Expressiveness of SNOMED CT for wound Care – Mapping a Standardised item Set for Leg Ulcers to SNOMED CT
Abstract Background: Chronic 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. The interdisciplinary and multiorganisational character of wound care demands interoperable information exchange that can be achieved by using international semantic standards such as SNOMED CT. This study, therefore, aimed to investigate the expressiveness of SNOMED CT in this medical domain, and thereby its clinical usefulness and the potential need for its extension.Methods: In this study, a consented wound care item set, the National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped to the international reference terminology SNOMED CT. In order to derive the relevant items of the wound domain, an information model was developed that served as the foundation for the mapping. The mapping itself was guided by the procedural formalism of ISO TR 12300. As a result, the reliability, equivalence and coverage rate were determined.Results: The 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 a symmetric match, the coverage rate of SNOMED CT was 67.2% overall, and 64.3% specifically for wounds. Conclusion: The results show acceptable reliability values. The overall coverage rate shows that two-thirds of the items found a symmetric map, which is a substantial portion of the source item set. As the differences in the coverage rates between different wound care sections demonstrate, some areas, such as “general medical condition” and “wound assessment”, in particular, were covered better than other areas (“wound status”, “diagnostics” and “therapy”). These deficiencies can be mitigated either by post-coordination or the inclusion of new terms in SNOMED CT. In general, 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.