SNOMED CT Clinical Use Cases in the Context of Electronic Health Record Systems: A Systematic Literature Review (Preprint)

BACKGROUND The Systematized Medical Nomenclature for Medicine (SNOMED CT) is a clinical terminology system that provides a standardized and scientifically validated way of representing clinical information captured by clinicians. It can be integrated into electronic health records (EHRs) to increase the possibilities for effective data use and ensure a better quality of documentation that supports continuity of care, thus enabling better quality in the care process. Even though SNOMED CT consists of extensively studied clinical terminology, previous research has repeatedly documented a lack of scientific evidence of SNOMED CT in the form of reported clinical use cases in electronic health record systems. OBJECTIVE The aim of this study was to explore evidence in previous literature reviews of clinical use cases of SNOMED CT integrated into EHR systems or other clinical applications during the last 5 years of continued development. The study sought to identify the main clinical use purposes, use phases, and key clinical benefits documented in SNOMED CT use cases. METHODS The Cochrane review protocol was applied for the study design. The application of the protocol was modified to fit the research problem step-by-step by first defining the search strategy, identifying the articles for the review by isolating the exclusion and inclusion criteria for assessing the search results, and lastly, evaluating and summarizing the review results. The result categories were based on previous research. RESULTS In total, 17 research articles illustrating SNOMED CT clinical use cases were reviewed. The clinical domain or EHR in use was partially documented. The use purpose of SNOMED CT was documented in all the articles, with the terminology as a planned standard in EHR being the most common. The clinical use phase was documented in all the articles. The most common category of use phases was SNOMED CT in development. Core benefits achieved by applying SNOMED CT in a clinical context were identified by the research team. These were related to terminology use outcomes (i.e., to data quality in general or to enabling a consistent way of indexing, storing, retrieving, and aggregating clinical data). Additional benefits were linked to the productivity of coding or to advances in the quality and continuity of care. CONCLUSIONS While the SNOMED CT use categories were well supported by previous research, this review demonstrates that further systematic research on clinical use cases is needed to promote the scalability of the review results. To achieve the best out-of-use case reports, more emphasis is suggested on describing the contextual factors, such as the electronic health care system in use and the usage of previous frameworks to enable comparability of results. An important lesson to be drawn from our study is that SNOMED CT is essential for structuring clinical data; however, research is needed to gather more evidence of how SNOMED CT benefits clinical care and patient safety. CLINICALTRIAL na