NHS e-Referral Service
SNOMED Clinical Terms
SNOMED Clinical Terms provide a reliable way of searching for services with the
NHS e-Referral Service and help to ensure that the right patient is seen in the right
place by the right clinician. Success does rely on the provider organisation setting up
their Directory of Services correctly with advice from the relevant clinician for each
service as well as having regard to the terms that referrers are likely to use when
searching for services.
The list of SNOMED terms within the Directory of Services advertises both the
clinical conditions treated and the treatments that are available within the provider
Service. It enables provider clinicians to check that their entry in the Directory of
Services reflects their skills. This should ensure that when a referrer uses a Clinical
Term familiar to them to search for a service they can be sure that their patient will
be seen in the correct clinic. This reduces the risk that the referral will be rejected or
redirected and should also prevent inappropriate patients presenting in clinics
providing a safer and more timely patient pathway. A full list of terms is now available
for offline use and available from the NHS the NHS e-Referral Services website.
SNOMED is a clinical terminology which has been adopted by the NHS in
association with the International Health Terminology Standards Data Authority
(IHTSDO) based in Denmark. The objective of SNOMED is to support the
unambiguous coding of validated clinical terms. Each Clinical Term is described as a
concept. Each clinical concept is identified by a unique concept ID number. Clinical
concepts should only occur once in the SNOMED terminology. However clinical
concepts can have more than one description. Descriptions can be one of the
following:
Fully Specified Name (FSN) – this is an unambiguous description of a clinical
concept.
myocardial infarction (disorder)
Preferred Term – this is often a more user friendly adaption of the FSN
myocardial infarction
Synonym - terms in common use associated with the FSN.
heart attack
Each SNOMED concept will have one FSN, and one Preferred Term but zero, one or
multiple synonyms. For example these are some of the descriptions associated with
the SNOMED concept with ID 22298006:
FSN
myocardial infarction (disorder)
Preferred Term
myocardial infarction
Synonym
cardiac infarction
Synonym
heart attack
Synonym
infarction of heart
Synonym
MI - Myocardial infarction
Synonym
myocardial infarct
Within NHS the NHS e-Referral Services both synonyms and preferred terms are
displayed when searching for a clinical term.
However once a clinical term has been selected, the description shown in the
application is made up of the Preferred Term + the hierarchy suffix in parenthesis
from the FSN, in the majority of cases this will look similar to the FSN. This decision
was made because some FSNs are very long and not clinician friendly. The addition
of the suffix signals to the user that what they are looking at is a coded concept
rather than simple text.
The NHS e-Referral Services currently uses about a tenth of the available clinical
concepts in the International SNOMED. The IHTSDO holds the master list in a US
style but there is also a UK list, these are known as the International and UK
fragments respectively. The NHS e-Referral Service has its own fragment containing
about 20,000 concepts. However there are almost 100,000 terms that can be
searched on within the NHS e-Referral Service allowing for preferred terms and
synonyms. These terms were decided upon after consultations with Clinician groups
when SNOMED was introduced into the Choose and Book Application in 2009. They
were felt to be the most useful clinical terms for Referrers to search on and for
Providers to use to describe the services they offered.
SNOMED terms are divided between some 19 different hierarchies in the
International Fragment but the NHS e-Referral Service only uses three of these.
They are sometimes referred to as “Chapters”. The three hierarchies in the NHS eReferral Service are Findings, Procedures and Situations with Explicit context.
Findings
Concepts in this hierarchy represent the result of a clinical observation, assessment
or judgment, and include both normal and abnormal clinical states.
Findings all have a suffix of “(finding)” or“(disorder)” attached to the FSN.
Examples of Findings:

Intermittent claudication (disorder)

Claudication (finding) (synonym)
Procedure
Procedure concepts represent activities performed in the provision of health care.
This hierarchy represents a broad variety of activities, including but not limited to,
invasive procedures.
Procedures all have a suffix of “(procedure)” or “(regime/therapy)” attached to the
FSN.
Examples of Procedure:

Bilateral inguinal hernia repair (procedure)

Manipulation of spine using traction (procedure)

Acupuncture and allied techniques (regime/therapy)
Situations with Explicit Context
SNOMED has developed a context model to allow users to specify context using the
terminology, without depending on a particular record structure such as found in the
above two hierarchies.
Situation with explicit context concepts all have a suffix of “(situation)”.
Examples of Situation with explicit context concepts:

Family history: Myocardial infarction (situation)

No family history of stroke (situation)

Nasal discharge present (situation)

Suspected epilepsy (situation)