In the Q&A below, Monica Harry, Director of Content and Mapping and part of the team at SNOMED International guided by Head of Terminology, Dr. Jim Case, answers some of the most frequently asked questions we receive about SNOMED CT and the process the organization uses to develop content and finalize each release.

What would you say is the most important highlight of this latest release of SNOMED CT International Edition (January 31, 2021)?

MH: For this latest release, I’d say it’s the COVID-19 vaccine-related content. We added 21 new concepts to support the vaccine administration process, which is extremely important as countries around the world ramp up their efforts to vaccinate their citizens against the virus. We also added new content reflecting the much discussed sentiment of "long COVID," a colloquial term for clinical signs that may persist after the acute COVID-19 disease. In SNOMED CT, this sentiment is represented by two concepts: "Post-acute COVID-19 (disorder) - 1119303003" and "Chronic post-COVID-19 syndrome (disorder) - 1119304009."
 
Other important highlights include anatomy changes to support cancer synoptic reporting, a clinical documentation method that uses structured checklists to help clinicians produce more complete, consistent and valuable medical reports; and the updated concept model for allergies and adverse reaction to vaccines. As well, the new content for food insecurity and housing status, i.e., two of the factors measured as part of social care, is an important addition: SNOMED International, as part of its strategic priorities, has been working with the U.S.-based Gravity Project  to ensure any Social Determinants of Health content that is internationally applicable is available for international usage.
 

Over the past year, SNOMED International has taken a number of steps to support the fight against the global COVID-19 pandemic, and the organization continues those efforts with the vaccination content in this latest release. What do you see as the trajectory for that ongoing work over 2021? 

MH: This is the challenge: that every day there is new information about the virus and the way it’s mutating. That in turn affects lab testing, and at the same time, there are new vaccines being approved, manufactured, put into service and injected into humans. Then there are the outcomes of how people respond to those vaccines, which is where the content related to adverse reactions and success rates may come into play. So there are a number of areas all related to expressing those different factors and we have to ensure we have the content to do that. I’d say that’s an ongoing project that we’ll have for at least the next release, if not the whole of the next year. One of the challenges around vaccines, though, is that we do not put the brand names of drugs into SNOMED CT because brand names don’t tell you the details of products, they just give you the brand name. If I say Kleenex, for example, that doesn’t tell you if it’s a thick or thin one, if it has perfume or no perfume or if it’s hypoallergenic -- a brand name is just too broad as well as country specific. We’re working on ways to address this challenge presently so that our Members can create content that would be too granular in the International Edition, but useful to the users and citizens of their regions. 
 

How is SNOMED International addressing the issue of emerging coronavirus variants and what are the challenges from an ontological perspective?

MH: In a nutshell, we’re not adding variants unless there is a clinical significance to their presence. As of this writing, the current variants of interest do not affect treatment or response to vaccination. We are monitoring the identification of new variants and are ready to add them if the clinical significance warrants it.
 

One of SNOMED International’s strategic priorities is to support the reduction of health inequity through developing and managing social determinants of health content within SNOMED CT. What are the plans for advancing this work in the future?

MH: This is a new endeavour -- to start including aspects of people’s lives that are not strictly clinical or health-related, such as housing and food, but that certainly have an impact on how people cope with disease and illness. More and more we are beginning to realize these factors are important. Unfortunately, different countries -- and even different regions within those countries -- record this information in a variety of ways, so what we’re doing is listening to and engaging in those conversations around how we harmonize this terminology. How do we all call things by the same names so we can share the information and understand each other and understand where and how we record this so we get some uniformity in reporting? It’s difficult because there are groups in countries working individually, so we have to try to bridge the gaps and get them together to have conversations. The U.S.-based Gravity Project is collating terms and names and harmonizing them within that project and sharing that information. There are similar projects elsewhere in the world working to ensure we are all using the same terms to describe things so that information can be stored in an EHR and provide a more holistic view of a patient’s life. SNOMED International is tapping into those groups to benefit from their findings. 
 

In this release, SNOMED International added a fair amount of content to support Members mapping from SNOMED CT to ICD-11. Why is this important?

MH: It’s important so that in the future, we can have a map from SNOMED CT to ICD-11 for those Member countries using SNOMED CT who report in ICD; we want to enable them to do that seamlessly. In the most recent release, SNOMED CT added 500 new concepts for the purposes of supporting our Members in those efforts to map from SNOMED CT to ICD-11.
 

So we’ve spoken about a breadth of clinical content that can be added to SNOMED CT. Can you describe the process of determining what does and doesn’t go into the international edition? 

MH: Our drivers for that decision-making process are multiple: one is our strategic plan set out by our Members and the organization. It’s focused on adapting to the evolving world of health care, imagining the future and planning for upcoming changes in clinical recording. We also have projects that drive content changes, such as our Quality Initiative, which is a restructuring of SNOMED CT to ensure content is in the right place. Think of it as if the documents in a filing cabinet were out of order and you wanted to refile everything in the right place so you can find it more easily when you search for something. Then we have our Content Request System, which Members who are implementing SNOMED CT and have individual requirements for changes can use to request content changes.
 

Where can people go to find more information on the latest SNOMED CT release?

MH: Please check out our latest news release for more information or write us at info@snomed.org.
 

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