I am Kent A. Spackman, MD, PhD, Associate Professor of Pathology and Medical Informatics at the Oregon Health Sciences University. Today I am here representing the College of American Pathologists (CAP) where I serve as the Scientific Director of the SNOMED International Division. On behalf of the CAP, I thank you for the opportunity to appear before the National Committee on Vital and Health Statistics’ (NCVHS) Subcommittee on Standards and Security. As the NCVHS turns its attention to standards for the patient medical record and the electronic exchange of such information, the CAP offers the following as guidance in this effort.
The CAP is a not-for-profit medical society serving nearly 16,000 physician members and the laboratory community throughout the world. The CAP is the world’s largest association composed exclusively of pathologists and is widely considered the leader in laboratory quality assurance. The CAP is an advocate for high quality and cost-effective patient care. Accordingly, the CAP has invested in several initiatives to ensure the delivery of quality clinical services. SNOMED® is one of these.
SNOMED, the Systematized Nomenclature of Medicine, is a comprehensive controlled reference terminology designed to encompass all of the terms used in medicine, including procedures and diagnoses. The CAP has more than 30 years of experience in the development and ongoing maintenance of a controlled clinical terminology that extends well beyond just the interests of pathologists. The CAP Committee on Nomenclature and Classification of Disease initiated this CAP initiative in the 1950’s.
The CAP launched its first work of clinical nomenclature in 1965 with the introduction of SNOP, the Systematized Nomenclature of Pathology. SNOP was designed as a comprehensive and flexible tool for those pathologists interested in the storage and retrieval of medical data and to serve as a means of preparing population-based epidemiological studies.
The CAP hoped that the coding work was sufficiently comprehensive and flexible to be useful to other disciplines and health care professionals. This was first proven true in 1974 with the introduction of an expanded 44,000 term vocabulary known as SNOMED and has continued to be reinforced in subsequent editions of the terminology.
By 1993, the CAP had expanded the scope of SNOMED to more than 144,000 terms. In development for more than seven years, the third edition of SNOMED was recognized as a work of enormous significance because it provided a multi-dimensional, structured nomenclature for indexing medical diagnoses and treatments. The classification of terms, placed within their natural hierarchies, was considered a major advancement in medical informatics and facilitated the development of medical software for the coding of electronic patient records.
Standardized medical vocabulary remains central to an organization’s ability to gather clinical information consistently for patient care, to retrieve information for disease management or research, as well as to conduct outcomes analysis for quality improvement. This position was publicly reinforced by a leading expert in medical informatics, Chris Chute, MD of the Mayo Foundation when he stated, “The single greatest obstacle to comparable data remains medical terminology. Failure to adopt and embrace a common terminology will doom outcomes research and data-driven clinical guideline development.”
While the CAP recognizes that no system today captures all clinical concepts, independent studies have demonstrated SNOMED to be one of the most complete reference terminologies in use today for the clinical environment.1,2 Thus we believe that SNOMED, the comprehensive, controlled vocabulary covering diseases, clinical findings, etiologies, therapies, procedures and outcomes, is the central component of the solution.
Unlike code sets used primarily for administrative and reimbursement purposes, SNOMED was designed for clinical applications and for detailed evaluation of patient data. Administrative terminologies work well for their intended purposes (e.g. billing, coding diseases/diagnoses for statistical purposes and reporting medical services and procedures). However, they lack the detail necessary to document the complete clinical encounter during illness or preventive care, as well as to assess the quality of patient outcomes. Administrative terminologies are not designed to represent the details of clinical documentation, and therefore do not fit all needs of the clinical environment.
The purpose of SNOMED is to index, store and retrieve detailed, clinical information about a patient in computer readable format. To ensure clarity of meaning, consistency in aggregation and ease of messaging, SNOMED’s design is based on the premise that a detailed and specific nomenclature is essential to accurately reflect the complexity and diversity of information found in a patient record. However, SNOMED is not, strictly speaking, a classification system. Nor is it the intent of the CAP to devote resources to the development of classification systems for diseases, diagnoses and medical procedures. These systems already exist and are widely accepted.
The granularity of concepts contained within SNOMED, which now number more than 157,000, can easily be linked to the broader classifications used for statistical and administrative purposes, but its applications and benefits extend far beyond these needs. The compositional nature of SNOMED and its hierarchical systematized structure transforms the notion of coded vocabulary into a powerful tool for telemedicine, outcomes analysis, cost-effectiveness studies, knowledge based practice guidelines, decision support systems and comparison studies of health care plans.
SNOMED is currently mapped to ICD-9-CM codes to facilitate health reporting and statistical analysis. This mapping has provided one point of reference for the coding of disease categories. SNOMED also contains a set of concepts and codes that fully support compatibility with MEDDRA, the Medical Dictionary for Drug Regulatory Affairs. A mapping to CPT-4 has begun in collaboration with the AMA.
SNOMED and LOINC are converging. This strategic alliance combines the strengths and uniqueness of SNOMED as a reference terminology with LOINC’s highly specific codes designed for message transmission. For example, the detailed codes for laboratory tests provided by LOINC are mapped to the SNOMED procedure code hierarchy and to the appropriate atomic SNOMED codes for analytes, body sites, organisms, and so forth.
Synergies with standards organizations are of high importance for SNOMED. The CAP is a member of HL7 and actively contributes to the coordination of HL7 messaging structure and SNOMED content. The HL7 vocabulary committee has voted to recommend SNOMED as one of the approved vocabularies for use in HL7 messages.
Another alliance fosters the SNOMED DICOM Microglossary. Developed at the request of the American College of Radiology, the DICOM Microglossary contains 24,382 terms and term codes. Using SNOMED as a foundation, the DICOM Microglossary specifies terminology that enables interoperability between biomedical imaging systems.
Finally, to further address the needs of SNOMED users, a number of other microglossaries (e.g. Pathology, Signs & Symptoms, Teratology, Neoplasms and Dentistry) have been developed. Also, the first of what will be an annual SNOMED Users Group Meeting was held in November.
The CAP is committed to the long-term development and enhancement of SNOMED as a work of medical health care nomenclature. This commitment was reinforced in September 1997 when the CAP announced its ambitious five-year strategic plan for SNOMED, which included more than $17 million in funding for its continued development.
A separate, not-for-profit operating unit, SNOMED International, oversees the daily administration and maintenance of SNOMED. It is staffed by a multi-disciplinary team that includes individuals with backgrounds in medical informatics, clinical medicine, laboratory medicine, pharmacy, nursing and education. The CAP, through SNOMED International, is committed to the excellence of patient care through the development of a scientifically validated reference terminology that enables clinicians, researchers and patients to communicate worldwide, across medical specialties and sites of care.
The CAP has implemented a policy of minimal barriers for the use of SNOMED, which is a proprietary work of the CAP. Implementation of this strategy includes the simplification of the license agreement, pre-qualification of potential users and nominal royalties based on the use of SNOMED. As an example of these initiatives, the CAP has made SNOMED available to the National Library of Medicine for research purposes on a royalty free basis. Significant resources, which include extensive and carefully conducted comparative modeling techniques, are required to ensure that SNOMED remains scientifically accurate, comprehensive and current. Therefore, nominal royalties are charged for use of the terminology.
The overriding focus for SNOMED is quality. Within the CAP governance structure, SNOMED is the direct responsibility of a group known as the SNOMED Authority. Currently comprised of six CAP members, four members of the CAP executive staff and two consultants. The six CAP members are academic administrators, informatics experts and practicing pathologists.
The SNOMED Authority reports to the Board of Governors of the CAP. Recognizing the importance of stakeholders outside the pathology community, the CAP Board approved the expansion of the Authority for 1999. The addition of these members will strengthen the expertise in clinical medicine and international terminology.
It is the CAP’s strategy to extensively involve the widest possible representation of clinicians in the definition and validation of SNOMED’s content. Participation in the development of SNOMED continues to include the involvement of diverse clinical groups as well as medical informatics experts.
The SNOMED Editorial Board is responsible for the scientific direction, editorial processes, and scientific validity of the content of SNOMED. The Editorial Board consists of both clinical content experts and medical informatics experts, the majority of which come from outside the CAP. In addition, liaisons from numerous associations such as the American Nursing Association (ANA), American Dental Association (ADA), American Veterinary Medical Association (AMVA), and American Academy of Ophthalmology (AAO), and government agencies such as the Centers for Disease Control and Prevention (CDC), reflect the vision of SNOMED as an integrated vocabulary useful for dentistry, nursing, veterinary medicine, radiology, ophthalmology, public health and other clinical specialties and compatible with standards such as HL7 and Digital Image and Communications in Medicine (DICOM).
One role of the Editorial Board is to establish and enforce quality standards regarding scope and structure of SNOMED content. Development of the content by a team of internal and external modelers follows a documented scientific process focused on reproducibility, understandability and usefulness. Content is defined and reviewed by multiple clinician modelers. Conflicts between the modelers are resolved through an interactive process, based on achieving agreement and consensus, before being integrated into the knowledge base. As necessary, additional experts are consulted to review the content. Such is the case with, for example, the CDC’s review of the names and relationships of bacteria that are named in the Living Organism axis. Final decisions about both content and process rest with the Editorial Board and the SNOMED Scientific Director.
As part of its long-term commitment to the quality of care, the CAP will premier the next generation in nomenclature in June, 1999. SNOMEDÓ RT3, under development in collaboration with health care providers in Kaiser Permanente for more than a year, is ready for beta testing by selected system vendors and end users. SNOMED RT, a reference terminology and knowledge base, underscores SNOMED’s integral foundation for the computerized patient record. It combines the granularity and comprehensiveness of SNOMED terms and term codes with improved clarity of meaning. In SNOMED RT, non-ambiguity of meaning is made possible by its multiple hierarchies and explicit semantic definitions. The ability to represent a vast number of additional concepts is made possible by a compositional syntax.
SNOMED RT is actively maintained by a highly professional staff, in collaboration with a wide diversity of health care professionals, enabling the terminology to be reflective of the dynamic changes in health care. It is ideal for detailed coding of clinical concepts in the electronic patient record, in addition to retrieving and analyzing information at a higher level of aggregation for outcomes assessment, research and decision support. In addition, SNOMED RT facilitates electronic messaging and supports the linking of information across different computer systems.
SNOMED is widely used today, and its use is expanding rapidly. SNOMED licensees include systems developers, medical group practices, managed care organizations, medical libraries, insurance companies, research entities and government agencies.
Four major user segments have been defined based on applications benefiting from the use of SNOMED. The first user segment is composed of software vendors. SNOMED is already embedded within or enabled by a broad range of systems that include electronic medical records systems, anatomic pathology laboratory systems, clinical pathology laboratory systems and decision support systems.
The second user segment is that of the health care enterprise. Included in this segment are multi-hospital systems such as Columbia HCA, pathology laboratories, payer/provider systems, single location hospitals and medical and health information providers. As quality initiatives are implemented, SNOMED is experiencing high levels of interest and use beyond the surgical pathology laboratories where it has been the core vocabulary for coding findings contained on the pathology reports.
The third user segment is composed of government users such as the State Departments of Health, the Department of Defense (DOD), the Veteran’s Administration (VA) and public health service agencies such as the CDC and the National Cancer Institute.
The fourth user segment is comprised of managed care organizations, insurance companies, disease management companies, contract research organizations and pharmaceutical manufacturers.
The uses of SNOMED are extremely diverse. Today, SNOMED is used for mapping terminologies, standardization of clinical reports, encoding of medical concepts, transmission of normalized data, article search and retrieval, decision support, outcomes assessment, coding adverse drug reactions in clinical trials, surveillance reporting and assessment of physician utilization patterns. Applications continue to be identified, as more people become aware and knowledgeable of the benefits of SNOMED. Overall, SNOMED can contribute to improvement in patient care, reduction of errors inherent in data coding, facilitation of research and support of compatibility across software applications.
SNOMED is truly an international reference terminology and knowledge base. It is currently used in more than 25 countries worldwide and is being translated into 16 languages.
A reference terminology such as SNOMED benefits clinicians, patients, administrators, software developers and payers. SNOMED standardizes medical terms, allowing easy transmission of patient-related data across often diverse and incompatible information systems. It allows health care practitioners, allied health professionals, and health care institutions to collect and analyze data more effectively, compare the quality of health care being administered, develop effective treatment guidelines, and conduct important outcomes research.
SNOMED helps to provide structure and computerize the patient medical record and benefits both health care providers and patients. For patients, a reference terminology would provide health care providers with easily accessible and more complete information pertaining to the entire patient health care process (e.g. medical history, illnesses, treatments, laboratory results) and thereby result in improved patient outcomes. For health care providers, a reference terminology would allow for the identification of patients based on certain coded information in their records and thereby facilitate patient follow-up.
SNOMED helps software developers throughout the world to eliminate redundancy in coding and simplify mapping techniques. Software developers are able to rely on one primary source for reference terminology.
Third party payers benefit from the use of SNOMED. By standardizing data that is currently heterogeneous, SNOMED allows payers to review and process claims in a more timely manner. It provides a means to simplify administrative tasks and save costs in the process. Finally, if integrated into various quality programs, such as the National Committee on Quality Assurance’s HEDIS measures or the American Medical Association’s AMAP program, SNOMED will streamline the collection and analysis of the clinical information that forms the basis for these quality assessments.
Furthermore, SNOMED is critical for research. SNOMED encompasses key elements necessary for research such as granularity, comprehensive coverage, clinical detail and the ability to retrieve and analyze clinical data at a more abstract level. These and other features position SNOMED as an invaluable tool.
With this as background, I would now like to turn your attention to the CAP’s response to the specific questions presented by the Subcommittee for the hearing today.
As you are well aware, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) expands the charge of the NCVHS to include assisting the Secretary of HHS and the Congress in adopting standards to facilitate the electronic exchange of health information.
Today's hearing focuses on the twofold HIPAA mandate to NCVHS: 1) to study the issues related to the adoption of uniform data standards for patient medical record information and the electronic exchange of such information (HIPAA section 263(4)(B)); and 2) to report to the Secretary ... recommendations and legislative proposals for such standards and electronic exchange (HIPAA section 263(4)(C)).
The CAP believes that the legislative directive to NCVHS is fairly broad and, therefore, allows the committee the discretion to focus its efforts on what is currently happening in the marketplace, including recommendations of clinical code sets for those purposes. The environment in which health care data is generated and used, and applications for its use is constantly evolving, as noted by Congress in the HIPAA Conference Report. "The conferees recognize that technological innovation with respect to electronic transmission of health-care related transactions is progressing rapidly in the marketplace. The conferees do not intend to stifle innovation in this area. Therefore, the conferees intend that the Committee take into account private sector initiatives." This language appears to be recognition on the part of Congress that initiatives related to electronic exchange of health information have occurred primarily in the private sector and for support of such initiatives.
With the exceptions of initiatives such as the National Library of Medicine’s UMLS and the current collaboration between the DOD, VA, and the Indian Health Service to develop the Government Computer-based Patient Record (GCPR), the public sector has not taken the lead in this area. In contrast, several private sector initiatives have been implemented that advocate for and provide research to support the concept of widespread adoption of standard clinical terminologies for the computer-based patient record.
To its proponents, standard clinical terminology holds the promise of creating consistent communication across clinical specialties and sites of care, thereby facilitating clinical decision support, research and efficient care delivery. By providing a common basis of understanding, reference terminologies streamline communication and help to improve patient outcomes by eliminating miscommunication among health care providers. A reference terminology allows easy transmission of patient-related data across often diverse and incompatible systems. SNOMED is such a clinical reference terminology.
SNOMED is a multi-dimensional, structured nomenclature for electronically coding all elements of the patient medical record, including pathology reports. The SNOMED terminology is comprehensive with content coverage including diseases, clinical findings, etiologies, therapies, procedures and outcomes. As a reference terminology, SNOMED enables the computerized recording, storage, retrieval, and analysis of clinical information essential in order to compare information related to patient conditions and events.
The pathology community continues to be among the strongest supporters of SNOMED. However, SNOMED users are expanding. This is a testament to the comprehensive and multidisciplinary nature of the terminology. More and more systems developers and vendors, hospitals, group practices, managed care organizations, medical libraries, insurance companies, research entities and government agencies are recognizing SNOMED as an essential component of their total information needs. Globally, SNOMED is used in more than 25 countries.
The CAP believes that HIPAA has served as the catalyst to promote public sector leadership in the development of standards for the electronic exchange of health information and can be the fuel to provide the continued support of such efforts.
There may be several factors delaying the development and widespread implementing of uniform standards for patient medical record information and its electronic transmission. We offer the following for your consideration.
Until recently there has not been a clear understanding of the differences and relationship between user interface terminologies, administrative terminologies and reference terminologies. An interface terminology is defined as sets of words or phrases used to describe patient specific information in the words common to the recorder of the information. Structured data entry screens and clinic-specific sheets with check-off lists are examples of interface terminologies.
Administrative terminologies ordinarily specify groups of clinical concepts that have specific purposes. These are typically based on broad categories of diagnoses or disease states that have been established for epidemiologic purposes, or based on collections of medical procedures and services that require similar resource utilization. Typically, administrative codes are recorded and reported for reimbursement purposes and are utilized secondarily for statistical analysis. From this perspective, ICD-9-CM and CPT-4 are considered administrative terminologies.
In contrast, a reference terminology, such as SNOMED, supports the detailed coding of all relevant clinical activities and concepts, based on the observations and activities of clinicians, patients and/or their families. The reference terminology also provides a semantic scaffolding onto which the various terms used in health care are placed, making concept meanings explicit. This facilitates interoperability between a wide variety of systems and clinical records.
Reference terminologies support detailed clinical documentation for charting purposes, analysis of data at higher levels of abstraction for outcomes determinations, clinical decision support or other research purposes. Comprehensive, hierarchical clinical reference terminologies such as SNOMED are designed specifically to support both clinical and research applications. Furthermore, more detailed SNOMED concepts can be linked to user interface terminologies and can be combined to create pre-coordinated terms for ease of use without compromising the integrity of meaning.
Perhaps an example will help to illustrate the difference between an administrative terminology and a reference terminology. CPT code 58150 represents total abdominal hysterectomy with or without removal of tubes, with or without ovaries. That CPT code may be appropriate for reimbursement purposes because it groups procedures with similar resource utilization. However, whether or not a patient has one or both ovaries or fallopian tubes is a detail that must be made explicit for charting and research purposes but is not apparent from the CPT code. By virtue of its granularity, SNOMED enables documentation at such detailed levels. In addition, it can be linked, if desired, to locally accepted user terms for these procedures.
Without a clear understanding of the three terminologies, a logical approach on how to proceed in the development and widespread adoption of uniform standards for patient medical record information and electronic transmission has been virtually impossible. Slowly, the three types of terminology, their differences and their relationship to one another are being articulated and better understood. Each has its place, but only a clinical reference terminology can adequately support the clinical detail required for the computerized patient record.
In the 1980’s the health care system focussed on efforts to contain health care expenditures and costs. Under this approach the need did not exist for standards to provide detailed analysis, abstraction, retrieval, storage, etc. of health information. Statistical and billing codes were adequate. The sharing of information electronically across multidisciplinary care teams was not commonplace. Under this health care environment, health care information systems were primarily legacy systems built around individual providers for local needs.
Partially fueled by President Clinton’s failed health care reform efforts, in the early 1990’s there was large-scale recognition that cost-containment approaches had limited success and that the health care system needed to be looked at more comprehensively. What has emerged is a health care environment with an emphasis on evidence-based medicine, emphasizing mechanisms to determine the quality of services provided to patients and outcomes of care.
The health care environment of today has evolved into one characterized by an increasing need and demand for timely, reliable, and easily accessible health care information in order to make decisions. Current changes in the health care environment fueling this include: increasing pressure on health care enterprises to understand and manage the costs associated with patient conditions; hospital and health care facility mergers to create integrated delivery systems; managed care organizations shifting financial risk for patient services to provider organizations; and payer demand for information in order to access and compare the quality of various providers. Other health care systems such as that of the United Kingdom face similar challenges.
The current health care environment has fostered the need for standardized terminology that can create internal consistency within the electronic record, facilitate information sharing as well as support population based studies at a very detailed level.
The development of uniform standards for patient medical record information and its electronic transmission has been a slow process. Until the passage of HIPAA, the private sector had been hesitant to expend additional resources, time and dollars to move toward a standard terminology that ultimately would not be accepted by the government.
The private sector, in particular the academic community, medical associations and the vendor market, has embarked upon initiatives to overcome the obstacles preventing the development and widespread implementation of standardized terminology but these efforts have been limited and narrowly focussed.
For more than 30 years, the CAP has worked on developing and enhancing its SNOMED terminology. And although SNOMED was initially developed for a unique purpose, pathology applications, its comprehensive nature has enabled it to evolve into a terminology used by multiple specialties for care management, quality assessment, clinical research and public health reporting. After more than 30 years, SNOMED continues to meet the changing needs of the health care environment and continues to serve as the bridge between the administrative and clinical environment.
One of the advantages of SNOMED is its ability to stimulate convergence of terminologies to enable clinicians, researchers and patients to speak with one vocabulary across medical specialties, and sites of care. For example, SNOMED has been selected by DICOM for representing anatomical and other concepts in the reports that accompany images in electronic messages. Also in cooperation with the ADA, SNOMED has been revised to incorporate the dental terminology proposed by the ADA, integrating, among other things, the ADA’s CDT nomenclature with the SNOMED structure. To further ensure lack of overlap with the medical community, the ADA will be adopting a wide range of SNOMED terms to document co-morbidities that are not dental specific (e.g. diabetes). This cooperative effort also permits the ADA wide latitude in determining the content of dental diagnoses contained in SNOMED.
Through its formal liaisons to the SNOMED Editorial Board, the CAP continues to work internally and with professional organizations to improve the detail and clinical content coverage of SNOMED. The CAP is committed to continuing these many efforts to meet the needs of the users of clinical vocabularies.
Development, maintenance and coordination of terminologies is a costly process. In September 1997, the CAP committed more than $17 million over a five year period of time to the continued success of SNOMED. This financial commitment is a testament to the CAP’s overall dedication to the development of SNOMED as a scientifically validated reference terminology.
However, it is not certain if the CAP’s financial commitment alone will be adequate to ensure continuous evolution of the terminology to meet the ever changing needs of contemporary clinical practice. The development and implementation of reference terminologies benefits both the public and private sectors and therefore should receive support and resources from both sectors.
The CAP believes that there should be a public-private partnership in the development of and ongoing maintenance. The private sector has the appropriate and necessary expertise required to develop standards; therefore, the government may not need to play a large role in the development of standards. Government involvement, however, is crucial in the testing, formatting and funding for ongoing maintenance, directly or indirectly: providing the financial resources and mobilizing use and evaluation of standard reference terminology. For example, the government could adopt core, leading clinical terminologies for use in government related projects by the National Cancer Institute, CDC, VA, and the DOD. Through this mechanism, the government would be using its influence in the health care industry to push the market toward greater uniformity.
Without adequate government support, widespread development and implementation of uniform standard terminologies will continue to be delayed.
The CAP believes that SNOMED itself is an important component of a solution to the needs of patient record information and its electronic transmission. Other existing standards we have already mentioned, such as HL7 and DICOM, can also be very much part of the solution. We also believe that existing administrative terminologies (e.g. ICD-9-CM and CPT-4) and the terminologies that are developed and/or adopted to replace them (e.g. ICD-10-CM and CPT-5) will continue to be a part of the overall solution.
The CAP believes that the four focus areas selected by the work group are appropriate and will assist the NCVHS in meeting its HIPAA Congressional mandate. Of the four focus areas identified, however, we would argue that focus area three (coordination, maintenance, continuous availability, interoperability, accountability and clinical specificity) is a key issue and perhaps should receive greater attention.
Any health information system is only as good as the maintenance and coordination of the system and the commitment by the overseeing structure to its future. Updates to the system must be made in a timely manner, meet the needs of the users, be consistent with the ever evolving health care environment, and be developed by experts within the context of adequate resources. Coordination should occur across clinical domains and with vendors.
An additional issue the work group may want to include among its focus areas, perhaps as an element of item number three, is collaboration with other terminologies both in the US and abroad. The CAP believes that collaboration between terminologies is essential in order to decrease redundancy across different systems and users and to increase resource efficiency.
Through a more than 30 year history, the CAP has demonstrated its commitment to SNOMED as a scientifically validated reference terminology that meets these core requirements. Updates are currently made to SNOMED on a biannual cycle. Updates to SNOMED occur in an open process. Users have a vehicle for feedback through the SNOMED User’s Group. Coordination and collaboration are high priorities.
The scientific content of SNOMED and the editorial direction is governed by the SNOMED Editorial Board. In addition, liaisons from the following associations and government agencies have been appointed to serve on the Editorial Board: the AMVA, ADA, ANA, CDC, and AAO. This depth of representation and involvement on the Editorial Board reflects the CAP’s commitment to producing an integrated terminology useful for all clinical specialty areas.
SNOMED is currently crossmapped to ICD-9-CM. Additionally, the CAP has recently embarked upon collaboration with the AMA to crossmap SNOMED to CPT-4.
As part of its longer term strategy, the CAP recognizes the importance of international collaboration and convergence to enable data transfer and accurate communication across the globe. To that end, the CAP is in discussions with the National Health Service in the United Kingdom, developers of Clinical Terms V.3 formerly known as the READ codes. When brought to fruition, this partnership will further expand SNOMED’s scope beyond national borders and maximize utilization of resources available to develop a truly comprehensive and internationally accepted clinical terminology.
In conclusion, the strengths and benefits of SNOMED as a recognized leader in clinical reference terminology have been demonstrated over the span of many years. The CAP is clearly a strong advocate for high quality, cost effective patient care as shown through its long term commitment to the on-going development of SNOMED as a comprehensive, broad based nomenclature. That commitment has not and will not change. As an organization, the CAP envisioned the importance of standardized terminology to support quality patient care. Therefore, it has continued to enhance the structure and expand the scope of SNOMED to ensure that it is scientifically accurate and representative of the practice of medicine. The CAP is also committed to widespread availability and access to SNOMED with minimal restrictions and nominal cost.
This has been done without external influence. These efforts continue to evolve in response to dynamic changes in health care.
A clinical reference terminology captures the detail necessary to document care, retrieve data to perform studies and assess patient outcomes. The CAP believes that SNOMED is such a reference terminology and is consistent with the standards requirements for a comprehensive clinical code set necessary to collect and analyze data more effectively, compare the quality of health care being administered, develop effective treatment guidelines and conduct important outcomes research.
Thank you for this opportunity to present the views of the CAP.