Digitally signed by Australian Digital Health Agency

Date: 2020.08.06 15:45:26 +10'00'

Terminologies and classifications:

SNOMED CT-AU and ICD-10-AM use in Australia
 Acknowledgement

We would like to acknowledge the traditional owners of country throughout Australia, and their
continuing connection to land, sea and community. We pay our respects to them and their
cultures, and to Elders both past and present.
Learning objectives

Give examples of different code sets

used in health
Describe the purpose of a clinical
terminology
Describe the purpose of a health
classification
Compare the features of
Be informed about the ICD revision, SNOMED CT-AU and ICD-10-AM
and maps between SNOMED CT and
ICD-10
Why record clinical data electronically?
Changes in the delivery of clinical practice

Evidence-based
Clinical medicine
experience
• Identifying best practice and gold
• Individual clinician standards for treatment
experience • Requires detailed audit and
• No real data requirements definition of treatment guidelines

DATA
Predictive Personalised medicine
medicine • Identifying optimal treatment for the
individual patient
• Accessing other clinicians • Requires high levels of data collection
knowledge and analysis to support automated
• Requires access to processes and decision support
published papers,
supported by simple audit
Use of standard vocabularies leads to actionable insights

Clinical
Standardisation in characteristics Reduction of
variation in
treatments How many? treatments

Patient level Population health

prediction estimation
What will happen to Can we find a cause?
me?
Overview of code sets used in health
Some of the most commonly used code sets in health
Terminology Classification
Set of concepts about a Organises concepts into
domain that shows categories or groups
properties and based on common
SNOMED CT-AU relationships between characteristics, enabling ICD-10-AM ICPC2
(includes the AMT) them, and organised by consistent statistical data ACHI ICNP
meaning. analysis.

Many other types of code sets,

that enable:
• Standardisation and ATC
interoperability between
systems LOINC MBS
• A listing (or schedule) of ARTG PBS
subsidised healthcare services
and medications
Definitions and links to these code sets are provided at the end of this slide deck.
Different levels of granularity and content to support specific use cases
• Support healthcare system management
• Stable
• 100s of groups, covering national
requirements
RESOURCE
GROUPS • Support secondary analysis of data
(HRG/DRG) • Grouped terms and stable
• 10,000s of concepts, covering specific use
cases, e.g. morbidity and mortality statistics
CLASSIFICATIONS
(ICD-10) • Support direct clinical care
• Granular and dynamic
CLINICAL TERMINOLOGIES • 100,000s of concepts, covering all
healthcare domains
(SNOMED CT)
Clinical terminology overview
What are clinical terminologies?
• A structured vocabulary of terms and concepts used Clinical terminologies enable
in clinical practice, implemented in software Structured recording of statements about
applications e.g. electronic health records (EHRs). the health and health care of an individual
patient

• Standardised naming and identification of those Communication of information without

concepts relevant to the patient and the healthcare loss of detail or change to meaning
(semantic interoperability)
that is delivered to them.
Various levels of data abstraction for
clinicians, patients, researchers or
• Concepts are defined by machine-readable organisations
relationships to other concepts (i.e. they hold
clinical meaning). A consistent way of indexing, storing,
retrieving and aggregating clinical data from
structured, computerised clinical records
Why use a clinical terminology?
To best utilise clinical systems, computing tools and apps Clinical terminologies support
used in healthcare we need computable data – this means
coded and structured data. Health information that is available
whenever and wherever it is needed

Terminology is coded, structured data Health information that can be exchanged

securely

• It provides a foundation for successful delivery and Continuous improvement of data quality,
realisation of the benefits of many of the national leading to high-quality data with a
digital health strategic priorities.1 commonly understood meaning that can
be used with confidence

1Australian Digital Health Agency. Australia’s National Digital Health Strategy: Australian Digital Health Better availability and access to
Agency; 2017
[Available from: https://conversation.digitalhealth.gov.au/australias-national-digital-health-strategy] prescriptions and medicines information
SNOMED CT is the preferred national solution for clinical terminology,
endorsed by the Australian Health Ministers’ Advisory Council (AHMAC)

SNOMED CT SNOMED CT-AU

• A large ‘dictionary’ of clinical terms • Australian extension of SNOMED CT
with a unique code that are machine- • Contains SNOMED CT core files plus
readable Australian developed content,
SNOMED CT-AU including:
• Designed to capture clinical data within – Australian Medicines Terminology (AMT), a
electronic records standard terminology for commonly used
medicines in Australia.
• Covers content areas of: – Australian dialect reference set.
– diseases, procedures, clinical findings and – Over 90 reference sets based around common
therapeutic products, organisms, substances, clinical use cases.
events – Emerging FHIR ValueSets
– plus additional content that helps define the SNOMED CT • Used across all healthcare sectors (GP,
meaning of these major content areas
Community, Allied Health, Child
• A logical model that supports Health, ED, inpatient)
inferencing because identifiers do not • Clinician medical record
carry meaning documentation
– Cimino, JJ Methods Inf Med. 1998 Nov;37(4- • Released monthly to licence holders
5):394-403. Desiderata for controlled medical
vocabularies in the twenty-first century.
When should we use a clinical terminology?

A) Structured and coded B) Sharing of clinical C) Meaning-based

clinical data capture at information between retrieval and analytics
the point of care systems
Structured and coded clinical data capture PROGRESS NOTES
81 year old female presents with
approx 1 month of decreased R
visual acuity

• Record information about a patient CF PH 6/18

For FFA
Right CALE ? cause - likely to
healthcare encounter at the point of be ??? Inflammatory anterior
vitreous cells
Anterior chamber ??
care, in a clinical information system. No chorioretinitis
No ???
? vascular
No history of diabetes or
hypertension but some AV ??
changes
? old branch retinal vein
• Allows clinicians to record what they occlusion

need:
– Content coverage
– Specificity
– One concept can be found using multiple
descriptions (synonyms)
A simple patient record with SNOMED CT-AU coding
Patient summary TEST, Patient - 24962
Male DOB: 6/9/1984 Last visit: 24/7/2018
Demographics
Problem list + Allergy +
Examination Date Name Status Date Name Status

History 11/1/2017 Chronic otitis media Active 3/12/1992 Shellfish Active

18/3/1996 Asthma Active

Family history

Medication history
Test request + Current medications +
Immunisations
In this example:
Date Name Date Name Status
• SNOMED CT-AU terms are
11/1/2017 Lipid panel 11/1/2017 Kenacomb Otic Active
Obstetrics displayed to users
ointment, 5 g
• SNOMED CT-AU concept
Implantable devices 18/3/1996 Ventolin 200 microgram Active identifiers are in the
powder for inhalation,
120 unit doses backend
Referrals
Note: terminologies work
together with an information
Patient portal
model in a well-designed EHR
Sharing of clinical information
• Standard terminology across the system

• Unambiguous concept identification

• Different systems can share information that

has a commonly understood meaning

• Synonyms (as depicted in the speech bubbles)

cater for local language preferences and
enable flexible term searching
Meaning-based retrieval and analytics
• The structure of SNOMED CT supports
flexible retrieval of clinical information for
analytics and reporting.
• A subject can be retrieved via many
pathways or properties (polyhierarchy)
• In this example, records encoded with
“Viral pneumonia” can be retrieved when
starting from any of the higher-level
concepts, such as
– Pulmonary disease
– Infection
– Inflammatory disorder
Meaning-based retrieval and analytics
• Concepts are represented by precise,
unambiguous and machine-readable definitions,
enabling a rich clinical dataset for analysis
• Subjects can be found based on common
defining attributes
• In this example, querying for infectious
processes in the lung will return records
containing (amongst others)
– Viral pneumonia
– Pulmonary tuberculosis
Meaning-based retrieval and analytics
• Clinical information can be retrieved
easily using Expression Constraint
Language (ECL)
– ECL is a computer processable language
that allows searching for SNOMED CT
concepts using their structure and
attributes.

• Static and dynamic on-the-fly queries

can be formulated for data retrieval
• An ECL tool is available in the CSIRO
Shrimp terminology browser
https://ontoserver.csiro.au/shrimp/ecl
Health classification overview
What are health classifications?
• A classification is a structured way of organising Classifications enable
information into standard groupings for statistical
reporting. Health Information Managers (HIMs) and
others to use aggregated data to support
their decisions and policies

• Rules for collecting and coding clinical information Epidemiological research, large dataset
are standardised nationally and internationally, to analysis, patient registry data collections
ensure patient data are grouped consistently and and public health performance/trends
accurately.

Casemix and Activity Based Funding

• For example, after a patient is discharged, diagnoses
and interventions are translated from the health
care record of a patient into alphanumeric codes
within a classification such as ICD-10-AM and ACHI.
Why use a health classification?
Placing data into meaningful, distinct and stable groups Classifications support
makes it easier to identify patterns and trends, enabling
Easy storage, retrieval and analysis of
better decision-making and management of the
health information for evidenced-based
healthcare system.
decision-making

Sharing and comparing health information

Classifications are output tools for between hospitals, regions, settings and
statistical reporting countries

Data comparisons in the same location

• Consistent and comparable method of reporting on across different time periods
conditions, treatment and associated cost.
• Improve management, measurement and funding of Measurement of hospital and health
services. service provider output
Coded data using ICD-10-AM/ACHI/ACS underpins the Australian Refined
Diagnosis Related Groups classification (AR-DRGs)

ICD-10 ICD-10-AM
• The International Statistical • Australian modification of ICD-10
Classification of Diseases and
ICD-10-AM – An expanded version of the World Health
Organization’s ICD-10
Related Health Problems, Tenth • Consists of a tabular list of diseases
Revision and an accompanying index and
• Foundation of health statistics coding rules (ACS)
• An alphanumeric classification • Companion Px classification (ACHI)
– Contains codes for diseases, signs and
ICD-10 • Used in public and private hospitals
symptoms, abnormal findings, social in Australia to classify episodes of
factors and external causes of mortality or admitted patient care only
morbidity.
– Mono-hierarchical, enumerated, codes
• Information is abstracted and
carry meaning assigned by trained clinical coders
• In Australia, ICD-10 is used to • Released every 2 years+
classify causes of death
When should we use a health classification?

A) Immediate and longitudinal B) Statistical reporting of clinical C) Casemix and Activity Based
data management and retrieval activity and other health Funding (measuring service
across a number of different information (disease and provision/use)
groups interventions)
ICD codes and leading causes of death
• In Australia, ICD codes are used when analysing deaths and their causes, enabling statistics to be
compared over time and between countries
• This approach contributes to policy development and planning related to health strategies and
interventions

https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/leading-causes-of-death
Indicator progress measure: potentially preventable hospitalisations
• Number of potentially preventable hospitalisations, divided into three groups and total, as defined by
ICD-10-AM 9th edition:
– vaccine-preventable conditions (e.g. tetanus, measles, mumps, rubella).
– acute conditions (e.g. ear, nose and throat infections, perforated/bleeding ulcer, pelvic inflammatory disease).
– chronic conditions (e.g. diabetes complications, asthma, angina, hypertension, congestive heart failure and chronic
obstructive pulmonary disease).

• all potentially preventable hospitalisations

• https://meteor.aihw.gov.au/content/index.phtml/itemId/698904
• Examples include: Vaccine-preventable Chronic Acute
Pneumonia (not vaccine-
Pneumonia and influenza
Asthma preventable)
(vaccine-preventable)
Codes: J45.-, J46 Codes: J15.3, J15.4, J15.7,
Codes: J10.-, J11.-, J13, J14
J16.0
Optimal management of healthcare services

Additions or
Patient casemix and Patient complexity and Measuring success of
modifications to health
volume trends clinical models of care
care services

Supporting managerial
Quality and safety of Business analysis for KPI
decision making to Accurate allocation of
health care services and monitoring and health
ensure provision of Activity Based Funding
policy development system improvements
high-quality health care
Australian Activity-Based Funding classifications
Admitted acute Subacute & Mental Health Emergency Non-admitted Teaching, Training
Non-acute & Research
Classification • Disease and • Disease and • Australian Mental • Urgency Related • Tier 2 Non-Admitted • Australian
Intervention Intervention Health Care Groups (URGs) Care Services Teaching and
Classifications: Classifications: Classification (AMHCC) • Urgency Disposition Classification Training
ICD-10-AM and ICD-10-AM Groups (UDGs) • Categories include: Classification
ACHI and ACHI • ED ICD-10-AM procedures, medical (ATTC)
• Australian Refined • Australian Principal Diagnosis consultation services,
Diagnosis Related National Short List diagnostic services, and
Groups (AR-DRG) Subacute and • Australian allied health and/or
Non-acute Emergency Care clinical nurse specialist
(AN-SNAP) Classification (AECC) intervention services

Patients are • Diagnosis • Setting • Setting • Visit type • Service type • This is not a patient
• Interventions • Care type • Phase of care • Discharge disposition • Clinician type classification
classified
• Length of stay • Phase of care, • Symptom/ functioning • Treatment urgency • Patient condition • This classification is
according to • Age Assessment of (Health of Nation • Diagnosis health professional
relevant • Sex function Outcome and Scales trainee oriented
measures • Mode of • Age HoNOS)/ Life Skills and key concepts
separation Profile (LSP-16) include profession
including:
• Newborn • Age and training stage
admission weight • Complexity
• Mechanical
ventilation hours
How SNOMED CT-AU and ICD-10-AM
support specific use cases
 SNOMED CT and ICD-10 were designed for their intended primary use case
SNOMED CT-AU Disease ICD-10-AM monohierarchy
polyhierarchy
Diseases Ch 10 Diseases of the respiratory system
Infection
Inflammatory
disorder J09-J18 Influenza and pneumonia
Respiratory disease Viral infection
J12 Viral pneumonia, not elsewhere classified
Pneumonia
Respiratory tract infection

* Not all pathways shown

Viral pneumonia ** Children of “Viral
pneumonia” are not shown
ICD-10-AM for statistical
aggregation and reporting
• Items organised into
non-overlapping
categories based on
their properties
SNOMED CT-AU
(monohierarchical)
concept definition
• No subject belongs to
multiple classes
• Complete and includes
a category for
SNOMED CT-AU for clinical data capture and retrieval everything
• Items defined according to meaning (polyhierarchical)
• A subject can be retrieved via many pathways or properties
• Precise and unambiguous definitions that are machine-readable
Supporting data capture and clinical communication
Specificity and content coverage are important considerations when selecting a standard code system for
data capture that can also communicate with other electronic systems.
Select diagnosis using SNOMED CT-AU Select diagnosis using ICD-10-AM
vascular myelopathy G95.1

Vascular myelopathy G95.1

G95.1 Vascular
Vascular myelopathies
myelopathies

More detailed concepts are available:

Encephalomyelitis co-occurrent and due to rubella
Infarction of spinal cord Save Includes: Save
Myelopathy due to acute infarction of spinal cord • Acute infarction of spinal cord
Myelopathy due to arterial thrombosis of spinal cord
• Haematomyelia
• Oedema of spinal cord
Myelopathy due to haematomyelia Cancel • Subacute necrotic myelopathy Cancel

SNOMED CT-AU is designed for primary data capture in a ICD-10-AM has limited values to capture specific clinical
clinical information system detail in individual health records
• Contains sufficient detail to allow clinicians to record the • Broad groupings represent one dimension of meaning
information they need • A single code groups multiple clinical meanings
• Meaning is retained when transferred between systems
 Supporting clinical data analytics
• Once data has been captured in a structured way, it can then be meaningfully analysed
• The types of questions that can be asked of the data and how easily relevant results are returned will
depend on the codes you are working with
• Terminologies and classifications support clinical analytics at different levels of specificity

Secondary use of data

Primary collection of data
SNOMED CT-AU coded health records are a rich source of
Clinicians input SNOMED CT-AU into clinical data for clinical cohort analyses, prognoses, outcomes,
individual health records which enables decision support and patient care exchange
analysis of patient data
• Health information managers
use the health care records to
code episodes into ICD-10-AM
and ACHI codes which enables
analysis of aggregated data in
predefined categories
Supporting clinical data analytics
• Define categories using ECL, identify records with SNOMED CT codes matching the criteria, and use
these codes to filter the clinical dataset, for example determining opioid usage by sex
opioids= [('<34841011000036108','dihydrocodeine'),
('<21821011000036104','codeine'),
('<21705011000036108','pholcodine'),
('<21232011000036101','buprenorphine'),
('<21357011000036109','methadone'),
('<135971000036102','tapentadol'),
('<21258011000036102','fentanyl'),
('<21259011000036105','oxycodone’),
…
('<21252011000036100','morphine'),
('<21486011000036105','tramadol'),
('<21901011000036101','dextropropoxyphene'),
('<34839011000036106','pethidine’),
('<1247191000168104','sufentanil')]

for opioid in opioids:

OpioidSet = PopulateSetWithECL(opioid[0])
filter = codeSet[“Medication"].isin(OpioidSet)
codeSet.loc[filter,"Opioid"]= opioid[1]
Supporting statistical reporting and aggregation
ICD-10-AM categories are broad and distinct, allowing single counting of an instance and meaningful
population health analysis.
Chapter Code categories Counts Category Count
1 Certain infectious and A15 Respiratory tuberculosis,
parasitic diseases bacteriologically and Total patients 10
histologically confirmed
Identify people with 4
10 Diseases of the J12 Viral pneumonia, not influenza and
respiratory system elsewhere classified pneumonia (J09-J18)
Identify people with 3
respiratory
J15 Bacterial pneumonia, not tuberculosis (A15.-)
elsewhere classified Double counting 0

8 Diseases of the ear H66 Suppurative and unspecified

and mastoid process otitis media
Supporting statistical reporting and aggregation
SNOMED CT is not as straightforward as ICD-10-AM for statistical uses in which we need strategies in place
to avoid the same disease being counted in more than one category.
Disease
Category Count

Respiratory disease Infection Total patients 10

Identify people with 7

Bacterial infection respiratory diseases
Identify people with 8
Viral infection Bacterial respiratory bacterial infections
infection Bacterial otitis media
Infective Double counting 5
pneumonia

Viral pneumonia Bacterial pneumonia Tuberculosis of Purulent otitis media

respiratory system
International Classification of Diseases revision
ICD-11 overview

The 11th Revision of the International Classification of Diseases (ICD-11) was released by World Health Organization in
2018.

In May 2019, it was adopted by the World Health Assembly for implementation by member states from 1 January
2022

No decision has been made in Australia (as of February 2020) as to whether, when or how ICD-11 may be
implemented to replace ICD-10 and ICD-10-AM for statistical or Activity Based Funding purposes.

Comparatively, ICD-11 offers a wider scope of services, a new digital format, improved clinical relevance and an
opportunity for expanded international comparison.

SNOMED International are collaborating with the World Health Organization to align SNOMED CT with ICD-11-MMS
https://www.snomed.org/news-and-events/articles/position-statement-snomed-ct-icd-11-mms-map
Features of ICD-11
Characteristic ICD-11

Size 55 000 coded entities, supported by more entities in the Foundation

Scope Diseases, related health problems, external causes, functioning

Used in All health settings

Use cases Patient episodes of care, death records

Primary purpose Statistical reporting on mortality and morbidity, Activity Based Funding

Deployed in Not yet deployed in Australia

Applied by -

Enables -

Structure Multi-parented, mutually exclusive

Logic Statistical, categorical (counting)

Granularity Sensitive

Update cycle Every year (index entries) to five years (code structure changes)
ICD-11 review: towards implementation planning in Australia
• The Australian Institute of Health and Welfare (AIHW) undertook a review of the ICD-11 and its potential
implementation in Australian health information systems (the Review project).
• The Review project aimed to provide evidence to support decision-making and implementation
planning.
• The first phase of the Review project was a stakeholder consultation overseen by the AIHW’s Australian
Health Classifications Advisory Committee (AHCAC). The complete ICD-11 Review Stakeholder
Consultation Report will be published by the AIHW on 12th March 2020.
• The Review showed that Australian stakeholders had limited knowledge of ICD-11, and that concerns
related to threats and weaknesses of ICD-11 would need to be addressed ahead of implementation. The
AIHW developed a proposed work program based on the findings of the Review with input and advice
from AHCAC, NHDISC and SCNHI in mid 2019.
• This program of work was endorsed for further prioritisation and work planning by the Australian Health
Ministers’ Advisory Council (AHMAC) in October 2019.
Proposed work program for prioritisation
The AIHW proposed four broad areas of work:
1. A comprehensive review of how ICD-10(-AM) is, and ICD-11 could be, used in health information
systems, including digital settings, including issues associated with ICD-10(-AM) and the way ICD-11
can address these.
2. Development of a national roadmap for classifications and terminologies and how they will be used
together within health information arrangements. This would ensure that classifications and
terminologies are used appropriately with consideration of their varied use cases.
3. Strategic communications activities to ensure that decision-makers and their advisors can contribute
to further work and decision-making over the next year about whether, when and how to implement
ICD-11.
4. Continued planning for implementation in mortality data systems to maintain and advance Australia’s
current involvement in this international process.
What is ICHI?
• ICHI is the International Classification of Health Interventions developed by the World Health
Organization (WHO) and the WHO Family of International Classifications (WHO-FIC).
• The aim is to meet a number of use cases such as:
– International comparison,
– National uses,
– Patient safety and quality, and
– Health system performance measurement (incl. financing).
ICHI Beta-2 – Australian Field Testing
• 50 Australian coders recently participated in global field testing of the Beta-2 version of ICHI.
• The assessment was undertaken in terms of content coverage and coding feasibility and utility, focussing
on comparing country-specific interventions (ACHI) with an ICHI tabular list to identify possible gaps and
structural issues.
• Assessing the coding feasibility and utility was done through:
– line coding of intervention terms representing four different settings i.e. medical-surgical interventions, primary care
interventions, functioning interventions and public health interventions
– case coding of intervention scenarios in medical-surgical and functioning settings.

• WHO will compile the results from all countries and provide the following analysis:
– Percentage distribution of coders agreement with the gold standard of the ICHI code assignment for each intervention term
and case.
– Basic descriptive statistics including frequency distribution, measures of central tendency (mean and median) of encountered
coding time, accuracy and usability disaggregated by appropriate covariates (e.g. age, background etc.).
Maps between SNOMED CT and ICD-10
 SNOMED CT and ICD-10 have complementary strengths

Situations may benefit from use Maps may be used when a link is required between
of both code systems SNOMED CT and ICD-10.

• Different maps for different purposes

• SNOMED CT for the capture • Any general map needs to be carefully applied
of clinical information, per use case
decision support,
communication, analysis
and clinical research Mapping is NOT a simple task, a one-off exercise,
or a low risk and low cost approach
• ICD-10 for statistical
analysis, administrative data Consult ISO standards for
and billing • Principles of mapping between terminological systems
• Terminology resource map quality measures
What maps are available?

Mapping tables between • snoMAP for ABF: Enables diagnoses

recorded using SNOMED CT-AU in
• Different editions of ICD-10-AM
Emergency Department to be
• Different editions of ACHI
converted to ICD-10-AM codes for
• ICD-10-AM to ICD-10 non-admitted patient reporting
• snoMAP Starter: For research &
analytics only. Maps from SNOMED
CT-AU to ICD-10-AM 11th Edition
• A complex map from SNOMED CT to
ICD-10 is available with the
International Edition of SNOMED CT Mapping tools may be used
• Technical guide available from • Snapper:Map
http://snomed.org/icd10map
snoMAP Starter

https://aehrc.com/

Australia’s National Science Agency

 snoMAP Starter
snoMAP is an AEHRC web-based mapping tool that utilises Ontoserver to provide
mappings between defined terminologies.

Provides a starter map from SNOMED CT AU to ICD-10-AM 11th edition

• Starter map will require application to data (ie. Different application rules for different
data sets)
• For research and analytic purposes only
• Requires understanding of SNOMED CT-AU structure and ICD-10-AM rules, as well as
application to data
• FHIR conceptmap

Does not support mandatory reporting for

• NMDS data
• Casemix funding (DRG or ABF)
 snoMAP Starter

Not for use in any user facing, point-of-care deployments

Different scope and design than the current snoMAP for ABF deployments; these are
optimised only for ABF purposes

Available under subscription - August 2020

For more information, please contact

[email protected],
[email protected] or
[email protected]
Summary
SNOMED CT-AU and ICD-10-AM/ACHI at a glance
Characteristic SNOMED CT-AU ICD-10-AM / ACHI

Size 480 000 20 000 / 7 000

Scope Anatomy, substances, organisms, diagnoses, procedures, Diseases, related health problems, external causes,
medications interventions

Used in All health settings Admitted inpatient

Use cases Individual longitudinal health records Patient episodes and populations

Primary purpose Clinical data entry in a patient record Statistical reporting on hospital morbidity, casemix,
Activity Based Funding

Deployed in Clinical information systems (CIS), Patient administration systems (PAS), National Minimum
Electronic health records (eHR) Data Set (NMDS), clinical registries

Applied by Clinicians Health information workforce

Enables Communication, messaging, decision support Health trends, national statistical reporting

Structure Poly-hierarchical, multi-parented Mono-hierarchical, mutually exclusive

Logic Definitional, description logic (knowledge) Statistical, categorical (counting)

Granularity Specific Sensitive

Update cycle Monthly Every two years

Highlights
•Support the primary collection (input) of clinical information
Terminologies •Enable patient care management through decision support and patient care exchange
e.g. SNOMED CT-AU •Enable effective retrieval and reuse of clinical information for clinical cohort analyses,
prognoses, outcomes, and more

Classifications •Support the statistical reporting of clinical activity and other health information
e.g. ICD-10-AM •Enable use in applications such as Activity Based Funding

• The broad classification groupings limits communication between clinicians for patient care purposes
Specific use • Clinical terminology reporting outputs as a secondary use is currently not well known or utilised in
Australia
cases • Increased integration and interoperability between digital health and health information environments

Using clinical terminologies and statistical classifications together for their intended primary
purposes (clinical inputs and communication, and statistical outputs and reporting, respectively),
enhances and strengthens clinical and patient information use, decision-making and outcomes.
Useful links and supplementary information
For further information
Topic Contact Details
SNOMED CT-AU and the AMT National Clinical Terminology Service (NCTS) at Help Centre: 1300 901 001
the Australian Digital Health Agency Email: [email protected]
Website:
https://www.healthterminologies.gov.au
Health classifications Independent Hospital Pricing Authority (IHPA) Email:
[email protected]
Website:
https://www.ihpa.gov.au
ICD-11 Australian Collaborating Centre for the World Email:
Health Organization Family of International [email protected]
Classifications, at the Australian Institute of
Health and Welfare
Statistical and epidemiological uses of Australian Institute of Health and Welfare Email:
health classifications: [email protected]
• data requests, general inquiries [email protected]
• specific advice on coding
Acronyms
Acronym Full name and hyperlink Acronym Full name and hyperlink

ACHI Australian Classification of Health Interventions ICHA-HP Classification of Health Care Providers

AIR Australian Immunisation Register ICNP International Classification for Nursing Practice

ANZSCO Australian and New Zealand Standard Classification of ICPC2+ International Classification of Primary Care, Version 2 PLUS
Occupations
LOINC Logical Observation Identifiers Names and Codes
AR-DRG Australian Refined Diagnosis-Related Groups
MBS Medicare Benefits Schedule
ATC The Anatomical, Therapeutic, Chemical (ATC) classification
system MedDRA Medical Dictionary for Regulatory Activities

BCP 47 Tags for Identifying Languages NCPT Nutrition Care Process Terminology

ChEBI Chemical Entities of Biological Interest OMIM Online Mendelian Inheritance in Man

CPT Current Procedural Terminology Orphanet Orphanet

DSM Diagnostic and Statistical Manual of Mental Disorders PBS Pharmaceutical Benefits Schedule

GMDN Global Medical Device Nomenclature SNOMED CT-AU Systematized Nomenclature of Medicine - Clinical Terms,
Australian extension
HPO Human Phenotype Ontology
TA Terminologia Anatomica
ICD-10-AM International Statistical Classification of Diseases and Related
Health Problems, Tenth Revision, Australian Modification UCUM Unified Code for Units of Measure

ICD-O International Classification of Diseases for Oncology UDI Unique Device Identification

ICF International Classification of Functioning, Disability and WHODrug WHODrug Global

Health
Acknowledgements
• This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the
International Health Terminology Standards Development Organisation (IHTSDO). All rights reserved.
SNOMED CT®, was originally created by The College of American Pathologists. “SNOMED” and
“SNOMED CT” are registered trademarks of the IHTSDO.
• This material includes reference to the International Statistical Classification of Diseases and Related
Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) and the Australian Classification
of Health interventions (ACHI), © Copyright Independent Hospital Pricing Authority, Darlinghurst, NSW.
All rights reserved. ICD-10-AM is based upon the International Statistical Classification of Diseases and
Related Health Problems, Tenth Revision (ICD-10) © Copyright World Health Organization. All rights
reserved. Modified by permission for Australian Government purposes.
The Independent Hospital Pricing Authority (IHPA)
• Independently sets the National Efficient Price (NEP) for ABF public hospital services and any 'loadings' to
account for variations in prices
• Determine the criteria for defining block funded services and the National Efficient Cost (NEC) of block
funded hospitals
• Specify all of the classification, costing, data and modelling standards that are required for ABF
 The Australian Digital Health Agency
The Australian Digital Health Agency is funded by all Australian Governments. It
designs and operates national digital health services and set data standards that:
• Give consumers more control of their health and care when they wish it
• Connect and empower healthcare professionals
• Promote Australia’s global leadership in digital health and innovation

When patients move between care settings, the absence of complete and up-to-date

“
medication data can contribute to instances of care becoming high risk, resulting in
medication misadventures and unnecessary hospital readmissions.
“
Pharmacy Guild of Australia, submission to National Digital Health Strategy 2017

The value of utilising pharmacists in digital health initiatives comes not only from the

“
provision of dispensing histories but mainly from pharmacists using their unique skills and
medicines expertise to meaningfully engage with the information contained in digital
health records... to ensure the safe, effective and judicious use of medicines. “
Pharmaceutical Society of Australia, submission to National Digital Health Strategy 2017
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