Systematized Nomenclature of Medicine (SNOMED)

            This paper analyzes the article “Implications of SNOMED CT versioning” by Leea, Cornetb and Laua. The main aim is to evaluate the purpose of the study presented in the article. The specific questions addresses during the research is analyzed and brought to clarity in this paper. Other aspects considered include the significant results obtained, the striking thing about the study including its findings, and how the study results are likely to affect healthcare regarding practice and health service delivery. Like any other study, the study should have some unanswered questions, which would be identified as well.

The article by Leea, Cornetb and Laua (2011) entails a case study purposely conducted to determine the changes undergone by Systematized Nomenclature of Medicine (SNOMED) clinical terms as well as their implication on the use of the SNOMED clinical terminologies within the electronic patient record systems. To address the purpose of the study, Leea, Cornetb, and Laua introduced the SNOMED clinical terms first including the way they were developed. The introduction here brings out a way of defining the purpose of the study. Further, analyzing how the terminology developed makes it effortless to determine the changes stipulated in the study and their implication on the health sector as a whole. The SNOMED terminology covers medical concepts like diseases, medical procedures, and clinical findings. SNOMED clinical terms were originally developed and created by “the College of American Pathologists in the United States” (Leea, Cornetb and Laua 442). The ownership according the study was transferred to the “International Health Terminology Standards Development Organization (IHTSDO)” according to Leea, Cornetb and Laua (442). The new body has about 15 member countries, all with a common goal of developing, maintaining, and promoting the terminology standard.

The study article was based on some specific questions. The questions were brought out in such a way that they would develop a way of achieving the study objective. Some key study questions should have been as follows:

• What changes do SNOMED clinical terms undergo with time?
• How often are these changes?
• What effect do the changes have on clinical practice and the health sector as a whole?

In order to answer the research questions, a method that combined various parts was used. The first part consisted of Component History documentation. The second part of the method was the Semantic History mechanism involving outlining a list of semantic changes, which are often made on SNOMED clinical terms concepts that are hardly recorded as a part of the first part; Component History mechanism. The third part of the method used was the SNOMED clinical terms Concept Model mechanism, which was reviewed including the way it has undergone various changes since the release of July 2006 (Leea, Cornetb and Laua 444). The methods were then applied to a subset of SNOMED clinical terms and then the respective changes were tracked between the releases of January 2009 and July 2009. The subset considered in this case was the Problem List of Clinical Observations Recording and Encoding (CORE), which was published by the US National Library of Medicine (Leea, Cornetb and Laua 443).

The Regarding the changes made on SNOMED clinical terms, the study points out that the SNOMED’s July 2009 version has more than 388,000 concepts (Leea, Cornetb and Laua 442).  According to the study, the version has at least 1.14 million descriptions alongside about 1.38 million relationships (Leea, Cornetb and Laua 442). Besides, a new release is witnessed each month and it happens through the National Release Centers within charter member countries. The study stipulates that every release comes with changes that have effect on the use of the SNOMED clinical terminologies within the electronic patient record systems of organizations. Some common changes include names/preferred terms that are fully specified, concept status, fully defined status, attribute definition, hierarchy position, and normal forms.

Generally, the study found out that some of the changes could contribute to unexpected consequences especially in subsequent encoding, subsumption testing, and equivalency as well as the querying of a SNOMED clinical term (Leea, Cornetb and Laua 443). In the study, five major types of changes were examined. These changes are clearly depicted in the case study article. They include fully specified name as well as preferred term, concept status, primitive/fully defined status, that includes the definition of attributes and normal forms, position changes in hierarchy including top-level, super-types, and subtypes, and finally, the effects that the changes to Concept Model have on the authoring post-coordinated expressions expressivity (Leea, Cornetb and Laua 443). The results showed that at least 41.2 percent of 5182 concepts that were considered in the subset had undergone some changes. Nevertheless, some of the changes were found to be minor like the changes regarding word ordering especially in the fully specified name as well as the preferred term. Some other changes were found to have significant implications such as changes in concept status, normal form, and hierarchy position (Leea, Cornetb and Laua, 444).

The most striking aspect of this study is its demonstration of many changes those SNOMED clinical terms is undergoing. It is also striking to find out much regarding the various changes (Leea, Cornetb and Laua 450). The study results also depicted that each SNOMED clinical terms release is accompanied by numerous changes that have both significant and minor impact on the use of the SNOMED clinical terminologies within the electronic patient record systems of healthcare organizations. It is also fascinating to know that the differences among various SNOMED clinical terms releases could be due to the endless changes in medical knowledge. Such medical knowledge usually finds its way to the SNOMED clinical terms. The differences could as well be a result of changes in the SNOMED clinical terms itself (Leea, Cornetb and Laua 450). A case of changes in medical knowledge is “when the concept ‘442696006|Influenza due to Influenza A virus subtype H1N1 (disorder)|’was added in July 2009” (Leea, Cornetb and Laua 444). A case of changes in the SNOMED clinical terms is “when the concept ‘371622005|Elevated blood-pressure reading without a diagnosis of hypertension (finding)|’ was more clearly defined as a situation as opposed to a finding in July 2009” (Leea, Cornetb and Laua 444).

The results of the study have some major impact on healthcare regarding its practice and service delivery. The changes outlined by the study are incorporated by healthcare institutions for many reasons. Healthcare professional can use the study results to differentiate the changes on the SNOMED clinical terms initiated by medical knowledge and those associated with the SNOMED terminology itself. The results are also useful to healthcare organizations and medical practitioners in determining the effect of the SNOMED release and its related changes on the use of the SNOMED clinical terminologies within the electronic patient record systems (Wang, Halper and Min 569). Such organizations would gain a clear way of updating their electronic patient records with respect to each SNOMED release and associated changes. Healthcare organizations are also able to predict possible changes accompanied by future releases of the SNOMED clinical terms (Shahpori and Doig 364.e3). This way, service delivery will be effective.  Nevertheless, possible complications in healthcare delivery could arise due to the resulting changes caused by the various releases.

While the study was well presented, the study failed to include a versioning number regarding the compositional grammar of the SNOMED clinical terms expressions. This failure brings in the question of the composition grammar for the SNOMED clinical terms expressions as well as the lack of completeness of terminologies (Silvaa, MacDonaldb and Patersond 326). Answering the question about the composition grammar would require it to be included in the study method. The respective details should however be finalized prior to its inclusion.

Works Cited

Leea, Dennis, Ronald Cornetb and Francis Laua. “Implications of SNOMED CT versioning.” international journal of medical informatics, 80 80 (2011): 442–453. Print.

Shahpori, Reza and Christopher Doig. “Systematized Nomenclature of Medicine–Clinical Terms direction and its implications on critical care.” Journal of Critical Care, Vol. 25 (2010): 364.e1–364.e9. Print.

Silvaa, Thuppahi Sisira De, Don MacDonaldb and Grace Patersond. “Systematized nomenclature of medicine clinical terms (SNOMED CT) to represent computed tomography procedures.” computer methods and programs in biomedicine, Vol. 101 (2011): 324–329. Print.

Wang, Y., et al. “Structural methodologies for auditing SNOMED.” Journal of Biomedical Informatics, Vol. 40 (2007): 561–581. Print.

 

 

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