Snoflake is an online SNOMED CT Browser, with support for SNOMED RT and ICD10 codes. Snoflake uses a variety of techniques to find, sort and retrieve codes, including a multi parent/child relationship viewer, to make it easier to traverse SNOMED CT relationships.
As a first-time user of Snoflake, you will be required to register.
This is done by completing and submitting the simple registration form
On submission of the completed form an email containing login credentials will be dispatched immediately.
The left hand side contains the Snoflake Search mechanism which enables a user to locate a required concept. This aspect of the browser will be dealt with later as will the explanations for the 3 tabs.
The right hand frame displays both the detail of a chosen concept, and Snoflake, the multi-parent, multi-child viewer.
The relationships between the parent and its children are represented by the light grey lines and the arrow preceding each concept label, red up for parent and grey down for child concepts. Whenever Snoflake is opened the default root, displayed in green text for clarity, is the SNOMED CT Concept and its 19 child concept types – e.g. Procedure, Clinical finding, Organism, and so on.
Note: In some cases when searching, the SNOMED Parent can have a large number of child relationships and for clarity the number of these displayed is controlled by the application. If there are more children a clickable Next button is displayed in the bottom RH corner of the frame. If this is clicked the user is taken to the next page of relationships where another Next button is displayed if more child options are available, and a Previous button provided to return the user to the previous view.
In the left hand frame of the screen you will find the Keyword Search mechanism.
For example, when the term Larynx is typed into the keywords field a list of concepts containing the term larynx is displayed as illustrated right:
Note: Depending on the search mode (see below) multiple keywords can be entered to reduce or increase the result set. The number of items listed will depend upon the return number selected (indicated on the specified button). The results will begin to appear as you type into the search box & words are recognised by the system.
As part of the v4.0 update there are now several more filter & search options available as well as some that are recognisable from previous versions of Snoflake:
Search field: Enter one or more terms, e.g. Larynx, on which to search.
Increase search box: The small icon in the top RH corner of the Search field is used to increase the size of the search field. When text input is complete, click the green tick to display it in full.
Search icon: Click to search. Note that the application will automatically begin searching as the search text is being input.
Snippet (sni) will match concepts that match all the search terms entered. This means the more terms input, the smaller the result set.
Sentence (sen) will match concepts that contain some or all the words supplied, delivering an expanding result set as input grows.
Full word search (wor) or prefix search (pre).
Maximum number of results to return.
Snomed or ICD10:
Choose which code-set to search on, Snomed CT (sno) or ICD10 (icd).
Suffix filter: Include single or multiple suffixes in search.
subset: Include or exclude single or multiple subset filters in search.
favourite: Include or exclude single or multiple favourite filters in search. The specific concepts in a favourite can also be viewed.
Extensions: Include/exclude UK and dm+d extensions.
Add to favourite: Will become highlighted when green tick is clicked on a concept in the search results list (per concept). When the add to favourite button is clicked, an existing favourite folder can be selected or a new one created. In either case selected (ticked) concepts can be saved.
Finding an ICD10 concept is simlar to the above mechanism with a few caveats.
The filtering (Suffix, Subset, Favourites and Extensions) only apply to Snomed concepts and therefore become unavailable when in ICD10 mode
Adding to favourites:
this is not currently available for ICD10 codes
All other functions are available, including search mode and type
Once you have typed search words then a list of concepts will begin to appear, this list will change as you type more words or prefixes.
The result list is made up of 3 columns:
For this example, see right, the concept selected is 107828000 Larynx manipulation (procedure).
As described in (2) above, to view a concept description move the cursor over the relevant results row and it highlights in green and the description displayed (see right). When clicked, the highlighted concept is displayed in the right hand frame of the Snoflake browser.
Note: Each Term used as a concept description has its own SNOMED CT code as shown & every entity within the SNOMED CT thesaurus has a code.
In the Snoflake Tree the selected, or root, concept is displayed in green text for both ICD10 and Snomed codes. The example below has 2 child concepts indicated by the grey Down arrows, and 2 parent concepts with red Up arrows). Clicking on any of the concept labels will cause the browser to refresh to display the newly selected node as the new root with its own associated parent and child concepts.
Note: When in ICD10 mode, the snoflake tree will display all children and the single parent of the concept. Because of the nature of relationships within ICD10, the amount of nodes that can be traversed is limited
In the area above the Snoflake tree the details of the root concepts are displayed. When displaying Snomed codes the detail panel includes:
The descriptions are each preceded by a type, which are signified as follows:
P = Preferred term, S = Synonym, H = Homonym, F = Fully specified and U = Unspecified
In the example above the Preferred (P) and Full (F) types are indicated to be in use.
When displaying ICD10 codes, the full concept description and code wil;l be displayed.
Note: If the root concept has a large number of associated concepts the full list would not be readable if displayed on a single page. Snoflake caters for this by displaying a maximum of 20 at a time and a button appears in the bar beneath the display. When clicked, the next 20 associated concepts will be displayed.
One or more Subsets and Favourites can be included or excluded from any search, and one or more Suffix can be included in any search.
To include a subset, click on the Subset button to display a list of all subsets.
To include a subset, click on its Green + symbol. Multiple subsets can be included in the fashion.
To exclude a subset, click on the Red - symbol. As before, multiple subsets can be excluded from a search.
A number is displayed on the appropriate button to indicate how many inclusions or exclusions are being applied to the filter.
To release any inclusion/exclusion, just click on its green/red symbol again.
Note. When searching specific words or phrases via the search field, the returned result set will filter on your exclusions/inclusions.
Note: This behaviour is not available when searching ICD10 codes
Users can create a library system where often used, i.e. favourite concepts, can be stored and maintained for quick and easy access.
These favourite lists can then be used to filter other searches, as well as being used as is to search when needed.
Returning to the search and selection stage as described earlier and again illustrated here, the tick to the left of the displayed concept
can be clicked, upon which it will change to .
At this point the Add to Favourite button becomes active & when clicked it opens the favourite section to enables the addition of the selected concept.
One or many concepts, can be added to an existing (named) favourite folder by selecting it from the dropdown list and then clicking the Save button.
To create a new favourite folder, select New Favourite in the dropdown, type a new name and click Save, the favourite and selected concepts will be saved
To edit favourites click on the Favourite button and select the required favourite folder from the list.
Note that clicking on the name rather than the + or – buttons will display all the favourites in the folder.
To remove a favourite concept from the favourite folder click the adjacent to the Concept ID and the concept will be removed from the list of items.
To change a favourite folders name, edit the name displayed above the search results, and click Save.
To delete a favourite, click Delete. This will delete the favourite folder and its contents.
Clicking on the sno button enables the switching between the Snomed and ICD10 modes.
ICD10 Search works in the same manner as Snomed, however the suffix, subset and favourite functionalities are not active in this mode.
Users can edit their account details by clicking on the Account tab on the main menu.
The following details can be edited when required:
When editing has been completed click the Save button.