Systematized Nomenclature of Medicine

The Systematized Nomenclature of Medicine (SNOMED) is a multiaxial, hierarchical classification system . As in any such system, a disease may be located in a body organ which results in a code in a topography axis and may lead to morphological alterations represented by a morphology code.

Purpose

SNOMED was designed as a comprehensive nomenclature

Nomenclature

Nomenclature is a term that applies to either a list of names or terms, or to the system of principles, procedures and terms related to naming - which is the assigning of a word or phrase to a particular object or property...

of clinical medicine for the purpose of accurately storing and/or retrieving records of clinical care in human and veterinary medicine.
The metaphor used by Roger A. Côté, the first editorial chair, was that SNOMED would become the periodical table of element of medicine because of its definitional organization beyond the hierarchical design. Indeed, diseases and procedures were ordered hierarchically and are further referenced back to more elementary terms (see Reference Ontology and Multi-Axial Design, below).

History

SNOMED was originally conceived by Dr. Roger A. Côté as an extension of the design of the Systematized Nomenclature of Pathology (SNOP) applicable for all medicine. SNOP was originally designed by Dr. Arnold Pratt to describe pathological specimen according to their morphology and anatomy (topography). The ambitious development of SNOMED required many more axes (see multi-axial design, below). SNOMED was jointly proposed for development to the College of American Pathologists

College of American Pathologists

The College of American Pathologists , is a medical society serving more than 17,000 physician members and the laboratory community throughout the world....

by Drs. Côté and Dr. Arnold Pratt and the former was appointed as Editorial Chair of the Committee on Nomenclature and Classification of Diseases of the College of American Pathologists and developed the Systematized Nomenclature of Medicine (SNOMED) from 1973 to 1997. In 1998, Dr. Kent Spackman was appointed Chair of this Committee and spearheaded the transformation of the multi-axis systems into a highly computable form (See SNOMED CT

SNOMED CT

SNOMED CT , is a systematically organised computer processable collection of medical terminology covering most areas of clinical information such as diseases, findings, procedures, microorganisms, substances, etc...

): a directed acyclic graph anchored in formal representation logic.

Brief timeline:

1965 SNOP
1974 SNOMED
1979 SNOMED II
1993 SNOMED International 3.0
1995 SNOMED Microglossary of Signs and Symptoms
1993-98 SNOMED International versions 3.1-3.5

Reference ontology

SNOMED was designed from its inception with complex concepts defined in term of simpler ones. For example, a disease can be defined in terms of its abnormal anatomy, abnormal functions and morphology

Morphology (biology)

In biology, morphology is a branch of bioscience dealing with the study of the form and structure of organisms and their specific structural features....

. In some cases, the etiology

Etiology

Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....

of the disease is known and can be attributed to an infectious agent, a physical trauma or a chemical or pharmaceutical agent.

Multi-axial design

The current concept uses eleven (11) axes that comprise terms organised in hierarchical trees. The axes and some examples are provided below:

T (Topography) – Anatomic terms

(T-28000) Lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...
(T-32000) Heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
(T-51000) Mouth
Mouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....
(T-D2500) Hip
(T-D9600) Heel
Heel
In human anatomy, the heel is the prominence at the posterior end of the foot. It is based on the projection of one bone, the calcaneus or heel bone, behind the articulation of the bones of the lower leg.- Human anatomy :...

M (Morphology) – Changes found in cells
Cell (biology)
The cell is the basic structural and functional unit of all known living organisms. It is the smallest unit of life that is classified as a living thing, and is often called the building block of life. The Alberts text discusses how the "cellular building blocks" move to shape developing embryos....

, tissues
Biological tissue
Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...

and organs
Organ (anatomy)
In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...

(M-40000) Inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
(M-44000) Granuloma
Granuloma
Granuloma is a medical term for a tiny collection of immune cells known as macrophages. Granulomas form when the immune system attempts to wall off substances that it perceives as foreign but is unable to eliminate. Such substances include infectious organisms such as bacteria and fungi as well as...
(M-54700) Infarcted
(M-54701) Microscopic infarct

For the Morphology axis, SNOMED has agreed to collaborate and use the same harmonized codes shared with International Classification of Diseases for Oncology
International Classification of Diseases for Oncology
The International Classification of Diseases for Oncology is a domain specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. This classification is widely used by cancer registries.It is currently in its third revision ....

. Additional examples on topology are provided on that page.

L (Living organisms) – Bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...

and viruses

(L-21801) Mycobacterium tuberculosis
Mycobacterium tuberculosis
Mycobacterium tuberculosis is a pathogenic bacterial species in the genus Mycobacterium and the causative agent of most cases of tuberculosis . First discovered in 1882 by Robert Koch, M...
(L-25116) Streptococcus pneumoniae
Streptococcus pneumoniae
Streptococcus pneumoniae, or pneumococcus, is Gram-positive, alpha-hemolytic, aerotolerant anaerobic member of the genus Streptococcus. A significant human pathogenic bacterium, S...

C (Chemical) – Drugs

(C-C137A) Bufferin Analgesic
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....

Tablets
(C-C137B) Bufferin Analgesic
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....

Caplets

J (Occupation) – Terms that describe the occupation
Profession
A profession is a vocation founded upon specialized educational training, the purpose of which is to supply disinterested counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain....

Businessman
School teacher
Computer programmer
Doctor
Nurse
Beautician

D (Diagnosis) – Diagnostic
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...

terms

(D-13510) Pneumococcal pneumonia
(D-14800) Tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
(D3-15000) Myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...

A (Physical agents, forces, activities) – Devices and activities associated with the disease

S (Social context) – Social conditions and important relationships in medicine

(S-10120) Mother
Mother
A mother, mum, mom, momma, or mama is a woman who has raised a child, given birth to a child, and/or supplied the ovum that grew into a child. Because of the complexity and differences of a mother's social, cultural, and religious definitions and roles, it is challenging to specify a universally...

External links

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