SNOMED CT® Order Set
Strategy
SNOMED International Nursing Working Group
June 20, 2006
Cyndie Lundberg, RN, BSN
Terminology Manager, Nursing
© 2005 College of American Pathologists
Outline
 Define order sets
 Describe order set concept model
 Describe order set implementation
challenges
© 2005 College of American Pathologists
How does one define
Order Set?
 Ordersets are associated with a
clinical state that may contain a list of
orders that share a common clinical
indication
– Standard admission orders
– Pre-op cardiac catheterization orders
© 2005 College of American Pathologists
How does one define
Order Set?
 Ordersets are developed to:
– Promote patient centric care
– Support clinical decision support
– Support clinical pathway development
– Support CPOE based on business/industry
standards
© 2005 College of American Pathologists
Types of orders that populate
order sets
– General ancillary orderables – orders that
pass to an ancillary interface system
• X-ray right forearm
• Colonoscopy with rigid sigmoidoscope
through colotomy
• Intravenous steroid injection
• Complete blood count without differential
© 2005 College of American Pathologists
Types of orders that populate
order sets
– General non-ancillary orderables – orders
that do not pass through to an ancillary
system
• closed drainage wound care
• wound treatment education
• packing of wound
© 2005 College of American Pathologists
Types of orders that populate
order sets
General non-ancillary orderables orders that consist of communication
from one clinician to another or from
one clinician to a patient regarding
something to be performed
– Communication orderables are orders that do not
pass through an interface system
• Generalized communication orders – e.g.:
–
–
–
–
Up ad lib
BRP
Diet as tolerated
Dangle at bedside. etc
© 2005 College of American Pathologists
Types of orders that populate
order sets
General non-ancillary orderables –
orders that communicates what
needs to be performed.
Protocol orderables
• e.g.: Skin Care Protocol
Concatenated Orders
• e.g.: No BP, No Blood Draws No IV
sticks on affected arm
© 2005 College of American Pathologists
Types of orders that populate
order sets
General non-ancillary orderables
that are communicated from one
clinician to another
• Complex communication
orders:: Criteria based orders
– e.g.: IF URINE VOLUME ON STRAIGHT
CATHETERIZATION < 30 ML INSERT
URINARY CATHETER
© 2005 College of American Pathologists
OrderSet Discussions
© 2005 College of American Pathologists
Nursing Order Requirements
for Integration
 What type of nursing orders will be
required for data analysis and
research?
 What are the healthcare integration
requirements for nursing orders?
© 2005 College of American Pathologists
Should All Orders Be
Coded?
Does all nursing orderables require
codified concepts?
–
–
–
–
–
–
Initial patient assessment
Admit to NICU
Speak directly into the patients best ear
Diet as tolerated
Notify provider lab results
Provide with reorientation, including use of clock, watch,
calendar, radio, TV, and newspapers
– Sleep apnea protocol
© 2005 College of American Pathologists
What Are The Integration
Requirements for Nursing
Orders?
© 2005 College of American Pathologists
Requested Orders: How Should
They Be Represented in
SNOMED CT?
 Clinician orders one orderable to contain
multiple meanings tucked into one order
– CPM (continuous passive motion machine)
application
– CPM machine is being monitored throughout the
treatment
 Question is: Is the SNOMED mapping to mean
to apply the machine and monitor the use of the
machine?
– Continuous passive motion therapy CID 229078009
© 2005 College of American Pathologists
Requested Orders: How Should
They Be Represented in
SNOMED CT?
 Neurovascular Assessment Lower
Extremity
 Maps via post-coordination to
SNOMED CID’s:
– Neurovascular assessment CID TBD
– Lower limb structure CID 61685007
© 2005 College of American Pathologists
Requested Orders: How Should
They Be Represented in
SNOMED CT?
 Small-Bore Feeding Tube Care
 Small-Bore Feeding Tube Discontinue
 Small-Bore Feeding Tube Insertion
 Maps to SNOMED CID’s???:
– Maintenance of gastrointestinal tract tube CID
384745002
– Nasogastric tube removal CID 81011003???
– Removal of gastrostomy tube CID 90838004??
– Open insertion of feeding tube into stomach
CID 173784007???
© 2005 College of American Pathologists
Questions?
[email protected]
© 2005 College of American Pathologists