A State-of-the Art Review of SNOMED CT Terminology Binding and Recommendations for Practice and Research

BACKGROUND

Unambiguous sharing of data requires information models and terminology in combination, but there is a lack of knowledge as to how they should be combined, leading to impaired interoperability.

OBJECTIVES

To facilitate creation of guidelines for SNOMED CT terminology binding we have performed a literature review to find existing recommendations and expose knowledge gaps. The primary audience is practitioners and researchers working with terminology binding.

METHODS

PubMed, Scopus, and Web of Science were searched for papers containing "terminology binding," "subset," "map," "information model" or "implement" and the term "SNOMED."

RESULTS

The search yielded 616 unique papers published from 2004 to 2020, from which 55 papers were selected and analyzed inductively. Topics described in the papers include problems related to input material, SNOMED CT, information models, and lack of appropriate tools as well as recommendations regarding competence.

CONCLUSION

Recommendations are given for practitioners and researchers. Many of the stated problems can be solved by better co-operation between domain experts and informaticians and better knowledge of SNOMED CT. Settings where these competences either work together or where staff with knowledge of both act as brokers are well equipped for terminology binding. Tooling is not thoroughly researched and might be a possible way to facilitate terminology binding.

An Empirical Approach to Enhancing Terminology Binding - An HL7 FHIR SNOMED CT Example

Information exchange at the level of semantic interoperability requires that information models and clinical terminologies work well together. In HL7 FHIR resources, terminology binding to standard terminologies such as SNOMED CT are suggested, and even though most are suggestions rather than rules, they still must reflect the clinical domain accurately. In this study, we suggest a method for empirically evaluating whether a terminology binding represents the value sets used in practice. We evaluated the terminology binding associated with the MedicationRequest.reasonCode using the Danish national indication value set which we mapped to SNOMED CT. We found two problems with the terminology binding, namely, that the reason for prophylactic treatment and that medication given as part of a procedure, but not related to the patients' problems per se could not be expressed within the boundary of HL7 FHIR's example terminology binding. Future work will include showing how more complex terminology binding issues could be informed by looking at value sets in use.