Information Systems HIMS

Nomenclature of Medicine – Clinical Terms) is a comprehensive, standardized, and computer-processable clinical healthcare terminology. While widely adopted globally for EHRs and HIE, the US continues to primarily use ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) for diagnoses and CPT (Current Procedural Terminology) for procedures. This paper explores the reasons behind this divergence, the potential benefits and challenges of SNOMED-CT adoption in the US, and the necessary steps for its implementation.

Benefits and Shortcomings of SNOMED-CT:

Benefits:

• Granularity and Specificity: SNOMED-CT offers a much more granular and specific representation of clinical concepts compared to ICD-10-CM and CPT. This allows for more accurate documentation, improved clinical decision support, and better data analysis.
• Comprehensiveness: SNOMED-CT covers a wider range of clinical concepts, including diagnoses, procedures, findings, symptoms, and social circumstances.
• Interoperability: SNOMED-CT's global adoption facilitates seamless exchange of health information across different healthcare systems and countries.
• Computer Processability: SNOMED-CT's structured format makes it easier for computers to process and interpret clinical data, enabling advanced analytics and decision support.
• Improved Research: The standardized terminology facilitates clinical research by enabling the aggregation and analysis of data from diverse sources.

Shortcomings:

• Complexity: SNOMED-CT's vastness and complexity can make it challenging to learn and implement. The steep learning curve can be a barrier for healthcare professionals.
• Maintenance: Maintaining and updating SNOMED-CT requires significant resources to ensure its accuracy and relevance.
• Implementation Costs: Implementing SNOMED-CT can be expensive, requiring investment in software, training, and infrastructure.
• Resistance to Change: Healthcare professionals may be resistant to adopting a new coding system, especially if they are already familiar with ICD-10-CM and CPT.
• Lack of Direct CPT Mapping: While mappings exist, SNOMED-CT does not have a one-to-one mapping with CPT, making the transition for billing and coding complex.

Why ICD-10-CM and CPT are Still Used in the US:

Several factors contribute to the continued use of ICD-10-CM and CPT in the US:

• Established Infrastructure: Significant investments have already been made in systems and training for ICD-10-CM and CPT. Changing to SNOMED-CT would require substantial additional investment.
• Billing and Reimbursement: CPT codes are deeply embedded in the US healthcare billing and reimbursement system. Switching to SNOMED-CT would require significant changes to this system.
• Physician Familiarity: Healthcare providers are accustomed to using ICD-10-CM and CPT. Changing to a new system would require extensive retraining.
• Lack of Mandate: While there have been discussions about adopting SNOMED-CT, there has not been a strong enough mandate at the federal level to drive widespread adoption.

Prospects of SNOMED-CT in US EHR Systems:

Despite the challenges, the long-term prospects for SNOMED-CT in US EHR systems are promising. The increasing emphasis on interoperability, data analytics, and personalized medicine is driving the need for more standardized and comprehensive clinical terminologies. As healthcare systems increasingly recognize the benefits of SNOMED-CT, adoption is likely to grow, albeit gradually.

Federal and State Level Actions for SNOMED-CT Adoption:

For SNOMED-CT to replace CPT in the US, significant action is required at both federal and state levels:

• Federal Level:

  • Mandate: A clear mandate from the federal government, perhaps through the Office of the National Coordinator for Health Information Technology (ONC), would be crucial to drive adoption.
  • Incentives: Financial incentives, such as meaningful use criteria or reimbursement adjustments, could encourage healthcare providers to adopt SNOMED-CT.
  • Standards Development: Developing clear standards and guidelines for SNOMED-CT implementation would be essential.
  • Mapping and Translation Tools: Investing in tools to map between SNOMED-CT, ICD-10-CM, and CPT would facilitate the transition.
  • Training Programs: Funding and developing comprehensive training programs for healthcare professionals on SNOMED-CT usage.

• State Level:

  • Regulation: States could align their healthcare regulations with federal mandates to promote consistent adoption.
  • Support: State-level HIEs can play a role in supporting the implementation of SNOMED-CT within their jurisdictions.
  • Collaboration: Collaboration between states can help share best practices and resources for SNOMED-CT implementation.

• Addressing Billing Challenges: A phased approach to integrating SNOMED-CT into billing processes is necessary. This may involve developing crosswalks between SNOMED-CT and CPT codes for reimbursement purposes during a transition period. Eventually, a transition to SNOMED-CT-based billing could be considered.

Conclusion:

While the adoption of SNOMED-CT in the US faces significant hurdles, its potential benefits for interoperability, data analytics, and patient care are substantial. A coordinated effort at both federal and state levels, including clear mandates, financial incentives, standardized implementation guidelines, and robust training programs, is essential for overcoming the barriers and realizing the full potential of SNOMED-CT in US healthcare. A phased approach, addressing billing and coding complexities, will be key to a successful transition. The long-term goal should be a unified, globally interoperable system that leverages the power of SNOMED-CT to improve healthcare quality and efficiency.

The Prospects of SNOMED-CT in US Healthcare: Overcoming Barriers to Interoperability

Abstract:

This research paper analyzes the benefits and shortcomings of using SNOMED-CT in Electronic Health Records (EHRs) and Health Information Exchange (HIE), examining the reasons for its limited adoption in the US despite its widespread use elsewhere. It explores the continued use of ICD-10-CM and CPT (4.0) in the US, assesses the prospects of SNOMED-CT adoption, and outlines the necessary steps at federal and state levels for SNOMED-CT to potentially replace CPT in the US.

Introduction:

Interoperability, the ability of different health information systems to exchange and use information, is crucial for efficient and effective healthcare. Standardized terminologies and coding systems play a vital role in achieving interoperability. SNOMED-CT (Systematized