SNOMED CT in Primary Care Updated: 31 th July 2017 Copyright 2017 Health and Social Care Information Centre. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital.
Contents Summary 3 Background 3 Purpose 3 Scope 3 Questions and responses 4 Copyright 2017 Health and Social Care Information Centre. 2
Summary Sessions have been held with representatives from CCGs and CSUs in relation to the transition to SNOMED CT from the Read codes and how it will impact. Questions raised have been captured, and this document aims to provide answers and clarification in relation to the EMIS web solution. Background CCGs are required to plan and prepare for the transition to SNOMED CT. To support this work, it is important for CCGs to understand the supplier s approach to the required redevelopment of their clinical system to enable SNOMED CT. With this understanding CCGs will be well positioned to shape their onward communications and the work they are required to do in preparation for April 1 st 2018. This document captures the current thinking following discussions between NHS Digital and EMIS. Purpose To provide answers to questions raised by those organisations supporting General Practice in their use of the clinical systems. Scope The content in this document relates to the EMIS Web principal clinical system. Copyright 2017 Health and Social Care Information Centre. 3
Questions and responses The following questions have been raised in discussions with CCGs; responses in relation to the EMIS solution are provided in this document. They are presented in no particular order. As development continues, changes to this document may be required, but at the date of publication, this document captures current intentions aimed at minimising the impact on existing users of EMIS Web. Readers of this document should ensure they have the latest version which can be found on the NHS Digital Delen site. What is the impact to end users? NHS Digital s aim is to minimise the impact to the NHS General Practice and related data processors in the transition from Read to SNOMED CT. The approach is for a measured transition, avoiding a single switch over date when all functionality would be based on SNOMED CT. Data Entry Data entry can be undertaken using a number of methods within EMIS Web. EMIS s intention is that data entry using a code-picker (wherever used in the application) will allow a user to: Enter native SNOMED CT codes (these can also be copied and paste from published guidance); Enter existing Read v2 codes Search on text to find SNOMED CT descriptions: via a search on any synonym or via the entry of partial words, in any order. FSNs 1 are not shown in the results list, however the hierarchy where the concept is located, is visible. From the results list, users can simply double click to enter the term into the record or they can select a term and navigate to the term required via the SNOMED CT hierarchy. The screen layout is very similar to current code-picker screens in EMIS Web. Via their code picker, EMIS plan to show search results from all of SNOMED CT, but when data entry is required to be in scope of the GP subset 2, users will only be able to select a SNOMED CT term from within this subset. A code may be displayed that is not within the subset; however it will be disabled for the purpose of selection. Users can trial this functionality by visiting the EMIS support centre where the trial version is available. ELearning on how to use the browser will also be available. EMIS have applied the same design principles to the SNOMED code picker as their Read code picker to help users with the transition. Data entry will be unchanged, other than SNOMED CT will be the clinical vocabulary supporting data entry in place of t Read. Upon entering text, users may see more options than they currently experience. This is due to the greater volume of codes in SNOMED CT; 1 The Fully Specified Name is an unambiguous human readable description of a SNOMED CT Concept e.g. Hematoma (morphologic abnormality) is the FSN of the concept that represents "hematoma". 2 The GP subset is provided in the TRUD pack NHS Data Migration and includes maps from SNOMED CT to Read. There are two versions: one for Read v2 and one for CTV3 Copyright 2017 Health and Social Care Information Centre. 4
however, the number that matches the words entered, should not be many more than currently experienced. EMIS local codes will still be present in the system. Where a SNOMED CT concept 3 exists that has the same meaning as a current local code, EMIS have endeavoured to map it to the appropriate SNOMED CT description. During the last two years, EMIS have also been making SNOMED CT descriptions available within their system via local codes. This means that these will be mapped to the appropriate SNOMED CT descriptions within the system Viewing historical content When a user views historical data, there will be a SNOMED CT code associated within the system for each Read code. The text on the screen will be the Read term text selected at the time of data entry. Users will however, be able to view the alternative SNOMED CT code/description through the details section in the consultation screen. This enables new searches written in SNOMED CT, to access data captured in Read. Templates From the 1 st April 2018 new templates must be created in SNOMED CT to accommodate new business requirements (e.g. QOF rules) that may require codes/terms available in SNOMED CT only. The availability of tools to support the creation of new SNOMED templates will depend on the EMIS roll-out plan. The functionality will only be available once switched on for each practice. Existing Read code templates will continue to work with the Read codes by mapping to appropriate SNOMED CT codes using the national mapping tables 4. The EMIS Web system enters the native EMIS code into the record and this is designed to enable the appropriate SNOMED CT code (and Read code) to be identified. New templates can only be created using the SNOMED CT vocabulary and/or EMIS local codes. While existing templates will continue to work as they do now, data that is returned will be based on the SNOMED CT hierarchy. End users are encouraged to review all their local templates over a period of time to ensure they continue to meet requirements and to check if a more appropriate SNOMED CT codes is available. EMIS will refresh all web library templates in SNOMED CT but not user developed templates. User developed templates will be the responsibility of the template developer or those that commissioned the template. However, all existing user developed templates will continue to operate. Searches/Reports/Protocols Existing searches/reports will continue to run when the system has transitioned to SNOMED CT. Where new coded data is required for inclusion in search/report and is within the GP subset and thus has a Read equivalent, the search will select such records. 4 Mapping tables provide a map from a Read term to a SNOMED CT description. For more information see the Fact Sheet in Delen. Copyright 2017 Health and Social Care Information Centre. 5
Where new coded entries are needed which do not have a Read equivalent, these will not be included in an existing Read defined search. Users will run searches at risk if these are not reviewed in order to validate that all patients have been selected. NHS Digital are communicating in their webinars, and are making clear New searches/protocols/reports will be written in SNOMED CT as it will not be possible to write a new search/report in Read v2. However, it will be possible in EMIS web to update an existing Read v2 search/report to one that runs as a SNOMED CT search/protocol/report. Users will be able to take an existing Read report, compare the search against the SNOMED hierarchy and make the changes required. They will then be able to save as a SNOMED version. Further Information on how to do this will be provided by EMIS through training and communications. EMIS plan to provide the ability for users to extend existing local searches/protocols/reports to the full SNOMED CT dictionary so users can compare the existing search to the SNOMED CT hierarchy. This will make updating existing searches much easier. This functionality will be available to users to view prior to go live via EMIS s support centre using elearning. EMIS concepts, national reports and decision support tools will be updated to SNOMED CT by EMIS and each will represent a SNOMED CT query over the set of full pre-coordinated 5 SNOMED CT codes. Data Extracts APIs 6 and data extracts will contain two additional fields (in many specifications these already exist but have previously not held any content) with the SNOMED CT concept id 7 and the SNOMED CT description id 8 as well as the Read codes (when there is a Read equivalent). Where newly entered SNOMED data does not have a Read equivalent, the fields that relate to the Read code and term id will contain null. Original text term will still be provided. EMIS partner APIs, IM1 and GP Connect will include SNOMED CT codes ahead of deployment as these data items are already a requirement of those specifications. These will start to flow before the end users have entered data with existing Read codes by utilising the associated SNOMED CT codes from the national mapping tables. Organisations will still also receive the Read codes. When will communications on changes within the system start to be sent from the supplier? EMIS currently provides end users with SNOMED CT information and a list of FAQs within their on-line support centre. EMIS have also communicated with all their partner programme suppliers. EMIS will work with their users via the NUG plus and other available channels to ensure their customers and stakeholders are fully informed of progress. What will happen to existing local codes? Many local codes in EMIS already have a SNOMED CT equivalent and this will be managed 5 Pre-coordinated expressions use a single SNOMED CT identifier for a clinical expression 6 Set of functions and procedures that allow different systems to interface with each other 7 SNOMED CT Concept ID is a unique numeric identifier that represents a clinical idea. 8 SNOMED Description ID is a unique numeric identifier and connects a concept with a human readable term Copyright 2017 Health and Social Care Information Centre. 6
by the EMIS terminology service. All new local codes are checked against SNOMED CT and allocated a SNOMED CT code if one is available; text for such codes aligns with that in SNOMED CT. How long do you plan to keep dual coding going beyond 1 st April 2018? Dual coding of content that has an equivalent Read code will continue indefinitely. New SNOMED CT codes without a Read equivalent will only be stored as SNOMED CT. When will we be able to access the code picker for providing training ahead of the change? This is available to download from the EMIS on-line Support Centre. Will we be able to design new templates, reports, business rules ahead of 1 st April 2018, and if so when is that expected? It will be possible to review the new functionality ahead of a system deployment through training materials. Functionality providing users the ability to design new templates, reports and business rules will be available on the live system. EMIS will communicate when this is available. The dual coding approach will allow users time to change these aspects of the system for when new terms only available in SNOMED CT are required. What training will suppliers provide and when will it be available? Training will be provided ahead of any system deployments using EMIS elearning. Will users still be able to request local codes? The use of local codes is discouraged unless absolutely necessary as these cannot be transferred to another system, other than as text. It will, however, still be possible to request local codes. Will any additional specialist training be available, if so when and what is the cost? Specialist training will be available from EMIS by request. This could include training on a subject that an organisation would like to explore beyond the training already available to users. An example of this could be creating data input templates. Costs will be determined depending on the nature of the training but will align with current training costs. Where current Read codes have text alongside the code, we assume that will still be the case? This functionality will be unaffected by the implementation of SNOMED CT: the text will still be visible in historical data and it will be possible to add text alongside a SNOMED CT code in a similar way Copyright 2017 Health and Social Care Information Centre. 7
In relation to Datasets for common events (e.g. review of chronic conditions), will that part of current system be converted by suppliers? EMIS will develop SNOMED CT datasets for all common events. Is it possible to get stats reports from suppliers in relation to data that cannot be mapped? It is possible to do this within EMIS Web already. A practice may want to report on data items that cannot be mapped with a view to improving their data quality; they can create an aggregate report on the clinical codes. Reference the session in the on-line support centre for problem code usage audit. https://supportcentre.emishealth.com/help/reporting/population-reporting/problem-code-usage-audit/ Is it possible to get the code usage frequency data for our CCG only, is it possible to get this on a practice by practice basis? See section above on stats reports; this is possible with current EMIS functionality. Will suppliers provide a toolkit /checklist as part of the transition? Yes, as part of the deployment approach EMIS will provide a practice checklist, this will include, for example, training required ahead of a deployment. Recommended training will be indicated by role and types of tasks undertaken (e.g. writing a report). When will QOF queries be run using SNOMED CT? QOF for 2017/18 will be run using the business rules as specified in Read v2. EMIS as part of their testing will also run QOF using the SNOMED CT rules but these will not be used to provide national data for 2017/18. QOF for 2018/19 will be run using SNOMED CT business rules. QOF business rules for 2018/19 will only be provided in SNOMED CT. Any new SNOMED CT codes in scope of QOF (and thus outside of the GP subset) will be available to end users for data entry as soon as possible after the SNOMED CT release. The normal GPSoC required release update timeframes is 2 months. Any local/regional QOF prediction functionality required to be able to take account of new SNOMED CT codes that do not have Read equivalents, will need to be reviewed by those providing such functionality.. If end users use such functionality, it is recommended they ensure this is happening for their practice. Will enhanced services reports be run in Read 2017/2018? As with QOF, enhanced service reports will be run in Read v2 for 2017/18, and in SNOMED CT for 2018/19. Extending beyond the GP subset Copyright 2017 Health and Social Care Information Centre. 8
New content required by the business must be recordable in the clinical system using SNOMED CT following practice deployment. New codes will only be issued in SNOMED CT (e.g. when a code is required for a new vaccination). Further information about EMIS s plans to extend beyond the subset will be communicated in the near future. The Joint GP IT expert reference group have advised that there will not be a nationally maintained GP subset (i.e. updated each SNOMED release). As GP services evolve and vary from practice to practice, it is felt this is not possible to do this in a reliable way. The code picker in EMIS Web however, has been designed to enable GPs to find the term they require quickly. GP2GP Data entered in SNOMED CT will appear in the GP2GP message using SNOMED CT codes; this is a current requirement of GP2GP. GP2GP will be tested and assured as part of the assurance being undertaken by NHS Digital How will systems such as decision support handle SNOMED CT? Clinical decision support within the supplier system and Prescribing Decision support systems will take account of SNOMED CT codes beyond the current GP subset from 1 st April 2018 release. EMIS provide the prescribing decision support within their system and work is underway to ensure this works appropriately with SNOMED CT data. Deployment approach Deployment will be undertaken using EMIS standard deployment approach. This will take approximately two months and practices will be informed when their deployment is scheduled after successful first of type deployments. Practices will be provided with checklists to enable them to appropriately prepare for the roll-out ahead of time. For information: The functionality for SNOMED CT will be rolled out ahead of it being switched on in a practice. Practices will be informed of when their planned switch-on is. First of type testing will be undertaken. NHS Digital will assist EMIS during first of type testing and ensure a fast response helpdesk is available during this time. Copyright 2017 Health and Social Care Information Centre. 9