Guest Blog: How Deep Should SNOMED CT Go?

SNOMED CT ® is becoming the standard for clinical terminology across health and care. As techUK we support this move in order to facilitate seamless care between information systems and across the care provider organisations in pursuit of the Paperless 2020 agenda. In November 2016 a standard was published which sets out the application of SNOMED CT in specified operational settings including implementation dates in alignment with national policy. The standard is SCCI0034 and can be found here.

techUK had reviewed the Advance Notification paper that had been issued in May 2016. It described the use of SNOMED CT for use in "electronic patient level communications" and we accepted that this was required in order to meet NHS objectives. However when the standard was issued in November 2016, this had subtly changed to "electronic patient level recording and communications". The impact of this change across the supplier community is potentially huge as it could be interpreted that the internal storage, representation and implementation of clinical terminology across all systems has to change by April 2020.

Fortunately this is not the case. We had a very successful meeting with the SNOMED CT team at NHS Digital, chaired by Tom Denwood (Director of Provider Support and Integration), during which our concerns were aired. The outcome of the meeting clarified that it was not mandatory for systems to capture or store clinical concepts as SNOMED CT codes/terms in the persistence layer. Systems can continue to capture and store clinical data using whatever terms/codes that are deemed appropriate but SNOMED CT must be used for external communications and hence robust mapping must be employed. This has now been formalised on the SCCI0034 web page as a downloadable Addendum dated 2nd August 2017.

There are two further points that are worth noting:

  1. Future datasets will be specified using SNOMED CT so it would make sense to capture and store these concepts using SNOMED CT if they don’t already exist.
  2. There is a move towards using SNOMED CT for central returns, commissioning, etc. and this will be explained in a terminology roadmap that NHS Digital will present to techUK in the near future.

In conclusion it is worth repeating what Richard Popplewell (chairman of SCCI at time the standard was published) said recently: "The standard gives guidance for those wishing to fully adopt SNOMED CT into their system, however the approach within the standard is to also provide the business requirements for SNOMED CT rather than specifically require SNOMED CT in user interfaces or data models."

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