The Expressiveness of SNOMED CT for Wound Care: Mapping a Standardized Item Set for Leg Ulcers onto SNOMED CT.

Abstract

BACKGROUND\nChronic health conditions are on the rise and are putting high economic pressure on health systems as they require well-coordinated prevention and treatment. Among chronic conditions, chronic wounds such as cardiovascular leg ulcers have a high prevalence. Their treatment is highly interdisciplinary and regularly spans multiple care settings and organizations, thus placing particularly high demands on interoperable information exchange that can be achieved using international semantic standards such as SNOMED CT.\n\n\nOBJECTIVE\nThis study aims to investigate the expressiveness of SNOMED CT in the domain of wound care, and thereby its clinical usefulness and the potential need for extensions.\n\n\nMETHODS\nA clinically consented and profession independent wound care item set, the German National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped onto the pre-coordinated concepts of the international reference terminology SNOMED CT. Before the mapping took place, the NKDUC was transformed into an information model that served to identify the relevant items systematically. The mapping process itself was carried out in accordance with the formalism of ISO/TR 12300. As a result, the reliability, equivalence, and coverage rate were determined for all NKDUC items and sections.\n\n\nRESULTS\nThe developed information model revealed 268 items to be mapped. Conducted by three health care professionals, the mapping resulted in moderate reliability (K=0.512). Regarding the two best equivalence categories (symmetrical equivalence of meaning), the coverage rate of SNOMED CT was 67.2% overall and 64.3% specifically for wounds. The sections general medical condition (83.4%), wound assessment (75.0%), and wound status (64.9%) showed higher coverage rates compared to the sections therapy (61.6, wound diagnostics (57.1%) and patient demographics (50.0%).\n\n\nCONCLUSIONS\nThe results yielded acceptable reliability values for the mapping procedure. The overall coverage rate shows that two-thirds of the items could be mapped symmetrically, which is a substantial portion of the source item set. Some wound care sections, such as general medical condition and wound assessment, were covered better than other sections (wound status, diagnostics, and therapy). These deficiencies can be mitigated either by post-coordination or the inclusion of new concepts in SNOMED CT. This study contributes to pushing interoperability in the domain of wound care and thereby responds to the high demand for information exchange in this field. Overall, this study adds another puzzle piece to the general knowledge about SNOMED CT in terms of its clinical usefulness and its need for further extensions.\n\n\nCLINICALTRIAL