From a healthcare informatics perspective, it's as if Juliet married Romeo and the parents approved.
Two not-for-profit standards-development organizations, producers of once-competing clinical codes, SNOMED-CT and LOINC, have reached a 10-year collaborative agreement to work together to “improve safety, functionality and interoperability for the rapidly growing number of clinicians who manage and exchange health data with electronic medical records.”
The agreement, announced by the Regenstrief Institute of Indianapolis and the International Health Terminology Standards Development Organization of Copenhagen, Denmark, will “link the rich clinical semantic of SNOMED-CT to LOINC codes, which provide extensive coverage of laboratory tests and some types of clinical measures,” according to a news release.
“The organizations believe it makes sense to work together to limit duplication of effort and focus limited resources on enhancements that serve the practical needs of the growing number of users” of both codes, according to the statement.
It wasn't always this way. SNOMED, originally released by the College of American Pathologists in 1975 and formally known as the Systematized Nomenclature of Medicine, has been controlled since 2007 by the IHTSDO, which claims support from 20 countries.
The formal internationalization of SNOMED has been underway of more than a decade. In 2002, the United Kingdom merged its "read codes" with SNOMED codes to create SNOMED Clinical Terms, or SNOMED-CT. In 2004, the National Library of Medicine, in an effort to promote SNOMED's widespread domestic adoption, announced an agreement with its developers to pay for a blanket license covering U.S. users.
Meanwhile, LOINC, the Logical Observation Identifiers Names and Codes, a standard for lab data, was developed in 1994 by the Regenstreif Institute, a medical informatics research organization based at Indiana University in Indianapolis. LOINC, too, has had an international presence, with Regenstrief claiming users in 150 countries.
During the past few years, the organizations have been working on “shorter-term and smaller-scale projects,” the joint news release said, but efforts to bring the two organizations to a rapprochement is “something we've been working on for a decade,” said Dr. Ray Aller, a pathologist and physician informaticist and the director of informatics at USC School of Medicine's Department of Pathology.
“We need to use both SNOMED and LOINC in different parts of the message,” Aller said. “Typically, in a message reporting disease to public health, reporting lab observations, LOINC would be used to code the question, what it is you're trying to measure, and SNOMED would be used to code the answer.
“LOINC is really specially attuned to providing the names of things we're testing for and SNOMED is particularly attuned to what we found,” Aller said.
Dr. William Bria, president of the Association of Medical Directors of Information Systems, a professional association for physician informaticists and the chief medical officer for Dataskill, a data-analytics firm, likened the historic rivalry between the two codes to “a religious war,” but said the agreement to collaborate is good news for provider and patients.
Health informatics is entering a new era of “intelligence assistance,” Bria said, where computers will aid both physicians and patients in arriving at diagnoses and care plans.
“Peace (between the rival SDOs) means, hopefully, that the idea of machine-readable information and the dream of having our machines doing some of grunt work regarding alerts, and flagging doctors, 'This is the information that you need to have for diagnosis,' ” is coming closer to reality, Bria said.
“The bottom line is, by having standardized terminology in lab, pathology and clinical domains means the mapping of information can be far more consistent,” Bria said. “The right knowledge can be provided to the right person at the right time, including the patient. Having better standards, better cross-linking of information, all of that is to the good. And it keeps changing. People learn new relationships between diseases, so the idea that it is an ongoing relationship is essential.”
The pact also received kudos from the Office of the National Coordinator for Health Information Technology at HHS, which has been promoting interoperability along with the adoption of electronic health-record systems.
“We believe the agreement between Regenstrief and IHTSDO is an important step in advancing international standards for healthcare terminologies and we applaud the efforts by both organizations,” said ONC spokesman Peter Ashkenaz.
Follow Joseph Conn on Twitter: @MHJConn
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