Over the past few years, SNOMED International has embarked upon a number of innovative initiatives and collaborations that deliver on its humanitarian goals of improving patient care globally by furthering the reach and utility of SNOMED CT.

One of the most exciting recent examples is our involvement in a joint integration project with the Bahmni Coalition, a group of organizations that use and contribute to the development and implementation of Bahmni, an open-source hospital electronic medical record system.

With more than 500 implementations in more than 50 countries, Bahmni is designed for use in resource-constrained settings, many of which are in the early stages of digital health transformation. It is the preferred solution in many Asian and African countries and a strategic asset for many large humanitarian organizations

In this blog, Shelley Lipon, Chief Customer Officer, and Nick Egarhos, Global Vendor Engagement Lead and Customer Relations Executive for the Middle East and Africa, discuss our role in the project and the potential it has for improving patient care in resource-constrained regions that may not yet have adopted SNOMED CT. They also highlight the benefits for SNOMED International, outline the collaborative process that has enabled this initiative and summarize the next steps.

Q: What is the initiative about and why did SNOMED International get involved?

A: This initiative involves openly contributing some of SNOMED CT’s clinical terminology to Bahmni’s open-source hospital information system and electronic medical record (EMR.) SNOMED International got involved in this work because it provided a great opportunity for us to raise the standard of clinical data coding and analysis in a way that aligns with our vision of enabling better patient care everywhere, not just in our Member countries. 

Bahmni’s open-source EMR has been recognized as a Digital Public Good, so it is listed across multiple catalogues of open source digital products including the DPGA Alliance Registry, UNDP Digital X and the Digital Impact Alliance (DIAL) solution catalogue.

We’ve also undertaken a number of other humanitarian and charitable types of partnerships over the past few years, including the development of the Ejo Health Platform, which focuses on maternal and child health in Rwanda. Our vision as an organization is to broadly enable the “one language of health” and projects like these help make that happen. 

Q: What are the goals of this initiative?

A: For the project as a whole, the goal is to provide an EMR that resource-constrained countries and organizations can use to access essential functionalities such as patient registration, appointments, recording diagnosis and procedures, billing, lab, pharmacy, and more, in one cohesive platform. For SNOMED International, the goal was to create a SNOMED CT module that integrates with the Bahmni EMR to make standardized clinical terminology available to the Bahmni open source EMR product and their users. It enables clinicians and organizations at the beginning stages of digital health maturity – capturing data using free text, radio buttons or simple value lists and not yet recording SNOMED CT directly in the health record – to move up the digital health maturity model and progress beyond that initial stage for data capture and retrieval.   

Q: Who else is participating in this project?

A: We’re working with a coalition of partners, including users, developers, implementers and thought leaders. One of the partners is the global technology consultancy Thoughtworks, which is the company that initially developed the EMR. You can find the list here: https://www.bahmni.org/bahmni-coalition 

Q: What are the benefits for healthcare organizations, patients and providers?

A: Patients whose providers use the Bahmni EMR will experience the general benefits EMRs provide. Their data can be standardized and therefore more easily exchanged with other EMRs and hospital information systems, eliminating the need for patients to find and carry copies of their medical records, including x-rays and other test results, and to constantly repeat their story as they interact with different medical professionals throughout their care journey. 

With the integration of SNOMED CT, providers can search and save diagnoses and clinical data, generate reports, create forms and access clinical decision support use-cases. They can also receive alerts when a drug-diagnosis interaction is contraindicated.

For healthcare organizations, it means they can manage patient information across registration, point of care, investigations, and billing. It’s simple to use with minimal training required. It can be hosted and operated at the hospital site, requiring no dependence on the Internet, and can be used on a variety of devices, including tablets and laptops. It’s modular, flexible and adaptable.

Q: What are the next steps?

A: The Bahmni EMR has been available for many years, but the current phase of work that will conclude by the end of 2023 focuses on enhancing clinical decision support use-cases for drug-to-drug interactions and drug dosage checking. It will also improve HL7 FHIR compatibility, integration with the SNOMED CT data analytics tool, enabling WHO ICD-10 reports, and integration with a new micro FHIR terminology server. 

Q: What were some of the challenges the collaborating organizations faced in launching the Bahmni project?

A: It’s clear that there can be significant technical challenges, especially from an infrastructure perspective. It can include everything from hardware and networking, all the way to a lack of suitable cellular services or intermittent internet services. This has required us to be nimble in terms of the scope of the project, which now includes a lightweight terminology server that can be run in low-resource environments. 

Q: Has SNOMED International learned anything in particular from its participation in this initiative that can be applied to future similar engagements?

A: Funding models for developing products in healthcare specifically for low- to middle income countries are extremely varied and can include multiple parties with their own unique mandates. Finding funding partnerships can come down to relationships with organizations that have an appropriate funding mandate for healthcare in these regions, some of which we’ve been able to develop through this project.

Q: Where can people learn more about it?

A: To learn more, visit SNOMED International’s Bahmni + SNOMED CT project on its website as well as Bahmni’s project documentation website.