Showcase how opensource Bahmni EMR integrates with SNOMED FHIR Terminology Server, to leverage advantages of the SNOMED terminology and knowledge graph, in areas of recording clinical data, reporting, CDSS, analysis, etc.
Nov 15, 2023
Integration with Snowstorm (opensource SNOMED Terminology Server) for diagnosis search, form data entry, etc.
Showcase benefits of SNOMED hierarchical terminology system in areas of: Reporting, CDSS, Analysis, etc.
This feature will allow customers to start using SNOMED terminology in their health facilities for recording diagnosis/clinical data, and also perform reporting & CDSS use-cases using this recorded data. Customers will be able to perform CDSS use-cases for Drug-Diagnoses, Drug-Drug, and Drug High Dosage interactions. The full implementation is opensource and SNOMED international is very happy to help support implementations/geographies that wish to adopt SNOMED.
Other features include export of bulk patient data as FHIR, integration with opensource SNOMED Analytics tool, WHO ICD-10 reports, and integration with Micro FHIR Terminology Server (Snowstorm Lite) for on-prem/offline hospitals. We look forward for community inputs and contributions.
Please contact @Angshuman Sarkar@Vijay Anand Shanmughadass@Gurpreet Luthra@Ketan Goenka@Kai Kewley (SNOMED Team) who can help you understand this integration better if you are interested in exploring SNOMED. Or come to our Slack channel to ask questions directly with the SNOMED team.
Tip: Bahmni ships with various options for Clinical Dictionary, which include Custom Dictionary, CIEL Dictionary or SNOMED TS integrated dictionary. Please refer to the following write-up to decide which option is most suitable to your facility / context. Link: https://bahmni.atlassian.net/wiki/spaces/BAH/pages/3251863630
Create an open-source reference implementation that displays best practices regarding how EMRs can leverage and benefit from SNOMED CT coding system
SNOMED CT International seeks to integrate SNOMED-CT codes with Bahmni, offering an open-source reference implementation for best practices in utilizing SNOMED CT coding systems. This is valuable for governments and countries adopting SNOMED CT, guiding them in enhancing existing digital systems to fully realize the benefits of SNOMED CT.
2. Phase 1 Features
Record patient diagnosis in Bahmni using SNOMED CT with real time Terminology Search - Diagnosis Search/Save
Reports in Bahmni displaying the power of SNOMED CT- Diagnosis Reports
CDSS alert in Bahmni based on recorded SNOMED diagnosis and drug interaction - CDSS
Support for recording chief complaints H&E forms using SNOMED CT & Support for designing Bahmni - Form Builder
3. Phase 2 Features
Generate ICD-10 reports based on SNOMED code mappings - ICD-10 Reporting
Export anonymised, FHIR based, patient data for SNOMED analytics tool - Bulk Export for Analytics Tool
CDSS alert in Bahmni based on drug-drug interaction, drug high dosage - CDSS
Implementation of micro FHIR terminology server for low resource settings (include Contract Tests) - Micro FHIR
Ability to setup and order procedures using SNOMED CT - Setup Procedures
Ability to Sync Procedures with SNOMED TS - Sync Procedures
4. Current Landscape of Bahmni-SNOMED Integration
The CDSS and Terminology Server (Snowstorm LITE), marked with dotted lines, are deployed within the premises (can be on same machine or different).
The CDSS and Terminology Server (Snowstorm), depicted with dotted lines, are deployed on independent computing instances external to the Bahmni compute instance.
5. Environments for Dev, QA & Demo
(Go to CLINICAL section. Default creds: superman/Admin123)
6.2 CDSS alert in Bahmni based on recorded SNOMED data
CDSS feature allows the clinicians to make informed decisions when prescribing medications to the patients, for scenarios which might have some negative impact on patient health outcomes, based on predefined rules.
Clinicians are notified with an alert when any of the below interaction has contraindications
Diagnosis-Drug: When one or more drugs are contraindicated to a diagnosis and vice versa
Drug-Drug: When two or more drugs are contraindicated to each other
Drug Dosage: When prescribed drug(s) daily dosage is more than the recommended average daily dosage
All or any of the above three alerts can be triggered at the same time
For Drug-Diagnosis alert, the hierarchical classification in SNOMED CT helps to identify all the descendants of a diagnosis and applies the CDSS rules to those as well. Therefore, if a drug is contraindicated to a diagnosis, then the drug will be contraindicated to all the descendants of diagnosis as well.
To mitigate the alert, clinicians can make amendments to the medications or their dosages in the medications tab
Clinicians can also take an informed decision and can choose to dismiss the alert. For ‘critical’ alerts, user also needs to provide a reason for dismissing the alert
Clinicians cannot save the data if an active critical alert exists, until they resolve the alert
Features of the Alert Notification implemented in the project
Three different severity (Critical, Warning, Info)
Consists of summary (mandatory) and details (Optional)
Includes link to the source of information (like Wiki, etc.)
Clinician can choose to override critical alerts by providing justification
CDSS Alert Notification for Medical Interaction with SNOMED-CT (Video)
8.8 Support for recording chief complaints H&E forms using SNOMED CT & Support for designing Bahmni
Users can customise set of questions in Bahmni according to their requirements to record patient’s responses
They can customise the questionnaire under the form builder module
SNOMED CT is leveraged to provide the list of responses to a given question
Once saved and published, the form is used by clinicians to record patient responses
Clinicians can also generate a report on the patients’ responses under reports module
Currently, the form names that can be used for creating forms and reporting the same are: "Test Form", "SNOMED H&E Form", "SNOMED Malaria Form", "SNOMED Asthma Form", "SNOMED COVID Form", "SNOMED Accident Intake Form"
Advantage of using SNOMED
Using SNOMED terms helps in standardising the responses from the patient, so that it can be easily exchanged with other EHR systems, hence improving patient healthcare
COVID-19 Form Designing and Recording Data using SNOMED CT Terms (Video)