HealthQik enables physicians and health-care professionals to utilize the latest EHR technology in making effective medical decisions with ease.

HealthQik provides the ability to exchange complete health information about a patient in real time. Accurate, up-to-date and thorough information naturally leads to a higher quality of care, from better diagnoses to reduced errors.

In effort to streamline processes, HealthQik worked closely with NRC India for use and implementation of SNOMED Clinical Terminology (SNOMED CT) standard and procured the SNOMED CT license to bring interoperability in healthcare.

• Collection of names and words
• Organized in a structure and logically consistent manner
• Relevant to the field of medicine
• Is the most comprehensive, multilingual clinical healthcare terminology in the world
• Is a resource with comprehensive, scientifically validated clinical content
• Enables consistent, processable representation of clinical content in electronic health records
• Is mapped to other international standards
• Is already used in more than fifty countries

History

• 1965 – the Systematized Nomenclature of Pathology (SNOP) was published by the College of American Pathologists (CAP) to describe morphology and anatomy
• In 1975, under the leadership of Dr. Roger Cote, CAP expanded SNOP to create the Systematized Nomenclature of Medicine (SNOMED)
• The most widely adopted version of SNOMED was SNOMED II, which was initially published in 1979.
• A major expansion and revision published in 1993 was called SNOMED International, or SNOMED 3.0
• Then in collaboration with Kaiser Permanente, CAP developed a new logic-based version called SNOMED RT, first published in 2000.
• Meanwhile, the Read Codes, developed originally in the UK in the 1980s by Dr. James Read, eventually evolved into Clinical Terms Version 3 (CTV3) under the National Health Service.
• A three-year project to merge the CTV3 and SNOMED RT was begun in September 1998 under the ownership of CAP. The result was the first version of SNOMED CT, released in January 2002.
• In 2007, the newly formed IHTSDO acquired the intellectual property rights to all versions of SNOMED.

Although SNOMED was originally an acronym for Systematized Nomenclature of Medicine, it lost that meaning when SNOMED was combined with CTV3 in 2002. The merged product was called SNOMED Clinical Terms, which was shortened to SNOMED CT.

IHTSDO considers SNOMED CT to be a brand name, not an acronym.

SNOMED CT Benefits:

• Benefits individual patients and clinicians
• Benefits populations
• Supports evidence based healthcare

SNOMED CT supports the development of comprehensive high-quality clinical content in health records. It provides a standardized way to represent clinical phrases captured by the clinician and enables automatic interpretation of these. SNOMED CT is a clinically validated, semantically rich, controlled vocabulary that facilitates evolutionary growth in expressivity to meet emerging requirements.

The use of Electronic Health Record (EHR) improves communication and increases the availability of relevant information. If clinical information is stored in ways that allow meaning-based retrieval, the benefits are greatly increased. The added benefits range from increased opportunities for real time decision support to more accurate retrospective reporting research and management.

SNOMED CT features:

• Is the most comprehensive, multilingual clinical healthcare terminology in the world
• Is a resource with comprehensive, scientifically validated clinical content
• Enables consistent, processable representation of clinical content in electronic health records
• Is mapped to other international standards
• Is already used in more than fifty countries

SNOMED CT is a core clinical healthcare terminology that contains concepts with unique meanings and formal logic based definitions organized into hierarchies.

SNOMED CT content is represented using three types of component:

• Concepts representing clinical meanings that are organized into hierarchies
• Descriptions which link appropriate human readable terms to concepts
• Relationships which link each concept to other related concepts

These components are supplemented by Reference Sets, which provide flexible features and enable configuration of the terminology to address different requirements.

Concepts

Descriptions

Relationships

Reference sets

SNOMED CT Hierarchies

SNOMED CT LOGICAL MODEL

SNOMED CT CONCEPT MODEL

The SNOMED CT concept model specifies the way in which SNOMED CT concepts are defined using a combination of formal logic and editorial rules. Concept model rules specify the top level concepts under which concepts are arranged in the subtype hierarchy and the types of relationships that are permitted between concepts in particular branches of the hierarchy.

Concept model – top level hierarchies

The top of the SNOMED CT hierarchy is occupied by the root concept (|SNOMED CT concept|). All concepts are descended from this root concept through at least one sequence of |is a| relationships. This means that the root concept is a supertype of all other concepts and all other concepts are subtypes of the root concept.

Below is a list of the Top Level Concepts with a brief description of the content represented in their branch of the hierarchy –

Clinical Finding – represents the result of a clinical observation, assessment or judgment and includes normal and abnormal clinical states (e.g. |asthma|, |headache|, |normal breath sounds|).

Procedure – represents activities performed in the provision of health care. This includes not only invasive procedures but also administration of medicines, imaging, education, therapies and administrative procedures

Situation with explicit context – represents clinical findings and procedures that have either not yet occurred, refer to a person other than the patient or have occurred at some prior time (e.g. |endoscopy arranged|, |family history of glaucoma|, |past history of myocardial infarction|).

Observable entity – represents a question or assessment which can produce an answer or result.

Body structure – represents normal and abnormal anatomical structures (e.g. |mitral valve structure|, |adenosarcoma|).

Organism – represents organisms of significance in human and animal medicine (e.g. |streptococcus pyogenes|, |beagle|, |texon cattle breed|).

Substance – represents general substances, the chemical constituents of pharmaceutical/biological products, body substances, dietary substances and diagnostic substances (e.g. |methane|, |insulin|, |albumin|).

Pharmaceutical / biologic product – represents drug products (e.g. |amoxicillin 250mg capsule|, |paracetamol + codeine tablet|).

Specimen – represents entities that are obtained (usually from the patient) for examination or analysis (e.g. |urine specimen|, |prostate needle biopsy specimen|).

Special concept – represents concepts that do not play a part in the formal logic of the concept model of the terminology, but which may be useful for specific use cases (e.g. |navigational concept|, |alternative medicine poisoning|).

Physical object – represents natural and man-made physical objects (e.g. |vena cava filter|, |implant device|, |automobile|).

Physical force – represents physical forces that can play a role as mechanisms of injury (e.g. |friction|, |radiation|, |alternating current|).

Event – represents occurrences excluding procedures and interventions (e.g. |flood|, |earthquake|).

Environments and geographical locations – represents types of environments as well as named locations such as countries, states and regions (e.g. |intensive care unit|, |academic medical center|, |Denmark|).

Social context – represents social conditions and circumstances significant to health care (e.g. |occupation|, |spiritual or religious belief|).

Staging and scales – represents assessment scales and tumor staging systems (e.g. |Glasgow Coma Scale|, |FIGO staging system of gynecological malignancy|).

Qualifier value – represents the values for some SNOMED CT attributes, where those values are not subtypes of other top level concepts. (e.g. |left|, |abnormal result|, |severe|).

Record artefact – represents content created for the purpose of providing other people with information about record events or states of affairs. (e.g. |patient held record|, |record entry|, |family history section|).

SNOMED CT Model Component – contains the metadata supporting the SNOMED CT release.

Concept model attributes

Representing characteristics of a concept SNOMED CT attributes (or relationship types) are used to represent a characteristic of the meaning of a concept. SNOMED CT currently uses more than fifty defining attributes when defining the meaning of concepts. Each SNOMED CT attribute can be applied to concepts in one or more branches of the hierarchy. The set of concepts to which an attribute can be applied is called the ‘domain’ of the attribute. The permitted set of values for each attribute is called the ‘range’ of the attribute.

The Domain is the hierarchy to which a specific attribute can be applied

The Range is the set of SNOMED CT concepts that are allowed as the value of a specified attribute

Attributes used to define SNOMED CT concepts

The SNOMED CT defining attributes are used to represent the meaning of concepts in these 9 hierarchies:

• Clinical finding concepts
• Procedure concepts
• Evaluation procedure concepts
• Specimen concepts
• Body structure concepts
• Pharmaceutical/biologic product concepts
• Situation with explicit context concepts
• Event concepts
• Physical object concepts

SNOMED CT IMPLEMENTATION

SNOMED CT is useful for clinical documentation, as it supports the Representation of detailed clinical information, in a way that can be processed automatically. Realization of the capability of SNOMED CT to support clinical information and meaning based retrieval requires careful consideration of the actual setting, in terms of scope of use, record structure, data entry, data retrieval and communication.

IMPLEMENTATION EXAMPLES:

Clinical record applications

SNOMED CT can be implemented in a wide range of clinical record applications. These include systems developed for use with other code systems that have been adapted to support SNOMED CT as as systems designed with the assumption that SNOMED CT would serve as the primary terminology

Clinical decision support

Clinical decision support is defined broadly as a clinical system application or process that helps health professionals make clinical decisions to enhance patient care.

The use of SNOMED CT makes clinical information available in a computable form which can be queried and used to trigger decision support rules and prompts. The hierarchies of SNOMED CT enable complex reasoning to support decision support rules. For example, in SNOMED CT the concept |stroke| is synonymous with |cerebrovascular accident| and subsumes all lower level concepts including |paralytic stroke|, |thrombotic stroke| etc. This means that decision support queries are easier to develop and implement because they do not need to identify all the individual terms and codes which may be relevant.

Enabling interoperability

Information can be recorded using SNOMED CT concepts and descriptions that are independent of the clinical information system being used and either independent of or tied to the context of use, depending on the user requirements. SNOMED CT is a common clinical terminology covering a wide range of requirements and its use. SNOMED CT allows meaning-based computation to be applied to information in messages sent between systems, and provides a foundation for interoperable interpretation of clinical information.

Reporting

Information encoded as SNOMED CT concepts is semantically consistent. In other words, there is one unique SNOMED CT identifier representing each separate meaning. This lends itself to reporting through specifying the SNOMED CT identifiers of interest. SNOMED CT supports recording at appropriate levels of detail and using relevant terms. This also means that reports can be generated at the appropriate levels of detail using relevant terms for display in the report.

SNOMED CT international release content development

SNOMED CT‘s content development is based on four basic principles that have and continue to guide development of its clinical content and technical design including:

• Development efforts must encompass broad, inclusive involvement of diverse clinical groups and medical informatics experts
• The clinical content must be quality focused and adhere to strict editorial rules
• The quality improvement process must be open to public scrutiny and vendor input, to ensure that the terminology is truly useful within health care applications
• There must be minimal barriers to adoption and use

The three basic operational criteria that help determine whether new content is following the principle of creating and sustaining semantic interoperability are that SNOMED CT must be:

• Understandable: The meaning must be able to be communicated, to be understood by an average health care provider without reference to inaccessible, hidden or private meanings
• Reproducible: It is not enough for one individual to say they think they understand the meaning. It must be shown that multiple people understand the meaning in the same way
• Useful: The meaning must have some demonstrable use or applicability to health or health care

Requesting content additions and changes

IHTSDO provides a request submission service to gather and process requests for additions and changes to the content of the SNOMED CT International Edition. This service is directly accessible by National Release Centers (NRC) in Member countries and recognized Terminology Authorities within organizations with whom IHTSDO is actively collaborating. Organizations within Member countries can submit their requests for additions and changes to the National Release Centre.

EXTENSION AND CUSTOMIZATION

SNOMED CT is designed to allow the International Edition to be enhanced by adding Extensions that address national or local requirements. Additional content required to support national, local or organizational needs that may not have international relevance or may not meet the editorial guideline for inclusion in the International Edition.

Extension content

Many clinical concepts are relevant in all countries, organizations and specialties but some concepts are relevant only to a particular environment. SNOMED CT is designed to allow the International Edition to be enhanced by adding Extensions to meet national or local requirements without compromising the main body of SNOMED CT. This is intended to meet the needs of different specialties and countries, regions, vendors and healthcare institutions.

The responsibilities of organizations that create an Extension and provide it for use by other organizations include:

• Maintaining Concept, Descriptions, Relationships, and Reference Sets that they create
• Inactivating these components as appropriate (duplication, ambiguous, outdated, etc.)

Reference sets

SNOMED CT has a broad clinical coverage and includes a depth of detail appropriate to a range of health care disciplines and clinical specialties. As a result, it has extensive content, different parts of which are needed in particular environments.

Reference sets can be used for many different purposes, including:

• Language and Dialects
• Maps to and from other code systems and classifications
• Subsets of concepts, descriptions or relationships
• Ordered list and navigation hierarchies

RELEASE SCHEDULE AND FILE FORMATS

SNOMED CT is distributed to IHTSDO Members and Affiliate Licensees as a set of downloadable files. Those wishing to implement SNOMED CT in software applications should understand the release schedule and the structure and content of the release files. Users should be aware that regular updates of SNOMED CT are made available and should be used in their systems to benefit from continuous improvements to coverage and quality.

Release schedule and process

The SNOMED CT International Edition is currently released twice a year on the 31st of January and the 31st of July. The release files are made available to Members in advance of the formal release date and Affiliate Licensees gain access either through their National Member or via the IHTSDO Affiliate Licensing system.

Release files and formats

Release Format 2 (RF2) is the primary format used for SNOMED CT release files. This format includes valuable additional data that was not supported by the earlier format.

Release types

The RF2 specification provides a history tracking mechanism within the distributed files. This enables different release types to be provided using the same file format and utilizing this mechanism to optimize installation and updating.

Full Release: A ‘Full’ release contains every version of every component that has ever been released prior to or in the specified Edition. This release provides a full historical record and can be used to obtain views of the state of any component at any point in time since its first release.

Delta Release: A ‘Delta’ release contains only those component versions created, inactivated or changed since the previous release. Adding a ‘Delta’ release to the previous version’s ‘Full’ release will update the installation to a ‘Full’ release of the current Version.

Snapshot Release:

A ‘Snapshot’ release contains the most recent version of every component released up to the time of the snapshot. The version of each component contained in a snapshot is the most recent version of that component at the release time.

In Snapshot Release files:

• Each SNOMED CT concept is held as a single row in the concept file. Each row represents a clinical concept
• Each description is held as a single row in the description

  file,and is associated with a single concept

• Each relationship, from a source concept to a destination concept, is held as a single row in the relationship file. Each row also refers to the concept that represents the relationship type

IHTSDO – THE ORGANISATION BEHIND SNOMED CT

International Health Terminology Standards Development Organization (IHTSDO)

is the international not-for-profit Organization that owns and administers SNOMED CT, and owns the rights to SNOMED CT and related terminology standards.

IHTSDO seeks to improve the health of humankind by fostering the development and use of suitable standardized clinical terminologies, notably SNOMED CT, in order to support safe, accurate, and effective exchange of clinical and related health information. The focus is on enabling the implementation of semantically accurate health records that are interoperable.

The purpose of IHTSDO is to develop, maintain, promote and enable the uptake and correct use of its terminology products in health systems, services and products around the world, and undertake any or all activities incidental and conducive to achieving the purpose of the Association for the benefits of the members.

National release centers

IHTSDO Members undertake a range of activities related to their involvement in the IHTSDO and their role in distributing, extending and supporting the use of SNOMED CT in their country. The Organisation or agency that coordinates this role in each country is referred to as a National Release Centre (NRC). National Release Centers provide a single point of contact for communications with IHTSDO and other IHTSDO Members. Within their own countries, NRCs manage the use of SNOMED CT and communicate with a range of stakeholders, including SNOMED CT Affiliate Licensees, healthcare institutions, clinical groups and end users.

HealthQik – About Us

HealthQik is a web and mobile-enabled healthcare platform that focuses on strengthening the doctor-patient relationship and enhancing patient loyalty by utilizing the latest technology to connect healthcare providers, patients, and data. By providing access to its online resources, HealthQik intends to make healthcare more accessible to the patients and more manageable for providers.

We help providers attract new patients through their visibility, real time availability and instant appointment booking. Our platform enables them to deliver premier experience through health reminders and digitizing patients medical health records.

Patients get the convenience to access their medical health records on the go that enables them to walk in hands-free and making it available to the doctors for better and faster care.

HealthQik empowers practices to thrive in the digital age by attracting and converting patients, improving patient experience, and streamlining front office operations.

HealthQik provides an all-in-one solution for patient acquisition, reputation management, retention marketing, and business insights.

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Our smart technology ensures that patients can find you online, verify that you are professional and legitimate, and easily book appointments. HealthQik also helps patients leave great reviews and generate word-of-mouth referrals online.