SNOMED International address to the NCVHS Semantic Standards Harmonization Panel James T. Case MS, DVM, PhD, FACMI Chief Terminologist, SNOMED International AUGUST 25, 2021 SNOMED International: Delivering CT What do we mean by ● Clinical meaning captured specifically and explicitly semantic ○ Granularity harmonization? ○ No implied meaning ○ Computable definitions In the context of healthcare ● Lossless transfer between terminology standards, systems harmonization is interpreted ● Bidirectional equivalence maps as the maintenance of fidelity ● Compatible with multiple of meaning of data information models throughout its lifecycle, ● Meaning maintained when unaffected by mappings or translated to another language translation. 2 SNOMED International: Delivering CT What is the greatest opportunity for harmonizing terminology standards? ● Identification of a subset of high priority, robust, fit-for-purpose standards ○ “The nice thing about standards is that there are so many of them to choose from.” - Andrew S. Tanenbaum ○ Reliably maintained, frequent releases ○ Focus on enhancement (comprehensive coverage) ○ USCDI is a good start (limited scope) ● Collaboration among SDOs (formal agreements) ● Joint Initiative Council for Global Health Informatics Standardization (JIC) Focus on a small set of “fit-for-purpose” standards. Agreement needed for SDOs to work together 3 SNOMED International: Delivering CT What are the greatest barriers to semantic harmonization? How do we move the barrier? • Leverage experiences in other ● Extensive use of local code sets (lack of adoption of countries standards) • National strategic plan developed ● Different underlying models and editorial policies of in collaboration with stakeholders terminologies ○ vendors ● Different primary focus of terminology standards ○ healthcare enterprises ○ clinical, administrative, reimbursement, classification, use-case specificity ○ payers ● Deeply entrenched implementations ○ government ● Reluctance to change/cost of change ○ SDOs ● Intellectual property constraints • Demonstration of the benefits ○ Real-World examples Barriers are long-standing, solutions will take a long time. SNOMED International: Delivering CT SNOMED International: Delivering CT 4 What crosswalks are SNOMED International actively currently available between integrates terminologies and maintains clinical data standards, administrative standard clinical crossmaps to other transactions data and code terminologies sets, for mappings of healthcare data? 55 SNOMED International: Delivering CT International collaboration Products from partnerships GMDN Maps ICD-10 and ICD-11 MMS AND NCPT (nutrition) content MedDRA Content ICNP nursing content Orphanet (INSERM) (Sept 2021) Improvement & NANDA-I content Additions Periodontal content COVID-19 Coding Guide SDoH content Other HL7 - SNOMED on FHIR Products & Global Patient Set (GPS) Global vaccine certificate DICOM Initiatives initiatives Refsets & Dentistry Diagnoses LOINC expression set Dentistry Odontogram Freesets Translated Education Products ERA-EDTA UNICOM project deliverables GP/FP HL7 International IPS Anticipated CPT map ICNP 2019 (Sept 2021) Products HPO map IHE Profiles Nursing 6 Healthcare industry should identify a few relevant, comprehensive, interoperable clinical standards driven by common information models to potentially reduce the need for an extensive number of What additional maps. crosswalks would be beneficial for nationally The cost of creating and maintaining maps can be significant and grows standardized cross maps? geometrically as new standards appear. From a quality perspective, any map poses an opportunity for error. In the long term, the creation and maintenance of an extensive number of SNOMED International: Delivering CT 7 maps is not sustainable. SNOMED International: Delivering CT ● Idiosyncratic implementation of standards What costs, burdens and ○ “If you’ve seen one, you’ve seen one” resource constraints ● Technical limitations ○ The proprietary nature of EHRs might impede greater (no common information model) ● Adoption of standards...or rather the harmonization of cost of implementation and standards? maintenance of standards ○ Legacy data migration ○ Updating interfaces ● Lack of perceived benefit/motivation 8 SNOMED International: Delivering CT Education on the benefits and appropriate use of terminology standards Development of a common What are the mitigation ontology for clinical steps that we can take? terminology Creation of focused terminology subsets (subontologies) Encourage a staged implementation strategy Building a common terminology and information model will enhance interoperability, provide a SNOMED International: Delivering CT (Minimize the pain) 9 platform for specialization SNOMED International: Delivering CT Thank You James T. Case MS, DVM, PhD, FHL7, FACMI Chief Terminologist SNOMED International [email protected] SNOMED International: Delivering CT 10 SNOMED International: Delivering CT.