Speaking the same language: why clinical terminology matters for quality improvement activities

You’ve generated a POLAR report to identify patients due for a diabetes review or cervical screening. As you review the results, you notice a familiar patient is missing.

The diagnosis exists in the patient’s clinical record, yet they do not appear in the report.

While there can be several reasons for this, with one common factor being how clinical information has been recorded and standardised. As general practice becomes increasingly connected through Clinical Information Systems, POLAR, My Health Record, electronic prescribing and other digital health tools, the quality of your data depends on those systems being able to consistently interpret the information they share.

This is where SNOMED CT-AU plays an important role.

Using standardised clinical terminology helps digital health systems consistently recognise diagnoses, procedures and other clinical concepts. For practices, this supports more reliable data extraction, patient identification and reporting, helping you get greater value from the clinical information you’re recording every day.

For practices undertaking Quality Improvement (QI) activities, consistent clinical terminology can support:

• Reliable patient identification for recalls and audits
• Accurate population health reporting
• Confidence in Quality Improvement data
• Interoperability between digital health systems

To support this, the Australian Digital Health Agency (ADHA) provides free access to Australia’s national clinical terminologies through the National Clinical Terminology Service (NCTS). An NCTS licence gives eligible organisations access to current releases of SNOMED CT-AU, the Australian Medicines Terminology (AMT) and supporting terminology resources to help maintain consistent, high-quality clinical data across digital systems.

Whether you’re using POLAR to support Quality Improvement, preparing reports, or simply looking to strengthen the quality of your clinical data, ensuring your practice has access to the latest national clinical terminologies is a simple step that supports the digital tools you already rely on.

The National Clinical Terminology Service licence is available free of charge. To learn more or register for a licence, visit the National Clinical Terminology Service website.