Systematized nomenclature of medicine

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The Systematized Nomenclature of Medicine (SNOMED) ( English systematized Nomenclature of Medicine ) is a family of medical terminology systems. Originally conceived as a nomenclature (from which its name is still derived), the latest - and currently only further maintained - version SNOMED CT can best be characterized as an ontology-based terminology standard

The aim of all SNOMED versions is to provide a language that represents clinical content largely unambiguously and as precisely as possible, regardless of its original language. This should enable search queries to be answered with high recall (completeness) and high precision .

history

SNOMED has its origins in SNOP , the Systematized Nomenclature of Pathology . In 1974 a first SNOMED trial was issued by the College of American Pathologists (CAP). The expansion to SNOMED II was published in 1979, followed by an update in 1982. SNOMED II was adapted and expanded for the German-speaking area by Friedrich Wingert and published in 1984 - this is why SNOMED II still has a certain significance in the German-speaking area. After Friedrich Wingert's death, the rights to the German version of SNOMED II were transferred to the Friedrich Wingert Foundation. In 1993, SNOMED 3 was published, also known as SNOMED International, and it was the first to include veterinary medicine. In 1997 the LOINC codes were fully integrated into SNOMED. In 1998, SNOMED 3.5 (12 axes) appeared. With the update to SNOMED RT ( Reference Terminology ) in 2000, the basis for formal term representations was created. SNOMED RT experienced a significant expansion in 2002 with the addition of the so-called read codes (also called clinical terms ) of the National Health Service (NHS) in Great Britain. The merged nomenclature was called SNOMED CT ( Clinical Terms ). At the end of 2003, SNOMED CT was integrated into the Unified Medical Language System (UMLS). Since April 2007 the rights to SNOMED CT have been held by the International Healthcare Terminology Standards Development Organization (IHTSDO). This has been called SNOMED International since 2016. She publishes SNOMED CT in English and Spanish. Translated versions exist for the Danish and Swedish languages. Other translation projects (Dutch, French) are ongoing. There is no official German version.

Versions

SNOMED II

SNOMED II contains 7 axes, each with its own systematic reference system (topography T, morphology M, etiology E, function F, disease D, work J, procedure P), the descriptors are hierarchically structured within the axes . Furthermore, SNOMED II contains synonyms and cross-references to other axes. The German version contains around 81,000 entries.

Notation: axis identifier (e.g. T) and duodecimal , five-digit number (where X = 10, Y = 11), (e.g. T8X500, F80000)

There are also qualifiers: FH (family history), CC (main complaint), SD (suspected diagnosis) etc. (e.g. FH D73450)

SNOMED 3 (SNOMED International)

For SNOMED 3, the previous axes of SNOMED were further divided or new axes were set up, so that SNOMED 3 can present a total of 11 axes with approx. 150,000 entries. Instead of duodecimal notation, the hexadecimal notation known from the IT sector was used. For the first time, SNOMED enabled 3 cross-references to the ICD -9. There are translations of SNOMED 3 in around ten languages. A German translation was planned, but was never realized.

SNOMED CT

SNOMED CT is published, closely maintained and made compatible with other standards by the international standardization organization SNOMED International. The name SNOMED has not been dissolved, since SNOMED CT is no longer regarded as a nomenclature, but as a terminology standard. Meaningful units are referred to as concepts in SNOMED CT . Each concept is identified by a fully specified name, e.g. B. pharyngitis (disorder) , a code e.g. B. 405737000 , formal and z. T. characterized textual definitions. There are also synonymous terms. All terms are called descriptions . Each concept is embedded in the semantic network via relationships. There are currently more than 1 million relationships between concepts.

There are translations of SNOMED CT in various languages. Complete translations are available for some languages ​​(Swedish, Danish), partial translations by SNOMEC CT for other languages ​​(French, Dutch, Spanish); national extensions have been made for some countries (Australia, Canada, USA, Denmark, Netherlands, Spain, Sweden, UK). The official translations can only be published by member countries.

There is no official German translation. Part of SNOMED CT was translated into German by a private organization and published in 2003, but this version has not been maintained since then and is therefore out of date.

criticism

With the 7 (SNOMED II) to 11 (SNOMED 3) axes described, SNOMED provides a multiple, largely orthogonal classification. Their connection with the ICD , OPS and DRG classifications specified for billing is weak in all known information technology products.

Without reinforcing the connection between the mandatory classifications (ICD, OPS and DRG) and the best conceivable medical classification methodology, every further classification remains just one of many.

In particular, the suspicion remains that scientifically sound completeness and practical usefulness do not serve the same target criteria. If a German translation was planned several times, but was not even realized by the state-funded DIMDI within more than four decades according to the first definition by SNOMED (1974), there is a possibility that the German interest groups will again take over from Australia (DRG, ICHI) or the Netherlands (OPS), but will not be able to develop it in the future either. However, a prerequisite is the integration of SNOMED in a productive context with the clinical routine.

literature

  1. ↑ Cimino JJ; Zhu X: The practical impact of ontologies on biomedical informatics . Methods Inf Med. 2006; 45 Suppl 1: 124-35, PDF
  2. ↑ Schulz S. Why do we need standardized terminologies such as SNOMED CT? . Swiss Medical Informatics 2011, doi : 10.4414 / smi.27.00272
  3. ↑ Getting the most out of Electronic Health Record systems .
  4. ↑ Conversion of diagnosis and procedure coding system (PDF; 44 kB).
  5. ↑ http://www.id-berlin.de/deu/_1ueberuns/texte/icpm_Hugelpapier.pdf .
  6. ↑ Semantic modeling for a knowledge-based system in pediatrics (PDF; 2.8 MB).
  • Medical documentation: Basics of quality-assured integrated health care / F. Leiner; W. Gaus; R. Haux. ... - 4th rework. and exp. Ed. - Stuttgart [u. a.]: Schattauer, 2003: With 6 illustrations and 12 tabs. ISBN 3-7945-2265-6

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