and take in slowly before approaching the surgery.

Fingers crossed that an accurate number will be obtained in the NHS, one day, for “just” M.E. patients
 
I mentioned in Post #120 that the SNOMED CT UK Edition includes some additional terms under Synonyms that are identified as "Acceptable" terms, viz:

Myalgic encephalitis
Myalgic encephalopathy

The UK Edition also includes a unique Concept term:

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

SCTID: 88776100000010 Medically unexplained symptoms (finding) |

in addition to:

SCTID: 702537003 | Medically unexplained symptom (finding) |

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


The former may have been incorporated for UK use as a legacy from the Read CTV3 terminology but I don't have access to the history of when the term was first added to the CTV3 system or first added to the SNOMED CT UK Edition.

CTV3 ConceptID: Xaafw
CTV3 TermID: YawVN
CTV3 Term30: Medically unexplained symptoms
SNOMED CT ConceptID: 887761000000101
SNOMED CT DescriptionID: 2287111000000114
SNOMED CT Term: Medically unexplained symptoms

--------------------------------------------------------------------

There are some differences in other editions of SNOMED CT.

In the Netherlands Edition, amongst the translated terms, the term "neurasthenie" has been retained, even though the SNOMED CT Concept SCTID: 192439005 Neurasthenia was inactivated (retired) from the International Edition some years ago (inactivated terms display their details on a pink background and can be searched for if "Active and inactive components" is selected):

http://browser.ihtsdotools.org/?per...dotools.org/api/snomed&langRefset=31000146106

nl chronischevermoeidheidssyndroom
nl neurasthenie
nl chronischevermoeidheidssyndroom [CVS]

--------------------------------------------------------------------

SNOMED CT is used in the United States and there is a SNOMED CT to ICD-10-CM map.

For the U.S., their edition of SNOMED CT maps CFS to ICD-10-CM codes and the clinician, other practitioner or coder can select either

G93.3 Postviral fatigue syndrome

or

R53.82 Chronic fatigue syndrome NOS

since for the U.S's ICD-10-CM, CFS is coded in the Symptoms, signs chapter.

--------------------------------------------------------------------

Although National Editions can include additional Concept terms, they also have the option of retaining Concept terms that have been inactivated.

When I was establishing what the rationale was for retiring the Multisystem disorder parent for the January 2018 release, the rationale was provided to Forward-ME by SNOMED International, themselves. But I also approached the U.S. National Release Center (NIH) for the rationale. I was given the same explanation, but advised that it would be possible to submit to the U.S. National Release Center for consideration of retaining the Multisystem disorder parent for the U.S. Edition.
 
Last edited:
It's M.E. Linda said:
Thank you so much @Dx Revision Watch for all this information.

I will read and take in slowly before approaching the surgery.

Fingers crossed that an accurate number will be obtained in the NHS, one day, for “just” M.E. patients
Click to expand...


Indeed. But first the NHS would need to be prepared to use any separate code that might be introduced in the future into their currently mandated terminology and classification systems; and GPs and secondary care would need the means of distinguishing between a diagnosis of CFS and a diagnosis of ME, the willingness to make that differentiation and the willingness to review patients with an historical diagnosis of undifferentiated CFS.

The U.S. has codes for both in ICD-10-CM, since October 2015, but it's unclear to what extent the G93.3 code is now being used, in practice, by clinicians.
 
Last edited:
A recently published study carried out in general practice. Full paper available. May be of particular interest to patients in Germany:

Coding of medically unexplained symptoms and somatoform disorders by general practitioners – an exploratory focus group.
N. J. Pohontsch,
corrauth.gif
1 T. Zimmermann,1 C. Jonas,2 M. Lehmann,2 B. Löwe,2 and M. Scherer1

BMC Fam Pract. 2018; 19: 129.
Published online 2018 Jul 27. doi: 10.1186/s12875-018-0812-8

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064152/
 
Last edited:
Dx Revision Watch said:
There are three Read CTV3 specifiers for Mild; Moderate; or Severe chronic fatigue syndrome.

These are assigned unique CTV3 codes and are mapped to the unique SNOMED CT ConceptIDs for the three CFS severities that are exclusive to the UK extension. That is, they have different codes to the SNOMED CT "Fully specified name" for CFS (which is 52702003).

CTV3 ConceptID: F2860
CTV3 TermID: YasQy
CTV3 Term30: Mild chronic fatigue syndrome
SNOMED CT ConceptID: 377181000000104

CTV3 ConceptID: F2861
CTV3 TermID: YasQz
CTV3 Term30: Moderate chronic fatigue syndrome
SNOMED CT ConceptID: 377171000000101

CTV3 ConceptID: F2862
CTV3 TermID: YasR0
CTV3 Term30: Severe chronic fatigue syndrome
SNOMED CT ConceptID: 377161000000108


As far as I can see, only Chronic fatigue syndrome has three severity option codes in Read CTV3.

That is, there do not appear to be CTV3 severity option terms or codes specifically associated with the terms Myalgic encephalomyelitis or Postviral fatigue syndrome.
Click to expand...

Thanks. This was the information I was after. Sorry I got it back to front (ie the three classifications are in SNOMED not WHO).
Interesting that it is only CFS (ie not ME etc) that has this distinction and only in the UK.
So I wonder if they will get used; presumably current readcodes that just have CFS will be 'translated' as just CFS on its own without the specifiers using SNOMED CT.

NICE currently have some very vague descriptions in the current guidelines about Mild, Moderate and Severe. You would think there should be something a bit more substantial particularly if it will affect any proposed treatment(?)

I see that BDD is also stratified this way........
"Bodily Distress Disorder which replaces the somatoform disorders. This is stratified into mild, moderate and severe" (source is from 2017).
Hmm
 
Dx Revision Watch said:
A recently published study carried out in general practice. Full paper available. May be of particular interest to patients in Germany:
Click to expand...

Thanks!

Not all patients with (severe) MUS will eventually be diagnosed with a psychiatric somatization disorder (ICD-10 F45.x), as preferences for diagnoses differ according to the specialty [14]; medical specialties prefer functional somatic syndromes [6] like fibromyalgia, chronic fatigue syndrome and chronic benign pain syndrome [15].
Click to expand...

That's the mainstream opinion in Germany and in the German medical/scientific literature (ME=MUS/functional disorder/somatoform disorder). ME is also part of the German guideline for functional disorders.

___
@Dx Revision Watch Do you know by any chance if Snomed is also used in Germany? I researched twice in the last months but couldn't really find anything and am still not sure.
 
Might be worth a skim:

https://www.microtest.co.uk/downloads/leaflets/SNOMED-FAQs.pdf

SNOMED CT in Primary Care

Extracts:

"All primary care settings must use SNOMED CT from April 2018. Not all GP surgeries will move to SNOMED CT at the same time and the estate will transition carefully across a number of months."

"The implementation across primary care will be phased and dependent on when the supplier of the clinical system has completed their design and it has been assured."

"How will Dual Coding support the change?

"To ensure that the move to SNOMED CT is as seamless as possible, there will be a phase where “dual coding” of both Read and SNOMED CT is active by the system. Dual coding will allow data to be safely transferred between GP practices who have transitioned to SNOMED CT and those which have not yet gone live. This will all happen in the background. This means that your Year End QOF in April 2018 will not be disrupted by the transition, as dual coding will still apply at this time. When systems have transitioned to SNOMED CT, Read codes will be automatically added to the record by the system so that any business critical requirements for Read that arise can still be met."

"Are all GP/primary care systems to implement subsets as part of the migration process, rather than giving users access to the full dictionary?

"Initially a subset only will be available, but once all suppliers have migrated, the full set of SNOMED CT will be available, although we expect practices will continue to use their own formularies.

"Can organisations create their own subsets or would you just limit a search field to a specified parent code?

"In primary care, it is expected that practices will still be able to create their own formularies.


"When the move takes place from Read v2 to SNOMED CT, will the codes ‘translate’ directly/automatically across in primary care (following input by GP IT systems suppliers)?

"Yes, they will be translated within the system using national tables that will be used by all the suppliers.

"How will mapping work with primary care systems? Will the codes be mapped in the background or will we notice changes in how our system looks and operates?

"Codes will be mapped in the background; however, systems will change to enable SNOMED CT terms to be entered. There will be some small changes but these are not anticipated to be major.

"Will Historical Data be coded in Read and SNOMED CT?

"Yes, all historical coded data in Read will have a SNOMED CT equivalent; this will enable time series analysis.

 
Joh said:
Thanks!

That's the mainstream opinion in Germany and in the German medical/scientific literature (ME=MUS/functional disorder/somatoform disorder). ME is also part of the German guideline for functional disorders.

___
@Dx Revision Watch Do you know by any chance if Snomed is also used in Germany? I researched twice in the last months but couldn't really find anything and am still not sure.
Click to expand...


Joh, these countries are listed by SNOMED International as Members:

https://www.snomed.org/members

It does not appear that Germany is a member.


These conference posters and papers also suggest that Germany is not. Though there was at one time a German language subset and may still be a German language translation:

https://confluence.ihtsdotools.org/...67/SNOMED_CT_Expo_Presentation_201728_SCH.pdf

Building an experimental German user interface terminology linked to SNOMED CT



https://www.egms.de/static/en/meetings/gmds2014/14gmds212.shtml

Meeting Abstract:

September 2014

Die Einführung von SNOMED CT in Deutschland – Eine exemplarische Betrachtung aus institutionenökonomischer Sicht

Einleitung und Fragestellung: Innerhalb einer Gesellschaft sind die Existenz und die Anwendung gültiger Standards Grundvoraussetzungen für das funktionierende Zusammenwirken der einzelnen Akteure. Dies gilt insbesondere im Bereich des Gesundheitswesens und in der elektronischen Übertragung medizinischer Informationen. Ein syntaktischer Standard zum Datenaustausch (z. B. HL7/CDA) benötigt eine geeignete Terminologie als semantischen Partner. In diesem Zusammenhang wird der Einsatz von SNOMED CT als semantische Komponente international favorisiert [1]. Bis heute ist eine flächendeckende Anwendung der Terminologie in Deutschland aufgrund einer fehlenden Mitgliedschaft in der IHTSDO unmöglich. Ohne einen belegbaren Nutzen innerhalb spezieller use cases werden der Beitritt zur IHTSDO sowie eine nationale Implementierung von SNOMED CT kontrovers diskutiert. Darüber hinaus gestaltet sich die Quantifizierung des korrelierten Nutzens als schwierig...


I don't read German, so via Google Translate:

Introduction and question: Within a society the existence and the application of valid standards are basic requirements for the functioning co-operation of the individual actors. This applies in particular in the field of health care and in the electronic transmission of medical information. A syntactic standard for data exchange (eg HL7 / CDA) requires suitable terminology as a semantic partner. In this context, the use of SNOMED CT as a semantic component is internationally favored [1]. To this day, a nationwide application of terminology in Germany is impossible due to a lack of membership in the IHTSDO. Without a provable benefit within special use cases, joining the IHTSDO and a national implementation of SNOMED CT are controversial. Moreover, the quantification of the correlated utility is difficult...

(The IHTSNO is the International Health Terminology Standards Development Organisation (IHTSDO) is the international not for profit organization that owns SNOMED CT.)
 
@Dx Revision Watch
Thank you as always! :emoji_bouquet:

Wikipedia says a private organization translated Snomed into German in 2003, but the translation wasn't used or updated and is now obsolete. And apparently the DIMDI planned to do a German translation for four decades but didn't manage to. It seems like people were just busy talking about implementing it for the last decades but nobody did, so I was a little confused by some sources. Thanks for the clarification! :)
 
Sly Saint said:
Thanks. This was the information I was after. Sorry I got it back to front (ie the three classifications are in SNOMED not WHO).

Interesting that it is only CFS (ie not ME etc) that has this distinction and only in the UK.
Click to expand...


This is perforce a rather lengthy response and probably somewhat boring, but bear with me.

As far as SNOMED CT is concerned: The "Fully specified name (FSN)" and "Preferred term" for this Concept, in all SNOMED CT editions, is CFS.

If the SNOMED convention is that only FSN terms are assigned severity options (in the case of terms where severities are being assigned), then I would not expect terms listed under Synonyms to have severity options associated with them, and for SNOMED CT, BME and ME are in the Synonyms list and not discretely coded for.

I haven't seen a full copy of the Read CTV3 system. Although CFS, BME, ME and PVFS all have different CTV3 codes, it may be that CFS is also designated as the preferred CTV3 term and it may be that, again, the convention is that severities are assigned only to the preferred term.


Going back to SNOMED CT: I don't have the history of who requested the addition of the three severities to the UK Edition or in what year they were added.

In order to insert severities under CFS in the International Edition, either the SNOMED terminology and classification team would have to decide these were universally useful and add them, themselves, or one of the National Release Centres, or some other health agency, other body, organization or individual would need to submit a proposal for addition of severity options for the International Edition, which would be subsequently incorporated into all of the various national editions.

Either no-one has done this or a submission for the International Edition has been considered at some point, but rejected, for example, on the grounds that only the UK uses another terminology system that also includes severity options and they would therefore be redundant for most other countries.

Note that a request for a change to a national extension does not automatically get considered for inclusion in the International Edition; for that, the submission would need to be submitted directly for consideration for the International Edition. Sometimes a request for a new term for the International Edition will be rejected but passed on to the submitter's National Release Centre, for potential consideration for their national extension only.


My guess is, that the three severity options in the SNOMED CT UK Edition are there for mapping alignment with CTV3.

Although some historical submissions for changes to the SNOMED CT UK Edition are archived, I cannot find documentation for when the three severities had been added under CFS. So I cannot determine whether these had been added before they were added to the Read Code/CTV3 system; or whether these were first added to the Read system, then a request made later to add them to the SNOMED CT UK Edition, for alignment and cross mapping between both UK systems. As I say, I shall try and make time to submit a query about this before I retire.


I think it's worth looking at the relationship of the Read Code system to SNOMED CT:

From a page summarizing the history of the development of SNOMED CT:

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


SNOMED CT is a growing and evolving product that has emerged over the decades from two primary roots.

In 1965, the Systematized Nomenclature of Pathology (SNOP) was published by the College of American Pathologists (CAP) to describe morphology and anatomy. In 1975, under the leadership of Dr. Roger Cote, CAP expanded SNOP to create the Systematized Nomenclature of Medicine (SNOMED). The most widely adopted version of SNOMED was SNOMED II, which was initially published in 1979. A major expansion and revision published in 1993 was called SNOMED International, or SNOMED 3.0. Then in collaboration with Kaiser Permanente, CAP developed a new logic-based version called SNOMED RT, first published in 2000.

Meanwhile, the Read Codes, developed originally in the UK in the 1980s by Dr. James Read, eventually evolved into Clinical Terms Version 3 (CTV3) under the National Health Service.

A three-year project to merge the CTV3 and SNOMED RT was begun in September 1998 under the ownership of CAP. The result was the first version of SNOMED CT, released in January 2002.

In 2007, the newly formed IHTSDO acquired the intellectual property rights to all versions of SNOMED. In 2017 IHTSDO adopted the trading name of SNOMED International to reflect our focus on the SNOMED CT product.

Although SNOMED was originally an acronym for Systematized Nomenclature of Medicine, it lost that meaning when SNOMED was combined with CTV3 in 2002. The merged product was called SNOMED Clinical Terms, which was shortened to SNOMED CT. SNOMED International considers SNOMED CT to be a brand name, not an acronym.

-----------------------------------------------------------------------------------------------------------------

So the Read CTV3 terminology has been absorbed into SNOMED CT.


So I wonder if they will get used;
Click to expand...

As far as I am aware, they are not recently added, so the question is: when were they added to both systems and to what extent have they been used in both systems, since they were added. (And the CTV3 system is now retired, having been superseded by SNOMED CT; so their potential future use applies only to SNOMED CT.)

...presumably current readcodes that just have CFS will be 'translated' as just CFS on its own without the specifiers using SNOMED CT.
Click to expand...

Yes, I would think this would be the case. I doubt very much that patients diagnosed with any CTV3 code where there is a severity option will have their diagnoses manually reviewed in order that one of the severities might be applied, unless a policy is brought in that makes the use of severity options mandatory in the future. It may be left to the discretion of individual practices or Trusts to decide whether to make use of optional specifiers in both primary and secondary care - but I don't know to what extent they are used.

NICE currently have some very vague descriptions in the current guidelines about Mild, Moderate and Severe. You would think there should be something a bit more substantial particularly if it will affect any proposed treatment(?)
Click to expand...

Indeed. This is something that will need looking into in the future.


I see that BDD is also stratified this way........
"Bodily Distress Disorder which replaces the somatoform disorders. This is stratified into mild, moderate and severe" (source is from 2017).
Hmm
Click to expand...


BDD was added to SNOMED CT for the July 2017 release.

SNOMED International's classification and terminology lead confirmed in October 2017 that the BDD Concept term was added by the SNOMED CT/ICD-11 Mapping Project team as an exact match for ICD-11's BDD concept. They also confirmed that the Fink BDS concept is not included in SNOMED CT.


It is not at all unusual for categories in the ICD-11 Mental, behavioural and neurodevelopmental disorders chapter to be assigned severity specifier options; these may take the form of:

Mild; Moderate; Severe
Mild; Moderate; Severe; Profound

Some categories have qualifiers, for example:

xxxxxxxxxxx with fair to good insight
xxxxxxxxxxx with poor to absent insight


BDD was first added to the ICD-11 Beta draft in 2012. By June 2013, a Severe BDD code had been added. By May 2014, three severities (Mild; Moderate; Severe) were included as coded for children, under the coded for parent, Bodily distress disorder.

More recently, the three severities went missing from the Beta (possibly due to a technical error when the restructuring of sections of the chapter was being undertaken). WHO's Project Lead for the Mental, behavioural and neurodevelopmental disorders chapter had to submit a proposal for the three BDD severity options to be restored to the draft.

At the point at which Forward-ME was in discussion with SNOMED CT in connection with the addition of the BDD term (September-October 2017), Dr Reed's proposal was still waiting to be processed.

Following discussions between myself and the Countess of Mar, it was agreed that Forward-ME should request that if the three severities were approved for reinsertion to ICD-11, that consideration should be given to also adding them under SNOMED CT's BDD.


No disorder definition or description/characterization text accompanies the SNOMED CT entry for BDD.

The rationale for requesting inclusion of ICD-11's BDD severities was the significant concern that the undefined SNOMED CT BDD Concept term might easily be confused with the differently conceptualized Fink BDS diagnostic construct, for which the BDD term is often seen being used synonymously (also used synonymously by Fink and colleagues). In the absence of a descriptive text, anything that might help differentiate between the two constructs would be welcomed.

SNOMED classification leads had already agreed that BDD should be moved from its initial parent location under Functional disorder and relocated under parent: Mental disorder, for consistency with ICD-11's conceptualization and chapter placement.

Dr Geoffrey Reed's proposal to restore the three severities under BDD and the potential for their inclusion in SNOMED CT was discussed with SNOMED CT terminology leads.

We were able to confirm, in December, that the three severities had now been restored to the ICD-11 Beta draft. A submission for addition of the three severities was submitted on behalf of Forward-ME by a SNOMED terminology lead and received prompt approval.

These were added to the July 2018 release for the International Edition, as set out in my report, last week:

https://dxrevisionwatch.files.wordp...snomed-ct-and-bodily-distress-disorder-v2.pdf

Statement on SNOMED CT and Bodily distress disorder


So instead of being located under Parent: Functional disorder, SNOMED CT's BDD Concept (added as an exact match for ICD-11's BDD concept) is now located under parent: Mental disorder.

Instead of having no severity options specified, it now includes the three ICD-11 BDD severities: Mild; Moderate; Severe.

Whereas the Fink et al (2010) Bodily distress syndrome has just two (very differently characterized) severities:

Modest or Moderate (single-organ type) bodily distress syndrome
Severe (multi-organ type) bodily distress syndrome


If we had not requested the addition of the three severities, last December, it is likely that these would have been added anyway by the Mapping Project team, for alignment with ICD-11, possibly for the January 2019 release, or when the next batch of new ICD-11 terms are incorporated into SNOMED CT.
 
Last edited:
Joh said:
@Dx Revision Watch
Thank you as always! :emoji_bouquet:

Wikipedia says a private organization translated Snomed into German in 2003, but the translation wasn't used or updated and is now obsolete. And apparently the DIMDI planned to do a German translation for four decades but didn't manage to. It seems like people were just busy talking about implementing it for the last decades but nobody did, so I was a little confused by some sources. Thanks for the clarification! :)
Click to expand...

Thanks for this additional info, Joh.
 
  • Like
Reactions: Joh
Dx Revision Watch said:
SCTID: 88776100000010 Medically unexplained symptoms (finding) |

in addition to:

SCTID: 702537003 | Medically unexplained symptom (finding) |
Click to expand...
Why that? Is, indeed, the difference that if only ONE "medically unexplained symptom" is thought to be found, the second SCTID has to be used?
 
Inara said:
Why that? Is, indeed, the difference that if only ONE "medically unexplained symptom" is thought to be found, the second SCTID has to be used?
Click to expand...


I don't know. Submitting a query asking when the

SCTID: 88776100000010 Medically unexplained symptoms (finding) |

concept term was added to the SNOMED CT UK Edition is another task I have to do before I retire (unless S4ME would like to take both these over from me).

In Read CTV3 there is a term:

CTV3 ConceptID: .16H.
CTV3 TermID: YaYS5
CTV3 Term30: Unexplained symptoms continue
SNOMED CT ConceptID: 161904006

and a term

CTV3 ConceptID: Xaafw
CTV3 TermID: YawVN
CTV3 Term30: Medically unexplained symptoms
SNOMED CT ConceptID: 887761000000101


Again, it may be the case that the Medically unexplained symptoms term, which does not appear in the International Edition, was added to the SNOMED CT UK Edition for alignment with the UK Read CTV3 system.

But this is unconfirmed.

Perhaps you would like to mention to those who have expressed an interest, that submitting these two queries (re the three severity options for CFS and the additional Medically unexplained symptoms Concept term, which are both exclusive to the SNOMED CT UK Edition) might be something they could consider taking over. This would be welcomed as I do need to focus on bringing my website up to date with recent developments before I step back in a couple of weeks' time.

Submitting queries:

https://hscic.kahootz.com/connect.ti/t_c_home/view?objectId=298163&exp=e1
 
Last edited:
Joh said:
Thanks!

That's the mainstream opinion in Germany and in the German medical/scientific literature (ME=MUS/functional disorder/somatoform disorder). ME is also part of the German guideline for functional disorders.

___
@Dx Revision Watch Do you know by any chance if Snomed is also used in Germany? I researched twice in the last months but couldn't really find anything and am still not sure.
Click to expand...
We must keep an eye on DIMDI regarding the MUS developments, having the efforts of the BPS group in mind. I don't know how to do that.
 
  • Like
Reactions: Joh
You must log in or register to reply here.
Back
Top