Modern Physician has learned that the National Library of Medicine, leading a consortium of federal agencies, and Snomed International have reached an agreement but have not yet signed a contract to provide government subsidies to promote wider use of the Snomed CT controlled clinical language.
The signing of such an agreement, in which the government would pay license fees for Snomed users, would be a huge boost to the field of medical informatics, according to experts in the field. An NLM agreement will afford scale and remove a financial barrier to a wider adoption of Snomed CT, a combination of a finely detailed vocabulary and semantic modeling that rises almost to the level of a language.
John Mattison, M.D., assistant medical director for clinical systems with the Southern California division of Kaiser Permanente, says the implications of the NLM deal go far beyond the narrow sphere of medical informatics.
"This is great news for everybody," says Mattison, who has been working to develop and deploy Snomed within the Kaiser system since the mid-1990s.
"What the NLM is doing is allowing all institutions, all vendors and all locations to use the same vocabulary across all information systems. It's hard to overstate the significance of this. It's going to be a watershed for the healthcare of the entire American public."
Jeff Rose, M.D., vice president and CMO of Kansas City, Mo.-based Cerner Corp., a healthcare IT vendor, says his company has been working with Snomed for years. Rose says the NLM deal does not mean Snomed will be an overnight sensation. Adoption and integration will be keys to development, he says.
"There are other vocabularies for other reasons we'll need to align with this," Rose says. "This is a good, not perfect, clinical terminology, but if people really migrate to this and use it--and the NLM has taken away the cost-- this will be really good."
And Sam Butler, M.D., a member of the clinical informatics team at Epic Systems of Madison, Wis., which recently landed a mega-clinical systems deal with Kaiser Permanente, says no one could agree on a common language, so, in effect, "it was like everyone saying, 'Make me do the right thing.'"
Now, he says, after the NLM agreement, "It will become the common language that all of our IT systems will speak. I think we'll look back and say this deal made history. It was the beginning of a lot of good things to come."
Money from the license fees would be used by Snomed, a not-for-profit organization, to maintain and expand the clinical vocabulary.
HHS, the Department of Defense and the Veterans Administration reportedly also are parties to the agreement.
Diane Aschman, vice president and COO of Snomed International, based in Northfield, Ill., was tight-lipped about details of the deal, which would culminate negotiations that began in 2000 between Snomed, a division of the College of American Pathologists, and the federally funded NLM.
"We have an agreement in concept for a contract for Snomed CT through the National Library of Medicine," Aschman confirmed. "More details will come the moment we get final review by HHS's legal counsel. They need to get approval, and we need to get approval from our board. We think we're there, but it's never over until it's over. We don't have a signed agreement."
Betsy Humphreys, associate director of the NLM and its point person in the negotiations with Snomed, says the last major barrier was funding, but the budget bill signed by President Bush on Thursday contains enough money to cover her agencies' costs.
But Humphreys, like Aschman, was saying it's not yet a done deal.
"We're not in a position to say more than we reached an agreement and now we should be able to move ahead and sign the contract," Humphreys said. She had no time frame for that, however.
Humphreys would not say how much of the cost of the contract would come from NLM and how much from other federal agencies.
Humphreys says that since a 1991 Institute of Medicine report calling for development of a standardized electronic medical record, one of the barriers to widespread electronic patient record and EMR system adoption has been the lack of a universally accepted, standardized clinical terminology.
The 1999 merger of Snomed and the United Kingdom's British National Health Service clinical terminology created something of a single, de facto standard in its field, Humphreys says.
In October, the IOM called for the government, as the largest healthcare payer, to take a leadership role and offer tax credits, subsidized loans and grants to help establish a national health information infrastructure. Humphreys says the agreement with Snomed is a step in that direction.
Kaiser's Mattison explained that ICD-9, a code developed by the World Health Organization for epidemiological tracking and CPT, owned by the AMA and developed for billing, "are good for what they were intended for" but "neither was designed for direct documentation of patient care and fall short in a number of areas. They don't cover a lot of the terms we do need in these (healthcare IT systems) for direct documentation and analysis and Snomed does."
Mattison praised Humphreys and NLM Director Donald Lindberg for supporting the agreement.
"It's not often you see such a visionary move on the part of the government," Mattison says.
