An evaluation of SNOMED CT® in the domain of complex chronic conditions

OBJECTIVE: To determine the content coverage in SNOMED CT® to represent the multidisciplinary terms and concepts in the domain for complex chronic conditions. METHODS: An evaluation of the coverage of multidisciplinary health factors in SNOMED CT® for the complex and chronic condition, multiple chemical sensitivity (MCS) is conducted in the study. The methodology included a retrospective audit of patient charts and feedback from multidisciplinary clinicians in the creation of a controlled vocabulary used in the generation of patient profiles for MCS. Clinicians and experts in the field reviewed and tested the vocabulary for its usefulness (scope, specificity and structure) by re-coding three patient profiles using the vocabulary. Cohen's kappa analysis was conducted to determine inter-rater reliability. Cronbach's alpha analysis was conducted to determine the internal reliability of the survey questionnaire. RESULTS: One hundred patient charts and nine clinicians from varying health disciplines participated in the study. SNOMED CT® was shown to capture nearly 82% of the concepts spanning multidisciplinary areas of health focus. The nutrition area of health focus had the highest level of exact matches. Furthermore, post-coordination was applied in an attempt to improve coverage of concepts to 75% (of 45 terms) of the missing terms in SNOMED CT®. Seventy-five percent (n=9) of the clinicians agreed on the overall usefulness of the vocabulary. CONCLUSIONS: SNOMED CT® had a reasonable coverage of the multidisciplinary health concepts required to describe a complex and chronic condition. Standardizing the multidisciplinary vocabulary with reference tag to a widely used reference terminology, such as SNOMED CT® to discuss the terms and concepts used may improve the understanding across disciplines and communities of practice. Overall, based on the availability of concepts in SNOMED CT® and the feedback from clinicians, the approach looks promising and should be further explored.