Health Information Technology Fundamentals

The Journal of AHIMA published an article co-authored by Michael Stearns, MD, CPC in its November 2014 edition.  The link to the index for this edition of the Journal of AHIMA is provided here, however, full access to the article requires AHIMA membership.

The article highlights the differences between the two code sets/terminologies, based on their intended purposes.  Several clinical examples are provided.

SNOMED CT was designed for use in clinical information systems but due to a number of factors it has not been readily adopted in the U.S.  One of the key barriers to its adoption was the requirement that a subset of SNOMED CT must be included (for coding problem list diagnoses) for EHRs to be certified for Stage 2 Meaningful Use.  This has led to a number of stakeholders integrating SNOMED CT into their information systems.  However, SNOMED CT is large and fairly complicated in its structure and design.  It was built using an artificial intelligence construct called Description Logics that allows the system to automatically infer relationships between concepts.  This component of SNOMED CT has been chronically underutilized but has the potential to address a number of challenges in healthcare, including data integrity, segmentation (for privacy), metaanalysis, predictive modeling, clinical research, genomics and proteinomics, clinical decision support, analysis of business operations, and perhaps most importantly clinical research.

The article serves in part as an introduction to SNOMED CT.  For additional information please see the SNOMED CT fundamentals page on this website.   SNOMED CT has a great deal of untapped potential for clinical use, including semantic interoperability.   In particular its ability to define concepts through the use of concept interrelationships.  Of particular interest will be how fully ICD-11 adapts the principles of SNOMED CT and whether or not a migration from SNOMED CT to ICD-11 (or ICD-11-CM) will be seamless or complicated.

For reprint requests of the AHIMA article please contact Dr. Michael Stearns at mcjstearns@gmail.com.

ICD-11 is scheduled for release in 2017, making the delay in the release of ICD-10-CM in 2014 until 2015 potentially problematic.  Further delays in ICD-10-CM, which at this point seem possible, will lead to additional voices recommending that ICD-10-CM be skipped entirely.  This makes some sense from an informatics standpoint as ICD-11 is being modified to make it more applicable to clinically oriented information systems and compatible with SNOMED CT.

If the U.S. goes forward with ICD-10-CM in October of 2015 this may not result a delay in ICD-11 until an ICD-11-CM version is completed.  ICD-11 could be adopted as the terminology for HIT systems in the near future, well ahead of a release of an ICD-10-CM version.  This advantage of this approach would be the following:

1. It would allow for compatibility for disease reporting with the majority of other nations, as ICD-11 will be adopted by the majority of industrialized nations outside of the U.S. within the next 3-4 years.
2. It may allow for improved mapping from a core clinical terminology system (e.g., if SNOMED CT is “updated” to ICD-11) to ICD-10-CM for claims reporting.
3. It will allow advances in the use of terminology to be shared internationally, leading to improvements in data integrity, analytics, predictive modeling, point of care clinical operations, clinical decision making, clinical research, genomic information at the point of care, and other emerging trends.
4. It will allow for improvements in the semantic interoperability between data captured by systems using different languages (e.g., Spanish, English, Mandarin, etc.)

If this approach were to be taken, one might expect to see the rapid development of an ICD-11-CM version in the U.S., unless ICD-11/SNOMED CT can be configured to meet billing and other reporting requirements that are intended features in ICD-10-CM.

The information shared in this article represent the opinions of its author, Michael Stearns, MD, CPC