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© 2018 International Health Terminology Standards Development Organisation.  All rights reserved.  SNOMED CT® was originally created by the College of American Pathologists.

This document forms part of the SNOMED CT® General Dentistry package distributed by International Health Terminology Standards Development Organisation, trading as SNOMED International, and is subject to the SNOMED CT® Affiliate License, details of which may be found at http://www.snomed.org/snomed-ct/get-snomed-ct/. 

No part of this document may be reproduced or transmitted in any form or by any means, or stored in any kind of retrieval system, except by an Affiliate of SNOMED International in accordance with the SNOMED CT® Affiliate License. Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International.

Any copy of this document that is not obtained directly from SNOMED International [or a Member of SNOMED International] is not controlled by SNOMED International, and may have been modified and may be out of date. Any recipient of this document who has received it by other means is encouraged to obtain a copy directly from SNOMED International [or a Member of SNOMED International. Details of the Members of SNOMED International may be found at http://www.snomed.org/members/].

 

 

 

Date

20170131

Document Version

1.0

Release Status

PRODUCTION

 

 

Page At A Glance

1 Introduction

The General Dentistry set of diagnostic terms is designed to provide dentistry with a relatively easy to implement set of terms that covers the vast majority of care provided in the dental field.  It does not attempt to meet the needs of dental sub-specialties but may prove to do so for a significant amount of the care provided by these specialists.

This document provides information about the General Dentistry diagnostic refset package.  It does not include a discussion or recommendation regarding the broader set of all SNOMED CT terms that are related to dentistry. 

2 Background

With few exceptions, the dental profession has rarely used or recorded in any structured way diagnostic terms.  While dentists may document a diagnosis or rationale for treatment in their clinical or progress notes, identifying the treatment provided continues to be the area most frequently documented in a structured form.  This may be due to requirements for reimbursement purposes.

2.1 Scope

The purpose of the refset is twofold:  

1 - it is designed to identify a set of frequently used diagnostic related terms for general dentistry (GD).  As dental clinicians only infrequently use structured terms (whether while being educated or after entering clinical practice) for diagnosis, a simple set may allow for better understanding of the use of dental diagnostic codes. 

2 - a small set may allow Electronic Dental Record (EDR) vendors and the dental payer community to more quickly and inexpensively implement tools that will allow for their use.

2.2 Use cases:

Data entry- Direct entry of SNOMED CT concepts using the GD term set

During a patient encounter, the dental clinician identifies a problem or need.  The clinician then enters the problem/disorder/finding into a “diagnosis” field and the EDR then provides a list of the most frequent SNOMED CT terms that the clinician can then use to select the best match from the GD term set.  Alternately, a set of “pick lists” could be used that would take a clinician through a hierarchy of one to several different levels that would result in the best possible match for the identified condition.

 

Referral/Transfer of care

A general dentist may wish to refer the patient to a specialist colleague.  The general dentist would enter the information regarding the problem/disorder/finding using a SNOMED CT term from the GD term set.  An HL7 message is then constructed containing the identified SNOMED CT concepts from the GD term set.  This would allow the specialist to have the information and possibly differential diagnosis from the general dentist.  This should reduce confusion and hopefully save the patient some time and reduce repetitive services.


Constraint of terminology for population and sub-population analysis

Whilst one can make a compelling case for a more granular and therefore larger term set, the infrequent  use of terms to date in dentistry potentially limit its value until dentists and other dental clinicians better understand the use of, purpose of, and proper identification of diagnostic concepts.

Dentistry has some general disease categories.  Dental caries, gingival diseases including periodontal, and endodontic diseases account for the vast majority of treatment procedures provided by dentists when treating diseases.  Further, it will take dentistry some time to get to the point where virtually all dental visits result in the assignment of a rationale or structured term for the visit.

Initially, in order to provide some level of data aggregation, less granularity may allow for the development of decisions support tools (CDS) and other forms of evidenced based tools for assisting in the determination of care plans.

3 Motivation

Recognizing the value of identifying a diagnosis and relating it to treatment for the improvement of outcomes and for development of decision support tools (CDS) by others in the medical profession, a group of members of the IHTSDO Dentistry SIG located in the United States began work on identifying a set of diagnostic terms that had the potential for being easily understood by all dental clinicians, easy to implement for electronic records system vendors, adaptable to current clinical workflows, and has the potential to support the development of CDS tools as well as relate diagnosis to treatment and even outcomes of care.

Over a period of approximately one year and with the cooperation of the payer community in the United States and two organisations that have been using diagnostic coding in dentistry for a significant period of time, the US effort resulted in a preliminary set of SNOMED CT terms that has was then been reviewed by the Dentistry SIG to ensure international relevance.  All comments received prior to the April 2016 meeting of the Dentistry SIG in London were positive.  At this meeting, the Dentistry SIG recommended that the IHTSDO move forward with further development to make this work an official refset of SNOMED CT.  In parallel, the SNOMED CT editors worked to include required new concepts in SNOMED CT so that all was completed for the July 2016 International release.

4 Content

The General Dentistry diagnostic refset (GD refset) primarily contains SNOMED CT findings.  Most of these findings are disorders, but some of the terms are other types of findings dental clinicians may document as the rationale for providing a specific treatment or sequence of care.  Further, the set includes a few attributes that allow clinicians to better define the extent of disease for the most common dental disease, caries. The entire refset consists of less than 250 terms as of March 2017.

The refset also includes terms that allow a dental clinician to provide a rationale for patients seeking preventive services that have no chief complaint.  In many countries, dentistry recommends periodic preventive visits that often include some limited treatments such as prophylaxis as a tool to reduce the risk of periodontal disease and obtaining radiographs as a method to potentially identify dental caries at an earlier stage, allowing for a more limited intervention.

This refset was designed using some very basic principles. It used the limited information available from sources known to be using diagnostic codes in dentistry and compared them to services actually provided.  Developers also used terms already available in SNOMED CT when the term could be used to represent clearly language (interfaces) most often used within the profession in the USA and, where known, other parts of the world.

5 Design

5.1 Version

The dependent version of SNOMED CT is the January 2017 International Edition release.

5.2 Ownership

Whilst IHTSDO are the owners of SNOMED CT, clinical validation and ownership is provided by the IHTSDO International Dentistry SIG

5.3 Frequency

The Production version of the refset will be published after the January 2017 International Edition release of SNOMED CT, provided there is no feedback requiring content changes. Subsequently it will be maintained in line with each release of SNOMED CT International Edition.

6 Implementation

With a very limited history of implementation of any diagnostic terms in dentistry and the fact that there are numerous different electronic dental records (EDR) system vendors worldwide using different methodologies of data structuring, databases, visualization, and workflow design, it is likely that there may be several unique and functional approaches to implementation of the GD refset.  Additionally, the varying payment mechanisms in different countries may have different needs and set different requirements as they become more involved in obtaining and using the data. 

7 Obtaining the Release

The SNOMED CT General Dentistry refset is available from the IHTSDO and is maintained and updated in line with the SNOMED CT International release which is currently 6 monthly.

Access within IHTSDO member countries is provided by the Member National Release Centre in each country, via the relevant Member page. Affiliates of IHTSDO in non-member countries can access the refset through their Member Licensing and Distribution SERVICE (MLDS) account. Please contact info@ihtsdo.org for more information if required.

8 Feedback

As mentioned previously, dentistry and dental clinicians only infrequently use any form of diagnostic terminology. The number of user interfaces is, therefore, very limited.  Currently there has been no usability testing completed of this refset.

It is also recognized that this is not an exhaustive set of terms dental clinicians might use.  It may not be suitable for dental specialists or general dentists who limit their practices to such areas as dental implants or treatment of specific conditions such as sleep apnoea. It is expected that, as adoption increases, the refset will need updating.  It may also be necessary to develop refsets for the limited number of recognized dental specialties.

9 Technical Notes

RF2 package format

The RF2 package convention dictates that it contains all relevant files, regardless of whether or not there is content to be included in each particular release.  Therefore, the package contains a mixture of files which contain both header rows and content data, and also files that are intentionally left blank (including only a header record).  The reason that these files are not removed from the package is to draw a clear distinction between:

  1. ...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in this or future releases, and 
  2. ...files that just happen to contain no data in this particular release (and are therefore included in the package but left blank, with only a header record), but are still relevant to RF2, and could therefore potentially contain data in future releases.

This allows users to easily distinguish between files that have purposefully been removed or not, as otherwise if files in option 2 above were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.

 

 


Approvals

 

Final Version

Date

Approver

Comments

1.014/03/2017Penni HernandezApproved
1.014/03/2017Jane MillarApproved
1.0 Lesley MacNeil 

 

 

 

 

Download .pdf here:

 

 

 

 

 


Draft Amendment History

 

Version

Date

Editor

Comments

0.1

9/11/16

Penni HernandezInitial draft, created from Jane Millar draft
0.224/10/2016Andrew AtkinsonUpdated in line with Jane's feedback
0.311/03/2017Andrew AtkinsonUpdates in line with new March 2017 Release date
0.414/03/2017Jane MillarFinal updates

 

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10 Comments

  1. Additional sections for consideration:

    • Scope of subset
    • Who owns it
    • Who will maintain it on what schedule
    • Who has vetted it
    • Any definitions needed?
  2. I added some sections, but there is overlap.  Andrew if you could confirm if any of the sections I added are of use.  Everyone feel free to rip things out, I was just trying to add some ideas.  You could also just revert to the previous version.

    1. I have done some editing and have the following points:

      -          I have removed 4.3, 4.4 and 4.5 as not needed as not a map. Do we need cardinality? I assume not as well but wanted to check so left in

      -          In maintenance section, it says this will be reviewed by SIG at the Fall meeting. I think we need to disentangle ‘review’ from maintenance, clarifying what SIG means by review and what we mean by maintenance. From a maintenance perspective, are we going to do updated releases every 6 months in line with SNOMED CT, which means SIG will need to check any changes, or are we only going to do alignment with SNOMED CT releases annually? What discussions have you had internally on this? I have no view and there is no contractual requirement as far as I am concerned.

      -          This flows in to 6.2.2 and 6.2.3 and differentiating between schedule and frequency

      -          I think we need to ensure alignment between section 4 statement about ownership and statements in section 6 on maintenance.

      -          And somewhere we should put very clearly that IHTSDO is responsible for the technical QA and RF2 release process

      -And we need to be consistent in naming - is this a refset or subset and replace accordingly throughout where 'term set' has been used. Whilst I know this is a subset, I understand that a decision is in process to call them refsets as a subset is a type of refset!

       

  3. The title in the tooling is: General Dentistry Diagnostic Refset

    My understanding is the same, that this is a "refset", or "simple refset"

  4. Hi, we are interested in adopting this refset for our EMR. Just wondering where we could download this Beta from? i cant seem to find any download links here. 

    Thanks in advance! 

  5. HI Adele

    We will be releasing the General Dentistry diagnoses subset after the January 2017 SNOMED CT International release. It will be a formal release then so can be used in live EMR's

    Good news that you are planning to implement and hope you will be happy to give us feedback

    Do not hesitate to contact me if you have any further queries about the release process - and obviously Mark and the SIG about the content.

    Jane Millar

  6. Hi Jane,

    Thanks for your response. We were hoping that we could review the beta Refset prior the official release in Jan 2017 to expedite the review process... are we able to download it anywhere at this point? (smile)

    Regards,

    Adele

     

  7. Hi Adele

    When we realised we would need to delay the formal release until after January 2017 International Release, we did consider whether to produce a Beta version. We talked this over with the chair of the Dentistry SIG who was not aware of anyone who was waiting for the release, so we made the decision not to go ahead with a Beta version.

    Our apologies for this delay, it was unavoidable but we plan to issue the refset as the first of our derivatives in February.

    Jane

  8. Hi Jane,

    Thank you for your prompt response.
    I suppose we will have to wait til Feb 2017 then.
    Looking forward to seeing it :)

    Regards,
    Adele

  9. Can not edit page (smile)