As the implementation of Meaningful Use Stage 2 gets underway, now is a good time to take a closer look at some of the ways the transition to ICD-10 will support better health care across the nation. One piece of the ONC 2014 Standards and Certification regulation that deserves a closer look is the requirement that certified electronic health record (EHR) technology use the Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT) to represent patient problems, and how this relates to the roll out of ICD-10 (International Classification of Diseases, 10^th Edition) for administrative coding, which kicks in next October.

As you look to transition to ICD-10, here’s a little background:

• SNOMED CT is the most comprehensive clinical healthcare terminology in the world and has 23 countries that actively contribute to its development and maintenance. As a clinical terminology, SNOMED CT is ideally suited for use in clinical documentation in electronic health records and is free through the National Library of Medicine (NLM). Stage 1 of Meaningful Use requires EHR systems to encode problem list data in either SNOMED CT or ICD-9-CM. The final rule for Meaningful Use Stage 2 (and in the 2014 EHR Certification Criteria) expands use of SNOMED CT and requires EHR systems use SNOMED-CT as the terminology for documenting problem lists, procedures, and some clinical findings such as smoking status. 

• SNOMED CT is different from ICD-10. SNOMED CT is designed for direct use by healthcare providers during the process of care, whereas ICD-10 is designed to be used by coding professionals once the episode of care is completed. SNOMED CT allows coding at any level of granularity as appropriate for the clinical situation using a hierarchal system, and as such, it is clinically practical and relevant. This hierarchy also readily allows for incorporation of new concepts and increased specificity, eliminating the need to rely on vague classifications such as NOS (not otherwise specified) and NEC (not elsewhere classifiable) codes.  This increased granularity also lends itself well to clinical research. 

• Clinical data coded in SNOMED CT can be used for multiple purposes. For example, providers can send SNOMED CT encoded data securely during transitions of care to other providers or upon discharge, or share data with patients themselves. This decreases barriers to the electronic exchange of critical patient information and improves the quality of the information. SNOMED CT coded data, in conjunction with other encoded data for medication and lab results, can also be used in clinical decision support, e- clinical quality measures, and registries. 

The use of ICD-10 and SNOMED CT go hand in hand

Implementation of SNOMED CT will help providers with the transition to ICD-10, because computer systems can use SNOMED CT content to seamlessly generate ICD-10 codes. Through a project with the National Center for Health Statistics (NCHS), the National Library of Medicine (NLM) created and published a map or “cross walk” from SNOMED CT codes (source) to ICD-10 (target). To facilitate use of the map in a semi-automatic manner (its intended use) in EHRs, NLM created the accompanying I-MAGIC tool for the map.  I-MAGIC uses the map to suggest candidate ICD-10 codes based on SNOMED CT codes and, if applicable, additional information obtained from the electronic patient record or direct user input. The healthcare provider or professional coder should then review the candidate ICD-10 codes, in some cases providing additional information to ensure accuracy of the final ICD-10 codes selected.

The benefits to you

The map and I-MAGIC can be embedded in EHR technology or administrative systems to assist coding professionals by suggesting ICD-10 codes in real time based on SNOMED CT encoded problems. Technology developers recognize that this will help providers transition to ICD- 10 and some have begun to incorporate this mapping into their products. CMS has also published fact sheets with tips for providers to use in talking with their technology developers.

NLM published the initial SNOMED CT to ICD-10 map in June 2012; that version covered the most frequently occurring SNOMED CT concepts and ICD-10 codes. An updated version in June 2013 expanded the map’s coverage to 35,963 SNOMED CT concepts. Thus far, on the target side, the map includes 32,286 ICD-10 codes which NLM estimates this covers over 90% of the most commonly used ICD-10  codes. The map will be updated periodically to continue to increase coverage of SNOMED CT concepts. Looking forward, NLM considers all SNOMED CT concepts that are appropriate for use in a problem list to be within scope for the map.

Providing for improved electronic documentation using SNOMED CT by integrating it in certified EHR systems and development of the NLM’s SNOMED CT to ICD-10 map, enabling providers to more efficiently transition to using ICD-10 codes, are just a couple of examples of how the meaningful use program is enabling more coordinated, safer, and better care.

Follow the links to learn more about the SNOMED CT to ICD-10 map and I-MAGIC tool.

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