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Dr. Richard Loomis, MD · Jan 21, 2014

SNOMED vs ICD: Transitioning your EHR code set

One of the many new features required for 2014 certified EHRs is the ability to capture and store diagnoses that are mapped SNOMED CT terms. Though making this transition has many benefits for both patients and our healthcare system, it might be challenging for medical professionals to make the switch to this terminology.

The healthcare system is also prepping for the switch from ICD-9 to ICD-10 later this year. The number of changes can seem daunting, but documenting diagnoses in SNOMED facilitates the leap to ICD-10. Practice Fusion aims to streamline the move for you, which will allow you to focus on caring for patients instead of searching for codes.

Since SNOMED CT is a clinical terminology, it is inherently more appropriate for clinical documentation of diagnoses in an EHR than other terminologies or classifications, such as ICD-9. SNOMED CT is not necessarily superior to ICD-9 or 10; they were created for different reasons. Using a standard medical terminology to capture and store diagnosis (and other medical terms) in an EHR ensures consistent expression of similar concepts which can be leveraged for decision support, reporting, and analytics, while ensuring consistent communication across the healthcare community — all of which leads to better care.

Due to its use in medical billing, ICD is largely familiar to healthcare providers and was incorporated into many EHRs as a way to capture diagnoses. The primary limitation with this strategy is the lack of clinical coverage available in ICD-9, which contains approximately 14,000 unique concepts.

SNOMED CT, on the other hand, has more than 100,000 unique concepts and many more synonyms and abbreviations. This also far exceeds the 68,000 codes in ICD-10, many of which are not unique at the diagnosis level, such as two codes to express a left ankle fracture versus a right ankle fracture. The diagnosis of “metabolic acidosis” is an example that demonstrates this lack of diagnostic specificity. In SNOMED CT, it is expressed as “metabolic acidosis” (code 5945509) as opposed to simply “Adicosis” in ICD-9 (code 276.2) or ICD-10 (code E87.2). Obviously, from a clinical perspective, it is important to make the distinction between other types of acidoses, such as respiratory or lactic, which is only possible using SNOMED CT.

Making the switch
With the significant increase in codes, the biggest challenge is easily finding the right diagnosis to record. With the limited scope of ICD-9, many medical professionals chose to memorize common codes, but that approach with SNOMED CT would be all but impossible. At Practice Fusion, we believe that a robust search is the key to solving this challenge. Allowing you to search for SNOMED CT concepts using synonyms, abbreviations, or even misspelled words should ideally return the correct diagnosis you’re seeking to add.

In fact, we have recently incorporated this search functionality when adding new diagnoses, all of which are mapped to a SNOMED CT term (see the image below). If you are currently using our product, then you have already made the switch, and each diagnosis that you record has a SNOMED CT ID attached. The search still supports looking up codes using the ICD-9 description or code that you may already be familiar with, but rest assured, we are also capturing the SNOMED CT code under the hood.

Next steps
If you currently use Practice Fusion, I encourage you to test drive the new diagnosis search. In addition to the clinical benefits, using SNOMED CT can aid in making the transition to ICD-10. In the coming months, Practice Fusion will make mappings from SNOMED CT to ICD-10 available in the product, eliminating the need for you to learn a host of new codes. When adding diagnoses, search for terms as you would express them clinically – chances are you will find a more appropriate term than in past.

The Systematized Nomenclature of Medicine Clinical Terms, widely know as SNOMED CT, is the most comprehensive multilingual clinical healthcare terminology. Though it was released in 2002, it has been slow to gain widespread use in clinical practice until now. The terminology has roots with the College of American Pathologists in 1960s with the development of SNOP, or Systematized Nomenclature of Pathology, which later became SNOMED RT (Reference Terminology). In 1999, SNOMED RT merged with Clinical Terms Version 3 developed in the UK by the National Health Service (NHS), becoming SNOMED CT, which is now overseen by the International Health Terminology Standards Development Organization. It has subsequently become established as the international medical terminology standard. In addition to diagnosis, SNOMED CT includes clinical findings, symptoms, procedures, body structures, and organisms, among other semantic types.