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We recently created an article about the value of standardising Traditional Indian Medicine for use in electronic patient records using SNOMED CT. This article is the second part of that series, where we focus on standardising Traditional Chinese Medicine using SNOMED CT.

Brief recap — our motivation is to make traditional medicinal interventions recordable in the electronic patient records, so we can compare their value/outcomes. Checkout our SNOMED CT Intro series for good use reasons why electronic health records are useful and the huge role that SNOMED CT has in making them shareable (interoperable) .

Background — Traditional Medicine

If you have been to see a doctor in your primary care practice or hospital, you have encountered `western medicine`. Okay, I know I am going to get this very wrong politically — but as a broad brush I am going to call all systems of medicine that do not conform to the `western medicine` notion as `traditional medicine`. That is not to dismiss them, but rather make the case that there might be valid reasons for patients to consult practitioners of `traditional medicine` before/after visiting the regular doctor. The World Health Organization (WHO) defines traditional medicine as

 “the sum total of the knowledge, skills, 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”.

I won’t get into the `why`, but I am going to focus on what happens when the patient does this.

> Recap: How do we reconcile this part of the patient’s journey when they are pursuing their well-being with what is in the EHR held in the hospital by their doctor?

Clearly traditional medicine can be quite broad and for the record I am not referring to voodoo and black magic here. I am referring to recognised systems like Chinese Traditional Medicine, Indian Systems — Ayurveda, Unani, Korean Traditional Medicine, etc. I will declare up front that I have a bias — I come from a culture where turmeric has been consumed for centuries in food, before it became more fashionable as turmeric tea due to its new found antibacterial/anti-carcinogenic properties. The point is — if we never record this aspect of the patient record/history, then we have very little chance of finding any beneficial or harmful effects of such treatments.

So what’s different now?

For a start, there is more acceptance of the fact that there are multiple systems of medicine beyond just the western school of medicine. Second, there is recognition that in some cultures these systems of medicine are part of their cultural history. So just like we wouldn’t dismiss anyone’s culture outright, in the modern world we would at the least recognise such cultural history embedded in traditional medicine. Here is a selected list of alternative medicines on wikipedia:

Clearly that is a long and impressive list. My point is — what we can to about this to:

1. Ensure that patient record about their traditional medicine encounters are recorded in the same way as the encounters in electronic medicine records from hospitals
2. Find a way to uniquely identify and analyse where such traditional medicine interventions have a significant effect on outcomes for patients?

Representing Chinese Traditional Medicine in SNOMED CT

There is a lot of work in this space — first off the back, the WHO has been pretty active in this space and has added significant content around Chinese Traditional Medicine into ICD-11. For a few years, SNOMED International has been quietly working away to add similar Chinese Traditional Medicine content to SNOMED CT too. However, we also know that both Korea and India have been working away on representing their own versions of traditional medicines in SNOMED CT. Let us focus on Chinese Traditional Medicine and its representation in this article. If you are interested in example uses cases for traditional, look at our previous article.

Current representation of Chinese Traditional Medicine

The following is a high level outline of how concepts in Chinese Traditional Medicine are represented in the SNOMED CT hierarchy. The broad notions here are of:

On the surface of it, this makes sense and more importantly, having them in SNOMED CT allows us to answer those questions we listed in the above section. We have broad notions of theoretical/abstract notions in Chinese traditional medicine, a sense of organisation in hierarchies using these broad notions. See hierarchies below for examples of how 1216946007 |Kidney yang deficiency (pattern)| is represented.

Expands into different organ system based patterns as shown below

Of course, this then goes on further to relate organ system patterns to abstract yin-yang etc, here is what it looks like:

Here is an example of the modelling for a concept:

Looks great doesn’t it and you can clearly see that there is the start of some excellent work that can be built on. Of course this is what SNOMED International are planning and you can contribute to this project if you want. You can join the project space dedicated for conversations on this topic.

So what next?

While the above start for Chinese Traditional Medicine look well thought out, here are some broader questions that come to mind. Note how some of these share analogies with our previous article on Indian Traditional Medicine.

• If both traditional medicine and western medicine have notions of `etiology`, would we be able to `merge` these notions together?
• If both traditional medicine and western medicine have notions of `organ system` what would be the relationship between `the renal/excretory system` in traditional medicine and the `kidney` in SNOMED CT?
• If more than one system of traditional medicine were represented in SNOMED CT, would we be able to associate the aetiology, morphology/organ-system in one system with another?

For course, the lack of answers to these questions should not stop us from using the current content in the Traditional Medicine extensions in SNOMED CT. The future does look bright for both practitioners of western and traditional medicine thanks to the power of SNOMED CT! I look forward to the day when I can have a consolidated record of my entire health information irrespective of which school of medicine I subscribe to!

However, these are the sort of questions that we at Termlex find interesting. This is why we have collated our thoughts about these questions and possible answers as a presentation for the upcoming SNOMED International #SctExpo22 in October 2022. So if you are interested in joining this discussion, then please leave your comments on this post and also join our upcoming presentation at the Expo.