New SNOMED CT mapping supports emergency care data and reporting

The Healthcare Pricing Office (HPO) and the SNOMED CT National Release Centre have developed a mapping between the Irish Edition of the SNOMED CT emergency department reference set and ICD-10-AM.

The mapping enables hospitals with emergency departments to record detailed clinical information using SNOMED CT while also supporting Activity-Based Funding (ABF) and other national reporting requirements that use ICD-10-AM.

It supports the increasing use of SNOMED CT within digital health systems while maintaining the classification requirements needed for national reporting and funding purposes.

Background

Hospitals in Ireland record inpatient activity electronically or on paper. This information is submitted to the Hospital Inpatient Enquiry (HIPE) unit within each hospital, where trained coders review the patient record and, using national standards, assign ICD-10-AM codes describing the activity during the patient’s hospital stay.

The ICD-10-AM codes, together with other administrative data, allow each case to be allocated to a Diagnosis Related Group with an associated price, which informs the cost of the patient’s stay. ICD-10-AM is an internationally recognised classification used in a number of countries.

Emergency departments use a different classification process for patients who are not admitted to an inpatient bed, and ICD-10-AM codes are not manually assigned in the same way.

In 2016, the Healthcare Pricing Office, in collaboration with the National Emergency Medicine Programme, began piloting an Activity-Based Funding model to electronically record emergency department activity using ICD-10-AM codes. This allows an Urgency Related Group to be assigned to each emergency department attendance for costing purposes.

Unlike the HIPE process, this model relies on clinical staff accurately recording diagnoses using ICD-10-AM.

In 2017, Ireland joined SNOMED International following a recommendation from the Health Information and Quality Authority (HIQA).

SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms) is a comprehensive, internationally recognised clinical terminology designed for use in electronic health records. It supports the consistent and structured recording and sharing of clinical information across systems and care settings.

Need for interoperability

The development of the ABF model for emergency department activity is an important national objective and is identified in a number of planning documents, including the ABF implementation plan and Sláintecare.

At the same time, SNOMED CT is increasingly being adopted within hospital information systems to record patient information at the point of care. This is supported by the Data Strategy and Digital for Care initiatives, the Health Information Act and the European Health Data Space legislation.

As healthcare providers increasingly capture clinical data using SNOMED CT, there is a need for interoperability between SNOMED CT and ICD-10-AM.

The successful implementation of the Activity-Based Funding model, together with broader national reporting requirements, depends on having a robust mapping between SNOMED CT concepts and the ICD-10-AM classification.

ICD-10-AM provides the level of specificity required for reporting, including for Activity-Based Funding models. However, it may not provide the same level of clinical specificity required for other uses in emergency care settings.

The key requirement is therefore to support both the recording of detailed clinical information at the point of care using SNOMED CT and the classification of activity for reporting and Activity-Based Funding purposes using ICD-10-AM.

International insights and Irish development

The Department of Health, the Healthcare Pricing Office and the SNOMED CT National Release Centre carried out a review of international practice to understand how this issue is addressed in other jurisdictions.

The NHS in the United Kingdom has made significant progress in developing an Emergency Care Data Set, while Australia has undertaken similar initiatives.

A key feature of these developments is the ability to map SNOMED CT to ICD-10 or ICD-10-AM. This allows emergency department activity to be recorded using SNOMED CT while also supporting management, reporting and Activity-Based Funding requirements.

Based on this review, Ireland developed the mapping between the Irish Edition of the SNOMED CT emergency department reference set and ICD-10-AM.

What this means for hospitals

Hospitals with emergency departments can use the mapping to support clinical recording in SNOMED CT while continuing to meet Activity-Based Funding and other reporting requirements.

The mapping enables clinicians to record more granular and specific clinical information using SNOMED CT, while also providing the data classified in ICD-10-AM required for funding models and other reporting purposes.

A process has been put in place to maintain the mapping table and take account of changes to SNOMED CT terminology.

Further information on the maintenance process is available by contacting SNOMED@hse.ie or HIPE.Coding@hse.ie.

This mapping will be particularly relevant to hospitals preparing to implement digital health solutions or those already using SNOMED CT.

For further information, please contact the Healthcare Pricing Office or the SNOMED CT National Release Centre.