SNOMED-CT means Systematic Nomenclature of Medicine, Clinical Terminologies. First question anyone would ask is why such nomenclature is required for clinical terminologies. It is required in order to computerize data, so that it is available for analysis. Next question is then why do computers need such terminology. This is because doctors inherently use different terms to describe the same thing and computers are unable to understand what doctors say. To give a simple example; for a doctor, enteric fever is the same as typhoid, or pneumonia is the same as pneumonitis and tuberculosis is the same as Kochs.. Unfortunately computers do not understand this and somebody has to teach this to computers.
Another example is for diagnosis of diabetes, some doctors write DM or diabetes mellitus, others write IDDM or type1 diabetes and some write MODY or type 2 diabetes which are variants of diabetes. So computers have to be told that DM or diabetes are the same and other terms are types of diabetes. Several such examples can be given, but it suffices to say that synonyms of medical terms as well as their classification has to be clearly and systematically recorded so that it is possible for computers to understand data at the time of analysis.
SNOMED international has developed a huge dataset of terminologies such as symptoms, findings, disorders, laboratory investigation parameters, treatments etc. It has also their interrelations such as a is a causative agent of b, c is type of d, etc. This helps computers to understand that a synonym used by one doctor is linked to a synonym used by another doctor through a specific term which is called a fully specified name in SNOMED-CT. Therefore at the time of analysis of data there will not be duplication or error of counting the number of patients having a particular symptom or disorder.
This may not be very important for an individual doctor who uses the same terminology while writing case records for all his patients. But we can easily imagine that in a cath lab in which several cardiologists are working, if the institute wants to analyze its data; it would fumble while evaluating risk factors as some will write DM, others will write IDDM and some will write type2 diabetes. In a paediatric hospital some will write AGE, others will write Gastroenteritis and some will write loose motions with grade II dehydration. The confusion in data will multiply if we were to collect data from different hospitals in one city which is essential for epidemiological analysis.
If we have to collect data from various states it would be desirable that software systems use a standard nomenclature while describing symptoms, findings, investigations, diagnoses and treatments given to patients by different specialists, government and private healthcare institutes, individual doctors and hospitals. The National Digital Health Mission envisages to create a lifetime record of each person from womb to tomb or birth to death. This is essential from two perspectives.
One is that each next doctor treating the patient should be able to access the previous health record of the patient. Very few of even educated people carry the entire medical record while visiting a doctor. Some may have taken some over the counter medicine, some may have visited a general practitioner and he may have referred to a specialist, who after treating for a few days sent the patient to a super specialist and so on.
Secondly at any given point in time what is the burden of any disease in a country / state / District or city may be useful for the Government to decide administrative policies. At international level reporting is done using International Classification of Diseases or ICD which has grown during the last several years to 10th version. However for micro management, only diagnostic data is not sufficient and it is necessary to evaluate the possibility of a diagnosis based on symptoms, syndromic data and laboratory findings which may increase suspicion of particular diagnosis. For this purpose clinical terminology is necessary, a need satisfied efficiently by SNOMED-CT.
Experts in health informatics are using SNOMED-CT in their software to achieve interoperability of data between two software systems. Transfer of data from one clinic or hospital to the city, district, state or national grid is a huge task. Data so collected can be analysed only if it is compliant with International standards such as SNOMED-CT or ICD. SNOMED-CT has an advantage over ICD because it has all the clinical terms. ICD 12 is being developed by WHO to bridge this deficiency, but it will take some time to match the benchmark created by SNOMED-CT.
MOHFW had declared standards for Electronic Health Records according to which all software companies were required to develop software for National Digital Health Mission. Compliance to SNOMED-CT, an international standard, was one of the requirements for which the Government of India had purchased licence since 2013 so that all software vendors and end user hospitals and doctors would be able to use it free of cost. We all developed our software accordingly, but suddenly in the beginning of 2021, MOHFW decided not to continue license of SNOMED-CT. Software vendors would have to either re-develop the software, or buy the licence at a huge price and recover from end user hospitals and doctors. All these were impossible propositions, so we decided to raise a protest with the Hon'ble Prime minister. Accordingly I led a team of healthcare informatics experts from all over INDIA and wrote an article available on link below.
http://dataonweb.com/uploads/WHY_SHOULD_INDIA_ADOPT_SNOMED-CT.pdf
We sent it to PMO with a grievance letter. I am happy to share that the letter was sent to MOHFW which has responded with a clear statement that no such decision has been taken. Letter dt 12th April is avalable on this link.
http://dataonweb.com/uploads/Letter_from_MOHFW_to_Dr_Rajeev_Joshi.pdf
Whether earlier decision was reversed or it was never taken and the issue only discussed will never be known. But the fact remains that all software vendors who have invested huge amounts in developing software compliant to SNOMED-CT standard have taken a sigh of relief. Hospitals and doctors will not be required to spend more. Another alternative would be to use substandard software, which no organization or doctor would like to do when the National Digital Health Mission takes shape and starts running with full speed. This will happen in the next couple of years.
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