In the SNOMED Implementation Team, we follow all contributions with great interest. We look forward to receiving user feedback from this experience when it starts being adopted by OpenMRS projects that choose this approach.
The SNOMED Implementation educational material and courses provide extensive advice on integrating SNOMED into clinical software. A native SNOMED CT integration enables rich and valuable features for implementers and clinical users.
Many clinical projects worldwide use SNOMED CT natively as the interface terminology. For example, the “Clinical findings” domain in SNOMED CT contains 110,000 concepts linked to almost 550,000 descriptions, providing many options for matching in search algorithms. The ECL Language provides a great tool to constrain the search to a particular domain, displaying only clinically relevant results. SNOMED International and national editions support the modeling of new concepts where content is missing or inadequate. There is a well-established editorial process for developing and improving previous content and correcting the terminology. Some concepts are deprecated over time and will not be available for recording clinical information using the latest edition of SNOMED. Retrieval of previous concepts is always possible by searching for inactive terms in the context of the information model or by using history operators in ECL for analytics.
SNOMED has ongoing collaborations with many standards organizations, producing official and quality-assured maps to other classifications and terminologies (e.g., ICD-10, Medra, EDQM, GMDN, etc.).
SNOMED receives extensive feedback and contributions from clinical implementations in member countries and clinical reference groups in a continuous improvement cycle where SNOMED CT content evolves with the evolution of health sciences and clinical users’ preferences. Another source of continuous improvement is the use of SNOMED CT as terminology binding for other standards, like HL7 FHIR, IPS, DICOM, etc.
The implementation in the Bahmni project combines access to the full content of SNOMED in a FHIR terminology server while synchronizing content with the local concept dictionary, which grows with SNOMED use and enables relational integrity for all records. The terminology server is also a key enabler for supporting the export of statistical reports using the official map to ICD-10 and for executing the logic of the decision support system using logical subsumption features.
This effort is a demonstration of all the advice and techniques for SNOMED implementations available in SNOMED support materials. Many commercial systems implement these techniques, but this Bahmni / OpenMRS implementation is the first Open-source example and is intended to work as a reference for implementers worldwide. The challenge for all developers is to decide whether to expand the terminology by adding synonyms and ‘clinician friendly terms’ or to focus on the information model and data fields for recording data at the point of care. The SNOMED community is exploring how best to use the promise of post-coordinated concepts to create greater expressiveness, but this approach is likely out of scope for the Bahmni project at this stage. There is an interesting challenge to the Open-Source community to develop safe ways of developing and implementing post-coordination for use within the clinical arena.
(The Implementation team at SNOMED International)