From April 1st 2020, secondary care, acute care, mental health, community systems, dentistry and other systems used in direct patient care must use SNOMED CT as the clinical terminology. Exact supports this functionality, but it requires some configuration and understanding to use.
You should be able to continue charting your regular services as normal, but you will need to make sure that they have been mapped to SNOMED codes. In cases where more than one SNOMED code may apply and a default code has not been selected you will be prompted to choose from a list of available codes when you chart.
This Exact update has shipped with the reduced set of SNOMED codes that the NHS Business Services Authority indicated would be required as a minimum. The list been extended a little to cover other common dental services and observations. Where possible these codes have been mapped by the Software of Excellence team to the standard list of codes that are shipped with a new install of Exact. It is up to each dental practice to satisfy themselves that this mapping is correct, and that they are happy with any SNOMED codes linked to a charted service by default. The practice must also go through any services that you regularly chart that are not in the standard list and add appropriate SNOMED codes.
Start in the Services list (Configure Menu → Services…), and open the first service you want to inspect. You will see a new button labelled Configure SNOMED.
Clicking on this button opens a dialogue which shows you any SNOMED codes already linked to a service.
Example with no codes selected
Example with codes already selected
To add codes start typing some text for the type of SNOMED code you want to add, for example ‘Exam’. A list will appear with SNOMED codes related to the word or words that you typed. Click on the Add button next to any of the codes that you want to add. You can add more than one.
Now that the service has one or more SNOMED codes assigned you can decide which if any of these codes should automatically be assigned to the service when it is charted. If you don’t choose any of the services, then the dentist will be asked to select from the list at the point of charting. For any codes that you want to automatically be applied, tick the ‘Default in chart’ checkbox. You can select more than one default SNOMED code for a service. For example in our standard code list, the HEX (Hygiene and Exam) service has been mapped to both the Scale and the Exam codes. 234696006 Scale and polish teeth (procedure) 5880005 Physical examination procedure (procedure)
To remove a SNOMED code click on the remove button at the end of the line.
If you decide not to assign any SNOMED codes to a service, and that service gets charted, then the dentist will be offered a free choice of codes to add to the service each time it is charted.
If would like to map a SNOMED code that is not in the list that we have included please let your support representative know, and we will be able to make it available in an update. See below for an easy way to stay up to date.
When you chart a service, in many cases you won’t see any differences from how you have used the chart previously. If the service you are charting has default SNOMED codes applied then this will happen in the background. You can inspect the applied SNOMED codes at any time by double clicking on the chart line to open up the Edit Chart Item window. In the top right of this screen you will see a button labelled Edit SNOMED Chart Items
Clicking the button will open a window showing the list of applied SNOMED codes.
Example of service with no SNOMED codes applied
Example of Service with SNOMED codes applied
If you have charted a service that applies to a tooth, or several teeth, you will see that Exact has automatically added the SNOMED codes for those teeth. You can’t directly edit those codes, but if you do change the tooth/teeth for the service, they will be updated to reflect the change. Similarly if the service has surfaces charted then the code for the surfaces will be automatically applied and updated if required.
If the practice has mapped SNOMED codes to the service and ticked one or more of them by default then you will see these default codes already in the list.
If you want to remove the existing SNOMED code use the remove button at the end of the lin.
To add new codes start typing in the search box at the top of the screen, and then click on the Add button for the code you want from the choices made available to you. If the practice has decided on a subset of codes for a particular service, then you will only be able to select from those codes. If you would like to have a wider choice for that service, or have the choice narrowed further see the section above on Mapping. You may need to talk to your practice administrator if you don’t have permission to do it directly.
If the practice has not decided on a list of SNOMED codes for the service item, then you will be able to choose from the full list of included codes. As above, start typing to narrow the list and then click Add to attach it to this service.
Sometimes when you chart there won’t be any default SNOMED codes assigned to the service. When that happens a SNOMED Service Selector dialogue will appear.
Select from the list directly or type in a search term for the SNOMED code you want and then click on the Add button from the drop down. If you don’t want to add a SNOMED code to this item just click Cancel. When the list contains the items that you want, click OK.
If you find that you have to do this a lot, consider editing the SNOMED mapping for the service and setting a ‘Default in chart’ option. It may be necessary to add additional EXACT services so that you can acheive a one to one mapping.
The situation with SNOMED is still evolving. The code list and requirements are likely to change over the coming months, and the NHS may soon have guidance on how claim transmission should change to include the SNOMED codes.
Exact now has the capability to take updates automatically overnight so that your practice can always remain up to date with the latest changes. Ask our support team about how to get hooked up to the new automated EXACT update process – this means you will never have to worry about EXACT being up to date again and you will maintain compliance with any updates to the SNOMED code list and associated requirements.