SNOMED = Confusion

SNOMED = Confusion

The implementation of the new requirement for all NHS clinical dental records to be stored using SNOMED CT, has been met with universal confusion and frustration by practitioners.

Originally scheduled for launch on April 1st, 2020, the use of the Systematized Nomenclature of Medicine - Clinical Terms was a mandatory NHS requirement from September 1st.

Dental forums and peer-group message boards were filled with queries from clinicians to colleagues yesterday, on the first day of the system’s introduction.  

On 31st August, England’s Deputy Chief Dental Officer Dr Jason Wong, and Director of Primary Care
NHS England, Ed Waller, made it clear in the latest NHS dentistry and oral health update, that from the first day of September, all records must be stored using the SNOMED CT software.

The update said “As dental practitioners contract directly with dental software suppliers, it is incumbent on practitioners to ensure that their practice management software is compliant with SNOMED CT.”

On the launch day, some practitioners said that codes were missing from their software and others said that published codes had been ‘taken down’ so that manual input by practitioners into their software was not possible.

On September 1st,  NHS England and NHS Improvement said  “Software suppliers were given Reference Sets on the BSA website ahead of the original implementation deadline of 1 Apr 2020.”

“Some software suppliers have used these to produce their software solutions. The ability to use the terminology rests with the software suppliers.”

“As dental practices contract directly with software suppliers, dental practices should contact their software supplier if the SNOMED-CT codes are not available.”

But the widespread problems associated with the SNOMED launch led the Dental Software Suppliers Association (DSSA) to issue an urgent statement on the launch day.

The DSSA made it clear that the software suppliers had NOT received a finalised set of SNOMED CT codes that they could incorporate into practice management software.

The statement said “We are aware that users of our members’ dental practice management software are contacting us to ask about the go live date which remains today, 1st September 2021.  We can confirm that the ability to input SNOMED codes against treatment codes is available in all DSSA members’ products.”

“It is important to note that, to date, we have not received a finalised set of SNOMED CT codes to be incorporated into our practice management software solutions.”

“The Dental Software Suppliers Association is continuing to seek clarification on the following points.”

“1. How and when SNOMED codes should be recorded in the day-to-day workflows of diagnosis and treatment through your practice management software?”

“2. The finalised list of SNOMED codes for practice management systems to implement, with mapping to treatment and diagnosis codes within the software?”

“3. How practices are expected to use the recorded SNOMED codes; when/if the information should be viewed, transmitted or simply stored in the database?”

The DSSA reassured customers of DSSA members will be provided with “Functionality to enable them to remain compliant with all requirements.”

“Each dental software supply company shall communicate directly with their customers as each of the above points are clarified and a roadmap for inclusion within the software is agreed upon.”

In 2020, the British Dental Association called for the implementation of the new software to “Easily integrate with the current dental software systems without becoming onerous on the practice.”

One practitioner said online that the maker of the software system he used, was unable to confirm that codes for NHS defaults were correct.  The onus being on the individual clinician to verify the codes before transmission.

Another practitioner said the new system was so frustrating, it was another reason to “Quit the NHS.”

Dr Wong and Mr Waller described SNOMED CT as  “A standardised terminology that allows collaboration across all healthcare platforms.  The capture of this richer data set should not make the patient charting more onerous.”

“SNOMED CT is a system that is essential to speed up referrals for oral cancer and enable dental practices to receive crucial information on issues such as child safeguarding.”

Today  (2nd September), the British Dental Association urged NHSX and the Office of the Chief Dental Officer to issue an urgent statement on the status of SNOMED CT, following updates instructing practices to implement the system from 1 September 2021. 

The BDA News website reported that the BDA had previously expressed grave concerns that the systems in place for its use in dental practices are not sufficiently robust at present to ensure patient safety and a smooth rollout that would not impact on time spent with patients.  

Shawn Charlwood, Chair of the BDA General Dental Practice Committee told BDA News 

"Since March, we have been engaging with NHSX, as advised by the Minister Jo Churchill, to resolve the outstanding issues with implementation of SNOMED CT. In our meetings, NHSX has been clear that it did not regard it as necessary for dental practices to implement SNOMED from 1 September 2021 and that instead it wished to take the time to work with BDA to develop a subset of dental-specific SNOMED codes that would be appropriate for use. 

"It was therefore unexpected that NHS England and the Office of the Chief Dental Officer announced on 31 August that practices were expected to begin using SNOMED from 1 September. 

Ian Gordon
Just for the record SFD is recording automatically and has done since April 1. It’s seamless for clinicians. Not sure why other software providers were not on top of this. ? If one Provider has done this why not others ?

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