SNOMED Documentation Search


 Other Documents

Versions Compared

Key

  • This line was added.
  • This line was removed.
  • Formatting was changed.

Gloss
tSNOMED CT
itself is only a part of the solution to addressing the requirements for effective electronic clinical records. A terminology on its own "does" nothing unless it is implemented as part of an application and used. Implementation of
Gloss
tSNOMED CT
requires software applications that exploit its features to meet the real and perceived needs of users.

The "users" of

Gloss
tSNOMED CT
include:
Anchor
_18959256-5fa8-40e0-a696-b81e83ea04b3__d
_18959256-5fa8-40e0-a696-b81e83ea04b3__d

  • Those who specify, commission and configure software for use in a particular clinical environment;
  • End-users who enter or retrieve clinical information.

As illustrated by , users experience

Gloss
tSNOMED CT
through application software which delivers services to access and apply
Gloss
tSNOMED CT
. The ways in which applications apply the features of
Gloss
tSNOMED CT
to address user requirements determine the extent to which the potential benefits are realized .

The following sections summarize some of the types of implementation that may be needed to meet different requirements. Some types of application do not need to support or use all

Gloss
tSNOMED CT
features. However, there are some overarching requirements for consistency between implementation used within a given organization, country or region. Even where requirements are limited, care should be taken to ensure that
Gloss
tSNOMED CT enabled applications
are aligned with good practice and with agreed policies applicable to the situations in which they are used.

Anchor
_18959256-5fa8-40e0-a696-b81e83ea04b3__5
_18959256-5fa8-40e0-a696-b81e83ea04b3__5
Anchor
_18959256-5fa8-40e0-a696-b81e83ea04b3__a
_18959256-5fa8-40e0-a696-b81e83ea04b3__a

Caption figure
Relationship between users application software and SNOMED CT

Anchor
_c6042ea3-2710-4aeb-b1d8-0e607b441b62
_c6042ea3-2710-4aeb-b1d8-0e607b441b62
Implementation Types - Clinical records

A

Gloss
tSNOMED CT
enabled clinical record application uses
Gloss
tSNOMED CT expressions
to represent clinical information in the records of individual patients.

Clinical record applications include specialized departmental systems, organization -wide systems and systems that integrate multiple systems to deliver a distributed

Gloss
telectronic health record
or a collection of widely accessible summary records.

A

Gloss
tSNOMED CT
enabled clinical record application needs to provide
Gloss
trecord services
including entry, storage, retrieval and communication of
Gloss
tSNOMED CT expressions
. These
Gloss
trecord services
depend on
Gloss
tterminology services
including the ability to search for
Gloss
tconcepts
and to interpret stored
Gloss
tSNOMED CT expressions
.

A wide range of types of information can be represented at different levels of detail using

Gloss
tSNOMED CT expressions
. The types of information and level of detail that are used may vary depending on user requirement or may be limited by the design of the application. Differences in the required level of expressivity influence the range of
Gloss
trecord services
that need to be supported.

The way that

Gloss
tSNOMED CT expressions
are represented within a record structure affects the range of services that are required to deliver the potential benefits of implementation. The value of the rich expressivity of
Gloss
tSNOMED CT
may be enhanced or diminished by the way the record structure relates
Gloss
tSNOMED CT expressions
to surrounding contextual information. For example, if a record structure permits similar or related information to be recorded in several ways a query to retrieve that information will need to consider all these possibilities. Retrieval is simpler if similar information is recorded in a consistent way - irrespective of the way it was entered. This issues are discussed in detail in the Record Services Guide .

Anchor
_60abe27b-702a-459f-993e-41ff2c5d2a71
_60abe27b-702a-459f-993e-41ff2c5d2a71
Implementation Types - Knowledge representation

A

Gloss
tSNOMED CT
enabled knowledge representation uses
Gloss
tSNOMED CT expressions
to represent or tag resources that represent clinical knowledge. Examples of resources that can be
Gloss
tSNOMED CT
enabled include electronic reference books, clinical guidelines, care pathways, decision support protocols and requirements for analysis and audit.

There are various ways in which

Gloss
tSNOMED CT expressions
can be used in a knowledge resource. These can be divided into two broad categories:

  • Use of
    Gloss
    tSNOMED CT expressions
    as an integral part of a structured representation of knowledge:
    Anchor
    _60abe27b-702a-459f-993e-41ff2c5d2a71__5
    _60abe27b-702a-459f-993e-41ff2c5d2a71__5
    • For example, a decision support rule that tests for the existence of a record of a particular type of finding represented using a
      Gloss
      tSNOMED CT expression
      .
  • Use of
    Gloss
    tSNOMED CT expressions
    to tag or index a knowledge resource:
    Anchor
    _60abe27b-702a-459f-993e-41ff2c5d2a71__f
    _60abe27b-702a-459f-993e-41ff2c5d2a71__f
    • For example, a reference book in which textual
      Gloss
      tdescriptions
      of indications, contraindications and side effects of particular treatments are tagged with
      Gloss
      tSNOMED CT expression
      that can be used to allow context-sensitive retrieval of relevant information.

There are two distinct but interrelated aspects to

Gloss
tSNOMED CT
knowledge representation.

  • Anchor
    _60abe27b-702a-459f-993e-41ff2c5d2a71__0
    _60abe27b-702a-459f-993e-41ff2c5d2a71__0
    Applying
    Gloss
    tSNOMED CT expressions
    to the resource:
    Anchor
    _60abe27b-702a-459f-993e-41ff2c5d2a71__4
    _60abe27b-702a-459f-993e-41ff2c5d2a71__4
    • The form of representation to be used must be specified in a way that takes account of the ways in which the resource is to be used and accessed.
    • The knowledge authoring environment must allow the specified representation to be applied consistently. This requires use of
      Gloss
      tTerminology services
      that allow searching and selection of
      Gloss
      tconcepts
      . Depending on the level of detail required, there may also be a requirement to support the construction of
      Gloss
      tpostcoordinated expressions
      .
  • Enabling appropriate access to and use of the resource:
    Anchor
    _60abe27b-702a-459f-993e-41ff2c5d2a71__d
    _60abe27b-702a-459f-993e-41ff2c5d2a71__d
    • The types of access required depend on the intended functionality.
    • The most basic level of functionality involves using
      Gloss
      tSNOMED CT expressions
      as a
      Gloss
      tconcept
      -based index. By taking account of the
      Gloss
      Spacetrue
      tSNOMED CT
      Gloss
      tsubtype hierarchy
      and defining
      Gloss
      trelationships
      , a
      Gloss
      tconcept
      -based index can provide more relevant results than a simple
      Specref
      RefTypefield
      tterm
      based search.
    • More sophisticated uses such as clinical decision support require
      Gloss
      tSNOMED CT expressions
      in the knowledge resource to be used to generate queries that can be applied to information stored in an
      Gloss
      telectronic health record
      .
    • The provider of a
      Gloss
      tSNOMED CT
      enabled knowledge resource may provide a specification that allows software developed by other organizations to interrogate it and provide the required level of functionality. Alternatively, the knowledge authoring organization may also develop and provide software that delivers the intended functionality.

Anchor
_2f970d86-0a3b-46f6-8a62-cfef8af9e400
_2f970d86-0a3b-46f6-8a62-cfef8af9e400
Implementation Types - Aggregation and analysis

Gloss
tSNOMED CT
enabled aggregation and analysis systems use
Gloss
tSNOMED CT
to enable effective aggregation and analysis of information derived from clinical record systems.

Gloss
tSNOMED CT
enables consistent processable representation of clinical information. As well as presenting opportunities for analysis of information within an individual clinical record system, this can be used to support analysis of a broader substrate of aggregated data.

There are two types of approach that be employed to enable analysis of aggregate data.

  • A
    Gloss
    tSNOMED CT
    enabled data warehouse:
    Anchor
    _2f970d86-0a3b-46f6-8a62-cfef8af9e400__e
    _2f970d86-0a3b-46f6-8a62-cfef8af9e400__e
    • The content and structure of data required from individual
      Gloss
      tClinical Information Systems
      is specified. The specified structure must include details of the required representation of data including
      Gloss
      tSNOMED CT expressions
      .
    • The required data is extracted and uploaded to a database designed for the purpose of large scale analysis. Usually the extract and upload will need to be repeated or updated at specified intervals.
    • The central database is structured to optimize common types of queries taking account of the
      Gloss
      tSNOMED CT expressions
      and the
      Gloss
      trelationships
      between referenced
      Gloss
      tconcepts
      asserted in
      Gloss
      tSNOMED CT
      content.
    • A
      Specref
      RefTypefield
      tquery
      interface is provided to allow common types of question to be expressed against the central database.
    • Queries are run taking account of the
      Gloss
      trelationships
      between
      Gloss
      tconcepts
      to provide comprehensive and accurate results ( minimizing the risks of false negatives or false positives).
    • The results of queries are presented where relevant using
      Gloss
      tSNOMED CT expressions
      as processable labels to enable further analysis.
  • A common
    Specref
    RefTypefield
    tquery
    specification supported by clinical record systems:
    Anchor
    _2f970d86-0a3b-46f6-8a62-cfef8af9e400__5
    _2f970d86-0a3b-46f6-8a62-cfef8af9e400__5
    • A common
      Gloss
      treference information model
      including
      Gloss
      tSNOMED CT expressions
      is specified. This is used as a common
      Gloss
      tmodel of meaning
      against which queries are evaluated.
    • Each clinical record system provider implements this common
      Gloss
      tmodel of meaning
      as a view of the information stored in their
      Gloss
      telectronic health record
      .
    • A
      Specref
      RefTypefield
      tquery
      interface is provided to allow common types of question to be expressed against the common
      Gloss
      tmodel of meaning
      .
    • Queries are distributed and run on individual systems and the results are returned to a central system for aggregate reporting.
    • The results of queries are presented where relevant using
      Gloss
      tSNOMED CT expressions
      as processable labels to enable further analysis.

In practice, there is significant overlap between these two approaches. A data warehouse approach can benefit from a common approach to specifying the information extraction requirements. This allows changes to the specification without re-engineering the contributing clinical record systems. A common

Specref
RefTypefield
tquery
specification approach requires a central element to manage distribution of queries and aggregation of results.

Irrespective of the approach taken,

Gloss
tSNOMED CT
enabled aggregation and analysis is most effective where the representation of information in the contributing clinical record systems is consistent with a common view. However, it is possible to aggregate information from diverse systems if the limits imposed by differences are understood. It is even possible for a
Gloss
tSNOMED CT
aggregation and analysis system to be applied information that was not originally encoded using
Gloss
tSNOMED CT
. An extraction and aggregation interface that includes mapping from another coding system may produce information of adequate quality and consistency for many purposes. Data derived by tagging textual records using
Gloss
tnatural language processing
may also meet requirements that are not safety-critical.

Anchor
_0bda98cf-ee67-46a4-a39a-66f1bbf1fe0e
_0bda98cf-ee67-46a4-a39a-66f1bbf1fe0e
Terminology tools

Gloss
tSNOMED CT
enabled terminology tools provide access to
Gloss
tSNOMED CT
content. On their own they are not practical end-user implementations but they enable the development and review of
Gloss
tSNOMED CT
. They may also deliver services that can be used by end-user implementations.

Anchor
_41c29a69-0ca0-4e2f-ba35-136045cc4f02
_41c29a69-0ca0-4e2f-ba35-136045cc4f02
Implementation Types - Terminology browser

A

Gloss
tSNOMED CT
enabled
Gloss
tbrowser
allows the content and structure of
Gloss
tSNOMED CT
to be explored and reviewed.

A typical

Gloss
tSNOMED CT
enabled
Gloss
tbrowser
can locate
Gloss
tconcepts
and
Gloss
tdescriptions
by
Gloss
tIdentifiers
and by searching the text of
Gloss
Spacetrue
tdescription
Specref
RefTypefield
tterm
. Various views of located
Gloss
tconcepts
may be displayed including the set of related
Gloss
tdescriptions
, the hierarchical
Gloss
trelationships
and other defining
Gloss
trelationships
.

A terminology

Gloss
tbrowser
may be:
Anchor
_41c29a69-0ca0-4e2f-ba35-136045cc4f02__7
_41c29a69-0ca0-4e2f-ba35-136045cc4f02__7

  • A stand-alone tool.
  • Part of a more extensive implementation.
  • Accessible via an
    Gloss
    tApplication Programming Interface
    (
    Gloss
    tAPI
    ):
    Anchor
    _41c29a69-0ca0-4e2f-ba35-136045cc4f02__5
    _41c29a69-0ca0-4e2f-ba35-136045cc4f02__5
    • This may allow the
      Gloss
      tbrowser
      to be used by client applications to select
      Gloss
      tSNOMED CT expressions
      ;
    • It may be part of a
      Gloss
      tterminology server
      which provides a wider range of
      Gloss
      tTerminology services
      .

Anchor
_968361af-0772-4dd3-9a10-a6fca3cc62d1
_968361af-0772-4dd3-9a10-a6fca3cc62d1
Implementation Types - Terminology server

A

Gloss
tSNOMED CT enabled terminology server
is a software application that provides programmatic access to
Gloss
tSNOMED CT components
. These services are made available through a documented
Gloss
tApplication Programming Interface
(
Gloss
tAPI
) which can be used by many different client applications.

A

Gloss
tSNOMED CT enabled terminology server
must be able to import SNOMED CT release files and provide some or all of the services described in the Terminology Services Guide. All
Gloss
tterminology servers
must support a basic minimum set of functions including Foundation Terminology Services and access to Reference sets and other metadata .

A

Gloss
tterminology server
may provide
Gloss
tuser interface
services, such as a set of screen controls to support term selection. Alternatively, while the
Gloss
tAPI
should support searches, the
Gloss
tuser interface
representation of the results of a search may be left to client applications. Where
Gloss
tuser interface
controls are provided by the server, these controls may also be packaged in an integrated form as a
Gloss
tterminology browser
.

A

Gloss
tSNOMED CT enabled terminology server
may also provide services that support the use of other terminologies. In this case, it may conform to a standard specification such as
Gloss
tCommon Terminology Services 2
(
Gloss
tCTS2
).

Anchor
_ceebd918-c319-45c0-9685-6f6df6027b43
_ceebd918-c319-45c0-9685-6f6df6027b43
Implementation Types - Terminology development and maintenance tools

Gloss
tSNOMED CT
development and maintenance requires tools which are able to create and update
Gloss
tSNOMED CT
content.

Development and maintenance tools may either be general purpose or may focus on specific requirements (e.g.

Gloss
tReference Sets
to support
Gloss
tlanguage
,
Gloss
tmapping
or development of
Gloss
tvalue sets
).

The process of maintenance needs to track changes and manage conflicts between edits made by different authors. In the case of content development, the tools must also ensure that

Gloss
tconcept
definitions conform to the
Gloss
tSNOMED CT Concept Model
. At regular intervals the tools need to generate a consistent set of quality assured
Gloss
trelease files
.

The

Gloss
tIHTSDO Workbench
is a set of software tools designed to support the development, maintenance, and use of
Gloss
tSNOMED CT
. Its key role is to facilitate the maintenance of the
Gloss
tSNOMED CT International Release
and the National
Gloss
tExtensions
developed by
Gloss
tMembers
. However, the future scope of use may extend to other organizations and to health information systems around the world. The
Gloss
tWorkbench
is owned by the
Gloss
tSNOMED International
and is available under an Open Source license agreement.