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Go to start of metadata Identifying and monitoring the health needs of a population

The provision of effective high-quality care to a population of patients requires an understanding of the state of health and healthcare needs of that population. Information recorded about individual patients must be available for analysis to determine trends in the prevalence of conditions.

  • It must be possible to retrieve and analyze information about specified conditions, procedures or other information recorded using SNOMED CT.

See Retrieval for analysis

Population trends are usually monitored at a higher level of abstraction, using codes with meanings that are more general than those used in individual patient records. Therefore SNOMEDCT should allow analysis of information aggregated in clinical rational ways. This may be achieved by one or both of the following methods:

  • Using hierarchical Relationships and/or equivalences defined within SNOMED CT.

See Aggregation of related codes

  • By mapping codes in SNOMED CT to codes in appropriate classifications.

See Mapping to classifications

Appropriate analysis of information requires that all relevant information is represented in a form that can be reliably and reproducibly queried.

  • The scope of SNOMED CT must be appropriate for the types of information relevant to health needs assessment.

See Content scope

  • Some aspects of health needs assessment require information about more than one clinical characteristic. These depend upon queries that interrogate records taking account of the record structure as well as the terminology used to populate it.

See Data structures and patient record architectures Auditing the quality of service

The requirements for analysis of records to audit the quality of service are similar to those for identifying and monitoring health needs. The main difference is that the scope of the analysis must be extended to cover consultations, referrals, procedures, medication and other interventions.

See  Content scope Supporting research 

The requirements for analysis of records research are similar to those for identifying and monitoring health needs. The main differences are the need to accommodate:

  • Recording interventions in ways that do not compromise blind and double blind trials.
  • Recording of experimental observations or treatments that have not been added to the main body of

SNOMED CT and which may never require permanent addition to SNOMED CT .

See Extensions Reducing bureaucracy while managing and funding care delivery

The management and funding of healthcare delivery often depends on recording and reporting of particular activities or packages of care. Separate procedures for collection of this management related clinical information create a bureaucratic overhead. Mechanisms for deriving the information automatically from the clinical record should offer a way of reducing or removing this overhead. This is dependent on the form in which this management information is required and the ability to map to this form from clinical information recorded using SNOMED CT .

  • Current requirements include information represented as Diagnosis Related Groups (DRGs) or Health Resource Groups (HRGs) that are based on classifications of the primary diagnosis, complications and procedures undertaken.

See Mapping to groupers and  Data structures and patient record architectures

Some information required for management and funding purposes is more specifically related to claims for particular events or services. For example in the NHS, part of the funding of GPs is dependent on hitting targets for immunizations and cervical cytology screening. The types of additional information required for administrative and management purposes are likely to be specific to particular countries ororganizations.

  • The scope of SNOMED CT must be adequate to meet these administrative needs or must be capable of extension to meet these needs.

See  Content scope

  • The aspects of SNOMED CT specific to the administrative needs of one country or organization must be available to those who need them without presenting irrelevant terms or coded meanings to those outside the realm in which these are used.

See Subsets of codes Enabling reporting of externally specified health statistics

Organizations such as WHO and some government bodies specify requirements for presentation of healthcare statistics in particular forms. Ideally clinical information recorded using SNOMED CT should be reused to generate these statistics. Where this is not possible, the clinical information should at least assist manual generation of these statistics. One option is to use structured data entry to force information to be refined or qualified to a level that allows direct mapping.

The reuse of clinical information for this purpose is similar to identifying and monitoring health needs and/or auditing the quality of service (see Identifying and monitoring the health needs of a population and Auditing the quality of service

  • SNOMEDCT must enable mapping to statutory national and international classifications such as ICD9.CM, ICD10, CPT4, OPCS4, etc.

See Mapping to classifications Identifying patients in need of proactive intervention

Within a population there will be patients who will benefit from particular types of preventative care. Information systems should be able to identify these patients based on their health records so that they can be offered appropriate advice. The analysis required varies but typically takes account of age, sex, time lapse since a previous preventative intervention and one or more clinical characteristics.

Identification of patients in need of intervention can be regarded as a type of decision support. However, it is a batch process to which different optimizations may apply.

See Retrieval for patient review and  Data structures and patient record architectures