Thursday, July 23, 2009

The SNOMED-CT Problem List has arrived

As promised in my earlier blog, the National Library of Medicine has created a "best practices" subset of SNOMED-CT which is highly usable by clinicians for documenting the symptoms and conditions used on a typical Problem List.

I've discussed previously the hazards of using ICD-9 as problem list vocabulary. It's an administrative billing vocabulary, not a clinical observation vocabulary.

You need a free SNOMED license (if you're in one of the countries that has licensed SNOMED, such as the US) to retrieve the SNOMED Problem List document.

The present subset is based on datasets submitted by 7 institutions - Beth Israel Deaconess Medical Center, Intermountain Healthcare, Kaiser Permanente, Mayo Clinic, Nebraska University Medical Center, Regenstrief Institute and Hong Kong Hospital Authority.

We're implementing this problem list vocabulary in our home grown systems first, then we'll work with eClinicalWorks to incorporate it into their EHR. We'll test it extensively with a few clinicians and then roll it out broadly if we achieve a good balance of functionality and clinician satisfaction.

The HIT Standards Committee will likely recommend SNOMED-CT as the preferred problem list vocabulary, so this release by the NLM is very important to all EHR stakeholders.


Keith W. Boone said...

Don't get me wrong, I love the idea behind this, but the execution leaves something to be desired. One of the problems is the lack of coordination between this subset and the VA/KP Subset already used for Medication Labeling. There's a huge overlap between these subsets, but it is just that, an overlap, which means that some harmonization is needed to ensure that interoperable use of SNOMED. See my own posting on this topic here:

GreenLeaves said...

John have you seen or investigated how well ICD-10 maps to SNOMED-CT recognizing that it still is an administrative billing vocabulary?

Unknown said...

The IHTSDO has an active project mapping ICD-10 to SNOMED CT. The Overview page is at and you can request a login account by emailing

krowwolf said...

David, the mapping project you refer to is actually going the other way: SNOMED CT to ICD-10 rather than ICD-10 to SNOMED CT.

Unknown said...

Sorry, I did know that, but I obviously didn't check what I typed :-(

Chip Perkins said...

Can you give us an update on your progress with the Problem List?