Standardising dietary supplements in Electronic Health Records – Using SNOMED CT
Dietary supplements are used by millions of people across the world to both enhance and maintain health. The size of the dietary supplements market is estimated to be ~150 billion and expected to grow to ~200+ billion towards 2030. However, very few efforts have been made to standardise how dietary supplement intake is recorded and reported in electronic and personal health records. A systematic approach to align SNOMED CT content with the Dietary Supplement Label Database (DSLD) (a database of 100,000+ printed labels of dietary supplement products sold in the United States) published by the National Institutes of Health (NIH) can allow standarised reporting of the benefits and adverse effects of dietary supplements intake. In this article, we cover the rationale for a dietary supplements extension in SNOMED CT, allowing member countries to benefit from SNOMED CT’s rigour and established use in EHR systems.
Background
Dietary supplements are commonly used by millions of people across the world to both enhance and maintain health – think vitamin, probiotics, etc not just botanical products. The size of the dietary supplements market is estimated to be in the order of ~150 billion world wide and expected to grow to ~200+ billion towards 2030. A large fragment of dietary supplements are also manufactured by well recognised pharmaceutical companies. Here is a brief list of some players your might recognise… 🤓
- Pfizer Inc.
- Bayer AG
- Amway Corp.
- Nestlé S.A.
- GlaxoSmithKline plc
- BASF SE
- Danone S.A.
- The Himalaya Drug Company
- Abbott Laboratories
- …
However, there have been very little efforts made to standardise how dietary supplement intake is recorded and reported in the context of electronic healthcare records and personal health records. The Dietary Supplement Label Database (DSLD) was developed by the Office of Dietary Supplements (ODS) at the The National Institutes of Health (NIH). It catalogs all information of over 100,000+ printed labels of dietary supplement products sold in the United States. The label information in the DSLD can be used by healthcare providers and patients alike to determine the contents of the products their patients are taking.
Why it matters
Most of us have at some time would have consumed some vitamin supplements, probiotics, mineral, botanical products or something else outside what our doctor prescribed. All these products, fall into the broad space of `dietary supplements`. With the growing trend of people wanting to be move involved in their health (a good thing), this is a growing space that does not get reflected or reported in our typical electronic health records. Personal health records sometimes allow users to scan/enter this information. However, this information is neither standardised nor is accessible in a meaningful way for our doctors to look at alongside all the other information in electronic health records.
In the broader context of personal health records and patient reported medication records, we ask the question:
Is it possible to record and report dietary supplements using standard terminologies in Electronic Health Records.
The ability to consistently record the ingredients of dietary supplements and other alternative medical products allows us to:
- Ensure that a patient’s record about their dietary supplements intake is recorded in the same way as regular medication intake in electronic medicine records from hospitals
- Detect and report possible adverse effects that might be associated with dietary supplements, using established mechanisms for reporting such events in hospitals.
- Find a way to uniquely identify and analyse where such dietary supplements intake have a positive benefits on outcomes for patients.
Why SNOMED CT?
SNOMED CT is the reference clinical terminology for use in the context of electronic health records, adopted by many countries across the world. The release of the International Patient Summary (#IPS) and inclusion of the IPS Terminology and Global Patient Set based on SNOMED CT by SNOMED International, increases the opportunities for personal healthcare records (#PHR) platforms and apps to include SNOMED CT. Since most PHR apps allow patients to record their medication information that commonly include dietary supplements, the ability to record these supplements using the framework of SNOMED CT allows PHRs and EHRs to share information more effectively. This also opens up the ability to extend existing EHR data recording and reporting mechanisms (e.g. adverse drug reporting) to cover both conventional pharmaceutical products and dietary supplements.
Area of work
There ~8,800 ingredients listed in the DSLD some of which are likely also present in the 27319 substances listed in SNOMED CT. The recent revision of the substance hierarchy in SNOMED CT presents an opportunity to align substances in dietary supplements that might be analogous with SNOMED CT. While SNOMED CT has historically been focussed on western medicine and some of these ingredients, it is likely that:
- There is a significant overlap between these ingredients/substances between SNOMED CT and DSLD.
- A significant portion of the ingredients in the DSLD are not present in SNOMED CT given the dietary focus and possible traditional/herbal medical focus of some of the products on the market.
Our work seeks to systematically align the content between the DSLD and SNOMED CT, covering the following aspects:
- Ingredients to Substance overlap between the two systems to allow cross walk where possible.
- Identify ingredient content that exists in the DSLD, that could form the basis for creating a Dietary Supplements extension in SNOMED CT.
- Infer relationships between organisms and organism derived product/substance – using SNOMED CT hierarchies. For example `ginseng` from the plant and what varieties of ginseng…
- Establish the broader applications of using SNOMED CT technology (e.g. content management and Description Logic) to enhance analysis of data coded using the DSDL in both the PHR and EHR space.
Relevance to the community
While this work is in the early stages of development, we believe that the findings from this work will be of relevance to both clinicians and regulatory bodies with an interest in standardising how dietary supplements consumed by patients are both recorded and reported. Our work also presents an opportunity to bring the advantages of the terminological rigour that SNOMED CT offers, to the world of dietary supplements and to the personal health records.
In the longer term, our work would allow clinicians, patients and policy makers to determine dietary supplements that are likely to benefit or cause adverse effects for relevant patient cohorts.
Let us also not forget that dietary supplements and intake are also an important part of in-hospital activities for example inpatients. So there is likely a subset of this data that is immediately relevant to the clinician. What are your thoughts about this? Are you a dietician or someone with an interest in nutritional supplements with an interest in seeing this information better represented? Can you think of other use cases or if you are involved in something similar, give us a shout or leave a comment below…