SNOMED CT adoption in Denmark – why is it so hard?

What prevents the National Health Care Terminology based on SNOMED CT from being implemented in the EHR systems and ongoing EHR implementations in Denmark? SNOMED CT was translated into Danish language from 2006-2009 and by 2013 it is not yet implemented in a clinical information system. Fourteen key persons broadly representing all major stakeholders in the process of system configuration accepted an invitation to discuss questions about what kind of challenges they experience in handling terminology in clinical information systems today and what they expect from a future implementation of a SNOMED CT based national terminology. Three types of challenges of terminology implementations resulted from two parallel focus group interviews: 1. Methods to manage terminology-implementation like preventing inconsistency and redundant representations of identical information. 2. The existing terminology and classifications used are sufficient to accommodate the required governance and 3. SNOMED CT is expected to be immature for system-implementation. These results suggest further research in methods to facilitate implementation of a complex terminology and studies that evaluate SNOMED CT in clinical use; but the results also support national and regional decision makers regarding what kind of challenges they must manage.