SNOMED International has introduced the Global Patient Set (GPS) to support the sharing of patient health information coded with SNOMED CT® without the need for a SNOMED CT Affiliate license. The GPS is a managed list of existing SNOMED CT unique identifiers, fully specified names (FSN), preferred terms in international English, and status flags, made available at no cost to users. The GPS supports health information interoperability across care settings, systems, organizations and national borders.
This GPS Implementation Guide provides information on downloading the GPS and considerations for its use.
The GPS (specifically the set of materials included in the GPS tab-separated values file) is produced by SNOMED International under the terms of the Creative Commons Attribution 4.0 International Public License, https://creativecommons.org/licenses/by/4.0/.
Additional information about this license specific to SNOMED International’s release of the GPS:
Without obtaining prior written permission from SNOMED International, you are expressly prohibited from using, distributing or reproducing the SNOMED International, SNOMED CT or SNOMED GPS logo, service mark or trademark. Please review all terms and conditions of use here.
The GPS contains the content of a number of SNOMED CT reference sets to support a variety of general purposes and is intended to be released annually. The file contains a concept’s:
The scope of the GPS contains concepts from SNOMED CT refsets to support the following domains and potential uses:
As part of each release, the GPS will be updated to reflect changes to the underlying terminology, including concept inactivations and additions.
If you would like to obtain the full version of SNOMED CT through membership or an Affiliate License, please visit the SNOMED International website .
EXAMPLE: The following representation shows the relationships, attributes and synonyms for myocardial infarction in SNOMED CT:
The equivalent representation for myocardial infarction in the GPS is featured below:
|22298006||Myocardial infarction (disorder)||Myocardial infarction||1|
The GPS is downloadable from the GPS page on the SNOMED International website.
For clinical safety reasons, SNOMED International strongly recommends that implementers do not translate the terms in the GPS based on GPS content alone. Refer to SNOMED International translation guidance for more information. For implementers considering translation, you are recommended to contact SNOMED International to take advantage of resources and existing translations.
The GPS does not contain the full SNOMED CT terminology and therefore implementers need to consider how they are going to incorporate the GPS into their applications and systems.
The GPS does not contain the full SNOMED CT terminology (e.g. relationships, attributes, hierarchies and historical versioning.) As a result, implementers need to consider how they plan to incorporate the GPS into their applications and systems. This guide references three types of fictional scenarios as illustrative examples of the use of the SNOMED GPS.
For select scenarios, each word or phrase in [square parentheses] presents examples of relevant words and phrases representing SNOMED CT concepts included in the GPS. For example, in the phrase, ‘The hospital pre-admissions team books Paulo for a [pre-surgery assessment] and a [CT scan]’ , [pre-surgery assessment] and [CT scan] represent Concept IDs in the GPS. These concepts can be used in software applications (e.g. an electronic health record) and databases to ensure consistent understanding by other clinicians. The consistent use of SNOMED CT concept identifiers included in the GPS allows for insight into the health of individuals and populations, as well as the ability to measure the efficacy and outcomes of health service delivery.
DISCLAIMER: All persons and events depicted throughout the GPS scenarios are fictional. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.
This health journey illustrates the use of GPS concepts in the planning and provisioning of a patient's care as they transition from an organization with a SNOMED International license and one that does not.
This is the journey of Paulo, a retired, 72 year old man living in a non-Member country. Paulo is a [smoker], has [type 2 diabetes], lives alone. He has a long-standing problem with [hip pain], due to [osteoarthritis], limiting his regular activities. His general practitioner (GP) orders an X-Ray and refers Paulo to an Orthopedic surgeon suspecting a [hip replacement] may be required.
The GP generates his referral using GPS since the university hospital has a SNOMED CT affiliate license - thus promoting interoperability and clear communication. The radiologist generates a radiology report using DICOM related SNOMED CT concepts included in the GPS. The report is transmitted electronically back to the GP’s EMR. The GP uses the GPS to look up the codes they’ve received.
The Orthopedic surgeon reviews Paulo’s X Ray information. Upon completion of his assessment, he recommends [hip replacement surgery]. The Surgeon books Paulo for a [pre-surgery assessment] and an [CT scan].
Paulo goes to the hospital for his pre-assessment. The nurse and anesthetist use the hospital’s Electronic Health Record (EHR) to review Paulo’s medical history, and current medications, all SNOMED CT coded. The anesthetist orders Paulo’s [blood tests] and the nurse conducts a [physical examination] to assess if Paulo is healthy enough to undergo the surgery.
All observations are recorded in the hospital’s EHR using SNOMED CT concept identifiers. These identifiers will be in the electronic hospital discharge summary that will be provided to Paulo’s GP, as well as to nursing staff and other allied health workers that provide services to him. Where a concept identifier of an observation is not in the GPS, the local language preferred term is used instead of the SNOMED CT identifier.
Paulo’s hip replacement surgery is routine and he recovers well. The SNOMED CT concept ids for the surgical procedure, outcomes, and prognosis are recorded in the EHR, and will be part of his discharge summary to his GP.
The university hospital [consults with the community home care services]. The integrated care team work together on the [Development of a care plan] that is to be used by all the care providers. The care plan [identifies the expectations of home care], providing information about Paulo’s acute care episode and the subsequent agreed course of postoperative rehabilitation and treatment. A discharge nurse informs Paulo of what to expect in the coming weeks, explains the physical activities permitted and what is to be avoided. Paulo is discharged to a [community service] for 6 weeks with [prescriptions] for [pain], inflammation, and [low molecular weight heparin] as his type II diabetes places him at high risk for a [deep venous thrombosis]. His integrated care plan includes referrals to a physiotherapist and a nutritionist.
The SNOMED concepts included in the care plan are those supported in the GPS. Where a concept identifier of something in the care plan is not in the GPS, the local language preferred term is used instead of the SNOMED CT identifier.
The home care nurse, physiotherapist and nutritionist review Paulo’s care plan using an integrated EHR application which is not SNOMED CT enabled but refers to GPS content and free text. The care plan is followed and information shared between the professionals as progress on Paolo’s recovery moves forward. 3 months later the team agree that the goals set out and agreed with Paolo have been achieved and he can be discharged and returned to the care of his GP. A discharge summary is created.
This health journey illustrates the use of GPS concepts in the diagnosis and treatment of breast cancer in a low to middle income country that is in the process of maturing its digital health systems. No health care facilities within this scenario are SNOMED CT enabled. The GPS has provided an opportunity for a LMIC to start the process of understanding the use and benefits of standardizing clinical language across health care facilities.
This is the journey of ‘Malillo, a woman living in the African nation of Lesotho who, at the age of 34, has been diagnosed with [intra-ductal breast cancer]. Advanced cancer diagnostics and treatment are unavailable in Lesotho, and instead are provided by transporting patients to neighbouring South Africa.
‘Malillo initially discovers a [lump in her left breast] that concerns her. She quickly reports it to her Village Health Worker. He agrees with her concern and advises her to go to the local community clinic and have it checked. ‘Malillo attends the community clinic, where the nurse creates a [referral to the district hospital] for [biopsy of breast]. Recently, a national initiative has introduced electronic referrals using HL7 messages, containing GPS concepts, as a step towards creating a digital health environment. Tested locally, the clinic nurse uses this to create the referral and send it via a mobile app. Where a concept is not available in the GPS, the local clinical language is used instead.
Following the [biopsy of breast] at the district hospital, which is documented in ‘Malillo’s health record, ‘Malillo receives her confirmed diagnosis of [intra-ductal carcinoma of the breast]. The results are then transmitted electronically to her community clinic and by SMS to ‘Malillo’s mobile phone.
The district hospital nurse offers [counseling] to ‘Malillo about the ‘likely’ difficult journey that she might undergo in treating her breast cancer. The nurse prepares ‘Malillo for [referral to the breast clinic] at the Queen Mamohato Memorial Hospital (QMMH) in Maseru and includes relevant health record information for their use. In Maseru, the Oncologist assesses ‘Malillo and makes a [referral for further care] to the oncology department at Bloemfontein in South Africa for further specialized treatment, including [chemotherapy] and [radiation therapy]. This, once again, uses the new electronic referral system which supports using codes from the GPS. The Oncologist shares all relevant health record information as part of the referral, using SNOMED CT codes in GPS within the message.
Bloemfontein is equipped with a GPS-enabled electronic record. Bloemfotein is exploring how SNOMED CT might benefit this hospital in light of recent discussions at a national level. Where a concept is not available in the GPS, the local clinical language is used instead. As well as providing a standardized language to record care, using the GPS encourages clinicians involved in ‘Malillo’s care use the same words for the same diagnoses, treatments and results. Further, Bloemfontein’s systems store SNOMED CT identifiers which are unique; eliminating duplication, supporting accurate retrieval and allowing consistent meaning over time.
Once in Bloemfontein, ‘Malillo undergoes a [lumpectomy of breast] which is captured in her health record. A six-month [development of care plan] is prepared for her including [chemotherapy] and a three-month course of [radiation therapy] and recorded as part of her health record. As a result of anti-cancer drug therapy, ‘Malillo enters [premature menopause]. This was explained to her as a possible side effect of her cancer treatments.
The aggressive treatment in South Africa proves to be successful. Upon discharge from Bloemfontein, a detailed summary of her care is provided back to ‘Malillo’s district hospital, created from the GPS enabled health record.
This scenario presents the example of an international humanitarian organization that delivers impartial medical care to people affected by conflict, epidemics, disasters, or exclusion from health care and their use of the GPS.
As health crises take place in SNOMED International non-Member countries, the International Patient Summary (IPS), part of the scope of the GPS, can support summary patient information gathering. In such situations, up to date patient information recording will not be undertaken and therefore, gathering of information on a summary level is more likely. The IPS is a minimal and non-exhaustive Patient Summary, speciality-agnostic, condition-independent, but readily usable by all clinicians for unscheduled patient care.
Coding patient data with SNOMED CT concepts included in the GPS at this point of emergency care will enable information to be added to a patient’s existing electronic records as well as supporting statistical analysis of the health outcomes of the event and the care provided as a whole.
For example, when undergoing initial triage due to conflict, epidemics, or disasters, patient summary records coded with SNOMED CT concepts included in the GPS, can then be provided to relevant local care providers, agencies etc. Further, in SNOMED International non-Member countries, the GPS can support structured clinical information sharing across primary, acute, community and homecare settings to benefit a patient’s journey to health and well-being.
The license being used for the SNOMED International GPS also allows for the use of GPS content in other artefacts including:
Additional Information on the GPS is located on the SNOMED International website along with frequently asked questions (FAQs.)
All GPS inquiries can be directed to email@example.com.
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