August 2014: The results of this consultation have been published and can be found as part of the August 2014 SCCI papers, agenda Item 9.
It has, for several years, been the stated strategic direction for the NHS in England to adopt a single terminology for the capture and exchange of structured coded clinical data. That single terminology is SNOMED CT. This approach will go a long way to ensuring realisation of the current strategic priorities of paperless working, sharing and transfer of patient clinical data, and the analysis of that data. As long as a mixed economy of coded information persists, the likelihood of clinical care being compromised remains, and the usefulness of such aggregated data is reduced.
The Information Standards Board issued an Information Standards Notice in August 2011 indicating that SNOMED CT should be used in electronic patient records as the fundamental standard for the NHS in England. The Information Strategy from the Department of Health and subsequent NHS England documents all stipulate the use of a single terminology; the ‘Power of Information’ states that from April 2014 data returns made through collections and data sets can be requested requiring data items in SNOMED CT.
SNOMED CT has been released within the UK since 2002 and resulted from the merger of the content from the UK clinical terms project and SNOMED RT in the US following the recognition of the many benefits of having an international terminology for healthcare. In 2007, the international organisation IHTSDO was set up as a member organisation to manage the terminology on behalf of a number of countries (its members); there are now 26 member countries of the IHTSDO, each with plans for the use of SNOMED CT for clinical terms within patient records.
Within the UK, a number of trusts have used SNOMED CT based systems for recording clinical details within patient records for a number of years; benefits are already being realised from such systems. A number of trusts are now planning to share and transfer records with other colleagues involved in the care of the patient. It is increasingly important, therefore, that all such systems use a single terminology for capturing structured coded clinical data; this reduces duplicated data entry and ensures drug alerts and decision support are based on consistent content.
The ‘Power of Information’ published in May 2012 set out the strategy for care information to deliver a range of benefits to patients and the public through better sharing of information. A key enabler for that is the proposal to base coded clinical information on a single clinical terminology of SNOMED CT. The Information Standards Board approval and notification of SNOMED CT as the terminology standard indicated an implementation date of April 2015. This consultation is to help determine appropriate timescales for moving to the use of a single terminology of SNOMED CT and to identify any outstanding issues that may need to be addressed to facilitate this.
There is a tension between the increasing requirement to share and transfer coded data safely across health and care organisations and the time required to migrate to SNOMED CT. There are now a number of healthcare systems available based on SNOMED CT with several of these systems having been deployed in organisations for upwards of 3 years.
The purpose of this consultation therefore is:
Note. This consultation DOES NOT include the Read Drug Dictionaries. There has been a previous consultation specifically on drugs and we are currently addressing the aspects raised during that consultation.
For these reasons, NHS England believe it is necessary to consult:
The Standardisation Committee for Care Information (SCCI) has approved this consultation exercise (SCCI is the body that approves information standards for Health and Social Care and replaces the Information Standards Board for Health and Social Care).
Kathy Farndon
Head of Health Information Standards and Information Governance
NHS England
This consultation is aimed at:
This includes system suppliers, end users of systems, data collection organisations such as the National Registries, professional bodies, government bodies, and national organisations such as health charities i.e. any party with an interest in the use of structured coded clinical data.
The consultation is in four sections: some aimed specifically at users and others aimed at system developers. We appreciate that some organisations with in-house systems may be both users and developers.
We wish to consult widely and welcome responses from professional organisations on behalf of their members. We welcome comments from any UK countries and also from suppliers in other countries who deploy their solutions in the UK.
We request that respondents provide the details of the organisation they are responding on behalf of so that we can check for duplication and understand the context of the response.
We appreciate that some responses may be considered commercially confidential. Responses will be treated as completely confidential and only aggregate information will be included in the final report published on this consultation site. Any possible use of quotes will be consulted with those intended to be cited prior to inclusion.
However, if you would prefer to discuss any response or any aspect of this consultation, please email angie.quinn@nhs.net and a call will be arranged.
Any feedback arising from this approach will then be generalised and agreed with you before any inclusion in the published findings of the consultation.
The UK Terminology Centre (UKTC) within HSCIC manage the terminology for the NHS. The UKTC has provided assistance to NHS organisations and suppliers wishing to adopt SNOMED CT and has engaged with professional bodies who have now endorsed the need to migrate. UKTC produce a number of awareness documents on SNOMED CT and provide a range of eLearning materials.
The NHS has been operating in a mixed terminology environment for a number of years and the Read codes have been maintained to keep abreast of NHS requirements to enable this to happen and support migration to SNOMED CT. However, the 5-character structure of Read v2 is limited, areas of Read v2 are already unable to accommodate new codes, and some aspects of Read v2 have presented issues that have needed extraordinary measures to rectify. The UKTC will continue to support the mixed environment as best as it can until migration to a single terminology is achieved.
The results of this consultation will be presented to the Standardisation Committee for Care Information (SCCI). SCCI includes representatives from the Department of Health, Public Health England, NHS England, the Health and Social Care Information Centre, Monitor, CQC, NICE, techUK, and Professional Body specialists (via PRSB). From the results, SCCI will make a recommendation to the National Informatics Board (formerly referred to as The Informatics Services Commissioning Group) on the timescales for the deprecation and subsequent withdrawal of the Read codes (Read v2 and CTV3). The decision will then be communicated widely.
Consultation in relation to withdrawal of the Read Codes Drug and Appliance dictionary (DAAD) will be undertaken separately.
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