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On October 23, 2024, as part of SNOMED CT Expo 2024 pre-conference sessions, SNOMED International is hosting a half-day workshop on traditional medicine. In this blog, Liara Tutina, SNOMED International’s Customer Relations Executive Asia and Pacific & Global Education Lead, and Yongsheng Gao, Senior Terminologist, discuss the purpose of learning goals for the session, the growing need for traditional medicine content in SNOMED CT and the benefits of its inclusion, as well as the challenges posed by integrating various global traditions into the terminology.
And while the inclusion of this type of content into SNOMED CT reflects SNOMED International’s commitment to our Members and to enabling better patient care delivery around the world, it also tells the story of the collaborative process driving SNOMED CT’s ongoing content development and refinement.
Q: What is traditional medicine? How does SNOMED International define it?
A: SNOMED International uses the same definition as that used by the World Health Organization: It is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. A few examples are acupuncture and homeopathy, both of which are widely available in Western countries as well.
Q: What is the goal for this initiative and what is driving the push for inclusion of traditional medicine content in SNOMED CT?
A: The objectives of the traditional medicine project are to support clinical practice and secondary use of data for research, policy making, patient safety, and clinical guidelines. To a certain extent, the project has been driven by Member requests, but the big-picture benefits are that it will enable practitioners and traditional medicine users around the world to use SNOMED CT to record conditions and access related services. Researchers and policy makers will benefit significantly from encoded health records for development of evidence-based practice and clinical guidelines and policies, and it will help close the gap in SNOMED CT content. It will enable clinical recording of traditional medicine in SNOMED CT and mappings to classification systems such as ICD-11. Interest and research in complementary and alternative medicine have increased considerably worldwide, and a number of ISO standards for traditional medicine have been developed in the last decade or so by ISO TC 249 and TC 215/JWG1, WG10.
Q: What traditional medicine content existed in SNOMED CT prior to the formation of the traditional medicine pilot project? Where are we now and what is our goal in terms of the type and amount of traditional medicine content?
A: At the beginning, SNOMED CT had a limited amount of content – a number of terms for acupuncture, herbal medicine agents/herbal medicines, a few concepts in other areas and a handful of related findings and procedure codes. Today, there are about 900 concepts for traditional medicine excluding clinical findings and diseases that are also applicable to traditional medicine. In particular, we have covered key pattern diagnoses with a new concept model in clinical finding, and introduced a new top-level category for the theoretical entity of traditional medicine. You can find them under the Traditional Medicine Community Content tab of the SNOMED CT Community Content browser.
Q: To what extent can the inclusion of traditional medicine in SNOMED CT contribute to a better understanding of the efficacy of such treatments?
A: Encoding traditional medicine content in SNOMED CT is a major step toward supporting comprehensive health data analytics, expanding the scope of health research and enhancing best practice guidelines for clinical care.
Q: What regions use some form of traditional medicine?
A: Traditional medicine has been widely used for millennia in many Asian and African countries as well as throughout Latin America, the Caribbean, the Middle East and Eurasia. They are also available in Europe and America as complementary and alternative medicines.
Q: How is the traditional medicine content in SNOMED CT being used – and by whom?
A: It is still in the early stages of content development for traditional medicine. One example of how this content is being used by our Members is from the Republic of Korea. At SNOMED CT Expo 2023, Ah Jung Byun and Hyeoun-AE Park presented on research to map Korean traditional medicine terms to SNOMED CT. Although the Korean health system introduced an electronic medical record (EMR) system in 2018, traditional medicine was not part of that development. Practitioners of traditional medicine in Korea took steps starting in 2021 to close that gap by developing a big data platform for traditional medicine and clinical practice guidelines on up to 30 diseases or conditions, and realized the need for standard terminology to describe those clinical ideas. Another example is that India has translated SNOMED content, e.g. clinical findings/diseases, related to traditional medicine, and started the development of traditional medicine specific content in their SNOMED CT extension.
Q: What is the scope of the traditional medicine project?
A: The initial stage for the development of traditional medicine terminology in SNOMED CT only covers top-level structures and some requests from Member countries. The project will build the infrastructural foundation for the future development of this type of content.
Q: Describe the collaborative process that has been used to include traditional medicine content in the Community Content area.
A: When the project kicked off, we already had received a request from Malaysia to incorporate 200 traditional medicine terms into SNOMED CT. Currently, the requests from Malaysia have been reviewed and existing concepts have been identified. The new concepts have been added to SNOMED CT. We have established key editorial decisions with the expert group:
Patterns as a new subhierarchy of clinical findings
A new top-level hierarchy for the theoretical entity of traditional medicine
The Chinese language represents the original meaning of concepts. Other languages can be added to extensions.
New concept models for modeling patterns by principles, organ frameworks, ect.
Organ systems are represented as theoretical entities, in contrast to pure anatomical representations.
The existing concepts in SNOMED CT have been utilized for disorders in traditional medicine, unless the specific disorders are different and needed as new additions.
The content has been published in the community content area and we are developing a subontology for traditional medicine that will be published soon.
Q: Are there any unique challenges to including traditional medicine content in SNOMED CT (e.g., capturing “notions” such as energy)? If so, what are they and how are we approaching it?
A: A 2019 research paper (Progresses and challenges in the traditional medicine information
system: A systematic review) identified many of these challenges: “Sometimes, one medicinal plant happens to be named differently using the general, Latin, local or commercial names. In contrast, some other of different species take similar names. This becomes more complicated given the prevalence of the terminology specific to different world languages (Mukherjee et al., 2015). Currently, there is no universal terminology and a unified coordinated regulatory attitude (Wiesner, 2014). To standardize the structured clinical data, an integration of the systematic terminologies is required (Liu et al., 2012). Accordingly, in line with the information standardization projects such as International Classification of Traditional Medicine (ICTM), a new project for the compilation of an international standard terminology has been incorporated into the recent ICD-11 revision (WHO, 2007; Gao and Watanabe, 2011; Katayama et al., 2012).”
The key challenge is to represent concepts, theories, and logics that are unique to traditional medicine. They do not fit into the current top categories of SNOMED CT. We have developed a new top category for theoretical entities in traditional medicine. The new concepts, such as Yin (阴), Yang（阳）, Qi（气）have been added. However, there are many different traditional medicines. It is a challenge to represent them when there are potential overlaps, similarities, or even conflicts. For example, Qi in traditional Chinese medicine can be loosely interpreted as a concept for energy. In Ayurvedic medicine, ojas is defined as ‘vigor’. It is the vital energy, or core essence, that nourishes all tissues and is responsible for the optimal functioning of our body, mind, and spirit. However, Qi also includes breathing air. We cannot map or treat Qi and Ojas as the same concept. More work and discussions are needed to overcome the challenge.
There are also changes in specific subject areas of traditional medicine. The representation of medications can be named differently using the general, Latin, local, or commercial names. In particular, some species could have similar or the same names. Furthermore, the classification of plants based on morphological features alone could be time-consuming and error prone. The advancement in genetic studies could provide reliable classifications, but it raises the challenge of connecting them to the daily clinical use of plants in traditional medicine.
Q: Why did we decide to hold a half-day workshop before Expo this year? Who is leading it?
A: Both of us, along with input from representatives from Korea, India, Malaysia and other countries, will be leading the session. The workshop will provide an opportunity for international collaboration, experience exchange and discussion on various aspects of the traditional terminology model and content development.
Q: Who should attend and what can people expect to learn at that session?
A: This session will be useful for anyone, whether your background is clinical or technical, who is interested in learning more about our traditional medicine project and the next steps for supporting a standardized terminology for this type of parallel healthcare system.
LEARN MORE
To learn more about SNOMED CT and traditional medicine, visit the SNOMED CT Traditional Medicine Pilot Project Confluence page, and view the following presentations on YouTube:
SNOMED CT Expo 2024 traditional medicine sessions:
Traditional medicine workshop, October 23 from 09:00-12:30 KST
How to improve SNOMED CT ontology t represent concepts used in Korean traditional medicine: October 24, from 13:30-14:00 KST