United States' Update April 2008
National activities
As the U.S. Member of the IHTSDO, the National Library of Medicine (NLM) is active in promoting use of SNOMED CT as part of a suite of vocabulary and messaging standards needed to promote nation-wide implementation of an interoperable health information technology infrastructure. NLM is in the early stages of developing an open and transparent process, representative of all stakeholders, for coordinating U.S. input to the IHTSDO for SNOMED CT development.
In 2007, NLM facilitated negotiations between IHTSDO Management and representatives of the American Dental Association to resolve intellectual property rights for existing SNODENT content and to establish a sound working relationship for future development of dental codes. NLM also coordinated meetings in September and December 2007 between IHTSDO Management and representatives of LOINC to establish a strong working relationship that avoids unnecessary duplication and promotes progress toward interoperable electronic health records. Participants in these meetings are optimistic that a resolution will be reached in 2008.
Implementation plans/activities
The U.S. health care system is based on an “open market” model, as compared with systems that are directed by a central government health care authority. Within the U.S., SNOMED CT is primarily used for normalizing data stored in clinical data warehouses, for indexing full-text clinical reports with controlled terminology (generally via natural language processing and use of the UMLS resources), for public health reporting, and in a variety of information indexing and retrieval applications (e.g., in PubMed/MEDLINE). Direct use of SNOMED CT by clinicians for capturing patient data is not yet prevalent. (The U.S. health maintenance organization, Kaiser Permanente, is a notable exception.) We expect this trend to shift in the coming years as vocabulary and messaging standards are implemented in new and updated clinical systems.
SNOMED CT is one of a suite of standards (along with RxNorm and LOINC) designated for use in U.S. Federal Government systems for the electronic exchange of clinical health information. In January 2008 the Secretary of the U.S. Department of Health and Human Services broadened the scope by encouraging adoption of these standards in the private sector by formally recognizing a first set of Interoperability Specifications as recommended by the Healthcare Information Technology Standards Panel (HITSP). HITSP is a cooperative partnership between the public and private sectors for the purpose of achieving a widely accepted and useful set of standards specifically to enable and support widespread interoperability among health care software systems throughout the United States. The Interoperability Specifications for “Electronic Health Record Laboratory Results Reporting” as well as for “Biosurveillance” include SNOMED CT as a standard.
Within the U.S., it is generally felt that the use of standardized vocabularies to capture patient care data will be further encouraged if the data can also be used to automatically generate billing data. The College of American Pathologists (CAP) and the American Medical Association (AMA) are jointly developing a rulebased map from SNOMED CT to CPT to serve this purpose. The AMA and CAP expect to release the map for beta testing in the summer of 2008.
Affiliate activities
NLM distributes SNOMED CT as part of the Unified Medical Language System (UMLS) Metathesaurus. (Licenses are issued to both US and international users; see Metrics, below.) Licensees have access to SNOMED CT (both English and Spanish versions) in multiple formats as part of the UMLS Metathesaurus, where it is linked to many other biomedical terminologies and natural language processing tools. Additionally, UMLS licensees have free access to SNOMED CT in its native file formats downloaded directly from the UMLS Knowledge Sources Server.
In November 2007, in conjunction with the AMIA 2007 Annual Symposium, NLM staff held a UMLS Users meeting to obtain input on the future direction of the UMLS. UMLS users were encouraged to provide their comments and suggestions for improving UMLS data, tools, documentation, and support.
In October 2007, NLM began offering UMLS Webcasts to provide opportunities for UMLS users to gain in-depth knowledge on the diverse products that make up the UMLS.
