SNOMED-CT India and EHRs

Advantages and Disadvantages of using SNOMED-CT in India

SNOMED CT is considered to be the most comprehensive clinical healthcare terminology repository in the world. It is continually updated with releases twice a year. It can be mapped against ICD codes or used independently.

Some of the the advantages of SNOMED are obvious

It helps standardise how clinical information is logged and stored. This can then in turn be used for research and development. Imagine you as a hospital cater to 100 thousand patient encounters, how would you harness the available clinical information meaningfully. SNOMED can make big data analysis easier and in the years to come inform use of Artificial Intelligence (AI) in Healthcare in India.

For instance, it can be possible to parse all health records to search for terms that match concepts and clinical codes within SNOMED. Say one used the terms Hip Surgery and Embolism, one could easily identify patient’s who had both terms recorded in their data. A cohort of patients can be located easily and trends, correlations and causal associations established.

The disadvantage/s of including SNOMED in an EHR could be several –

  • Time and cost to integrate this in to an EHR
  • Given there are over 400K clinical concepts, it can be a nightmare trying to ensure conformity among clinicians which codes are used when? To ensure this, systems start becoming prescriptive about what is coded and how – the impact of this potentially being that the clinicians start to spend more time in front of computer screens and less so in face-face contact with the clinicians.
  • The applications can become complex and slow to use and the user interface less friendly, a common cause for clinicians to become alienated from use of electronic health care records.

SNOMED and the Indian context – given how poor the reach and availability of EHRs in individual doctor practices and small clinics and hospitals in India, at this time, fascinating and attractive as it seems, the flirtation with big data and AI perhaps is misplaced. What is needed in the Indian context first is to mandate and encourage all medical professionals are expected to start using EHRs in the simplest forms – Scheduling, Patient Notes, ICD 10 or 11 coding and prescribing. Once there is growing confidence, the clinicians and hospitals can scale up the extent and complexity of what modern EHRs can offer.

For the above reasons with the patient-tracker we have taken a modular approach wherein an individual doctor or a small practice/hospital may start slow, go slow and scale up whereas a big Corporate Hospital may have the means at their disposal to allow clinicians to use the EHR in a simple, intuitive manner while employing clinical coders and medical records staff or research fellows to use more complex time consuming modules that include use of SNOMED and the opportunities it brings.