Expressiveness of an International Semantic Standard for Wound Care: Mapping a Standardized Item Set for Leg Ulcers to the Systematized Nomenclature of Medicine–Clinical Terms (Preprint)

Abstract

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. Their treatment is highly interdisciplinary and regularly spans multiple care settings and organizations; this places particularly high demands on interoperable information exchange that can be achieved using international semantic standards, such as Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT).

This 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.

A clinically consented and profession-independent wound care item set, the German National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped onto the precoordinated concepts of the international reference terminology SNOMED CT. Before the mapping took place, the NKDUC was transformed into an information model that served to systematically identify relevant items. The mapping process was carried out in accordance with the ISO/TR 12300 formalism. As a result, the reliability, equivalence, and coverage rate were determined for all NKDUC items and sections.

The developed information model revealed 268 items to be mapped. Conducted by 3 health care professionals, the mapping resulted in <i>moderate</i> reliability (κ=0.512). Regarding the two best equivalence categories (symmetrical equivalence of meaning), the coverage rate of SNOMED CT was 67.2% (180/268) overall and 64.3% (108/168) specifically for wounds. The sections <i>general medical condition</i> (55/66, 83%), <i>wound assessment</i> (18/24, 75%), and <i>wound status</i> (37/57, 65%)<i>,</i> showed higher coverage rates compared with the sections therapy (45/73, 62%), wound diagnostics (8/14, 57%), and patient demographics (17/34, 50%).

The 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 <i>general medical conditions</i> and <i>wound assessment</i>, were covered better than other sections (<i>wound status</i>, <i>diagnostics</i>, and <i>therapy</i>). These deficiencies can be mitigated either by postcoordination or by the inclusion of new concepts in SNOMED CT. This study contributes to pushing interoperability in the domain of wound care, thereby responding 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.