Forty years of SNOMED: a literature review

BACKGROUND: Over a period of 40 years, SNOMED has developed from a pathology-specific nomenclature (SNOP) into a logic-based health care terminology. In spite of its long existence and continuous evolvement, it is yet unknown to what extent SNOMED is used in clinical practice, and what benefits were achieved. The aim of this paper is to investigate this by providing an overview of published studies in which a version of SNOMED was studied or applied. METHODS: This paper analyzes the use of SNOMED over time, as reflected in scientific publications, by means of Medline literature search in PubMed. The search included papers from 1966 until June 2006. For each selected paper the following characteristics were classified: version, medical domain, coding moment (during or after the care process), usage, and type of evaluation (e.g., does SNOMED work, does SNOMED help). RESULTS: 250 papers were included in this research. The number of annual publications has increased, as has the number of domains in which SNOMED is being used. Theoretical studies mainly concern comparison of SNOMED to other terminological systems and SNOMED as an illustration of a terminological systems' theory. Few studies are available on the usage of SNOMED in clinical practice, largely involving coding information and retrieval/aggregation based on SNOMED codes. CONCLUSION: The clinical application of SNOMED is broadening beyond pathology. The majority of studies concern proving the value of SNOMED in theory. Fewer studies are available on the usage of SNOMED in clinical practice. Literature gives no indication of the use of SNOMED for direct care purposes such as decision support.