Country / Region
EMEA
Tags
Collaboration, Data quality, Mapping, Tooling
Background context of Scotland organisational structure, system landscape. Outline of the Digital Foundations stream of the Scottish 2021 Digital Health and Care Strategy and applying it to the programme to improve Laboratory Medicine data.
Sharing experience, progress and learnings from the journey to implement this strategy by standardising laboratory medicine data in Scotland using SNOMED as a foundation. Where we are on the journey, challenges overcome and still to face.
Creation of Standard Operating Procedures on how to create maps as well as identify and resolve content gaps in SNOMED PaLM. Covering the creation and ongoing maintenance and management of foundational terminology artefacts.
Collaboration between vendors, domain experts, operational and clinical leads. Including the use of the tooling provided as part of the National Terminology Server for Scotland to create FHIR ValueSets and FHIR ConceptMaps to establish, publish, share, control and use that data across the ecosystem.
Description
In 2022, NHS Scotland were commissioned to implement the Standardisation of Laboratory Test Codes to Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT) as the primary structured clinical vocabulary used in electronic clinical systems. The Impact and benefits of introducing a standardised terminology to new and existing Health IT systems are multi-fold; consistent data entry, improved data sharing between systems, decision support advancements, reduction in re-coding and improved patient care.
The implementation of this is through the deployment of a new national LIMS solution to replace multiple inconsistent health board level solutions; as part of this implementation the integration to the existing system landscape involves mapping and translation of concepts for both the transition period as well as the lifecycle update period of the wider ecosystem.
Scope
READ codes have been deprecated and following the 2021 Scottish Government Digital Health and Care Strategy SNOMED CT was defined as the replacement as part of the Digital Foundations for Scotland.
As laboratory services have grown, The PBCL READ code system wasn't able to keep up with the granularity required of the reported data, and was officially retired in 2018 in favour of moving to SNOMED CT. To aid this transition, a set of similar SNOMED CT codes were created, generally referred to as Snomed CT PBCL.
To fully support laboratory medicine, a true SNOMED CT replacement to READ PBCL began development. NHS Digital started this work in late 2018 as the “Unified Test List and was introduced into various UK distributions of SNOMED. This was officially merged into the main International release of SNOMED CT in 2023, and is now referred to as the Pathology and Laboratory Medicine (PaLM) reference set.
SNOMED CT PaLM concepts are more detailed than SNOMED CT PBCL concepts and conform to well-defined editorial principles. All PaLM concepts are fully modelled; the modelled components logically define each concept and allow for machine processing, enabling clinical decision support, and improved analysis of the data. Thanks to SNOMED CT's concept model, some of the information about a laboratory test is carried inherently in the terminology, with Observable entities carrying defining coded attributes relating to measurable characteristic, substance, specimen, and technique.
How SNOMED CT will be used
SNOMED CT is used as a direct replacement for legacy READ v2 to codify laboratory procedures and observables for primary care and other downstream systems and research analysis. SNOMED enables much richer use than READ v2 both in terms of the concept modelling as well as the concept scope; so we are expanding the use to cover other data items such as surveillance data for Public Health Scotland (organisms).
Why SNOMED CT will be used
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