Blog

Ten years fighting for a single language

SNOMED CT is the clinical vocabulary for electronic patient health records across the NHS. Denise Downs, Principal Terminology Specialist, talks about the ‘major stock take’ that the implementation of SNOMED CT across general practice involved and how she gained the support of clinicians.

Author:: Denise Downs, Principal Terminology Specialist, NHS Digital

Date:: 16 January 2020

Denise Downs

Ten years ago, when I took up my role to support SNOMED CT implementation, I realised very quickly that no one knew what it was, let alone recognised its benefits.

Most people still have no idea what I’m talking about at dinner parties. However, where it matters, there has been a significant change in awareness. At a recent national conference for providers of mental health services, not only did everyone know what SNOMED CT was, but a mental health trust was giving advice on its implementation. This was a first, although the number of people who don’t know what SNOMED CT is has been reducing year on year.

I’m proud of how far the health system has come in the last 10 years. In a few months’ time, almost all GP practices in England will use SNOMED CT.

What is it?

SNOMED CT is a standardised clinical vocabulary for electronic patient health records across the NHS. By standardising how we describe and code health, care and treatment, we allow NHS IT systems to talk efficiently to one another.

It’s like using a supermarket website as opposed to compiling a free text shopping list. You might write down that you want a can of baked beans, but it won’t be clear if you require a small, medium or large tin. However, if you have to select it from a list of 200g, 300g and 400g, you know what you have ordered and so does the retailer.

This interoperability releases the efficient flow of data and allows for better patient care and resource management, time-savings for clinicians, improved data collection, and the ability to harness real-time data to support clinicians in their decision-making.

Turning over stones

Moving to SNOMED CT in general practice was a bit like undertaking a major stock take. It turned over stones that hadn’t been turned over in a while and revealed differences in approaches between suppliers.

For example, when key partners TPP and EMIS integrated SNOMED CT into their general practice systems, we discovered that guidance which enables suppliers to provide clinical calculators and alerts in their systems were often only provided in the old CTV3 or READ v2 codes. SNOMED CT replaces these codes so that system providers are all working with the same terminology – this means that no matter which supplier a GP practice uses, the alerts they receive will all be based on the same logic.

Gaining the support of clinicians

We asked ourselves “what do clinicians need to know?” Aware that this will vary considerably depending on the role and interest of the clinician, we ran a variety of awareness sessions tailored to different audiences.

These webinar sessions ranged from a general overview and discussion of the key time-saving benefits of moving to SNOMED CT for audiences that only needed the basics, to more technical presentations for those writing queries and business rules. These recorded webinars were then split into a series of ‘byte size’ topics (no more than five minutes in length) that people could watch when it suited them.

If we estimate a cost-saving of two minutes per letter, this results in an average saving of over two hours of staff time per practice, per week.

A tipping point in gaining the support of clinicians occurred when they learned of the cost-saving and time-saving benefits of using SNOMED CT. For example, GP surgeries receive over two million A&E discharge letters per month that need to be coded. Receiving these letters in SNOMED CT removes the need for practices to do this themselves. If we estimate a cost-saving of two minutes per letter, this results in an average saving of over two hours of staff time per practice, per week.

We also engaged with the Joint GP IT Committee, who fully support the move to using SNOMED CT as a universal language. They continue to increase awareness and uptake of SNOMED CT by providing advice and written updates to their members.

The future is bright

So, what’s next? We’re currently engaging with our colleagues in mental health to record more information via structured data, rather than only using supplementary notes. Research is also underway in partnership with Great Ormond Street Hospital to explore transforming clinician notes to incorporate SNOMED CT. This will help to collect quality data to understand which interventions improve clinical outcomes.

The use of SNOMED CT has already transformed aspects of health and care services over the past decade, but there is still work to be done. Interoperability of IT systems is a focus of the NHS Long Term Plan, and SNOMED CT plays a key role in driving this agenda forward.

Find important publications, education and training materials, blog entries, useful links and much more, on our sharing website.

Related subjects

SNOMED CT

SNOMED CT is a structured clinical vocabulary for use in an electronic health record. It is the most comprehensive and precise clinical health terminology product in the world.