May, 2020
Following the introduction of SNOMED CT as part of the BMBF-funded Medical Informatics Initiative (MII), the terminology can now be used in Germany. SNOMED CT is used for the core data set (Kerndatensatz, KDS) of MII. The KDS serves as a common interoperability standard for data exchange between sites. All sites must implement the six basic modules of the KDS. Technically, the KDS is implemented as Fast Healthcare Interchange Format (FHIR) profiles, in which the values that can be taken by individual data elements are mapped to standard terminology. Different standardized terminologies and classification systems are used: e.g. ICD, OPS, LOINC, UCUM, UNII, ASK, ATC, but especially SNOMED CT. The modules of the KDS are edited and can be viewed in the tool ART DECOR: Person (person), Fall (case), Diagnose (diagnosis), Prozedur (procedure), Laborbefund (laboratory finding), Medikation (medication). For further requirements, additional modules are defined, e.g. Pathologiebefund (pathology), Onkologie (oncology), Symptome & klinischer Phänotyp (symptoms & clinical phenotype).
Some examples for the use of SNOMED CT in the basic modules of the KDS are Person: administrative gender and date of birth, Diagnosis: complete diagnosis code and body site, Procedure: complete procedure code, body side, procedure category and outcome, Laboratory finding: the value set Semi_quantitative_laboratory results, for the representation of the sample type and the place of origin of the sample, and Medication: representation of the active ingredients, the site and route of application.
Due to absence of other terminologies for the representation of complex clinical relationships besides SNOMED CT, its application will be even more important in the emerging extension modules.
In addition to this application in MII, SNOMED CT is also used in the fight against COVID-19 in the National Consensus Data Set on COVID-19 (GECCO) of the National Research Network of University Hospitals. In ART DECOR, SNOMED IDs and Fully Specified Names (FSN) are attached to the selected concepts, such as drugs and symptoms. The 'COVID-19 content in SNOMED CT' was considered.
The training of the involved parties is also progressing: At the beginning of June, the TMF as National Release Center will offer a webinar for the university medical sites of MII and its partners, in which the experts from SNOMED International Ian Green (Customer Relations Lead Europe and Clinical Engagement Business Manager) and Rory Davidson (Products & Services Executive Lead) will inform about the use of SNOMED CT and answer questions of the participants.
Finally, a short update on licensing: the number of license holders continues to increase, with 51 institutions (e.g. university hospitals, universities, research organisations and industry partners) having obtained a license by the end of May.
June, 2020
Within the German Medical Informatics Initiative (MII), four consortia are funded by the Federal Ministry of Education and Research (BMBF): DIFUTURE (Data Integration for Future Medicine), HiGHmed (Heidelberg - Göttingen - Hannover Medical Informatics), MIRACUM (Medical Informatics for Research and Care in University Medicine) and SMITH (Smart Medical Information Technology for Healthcare).
In today's report we would like to give you an example of the use of SNOMED CT in Germany based on the activities of one site of the MII: the University Hospital Schleswig-Holstein (UKSH). As one of the participating sites of the MII’s HiGHmed consortium (interactive map), the UKSH received a SNOMED CT license in May 2020.
Since then the UKSH joined forces with the whole consortium to integrate SNOMED CT into the consortium’s use cases “Cardiology” and “Infection Control”. UKSH Campus Kiel is responsible for conducting a register study as part of the HiGHmed use case “Cardiology” and is continuously recruiting patients with heart failure. Relevant patient data are integrated into the “medical data integration center” (MeDIC) at UKSH and will be made available for HiGHmed queries based on patient consents. Cardiological data integrated into the MeDIC will be enriched with SNOMED CT codes in order to standardize the data internationally. UKSH Campus Lübeck focuses on the use case “Infection Control” and is therefore responsible for establishing a “Smart Infection Control System” (SmICS) based on an openEHR repository. SmICS will be used to monitor and prevent infection chains and outbreaks in the hospital based on patient movement data and pathogens.
Therefore, the UKSH supports the joint modeling of standardized data structures using SNOMED CT for full semantic interoperability as well as the integration of SNOMED CT into the local microbiology IT-systems to enable accurate and interoperable test reporting. A first draft of mapping local terms to standardized and meaningful SNOMED CT concepts is currently under review. Further implementation into existent software and interfaces will follow in close collaboration with the domain experts.
Furthermore, a local FHIR terminology server (Ontoserver) was set up to flexibly query SNOMED CT contents and use its extensive features from within applications. Researchers at the UKSH are excited about the new possibilities offered by the licensing of SNOMED CT in Germany and will continue to explore the potential offered by both its comprehensive terminology and logic-based foundation.
In addition to the UKSH, 30 university hospitals, 19 universities, 3 research institutions, 4 industrial partners and 2 other partner institutions (in total 59) received a license by the end of June.