Bridging the Gap in Healthcare: Bahmni SNOMED Integration Project

Healthcare systems have come a long way in improving patient care and streamlining operations. One of the key challenges faced by healthcare providers worldwide is the seamless integration of clinical data with standardised medical terminologies. In this blog, we explore the Bahmni SNOMED integration project, a significant step towards bridging the gap in healthcare information exchange.

About Bahmni

Bahmni is an open-source hospital information system that aims to provide a comprehensive solution for healthcare facilities in resource-constrained settings. Developed by ThoughtWorks, Bahmni brings together essential functionalities like patient registration, appointments, recording diagnosis and procedures, billing, lab, pharmacy, and more, into one cohesive platform.

About SNOMED

SNOMED CT is a comprehensive and multilingual clinical terminology that encompasses a vast array of medical concepts. Its adoption ensures that health information is consistently and uniformly represented, shared, and analysed across different systems and countries. However, integrating SNOMED CT into existing healthcare platforms can be complex and challenging.

Objective of Bahmni SNOMED Integration

Showcase how an opensource HIMS integrates with a SNOMED CT enabled FHIR Terminology Server, to leverage advantages of the SNOMED terminology, in areas of recording clinical data, reporting, Clinical Decision Support System (CDSS), analysis, etc.

In the first phase of this engagement, we have features that allow Bahmni to record clinical data using SNOMED CT, and then create reports and also perform CDSS use cases using the recorded data.
More on this can be found on our Wiki page.

Phase 1 Features

1. Record patient diagnosis in Bahmni using SNOMED CT with real time Terminology Search

• Clinicians can record diagnoses/conditions by performing real-time search against the complete set of clinical findings in SNOMED CT.
• Search keyword can match synonyms, fully specified names (FSNs), or SNOMED codes
• System displays the preferred terms of concepts as the search result

2. Reports in Bahmni using the power of SNOMED CT

• Leverage the hierarchical structure of Clinical Terms in SNOMED to identify and report all types / descendants of the selected diagnosis
• For example Vivax Malaria (SNOMED Code 27052006) is a subtype/descendant of Malaria disorder (SNOMED Code 61462000). So if a clinician records a patient’s diagnosis as Vivax malaria and runs report on patient count with Malaria, the system will automatically include the subtype Vivax malaria, and all other subtypes in the report.

3. CDSS alert in Bahmni based on recorded SNOMED diagnosis and drug interaction

• In this feature, the clinicians are notified with an alert when a Drug-Diagnosis combination is contraindicated
• Currently we have a customised CDSS rule engine which is hosted on our environment
• Patient diagnoses/conditions and their medication data are sent through FHIR to this CDS Service
• The CDS Service processes the patient data, using the rule engine, and responds with any triggered alerts

4. Support for recording chief complaints and patient history through forms using SNOMED CT & Support for designing Bahmni

• Users can customise set of clinical questions in Bahmni according to their requirements to record patient’s responses
• SNOMED CT is leveraged to provide the list of responses to a given question

5. Ability to setup and order procedures using SNOMED CT

• Users can order procedures using SNOMED CT concepts within Bahmni, navigation is driven by by body-site

Benefits for Bahmni from this engagement

• From this engagement, Bahmni can showcase that it can integrate with different clinical dictionaries to record patient data.
• Addition of CDSS feature will enhance decision-making of clinicians to improve patient healthcare. This gives Bahmni a competitive advantage over other EMRs
• SNOMED CT is adopted internationally, enabling Bahmni to be more compatible with other healthcare systems worldwide, making it easier to collaborate and share information across borders.
• Bahmni can also integrate with any FHIR compatible 3rd party CDSS rule engine

How does this benefit the end user / implementers / countries?

The Bahmni SNOMED integration project benefits end users, implementers, and countries alike. Healthcare professionals gain access to standardised and accurate clinical data and CDSS, leading to improved patient care and streamlined workflows. Implementers benefit from increased interoperability, standardised data management, and support for research initiatives. At the national level, countries can leverage the integration to improve public health initiatives, foster international collaboration, devise efficient healthcare policies, and attract investments.

Future Scope of the engagement

As part of Phase2 of this engagement, we are focusing on enhancing CDSS use-cases for Drug-Drug interactions, Export of Bulk Patient Data as FHIR, Integration with SNOMED Analytics tool, WHO ICD-10 reports, Integration with micro FHIR Terminology server for on-prem/offline hospitals.

Disclaimer: The views and opinions expressed in this blog are solely those of the author and do not necessarily represent the views of Thoughtworks or SNOMED. The author’s opinions are based on their personal experiences, knowledge, and research at the time of writing