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DOI: 10.4338/ACI-2011-10-RA-0056
Implementing SNOMED CT for Quality Reporting: Avoiding Pitfalls
Correspondence to:
Publication History
received:
04 October 2011
accepted:
18 November 2011
Publication Date:
16 December 2017 (online)
Summary
Objective: To implement the SNOMED CT electronic specifications for reporting quality measures and to identify critical issues that affect implementation.
Background: The Centers for Medicare and Medicaid (CMS) have issued the electronic specifications for reporting quality measures requiring vendors and hospital systems to use standardized data elements to provide financial incentives for eligible providers.
Methods: The electronic specifications from CMS were downloaded and extracted. All SNOMED CT codes were examined individually as part of the creation of a mapping table for distribution by a vendor for incorporation into electronic health record systems. A qualitative and quantitative evaluation of the SNOMED CT codes was done as a follow up to the mapping project.
Results: A total of 10643 SNOMED codes were examined for the 44 measures. The approved SNOMED CT code sets contain aberrancies in content such as incomplete IDs, the use of description IDs instead of concept IDs, inactive codes, morphology and observable codes for clinical findings and the inclusion of non-human content.
Conclusion: Implementers of these approved specifications must do additional rigorous review and make edits in order to avoid incorporating errors into their EHR products and systems.
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Conflicts of Interest
None
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References
- 1 Centers for Medicare and Medicaid Services, Department of Health and Human Services. 42 CFR Parts 412, 413, 422 et al. Medicare and Medicaid programs; electronic health record incentive program; final rule; published July 28, 2010 http://edocket.access.gpo.gov/2010/pdf/2010–17207.pdf Accessed October 4, 2011.
- 2 Public Law 111 –5 –American Recovery and Reinvestment Act of 2009. February 17, 2009. http://www. gpo.gov/fdsys/pkg/PLAW-111publ5/pdf/PLAW-111publ5.pdf Accessed October 4, 2011
- 3 CMS: Electronic specifications quality measures. http://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp Accessed October 4, 2011
- 4 NQF: Health IT Expert Panel II (HITEP II). http://www.qualityforum.org/projects/hitep2.aspx Accessed October 4, 2011
- 5 NQF: Electronic quality measures (eMeasures). http://www.qualityforum.org/Projects/e-g/eMeasures/Electronic_Quality_Measures.aspx Accessed October 4, 2011
- 6 Medicomp Systems. Available at http://www.medicomp.com Accessed October 4, 2011
- 7 The Clinical Information Consultancy, CliniClue Xplore http://www.cliniclue.com/cliniclue_xplore Accessed October 4, 2011
- 8 United States National Library of Medicine, Unified Medical Language System® . (UMLS®), Downloads, 2011 http://www.nlm.nih.gov/research/umls/licensedcontent/downloads.html Accessed October 4, 2011.
- 9 U.S. Department of Health and Human Services (April 26, 2007). “HHS joins international partners to promote electronic health records standards”. News Release http://www.hhs.gov/04/pr20070426a.html Accessed October 4, 2011
- 10 International Health Terminology Standards Development Organisation (IHTSDO). http://www.ihtsdo.org/ Accessed October 4, 2011
- 11 International Health Terminology Standards Development Organisation. Chapter 4. Attributes used in SNOMED CT SNOMED Clinical terms® User Guide January 2011 International Release.
- 12 Cornet R. Definitions and qualifiers in SNOMED CT. Methods Inf Med 2009; 48 (Suppl. 02) 178-183.
- 13 Nadkarni PM, Marenco LA. Implementing description-logic rules for SNOMED-CT attributes through a table-driven approach. J Am Med Inform Assoc 2010; 17 (02) 182-184.
- 14 Cornet R, Abu-Hanna A. Auditing description-logic-based medical terminological systems by detecting equivalent concept definitions. Int J Med Inform 2008; 77 (05) 336-345.
- 15 Wade G, Rosenbloom ST. Experiences mapping a legacy interface terminology to SNOMED CT. BMC Med Inform Decision Making 2008; 8 (01) S3.
- 16 Rosenbloom ST, Brown SH, Froehling D, Bauer BA. et al. Using SNOMED CT to represent two interface terminologies. J Am Med Inform Assoc 2009; 16 (01) 81-88.
- 17 Wade G, Rosenbloom ST. The impact of SNOMED CT revisions on a mapped interface terminology: terminology development and implementation issues. J Biomed Inform 2009; 42 (03) 490-493.
- 18 Liu J, Lane K, Lo E, Lam M, Truong T, Veillette C. Addressing SNOMED CT implementation challenges through multi-disciplinary collaboration. Stud Health Technol Inform 2010; 160 (Pt 2) 981-985.
- 19 Rector AL, Brandt S, Schneider T. Getting the foot out of the pelvis: modeling problems affecting use of SNOMED CT hierarchies in practical applications. J Am Med Inform Assoc 2011; 18 (04) 432-440.
- 20 International Health Terminology Standards Development Organisation. 5.5. Observable entity. SNOMED Clinical terms® User Guide January 2011 International Release.
- 21 Ingenerf J, Beisiegel T. A version management system for SNOMED CT. Stud Health Technol Inform 2008; 136: 827-832.
- 22 Lee D, Cornet R, Lau F. Implications of SNOMED CT versioning. Int J Med Inform 2011; 80 (Suppl. 06) 442-453.
- 23 Schulz S, Suntisrivaraporn B, Baader F, Boeker M. SNOMED reaching its adolescence: Ontologists’ and logicians’ health check. Int J Med Inform 2009; 78 (01) S86-S94.
- 24 International Health Terminology Standards Development Organisation: SNOMED CT® Editorial Guide, January 2011 International Release.
- 25 Pathak J, Jiang G, Dwarkanath SO, Buntrock JD, Chute CG. Adopting graph traversal techniques for context-driven value sets extraction from biomedical knowledge sources. Proc IEEE Int Conf Semant Comput. 2008: 460-467.
- 26 Rector A, Qamar R, Marley T. Binding ontologies and coding systems to electronic health records and messages. 2nd International Workshop on Formal Biomedical Knowledge Representation; 2006: 11–19. CEUR WS Proceedings.
- 27 Lee DH, Lau FY, Quan H. A method for encoding clinical datasets with SNOMED CT. BMC Med Inform Decis Mak 2010; 10: 53.
- 28 Bodenreider O, Smith B, Kumar A, Burgun A. Investigating subsumption in SNOMED CT: An exploration into large description logic-based biomedical terminologies. Artif Intell Med 2007; 39 (03) 183-195.
Correspondence to:
-
References
- 1 Centers for Medicare and Medicaid Services, Department of Health and Human Services. 42 CFR Parts 412, 413, 422 et al. Medicare and Medicaid programs; electronic health record incentive program; final rule; published July 28, 2010 http://edocket.access.gpo.gov/2010/pdf/2010–17207.pdf Accessed October 4, 2011.
- 2 Public Law 111 –5 –American Recovery and Reinvestment Act of 2009. February 17, 2009. http://www. gpo.gov/fdsys/pkg/PLAW-111publ5/pdf/PLAW-111publ5.pdf Accessed October 4, 2011
- 3 CMS: Electronic specifications quality measures. http://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp Accessed October 4, 2011
- 4 NQF: Health IT Expert Panel II (HITEP II). http://www.qualityforum.org/projects/hitep2.aspx Accessed October 4, 2011
- 5 NQF: Electronic quality measures (eMeasures). http://www.qualityforum.org/Projects/e-g/eMeasures/Electronic_Quality_Measures.aspx Accessed October 4, 2011
- 6 Medicomp Systems. Available at http://www.medicomp.com Accessed October 4, 2011
- 7 The Clinical Information Consultancy, CliniClue Xplore http://www.cliniclue.com/cliniclue_xplore Accessed October 4, 2011
- 8 United States National Library of Medicine, Unified Medical Language System® . (UMLS®), Downloads, 2011 http://www.nlm.nih.gov/research/umls/licensedcontent/downloads.html Accessed October 4, 2011.
- 9 U.S. Department of Health and Human Services (April 26, 2007). “HHS joins international partners to promote electronic health records standards”. News Release http://www.hhs.gov/04/pr20070426a.html Accessed October 4, 2011
- 10 International Health Terminology Standards Development Organisation (IHTSDO). http://www.ihtsdo.org/ Accessed October 4, 2011
- 11 International Health Terminology Standards Development Organisation. Chapter 4. Attributes used in SNOMED CT SNOMED Clinical terms® User Guide January 2011 International Release.
- 12 Cornet R. Definitions and qualifiers in SNOMED CT. Methods Inf Med 2009; 48 (Suppl. 02) 178-183.
- 13 Nadkarni PM, Marenco LA. Implementing description-logic rules for SNOMED-CT attributes through a table-driven approach. J Am Med Inform Assoc 2010; 17 (02) 182-184.
- 14 Cornet R, Abu-Hanna A. Auditing description-logic-based medical terminological systems by detecting equivalent concept definitions. Int J Med Inform 2008; 77 (05) 336-345.
- 15 Wade G, Rosenbloom ST. Experiences mapping a legacy interface terminology to SNOMED CT. BMC Med Inform Decision Making 2008; 8 (01) S3.
- 16 Rosenbloom ST, Brown SH, Froehling D, Bauer BA. et al. Using SNOMED CT to represent two interface terminologies. J Am Med Inform Assoc 2009; 16 (01) 81-88.
- 17 Wade G, Rosenbloom ST. The impact of SNOMED CT revisions on a mapped interface terminology: terminology development and implementation issues. J Biomed Inform 2009; 42 (03) 490-493.
- 18 Liu J, Lane K, Lo E, Lam M, Truong T, Veillette C. Addressing SNOMED CT implementation challenges through multi-disciplinary collaboration. Stud Health Technol Inform 2010; 160 (Pt 2) 981-985.
- 19 Rector AL, Brandt S, Schneider T. Getting the foot out of the pelvis: modeling problems affecting use of SNOMED CT hierarchies in practical applications. J Am Med Inform Assoc 2011; 18 (04) 432-440.
- 20 International Health Terminology Standards Development Organisation. 5.5. Observable entity. SNOMED Clinical terms® User Guide January 2011 International Release.
- 21 Ingenerf J, Beisiegel T. A version management system for SNOMED CT. Stud Health Technol Inform 2008; 136: 827-832.
- 22 Lee D, Cornet R, Lau F. Implications of SNOMED CT versioning. Int J Med Inform 2011; 80 (Suppl. 06) 442-453.
- 23 Schulz S, Suntisrivaraporn B, Baader F, Boeker M. SNOMED reaching its adolescence: Ontologists’ and logicians’ health check. Int J Med Inform 2009; 78 (01) S86-S94.
- 24 International Health Terminology Standards Development Organisation: SNOMED CT® Editorial Guide, January 2011 International Release.
- 25 Pathak J, Jiang G, Dwarkanath SO, Buntrock JD, Chute CG. Adopting graph traversal techniques for context-driven value sets extraction from biomedical knowledge sources. Proc IEEE Int Conf Semant Comput. 2008: 460-467.
- 26 Rector A, Qamar R, Marley T. Binding ontologies and coding systems to electronic health records and messages. 2nd International Workshop on Formal Biomedical Knowledge Representation; 2006: 11–19. CEUR WS Proceedings.
- 27 Lee DH, Lau FY, Quan H. A method for encoding clinical datasets with SNOMED CT. BMC Med Inform Decis Mak 2010; 10: 53.
- 28 Bodenreider O, Smith B, Kumar A, Burgun A. Investigating subsumption in SNOMED CT: An exploration into large description logic-based biomedical terminologies. Artif Intell Med 2007; 39 (03) 183-195.