The purpose of the Nursing Problem List Subset of SNOMED CT is to facilitate the use of SNOMED CT as the primary coding terminology for problem lists or other summary level clinical documentation.

For older Nursing Problem List Subset Files, please see the SNOMED CT Archives page.

Additional Information

Introduction

The use of a common list of SNOMED CT concepts will maximize data interoperability among institutions. However, local problem list vocabularies often need to be expanded to satisfy specific user needs. Users should check to see if SNOMED CT contains terminology for concepts they need to fulfill their local requirements and use case. The UMLS Terminology Services (UTS) includes a SNOMED CT browser that may be used for this purpose. The SNOMED CT Browser is available through the SNOMED CT menu of the UTS.

If needed concepts are not found in the terminology, users are encouraged to submit them for inclusion in the US Extension of SNOMED CT. To submit a new nursing problem concept, go to U.S. SNOMED CT Content Request System (USCRS). Additional assistance on submitting requests can be found on the USCRS User Guide page. In this way, the link to the Nursing Problem List concepts is maintained and divergence of problem list vocabularies can be minimized. Institutions that use their own problem list vocabularies are encouraged to map them to SNOMED CT with a focus on the Nursing Problem List concepts to facilitate data interoperability.

Choice of SNOMED CT Concepts

To find the most appropriate SNOMED CT concepts for each problem list term, the following guidelines are used:

• Only FSN (Fully Specified Name) SNOMED CT atoms are included (Term Type [TTY] = "FN"). Each SNOMED CT concept has a UMLS CUI (concept unique identifier) that has at least one term (atom) from at least one nursing vocabulary. If cross-mappings between nursing vocabulary and SNOMED CT are avaialable in the UMLS Metathesaurus, those concepts are also included in this subset.
• Only active SNOMED CT concepts are included.
• Most concepts are chosen from the SNOMED CT clinical finding hierarchy.

Additional Resources from the UMLS

For each SNOMED CT concept in the subset, the corresponding UMLS CUI is listed. Through this, users can have access to resources available in the UMLS such as additional synonyms (beyond those present in SNOMED CT itself), text definitions for many terms, and corresponding codes in other terminologies.

File Description

The Nursing Problem List subset data file has the following fields:

• SNOMED_CID – conceptId of the SNOMED CT concept
• SNOMED_FSN – SNOMED CT fully-specified name
• SNOMED_CONCEPT_STATUS – concept status of the SNOMED CT concept
• UMLS_CUI – the corresponding UMLS concept identifier, if concept is not yet in the UMLS this will be NA (not available)
• OCCURRENCE – number of institutions having this concept on their problem list (from 1 to 8), not populated for concepts retired from Subset
• USAGE – the average usage percentage among all institutions (i.e. sum of individual usage percentages divided by 8), not populated for concepts retired from Subset
• FIRST_IN_SUBSET – the version of Subset first containing this concept
• IS_RETIRED_FROM_SUBSET – in future, some concepts will be marked retired if they are retired by IHTSDO or no longer considered to be useful e.g. when there are more appropriate SNOMED CT concepts
• LAST_IN_SUBSET – the version of Subset last containing this concept, only populated for concepts retired from Subset
• REPLACED_BY_SNOMED_CID - SNOMED CT concept to replace concept retired from Subset, only populated for concepts retired from Subset

A sample database load script can be found here.

The file identifies what we hope is a useful subset of SNOMED CT, but does not include all the information likely to be required to make effective use of SNOMED CT in an application, such as synonyms that may include more clinician-friendly terms than the SNOMED CT fully-specified name. The identifiers in the file can be used to extract more complete information for these concepts from either the UMLS release files or the SNOMED CT native format files.

Update and Maintenance

A new version of the subset will be published for each new International SNOMED CT and the UMLS release. Newly retired SNOMED CT concepts will be flagged and additional concepts may be added if appropriate.

SNOMED CT License Requirement

SNOMED CT is owned by the International Health Terminology Standards Development Organisation (IHTSDO). The NLM is the U.S. Member of the IHTSDO and, as such, distributes SNOMED CT at no cost in accordance with the Member rights and responsibilities outlined in the IHTSDO's Articles. The license terms are incorporated into the License for Use of the UMLS Metathesaurus. Use of SNOMED CT is subject to the IHTSDO Affiliate license provisions and is free in IHTSDO Member territories including the United States, in low income countries, and for Qualifying Research Projects in any country.

To request a license click "Sign Up" on the UTS Homepage. Additional information can be found on the UMLS License page.

Feedback and Suggestions

We welcome any questions, comments or suggestions that would improve the quality, accuracy, and usability of the subset. Please send feedback to Dr. Judy Warren (jjwarren@live.com) and Dr. Susan Matey (samatney@mmm.com).

Acknowledgements

The IHTSDO Nursing Work Group Problem List Project Team thanks the IHTSDO, the IHTSDO Nursing Work Group, and the NLM for their participation in and support of this project.