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• The different locations for use of SNOMED CT within EHR systems and subsystems
• What is commonly done for each
• Some common implementation stages: moving to more extensive or more integrated use

A set of notional Implementation Levels are included in the Technical Implementation Guide.

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Introduction to Target Configurations

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Based on the categorization introduced earlier about clinician use or use by others, approaches 1, 2, 4, 5, 8, 9 and 10 are primarily aimed at clinician use, whereas approaches 3, 6 and 7 are primarily aimed at use by others. However approaches 6 and 7 include elements of interest to clinicians, and approaches 9 and 10 include elements of interest to others.

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1. SNOMED CT as a Reference Terminology for Communication

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• The benefits derived from a more extensive use of SNOMED CT are not realized
• This approach allows continuity of systems interoperation despite limited use of SNOMED CT, in an environment which requires some use of SNOMED CT
• This requires that a sufficient proportion of existing coded clinical items can be successfully mapped to and from SNOMED CT
• Mapping between the terminology scheme used in the EHR and SNOMED CT needs to be kept up-to-date
• Exceptions will need to be gracefully handled

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2. SNOMED CT as a Reference Terminology for Data Integration

Figure 8. SNOMED CT as a Reference Terminology for Data Integration

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• Mapping between the source code systems and SNOMED CT needs to be kept up-to-date
• Natural Language Processing to encode unstructured records may need manual validation to ensure high quality coding
• Exceptions will need to be handled gracefully

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3. SNOMED CT as an Indexing System for Data Retrieval

Figure 9. SNOMED CT as an Indexing System for Data Retrieval

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• The benefits derived from a more extensive use of SNOMED CT are not realized
• This requires that a sufficient proportion of existing coded clinical items can be successfully mapped to and from SNOMED CT
• Individual coded items may map to more than one target in SNOMED CT; in some computations, this will require the selection of just one target from the set of candidates, in others it will be unproblematic
• Quality of the clinical data itself may be the dominant factor in the value of this approach, more than the existence of exceptions e.g. where no single map exists for a coded item
• Exceptions will need to be gracefully handled

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4. SNOMED CT as a Code System for Clinical Data in the EHR

Figure 10. SNOMED CT as a Code System for Clinical Data in the EHR

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• This requires that a sufficient proportion of existing interface terminology can be successfully mapped to SNOMED CT
• An ideal map between the interface terminology and SNOMED CT is a one-to-one map.
  • Exceptions will need to be handled gracefully where no map exists between an existing interface item and SNOMED CT.
  • It may be appropriate to adjust the interface item to remove any ambiguity.
• Mapping between the interface terminology and SNOMED CT needs to be kept up-to-date

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5. SNOMED CT as an Interface Terminology for EHR Data Entry

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• This approach may require a transition of the user experience. However, it should be noted that new descriptions may be added to SNOMED CT to meet the expectations of the users.
• Subsets need to be created and maintained to support users in searching for and recording the appropriate SNOMED CT concepts

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6. SNOMED CT for Simple Aggregation and Analysis of Data

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• Supports the use of SNOMED CT for analysis and reporting purposes, such as:
  • To improve the user experience of longitudinal record review
  • For exploration of data in support of clinical process review
  • For identification of cohorts of patients for research studies
  • To meet mandatory reporting requirements
• Can utilize internationally developed mappings such as the mappings to ICD-9 and ICD-10
• Standardized descriptions in the user interface
• Patient data stored using SNOMED CT concepts
• Communication using shared meaning

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7. SNOMED CT for Analytics Using Description Logic

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• More sophisticated and flexible reporting and analysis

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8. SNOMED CT for Knowledge Linkage

Figure 14. SNOMED CT for knowledge linkage

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• Enables integration of EHR with knowledge bases
• Rules can use SNOMED CT's hierarchy and defining relationships for aggregation and querying
• Can be used to provide real-time clinical alerts relevant to the given patient
• Can be used to suggest relevant clinical guidelines and protocols relevant to the given patient

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9. SNOMED CT as an Extensible Foundation for Representing Clinical Data

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