Problems

The American National Standard/American Dental Association Standard - SNODENT (Systemized Nomenclature of Dentistry) should be added as an element to the USCDI. SNODENT is a clinical terminology designed for use with electronic dental and health records that enables the capture, aggregation and analysis of detailed oral health data. The scope of SNODENT is to provide semantic interoperability for exchange of concepts that is also interoperable with SNOMED CT. SNODENT includes oral anatomical sites, oral health conditions, findings, and other clinical concepts unique to dentistry. SNODENT enables patient data to be recorded by different people in different locations, and to be combined into simple information views in the patient record. It provides a standardized way to represent clinical oral health descriptions captured by dentists and enables automated interpretation of their observations. There remains significant demand from government, educators, researchers, and third parties to relate treatments provided to patients to a diagnosis. Until recently there has not been a diagnostic or descriptive code set created for dentists that enables the provision for a platform-independent, language-independent, cross-cultural, oral health care record. SNODENT is this code set created by the ADA to satisfy this need and it became an ANSI standard in 2017. Unlike other areas of medicine, dentistry has infrequently used diagnostic codes of any sort. Most dental practice management systems were not designed to include diagnostic or other terms, beyond those used for payment purposes.

SNODENT is a terminology designed for use in the electronic health records (EHR) environment and its features include:
• An oral health resource with a granular clinical content
• Provides consistent oral health content for use in electronic dental records
• Is mapped to other standard terminologies
• Is included in the ONC ISA
• Is recognized by and included in HL7/FHIR standards developed for dental data exchange

The ADA is a leader in the development, publication, and implementation of interoperability standards in the oral health care setting, and is an American National Standards Institute (ANSI) Accredited Standards Development Organization for dental information technology through its Standards Committee on Dental Informatics (SCDI). The SCDI membership consists of a broad range of stakeholder interests, including technology vendors, dental plans, clearinghouses, national dental specialty organizations, practicing dentists, and academics.

Submitted By: Jean Narcisi / American Dental Association
Data Element Information
Rationale for Separate Consideration	SNODENT is a terminology designed for use in the electronic health records (EHR) environment and its features include: • An oral health resource with a granular clinical content • Provides consistent oral health content for use in electronic dental records • Is mapped to other standard terminologies • Is included in the ONC ISA • Is recognized by and included in HL7/FHIR standards developed for dental data exchange
Use Case Description(s)
Use Case Description	• Use Case 1 Medical to Dental Referral Note • Use Case 2 Dental to Medical Consult Note • Use Case 3 Dental to Dental (Specialist) Referral Note • Use Case 4 Dental (Specialist) to Dental (General Dentist) Consult Note
Estimated number of stakeholders capturing, accessing using or exchanging	The ADA currently has more than 163,000 member stakeholders. In addition, the Department of Defense plans to implement the HL7 dental summary exchange standards that include SNODENT as part of their dental readiness program for reservists and active duty personnel.
Link to use case project page	http://hl7.org/fhir/us/dental-data-exchange/2020Sep/index.html
Healthcare Aims	Improving patient experience of care (quality and/or satisfaction) Improving the health of populations Reducing the cost of care Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s)	N/A
Additional Specifications	HL7 FHIR® Implementation Guide: Dental Data Exchange, Release 1 - US Realm; HL7 CDA R2 Implementation Guide: Dental Data Exchange, Release 1 - US Realm; HL7 CDA® R2 Implementation Guide: Exchange of C-CDA Based Documents; Periodontal Attachment, Release 1 - US Realm; HL7 CDA® R2 Implementation Guide: Orthodontic Attachment, Release 1 - US Realm
Current Use	In limited use in test environments only
Supporting Artifacts	The Department of Defense plans to implement the HL7 dental summary exchange standards as part of their dental readiness program for reservists and active duty personnel. The FHIR Dental Data Exchange implementation guide was tested at the May 2020 HL7 Connectathon. https://confluence.hl7.org/display/FHIR/2020-05+Connectathon+24
Number of organizations/individuals with which this data element has been electronically exchanged	4
Supporting Artifacts	May 2020 HL7 Connectathon https://confluence.hl7.org/display/FHIR/2020-05+Connectathon+24
Potential Challenges
Restrictions on Standardization (e.g. proprietary code)	SNODENT is and ANSI Standard - AMERICAN NATIONAL STANDARD/AMERICAN DENTAL ASSOCIATION STANDARD NO. 2000.4 SNODENT (SYSTEMIZED NOMENCLATURE OF DENTISTRY)
Restrictions on Use (e.g. licensing, user fees)	SNODENT can be licensed from the American Dental Association and there are no user fees.
Privacy and Security Concerns	No privacy and security concerns
Estimate of Overall Burden	An estimate of overall burden is unknown at this time. SNODENT maps work to provide explicit links to health related classifications and coding schemes used in the United States such as SNOMED CT, ICD-9 CM, ICD-10 CM, and CDT. Maps facilitate use of SNODENT based clinical data for interoperability between systems and other purposes also, such as quality measures and/or statistical reporting.