Integration of ICNP into SNOMED CT Brings Voice to Nursing Practice

Posted on December 1, 2020 by Kelly Kuru and Kelly Davison

The 2020 agreement between SNOMED International and the International Council of Nurses (ICN) is an opportunity to highlight the clinical work of nursing. The ICN is a federation of more than 130 national nurses’ associations worldwide. Under the agreement, the International Classification for Nursing Practice (ICNP) will be incorporated into SNOMED CT, the world’s most comprehensive clinical terminology with more than 350,000 active concepts, and SNOMED International will manage, produce and release the ICNP on behalf of ICN, which will maintain governance and ownership of the ICNP content.

National and international stakeholders that use SNOMED CT can seamlessly integrate ICNP concepts into their SNOMED CT-enabled electronic health records. Moreover, countries that currently use both ICNP and SNOMED CT will no longer need to engage in mapping activities between the two code systems.

The agreement is particularly timely as the World Health Organization has declared 2020 the Year of the Nurse and Midwife, and it builds on SNOMED International’s commitment to global interoperability as part of the Joint Initiative Council for Global Health Informatics Standardization.

Advancing interoperability

The addition of ICNP to SNOMED CT is a huge step toward interoperability as ICNP concepts represent the practice of 20 million nursing professionals worldwide. Interoperability is more than just computers exchanging information. It also means that computer systems can exchange data with unambiguous, shared meaning and that the clinicians who document and interpret those concepts can then understand and utilize them in the same way across practices and clinical settings.

Using ICNP, we can measure nursing-related indicators; use that information to improve global, national and regional health care systems; and use that data to produce scientific evidence that will inform health system transformation needed to enable planetary health.

Supporting real-time disease surveillance

Public health is receiving considerable attention due to the COVID-19 pandemic, and health care agencies around the world are re-investing in community-based nursing activities including prevention, surveillance and immunization. The relationship between ICNP and SNOMED CT opens up possibilities for reporting of COVID-19 public health surveillance at regional, national and international levels. As nurses do the bulk of sample collection, this partnership could enable public health officials to have access to near real-time testing data that has been reliably documented by regulated health professionals, as well as subsequent additional analyses about nursing care.

Even more important, though, are the improvements in patient outcomes and the ability to meet the health needs of patients through integrated health and social care systems. Lorraine Block, RN, a PhD Candidate, School of Nursing, University of British Columbia, says that standardized clinical terminologies and computerized ontologies are key building blocks for information and communication technologies, such as decision support, natural language processing and data analysis.

“The representation of nursing knowledge in computerized terminologies and ontologies are necessary to ensure these advanced applications are meaningful to patient care and fit within the context of the nursing profession,” she says. “The agreement between ICN and SNOMED International is an important step toward this necessity, as it will help ensure nursing knowledge continues to be built, managed and operationalized in the largest, international clinical terminology (SNOMED CT).”

Building on current standards

SNOMED CT + ICNP complements ongoing nursing standards work in Canada that have been central to improving outcomes, and to enhancing our health care system. The National Nursing Data Standards (NNDS) initiative is guiding the development of a pan-Canadian strategy to advance clinical data standards in Canada and support the exchange of health information between providers and care sectors. The NNDS is co-led by Dr. Lynn Nagle and Peggy White, RN, MN, who is a consultant with the Canadian Nurses Association - National Project Director for Canadian Health Outcomes for Better Information and Care (C-HOBIC). “The NNDS is supporting clinicians in understanding how information in electronic health records can support their practice and improve clinical outcomes for patients and populations,” says White.

C-HOBIC is a set of standard nursing outcome measures that has been widely implemented in the Canadian acute care system, and is mapped to both ICNP and SNOMED CT.

This post was made possible through the collaboration of Canada Health Infoway and SNOMED International staff. Thank you to Kathleen Sibley, Dr. Lynn Nagle, Lorraine Block and Peggy White for their contributions.

Kelly Kuru is responsible for engaging and supporting SNOMED International's global stakeholders and Community of Practice through strategic messaging that delivers value.  Kelly is responsible for the organization's global communication and marketing efforts in support of SNOMED CT's, the world's most comprehensive clinical terminology, and its related products and supporting services and resources.

Prior to joining SNOMED International, Kelly held a number of strategy and engagement roles with Canada Health Infoway, an organization established to support the vision of healthier Canadians through innovative digital health solutions, as well as developing her business and communications skills at the University Health Network in Toronto.

Kelly holds a Masters of Public Administration from the University of Victoria and is a participating member of the International Association of Business Communicators (IABC).

Kelly Davison MN, MSc, RN, CPHMN(C), CTSS is a Senior Specialist with the standards team at Infoway, where his primary responsibility is supporting Canadian stakeholders with SNOMED CT® as a terminologist. Kelly’s interests lay at the intersection of health technologies and the health equity of marginalized and structurally vulnerable Canadians. Kelly brings a social justice lens to health technology, and more specifically, to standards work; Canadian standards need to support Canadian values, and ought to be beneficial to and inclusive of all Canadians. Kelly is a doctoral student at the University of Victoria, and co-leads Infoway’s Sex-Gender Working Group which is aimed at modernizing current gender, sex and sexual orientation information practices in Canadian EHR systems.