Terminology Talk

By Dr. Linda Vidone, Delta Dental of MA

Diagnostic Terminology SWG Chair

Highlights from SNOMED Business Meeting 2024

Leveraging Artificial Intelligence (AI) to advance the use of diagnostic terms and SNOMED CT was the overarching theme of the recent SNOMED business meeting, April 14-17, in London, England. The recent SNOMED meeting presentations explained how AI is used to sort through massive amounts of information to provide better patient choices, diagnoses, and outcomes. Drs. Mark Jurkovich, HealthPartners, and Linda Vidone, Delta Dental of Massachusetts, plus NADP Deputy Executive Director Timothy L. Brown represented the dental benefits industry during this vital stakeholder event, featuring two meetings of the Dentistry Clinical Reference Group (CRG), chaired by Dr. Jurkovich.

(left to right) Dr. Linda Vidone, Timothy L. Brown, Dr. Mark Jurkovich, Rebekah Fiehn (ADA)

SNOMED Updates

Increasingly, SNOMED is being used as the necessary structured data that analysts use to provide better tools for clinicians.  The SNOMED (and corresponding subset of dental-only terms, SNODENT) terminology allows analysts to correlate clinician findings (ex: probing depths), observations (such as swollen and inflamed tissue), patient-reported problems (bad breath) and a host of other factors that can be used to identify not only the most likely diagnosis using the periodontal classification system, but, potentially, applying treatment guidelines to move the patient into a healthier position.

To facilitate the continued advancement of SNOMED, updates were provided in the following areas and discussed during the CRG meetings:

• General dentistry diagnostic reference set (refset) review:
• Orthodontic photography requests
• Dentistry endodontic procedures

Compared to medical plans, dental plans remain far behind in developing these tools and creating the types of correlations described above.  Without similar capabilities, dental plans may not be able to understand the various relationships between medical and dental conditions in a format that will improve outcomes and potentially lower costs.

CRG Updates

The SNOMED Dentistry CRG and SNODENT Maintenance Committee (SMC) are working to provide basic tools that can make the adoption and use of diagnostic terminology easier, more accurate, and more efficient. The goal is to improve AI and help us better understand the oral/overall health connections. NADP is a very active participant in these efforts.

CRG and SMC focused on three (3) specific areas:  Improving quality and understanding of how dental concepts should best follow similar methods used for medical concepts (so that AI can be more effective), developing the necessary tools to create methods to share records more efficiently and effectively, and designing easy to adopt sets of concepts that a dental records system could readily apply and clinicians could more easily document to improve their workflows.

Using endodontics as a starting point, the CRG and SMC spent time identifying how language and use has changed, deciding to replace (recommend inactivation) for older language and use terms that the endodontic community believes are both currently used and more accurate.

The CRG has been working with the orthodontic community to develop the necessary “backbone” (SNOMED concepts) that will allow for easy identification of visible and radiographic images for use in information transfer using the most common standard for this, Digital Image and Communications in Medicine (DICOM).  DICOM and SNOMED have an agreement that allows this to work as smoothly as possible.

The third major issue has been the development of the concepts (terms) that dentists would use most frequently for diagnosing dental diseases and conditions.  Referred to as the general dentistry “refset”, this will be the second and far improved iteration.  With considerable assistance from academic institutions, a large private practice, and a large payer, this set is being refined using millions of data points, perhaps one of the most scientific methods to identify dental diagnosis ever developed.  The working group “matched” diagnosis to the most common procedures.  The result is that this new set will offer a diagnosis for up to 99% of all procedures provided to patients.  With increased ability of electronic dental record systems to begin recording this information, the opportunity to “catch up” with medical plans should grow substantially.

NADP’s Diagnostic Terminology (DT) Sub-WorkGroup (SWG) remains active participants during the SNOMED meetings as well as the SNOMED International Dentistry Clinical Reference Group (CRG). The SNOMED CRG group meets virtually bi-monthly on the first Wednesday of the month. The next meeting is June 5. Reach out to Dr. Mark Jurkovich, Dr. Linda Vidone or Tim Brown for details about attending these meetings.

The Diagnostic Terminology SWG welcomes your feedback and suggestions for future newsletters. Contact NADP Deputy Executive Director Timothy L. Brown or myself with your comments.