How we use SNOMED CT to deliver better care at Birdie
At Birdie, we are committed to building a society where people can age with confidence. We want to help people explore ageing on their own terms, keeping individuals happier, healthier, and support them to live at home independently for longer.
A big part of addressing this involves understanding the wider picture of contemporary health and social care provision. Not only do the aims expressed above form a central tenet of the NHS’s Five Year Forward View, but at Birdie we strive to harness tools to improve interoperability (ensuring our system works well with other systems). One of these tools is called SNOMED CT.
What is SNOMED CT? Where is it used?
SNOMED CT stands for SNOMED Clinical Terms. It is a structured clinical vocabulary for use in any electronic health record (EHR). It is the most comprehensive and precise clinical health terminology product in the world, the benefit of which is data can be shared across health and social care settings and providers. EHRs represent a massive shift in healthcare provision. As notes become less symptomatic journal and more precision-based observation, incorporating readings and reports, EHRs are much more suited to tracking this data and turning information into knowledge. In addition, EHRs are much less likely than paper to be lost, accidentally defaced or damaged, or contain errors from copying over, for example, someone’s date of birth or hospital number.
Unfortunately, the many different EHR systems used in UK and global healthcare aren’t often able to interact with or understand each other. This leads to duplication of information on different systems, and a lot of writing up, tracking down, or attempting to correctly consolidate this information. A single electronic health record using the same vocabulary throughout, in comparison, would have none of these issues, and that’s what the NHS is working towards.
How does SNOMED CT work?
SNOMED CT (hereafter just SNOMED) is essentially a vast reference list of words. These words are how we can classify everything in an EHR. The idea is not dissimilar to how photos work on social media sites; you can tag all the ones of your face, and then with a click you can see only “photos of you”. A carer could write their usual care note using the Birdie app, noting that the client had constipation. Our system would know to “tag” or “codify” this word with the related SNOMED concept, and with a few clicks the care manager in the office could be able to see “all occurrences of constipation for this person in the last 30 days”.
SNOMED works by classifying information and ensuring we are all using the same vocabulary. In human language, everything is described using everything else; it is “an essential part of communication to refer to ideas.” As Dr. Gavin Jamie, a SNOMED specialist, put it:
“Even if you’ve never met a hippopotamus, you would be able to identify or recognise one because you are familiar with the concept of them. […] But the naming and concept mapping needs to be specific — if we can’t agree on the meaning then we won’t have much idea about the message.”
Concepts are the fundamental building blocks of SNOMED; there are 311,000 of them currently in use, and each one has its own unique identification number and Fully Specified Name. For example, the concept of a hernia has the ID of 414403008, and FSN of Herniated structure (morphologic abnormality). SNOMED follows a tree-like taxonomy where concepts broadly follow a “IS A” type-flow. For a hernia, it follows that it IS A Protrusion, which IS A Mechanical abnormality, which in turn IS A Morphologically abnormal structure. A hernia can also have its own “children”, going further down this tree and becoming more specific:
SNOMED concepts can be related to each other to build up more precise descriptions using relationships. Relationships themselves don’t store information, but they make it possible to define a condition or behaviour more clearly. There are approximately 1,360,000 relationships currently in use, which highlights all the potential ways in which concepts are currently related to each other. These two primary mechanisms improve the process of digitally recording health (and, in our case, social care) information: concepts enforce consistency, and relationships allow clarity.
The way SNOMED concepts classify the human condition falls into a handful of “root” concepts. Each of these primitive concepts forms the foundation on which all other concepts are built, and is the head of its own, entirely separate tree — so you can see why relationships are needed to link concepts. These fundamental concepts are: Body structure, Clinical finding, Environment or geographic location, Event, Observable entity, Organism, Pharmaceutical or biological product, Physical force, Physical object, Procedure, Qualifier value, Record artefact, Situation with explicit content, SNOMED CT concept (metadata), Special concept, Staging and scales, and Substance. A described concept can only belong to one of these fundamental concepts.
Hopefully, this has given you an understanding of how SNOMED works at a very high level. Now we’re going to unpack why it’s useful to Birdie.
What do we mean by ‘turning information into knowledge’?
Data becomes information through context and meaning, and information becomes knowledge through application of human experience. Dots on a graph are just dots until you know what the axes on the graph read, and when you can then apply this information to a specific person, you’ve suddenly got a wealth of knowledge.
SNOMED is currently primarily used to codify healthcare notes, for example at your GP surgery, in A&E departments, and certain medical specialties. As aforementioned, it reduces the variability of how clinical notes are recorded, and means clinicians can build up a sort of “biography” of a person’s health using standardised vocabulary. However, this currently doesn’t happen so much in social care, primarily because care notes are currently captured on paper. Birdie supports care agencies to make the move from paper to digital, but we don’t stop there.
If we codify words or items in a care record or EHR, we are then able to interact with that data — which can be really helpful in supporting clinicians and carers. If Birdie is able to codify information about an elderly person living at home — where many elderly people spend their time — we can start to turn information (“5 visits to the toilet in 2 hours lasting an average of 4 minutes each time”) into knowledge (“Brenda has visited the toilet more frequently than usual in the last 2 hours; given the frequency and her reports of discomfort and inability to pass urine, it may indicate a Urinary Tract Infection”). There are SNOMED concepts for dysuria (pain when passing urine), confusion, and unusual-smelling urine, all of which are potential indicators of a UTI in older adults, especially when happening in conjunction. Combined with the care notes which our carers already collect, this codified data can now be easily read by another system (for instance, if Brenda were to be admitted to a hospital where they also use SNOMED in their notes). We aren’t quite there yet with UK healthcare, but we are well on the way.
In computer science, there’s an acronym called “GIGO” — Garbage In, Garbage Out. We want to ensure that not only do we push for electronic capturing of data, but we record it to the highest, most interoperable, and useful standard possible.
Why does it matter?
There are currently 1.5 million people working in social care (and 6.5 million unpaid carers) in the UK alone; the United Kingdom Home Care Association (UKHCA) estimates that around 249 million hours of home care are delivered in England each year. Put simply, one in ten people in the UK is a carer, and this number is rising. People are living longer, with multiple health conditions, and receiving more care. And yet — very little (if any) data is collected from these care visits which could directly impact and improve the quality of care. We believe this should be a priority.
What does better care look like?
Birdie is focussed on building a world-class digital care companion. This enables care agencies to provide the excellent care they already do, but makes the process easier and quicker for them. By providing digital versions of everything they already use (medication manager and eMAR chart; list of tasks for each care visit; being able to raise alerts quickly, and much more) we can support them. One way Birdie can further support them is taking all that amazing data they collect as a by-product of doing their job and give them back helpful information.
As aforementioned, the digital social care landscape has much less electronic data in it than its health care counterpart. However, there is potential. SNOMED is the biggest system in the world of its kind. SNOMED also has the capacity to make what it calls “subsets”, which are “sets of concepts to be used in specific contexts” to avoid people having to DIY their own descriptions again and again. It would be fantastic to see a subset created specifically for the care industry.
The less time clinicians and carers are spending writing down notes, the more they can support and care for the people who need it. Carers and care managers are deeply committed to providing outstanding face-to-face care, and we are similarly committed to making that job as smooth and simple as possible for them. Using SNOMED, we can make sure we are planning for the future of digital social care.
Special thanks to Dr Gavin Jamie.
