Laurie McGraw explains the link between two medical terminologies and quality care

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In today’s COVID-19 update, AMA Chief Experience Officer Todd Unger speaks with experts about two medical terminologies, CPT and SNOMED CT, and the importance to providing quality care during the COVID-19 pandemic and beyond.

Learn more at the AMA COVID-19 resource center.

Speakers

• Laurie McGraw, senior vice president, Health Solutions, AMA
• Don Sweete, chief executive officer, SNOMED International

Unger: Hello, this is the American Medical Association's COVID-19 update. Today, we're discussing two medical terminologies, CPT and SNOMED CT, and their importance to providing quality care during the COVID-19 pandemic and beyond.

I'm joined today by Laurie McGraw, the AMA's senior vice president of health solutions in Boulder, Colorado, and Don Sweet, chief executive officer of SNOMED International in Nova Scotia, Canada. I'm Todd Unger, AMA's chief experience officer in Chicago.

Laurie, for those of us that might not be familiar, what is medical terminology and why is it so important?

McGraw: Great, thanks Todd. And it's great to be here this morning. And Don, it's really great to see you. I really miss seeing you at the SNOMED Global Expo this year, except on camera.

So, what is medical terminology? So, these are the classification systems that describe all of the terminology used to document care, to codify care, to really describe it. And that is critically important because, more and more, as we look to make things computable, and we talk about things like AI and analytics, and having the terminologies to describe what care is being delivered, that allows us to do all kinds of important things for research, for documentation, for coding and billing and the like. So, it is the classification systems to describe what care is being delivered.

CPT specifically, and obviously Don can talk about SNOMED, CPT specifically, the current procedural terminology, that's about 10,000 codes. It's the standard used in the United States, but also in several other geographies across the globe to describe procedures and services delivered by physicians and health care professionals. We can talk more about that, but that's the bottom line of what terminologies are used for.

Unger: Don, anything to add to that? Sorry.

Sweet: Great opening, Laurie. Great to see you as well.

Well, I agree with Laurie. I think the promise of terminologies is wonderful, but it's wonderful from a patient and clinician perspective. SNOMED CT is the largest clinical terminology in the world. And really what it does is it provides clinicians context on the patient. It provides the information they need in order to have a discussion with the patient about their care and how their care moves forward and outlines any given things that may have been missed that they can consult on.

I think the wonderful thing about terminologies and putting two terminologies together is the ability to have the clinical context and then understand how the resources work to provide clinical care. And that's why it's so important that we're here today to talk about a collaboration between the American Medical Association and SNOMED International.

Unger: Well, let's dig into that. Laurie, can you talk about how these terminologies work together and what are the benefits of doing that?

McGraw: Yeah, so let me go back to a little bit more about CPT. So, again, 10,000 codes, and these are updated continually with an open, transparent process with an independent body, the CPT Editorial Panel, practicing physicians with literally hundreds, if not thousands of clinicians that contribute to keeping it current for what are the services, and procedures that are delivered in care. And the important thing about CPT, in terms of describing all of those services, which now include things that are exploding, digital medicine, therapeutics, AI and the like is that we also have the ability to understand the value, the resources that are required to deliver these services.

So, we think about that as a proxy, if you will, for almost understanding sort of like cost of care. And that allows us, as Don was saying, to really get at really critical things for patient access to care, doing things in the area of improving outcomes and then understanding just the cost of delivery. So, those are some of the things of why the collaboration is really important for CPT to work with the broader clinical medical terminology, which is what SNOMED is.

Unger: About how long, or what's the source of the collaboration, where did that come from and how long you been doing that?

McGraw: So, it was a couple of years ago, about five years ago, Don and I started working together when I first joined the American Medical Association. And Don has a vision for SNOMED that he has been executing on as SNOMED is now used globally. What is it, 40 plus countries, Don, that SNOMED is in? And we really felt that with the advances of medical terminology that not just understanding how to describe medical care, but really getting to that value and sort of those cost equations was critically important. Don, I'm sure you can talk about more what you were thinking when you sort of answered the telephone call.

Sweet: I guess, from our perspective, we looked at it looked as a tremendous opportunity. In Europe, they're launching a cross border initiative where the patient population of Europe, and I know firsthand having lived in both Copenhagen, Denmark and in London, England, every weekend people leave those countries to go to other countries. And so, you can imagine, if you will, the issues that may arise when patients have, let's say, an adverse event in one of those foreign countries, but their medical record isn't there.

Marrying these two terminologies together, and having them spread over a geographic area similar to Europe allows the information to flow with the patient. They can start to see the patient information using SNOMED CT, and they can also, the promise is, see the resources, and see the value of assigning the particular resources that are going to have the best effect for patient outcomes in that regard.

So, for us, being a global organization, as Laurie said, we're in 40 member countries, but we're used in over 80 countries now. That is the promise that this collaboration holds, the ability to offer what we're doing really in North America to spread that to other countries around the globe, so that they have the best of both worlds, if you will.

Unger: Is it hard for these two languages, so to speak, to communicate with each other? Or is there an infrastructure that has to be built for that to happen?

McGraw: Yeah, well it takes work. I mean, it's not just sort of like lining it up. I mean, we have, and we have had maps in terms of making sure that there is sort of a correlation of one particular code to what are the one or more SNOMED codes that might correspond, but more is needed. And so, part of this collaboration includes a commitment to resources, a commitment to providing tooling, a commitment to providing use cases that show this value.

Terminology, I mean, we're sort of like in a level the average physician, perhaps, they don't really understand sort of these details. They just want it to work when they're documenting care. And they want it to be seamless. And they don't care about the technical details under the covers. So, part of the work that we're doing together is we just, at Don's conference, unveiled a new demonstration tool to show some of these use cases. It was with a breast cancer example, to understand how the care was documented. And then, how you might evaluate how the resources were used to determine what are the care pathways that might be the best for your patient population. It's one example, but there are many more.

And then, there were some other things that we have planned together, whether it's a sandbox environment, so people can play around with these things, and more will be needed. But it's the resources under the covers to make this more accessible to people who are trying to achieve the broader large questions that Don was describing.

Unger: When you look at this integration, Don, and in the terms of population health, what do you see as the benefits there?

Sweet: Well, there's huge benefits. I mean, regardless of whether you're dealing with a clinician's catchment population area where, eventually, if they're using both terminologies and they don't get to see it, it's all under the covers, and the software works well, they can actually to do predictive analytics. And they can look at their population and say, "We have a cohort of patients that may be susceptible to this disease, or to this condition. And so, we should proactively move forward and start to do some interaction with that group of patients." At the same time, because they will be able to see the resources that it's going to take for that cohort of patients down the road, they can also start to marshal resources in that area, so that they're prepared.

Too often, I think, in health care it's always what is happening in any given day, or any given week, rather than look taking the long-term view, and using those scarce resources effectively in order to make sure that all patient outcomes are improved. And the only way that you can do that is if you have the clinical context on the population that you're looking at from an analytics perspective, and the underlying factor of what are the resources required in order to follow those clinical pathways. And that way you're not swamped, as we have been with the pandemic, because that information isn't available. So, this gives you a more predictive view of what's going to happen.

Unger: Well, the pandemic is, of course, the big topic. Neither of you were anticipating that at the beginning of the year. So, I'm eager to hear, from both of you, about how the pandemic has affected the evolution of the code sets. Laurie, will you start by talking about CPT?

McGraw: Sure. I mean, so we have a very structured and predictable process with CPT in terms of the number of updates, and how it comes out to stay current. And then, boom, a pandemic happens. And that doesn't work on a schedule. And, Todd, you've been talking about the work of the AMA, but in the world of CPT, the editorial panel immediately got to work. And so, we are on our sixth emergency meeting over the course of the past six months to make sure that we get the codes for the diagnostic testing, and there's been all kinds of different types of testing that's been needed and involved, and we need the codes to get it right. How are these things documented? And then, therefore, paid for.

And now, we're working on the vaccines. The vaccines are coming, and we are really wanting to make sure that we get it right, because as soon as they come onto the market, it's not just about describing what are those vaccines, but what does it take to refrigerate them? How many doses do you need to apply? There's a lot of work, there's a lot of consultation that clinicians are going to be doing with their patients to deliver those vaccines. And we are working on getting the coding right, so that we can document, and then it can work through the health care ecosystem. So, that's the CPT side. Don, I'm confident you've been doing that and then some for the broader terminology.

Sweet: Yes. I mean, I want to just a shout out to our member countries who have helped us. We have a distinct advantage in the fact that we crowdsourced to a certain extent, because we're so engaged with our member countries. So, we had an initial batch of COVID-19 codes that were put forth. They were reviewed both by our editorial board, within 48 hours, as well as a group of our member countries. We have put those codes in the international release, so that our members can avail themselves of those codes. We also have, what's called, a global patient set, which is freely available to anyone in the world. And we've put those COVID-19 codes in there.

We further, on an ongoing basis, see codes coming in from our members as more and more information is garnered about the process, about the symptoms and the diagnosis and their underlying symptoms. And all of that is added into the international and released in the global patient set, just as soon as our members agree that those codes are necessary and it's approved by our editorial board.

Looking forward, we're already working on vaccines. We have a vaccine grouping within SNOMED, and that's under review right now and revamping, so that we can adapt with the times. So, for us, being a virtual organization, it's much easier to get ahold of people at home and get those decisions made. So, we're ready.

And we've also taken two other steps. We've joined a number of interoperability collaboration groups, especially in the United States, so that we can work with other standards such as IHE, HL7, as well as Regenstrief who have the LOINC vocabulary, so that when those standards all go out to the individual users, they have a good idea how they mesh together, how they can be implemented together, and work together to provide the clinician with all the information they need.

McGraw: Yeah. And Todd, if I can just add, because when we talk about all these things, they're technical terms, and the general folks, again, it's very important that the foundation of the terminology, the technology that's used to interoperate that it's laid, and that it's kept up-to-date. But for the end user that is just trying to take care of these patients, they just want it to work. And so, that's why it's so critical for us to keep it current and work in an accelerated fashion.

We've talked about the testing. We've talked about the vaccines. The amount of telemedicine, digital health that has been adopted in the past six months. We just saw a decade of technology adoption happen overnight. And the amount of sort of underpinnings that we needed to get right, and need to continue to evolve is enormous. And, I think, that we can be very, very proud of the work of both the AMA and SNOMED CT to lay that groundwork for what is a lot of important work going on across the globe.

Unger: It really is an incredible period of change.

That's it for today's COVID-19 update. I want to thank Laurie and Don for being here, and sharing their perspectives about this important topic. We'll be back soon with another segment. For updated resources on COVID-19, you can visit the AMA site. Last question to you, Laurie and Don, if people want to find out more information about CPT and SNOMED, where would they go?

McGraw: They can, certainly, come to the AMA website. And we have a lot of resources there. And I think that those are also available, Don, on your website, aren't they?

Sweet: Yes, they are. The SNOMED International website has both information about ourselves and also about CPT and all the collaboration work we're doing with the American Medical Association.

Unger: Thank you very much. Everyone, thanks for being with us here today, and please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.