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SNOMED CT helps Cantebury District Health Board realize its data driven vision

November 23, 2020

SNOMED International has released a series of videos that demonstrate the value that a healthcare system is deriving from implementing and using SNOMED CT, the world’s most comprehensive clinical terminology.

The first chapter of the SNOMED CT Value Series, which focuses on New Zealand’s Canterbury District Health Board (CDHB), highlights the advances the organization has made in realizing its vision of a connected, integrated system that supports the country’s Healthy Ageing strategy and enables it to better serve its population. Acting Executive Director Planning, Funding and Decision Support, Ralph La Salle offers that “an integrated health system is essential for the health outcomes of the Canterbury population and quality data with thorough analysis leads to shared clinical insights and new ways of working collectively to optimise this integration.”

Carolyn Gullery, who at the time of filming was the Executive Director, Planning, Funding and Decision Support for the CDHB, said New Zealand’s commitment to becoming a SNOMED International Member in 2007 was the beginning of a positive change for a healthcare system that was, like so many others across the globe, under extreme financial and performance-related pressure. She explains that in 2007, while its primary care system was thriving, its hospital system was struggling. Canterbury needed a better picture of its current situation and a way to predict the future needs of its 578,000 residents.

Harnessing the power of data analytics

Key to that goal, she noted, was the ability to use data and analytics to understand why people were ending up in the health system, who they were and how to intervene more effectively to reduce the demand on the system and provide better care for patients. By using SNOMED CT as part of its core infrastructure, and its Healthcare Analytics Solution (HCAS), a software tool that applies natural language processing to the unstructured text-based data in a clinical record, the health boards were able to code their existing data to SNOMED CT and then demonstrate to clinicians the power of using those codes to analyze that data. It is estimated that approximately 80 percent of health data is unstructured, and can represent text, photos, X-rays, voice/video recordings, slides and emails, among other types of health data.

By building a series of systems that act as an integrated health platform, CDHB managed to use the same number of beds in 2019 as it did in 2007 for a population that over 12 years had grown by 80,000. Canterbury representatives also observed a 30 percent lower emergency department use and a 30 percent lower acute medical admission rate than the national average, meaning New Zealanders are less likely to end up in the hospital in Canterbury than in any other part of the country.

Reducing manual labor for clinicians

According to Dr. Nigel Gilchrist, a Canterbury physician, the organization had also struggled to identify vertebral spine fractures and identify patients who may not have received care for those fractures. By using SNOMED CT to search 13,000 X-ray reports as part of a pilot project involving West Coast DHB patients, the organization found that one-third of relevant patients had been treated, another third had not, and the remaining third had been misclassified.

“We now identify over 200 new vertebral fractures every month,” he explained. “SNOMED CT has enabled us to identify specific case mixes that would otherwise take someone a long time to do manually.” In fact, the organization saved more than a year of a clinician’s time.

Interoperability across platforms

Another benefit of using SNOMED CT is its interoperability across the healthcare district’s best-of-breed applications. “We need to be sure we’re speaking the same language when we use data, and if we move it around, it’s got to mean the same thing in one place as in another,” said Dr. Saxon Connor, a Canterbury physician.

Other Canterbury clinicians say they are most excited by SNOMED CT’s ability to help two different clinical tools – an electronic medical record system and a pathways tool – talk to each other via a SNOMED CT code linked to diagnoses, and by the ability to search for pathways and find hierarchies.

“In the past, we had to go through our pathways manually and put keywords on them so people could find them, and with SNOMED we get all those synonyms for free,” said Kieran Holland, Clinical Lead for New Zealand’s HealthPathways Programme, an online clinical guidance tool. “It has improved the user search experience.”

SNOMED CT: a piece of the digital health ecosystem as CDHB realizes multiple benefits

  • 30 percent lower emergency department use than the national average

  • 30 percent lower acute medical admission rate than the national average

  • Held 2019 bed use to same numbers as in 2007 while serving a population that had grown by 80,000

  • Identified vertebral fracture patients who had not received care or whose cases had been misclassified

  • Saved a year of clinician time by automating previously manual processes

  • Interoperable across best-of-breed system

  • Ability to link clinical tools via a SNOMED code

  • Ability to search for pathways and hierarchies and improved user search experience

There is more energy than ever in rolling out SNOMED CT as a key clinical information standard for an equitable New Zealand health and disability system, one that is data-driven and digitally enabled and SNOMED International’s CEO, Don Sweete, recognizes the dedication of New Zealand’s implementation efforts. “Canterbury is a great example of the breadth of maturity that SNOMED CT offers from data coding, data analysis, and ultimately the ability to apply artificial intelligence to already structured SNOMED CT data. It’s an end to end example of the benefit of SNOMED CT.”

New Zealand’s focus over the next few years is on primary and community care, where users are migrating their systems from Read Codes to SNOMED CT as they introduce new models of care and supporting software.

Watch the Value Series to learn more about SNOMED CT and New Zealand, a founding SNOMED International Member represented by the Ministry of Health Manatū Hauora. 

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