Subscribe to RSS
DOI: 10.1055/s-0038-1667077
Recent Developments in Clinical Terminologies — SNOMED CT, LOINC, and RxNorm
Publication History
Publication Date:
29 August 2018 (online)
Summary
Objective: To discuss recent developments in clinical terminologies. SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) is the world's largest clinical terminology, developed by an international consortium. LOINC (Logical Observation Identifiers, Names, and Codes) is an international terminology widely used for clinical and laboratory observations. RxNorm is the standard drug terminology in the U.S.
Methods and results: We present a brief review of the history, current state, and future development of SNOMED CT, LOINC and RxNorm. We also analyze their similarities and differences, and outline areas for greater interoperability among them.
Conclusions: With different starting points, representation formalisms, funding sources, and evolutionary paths, SNOMED CT, LOINC, and RxNorm have evolved over the past few decades into three major clinical terminologies supporting key use cases in clinical practice. Despite their differences, partnerships have been created among their development teams to facilitate interoperability and minimize duplication of effort.
-
References
- 1 Bodenreider O. Biomedical ontologies in action: role in knowledge management, data integration and decision support. Yearb Med Inform 2008; 67-79
- 2 Cimino JJ, Zhu X. The practical impact of ontologies on biomedical informatics. Yearb Med Inform 2006; 124-35
- 3 Cornet R, Chute CG. Health concept and knowledge management: Twenty-five years of evolution. Yearb Med Inform 2016; S32-41
- 4 NHS Business Service Authority. Dictionary of medicines and devices (dm+d). 2018
- 5 Australian Digital Health Agency. Australian Medicines Terminology; 2018
- 6 Marcotte L, Seidman J, Trudel K, Berwick DM, Blumenthal D, Mostashari F. , et al. Achieving meaningful use of health information technology: a guide for physicians to the EHR incentive programs. Arch Intern Med 2012; 172 (09) 731-6
- 7 Hripcsak G, Duke JD, Shah NH, Reich CG, Huser V, Schuemie MJ. , et al. Observational Health Data Sciences and Informatics (OHDSI): Opportunities for Observational Researchers. Stud Health Technol Inform 2015; 216: 574-8
- 8 Dunham GS, Pacak MG, Pratt AW. Automatic indexing of pathology data. J Am Soc Inf Sci 1978; 29 (02) 81
- 9 Spackman KA, Campbell KE, Cote RA. SNOMED RT: a reference terminology for health care. Proc AMIA Annu Fall Symp 1997; 640-4
- 10 Wang AY, Barrett JW, Bentley T, Markwell D, Price C, Spackman KA. , et al. Mapping between SNOMED RT and Clinical terms version 3: a key component of the SNOMED CT development process. Proc AMIA Symp 2001; 741-5
- 11 Spackman KA, Dionne R, Mays E, Weis J. Role grouping as an extension to the description logic of Ontylog, motivated by concept modeling in SNOMED. Proc AMIA Symp 2002; 712-6
- 12 World Wide Web Consortium (W3C). OWL 2 Web Ontology Language Profiles (Second Edition); 2018
- 13 SNOMED International. Members 2018 [Available from: https://www.snomed.org/members/ ]
- 14 SNOMED International. SNOMED CT Expo; 2018
- 15 Schulz S, Rodrigues JM, Rector A, Chute CG. Interface Terminologies, Reference Terminologies and Aggregation Terminologies: A Strategy for Better Integration. Stud Health Technol Inform 2017; 245: 940-4
- 16 Health IT, Buzz Blog. EHR Certification Criteria for SNOMED CT will help doctors transition to ICD-10 2013 [Available from: https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/ehr-certification-criteria-snomed-ct-doctors-transition-icd10/ ]
- 17 NHS Business Service Authority. SNOMED CT 2018 [Available from: https://www.nhsbsa.nhs.uk/clinical-services/dental-snomed-ct ]
- 18 Lee D, de Keizer N, Lau F, Cornet R. Literature review of SNOMED CT use. J Am Med Inform Assoc 2014; 21 (e1): e11-9
- 19 SNOMED International. SNOMED in action; 2018
- 20 Orphanet. The portal for rare diseases and orphan drugs 2018 [Available from: https://www.orpha.net/ ]
- 21 Stanford Center for Biomedical Informatics Research. Protégé 2018 [Available from: https://protege.stanford.edu/ ]
- 22 Dentler K, Cornet R, ten Teije A, de Keizer N. Comparison of reasoners for large ontologies in the OWL 2 EL profile. Semantic Web 2011; 2 (02) 71-87
- 23 Piro R, Nenov Y, Motik B, Horrocks I, Hendler P, Kimberly S. , et al., editors. Semantic Technologies for Data Analysis in Health Care 2016. Cham: Springer International Publishing; 2016
- 24 SNOMED International. Consultation for SNOMED CT Description Logic Enhancements 2018 [Available from: https://www.nhsbsa.nhs.uk/clinical-services/dental-snomed-ct ]
- 25 McDonald CJ, Huff SM, Suico JG, Hill G, Leavelle D, Aller R. , et al. LOINC, a universal standard for identifying laboratory observations: a 5-year update. Clin Chem 2003; 49 (04) 624-33
- 26 Vreeman DJ, McDonald CJ. Automated mapping of local radiology terms to LOINC. AMIA Annu Symp Proc 2005; 769-73
- 27 Vreeman DJ, McDonald CJ, Huff SM. LOINC(R) - A Universal Catalog of Individual Clinical Observations and Uniform Representation of Enumerated Collections. Int J Funct Inform Personal Med 2010; 3 (04) 273-91
- 28 Frazier P, Rossi-Mori A, Dolin RH, Alschuler L, Huff SM. The creation of an ontology of clinical document names. Stud Health Technol Inform 2001; 84 (Pt 1): 94-8
- 29 Subramanian A, Westra B, Matney S, Wilson PS, Delaney CW, Huff S. , et al. Integrating the nursing management minimum data set into the logical observation identifier names and codes system. AMIA Annu Symp Proc 2008:1148
- 30 Regenstrief Institute. Regenstrief LOINC¯ Mapping Assistant (RELMA¯) and online search application 2018 [Available from: http://search.loinc.org ]
- 31 Vreeman DJ, Chiaravalloti MT, Hook J, McDonald CJ. Enabling international adoption of LOINC through translation. J Biomed Inform 2012; 45 (04) 667-73
- 32 Seerainer C, Sabutsch SW. eHealth Terminology Management in Austria. Stud Health Technol Inform 2016; 228: 426-30
- 33 Vreeman DJ. LOINC - An overview and background 2018 [Available from: https://danielvreeman.com/loinc-overview-background/ ]
- 34 Collins FS, Hudson KL, Briggs JP, Lauer MS. PCORnet: turning a dream into reality. J Am Med Inform Assoc 2014; 21 (04) 576-7
- 35 IVD Industry Connectivity Consortium. LIVD – Digital format for publication of LOINC to vendor IVD test results 2018 [Available from: http://ivdconnectivity.org/livd/ ]
- 36 Sperzel WD, Broverman CA, Kapusnik-Uner JE, Schlesinger JM. The need for a concept-based medication vocabulary as an enabling infrastructure in health informatics. Proc AMIA Symp 1998; 865-9
- 37 Bodenreider O. The Unified Medical Language System (UMLS): integrating biomedical terminology. Nucleic Acids Res 2004; 32 (Database issue): D267-70
- 38 National Library of Medicine. RxNorm technical documentation 2018 [Available from: https://www.nlm.nih.gov/research/umls/rxnorm/docs/index.html ]
- 39 National Library of Medicine. RxNav 2018 [Available from: https://rxnav.nlm.nih.gov/ ]
- 40 National Library of Medicine. RxNorm application programming interface (API) 2018 [Available from: https://rxnav.nlm.nih.gov/ ]
- 41 National Council for Prescription Drug Programs. SCRIPT standard for electronic prescribing 2018 [Available from: https://www.ncpdp.org/NCPDP/media/pdf/EprescribingFactSheet.pdf ]
- 42 Centers for Medicare & Medicaid Services. Formulary Guidance 2018 [Available from: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/RxContracting_FormularyGuidance.html ]
- 43 National Library of Medicine. Value Set Authority Center 2018 [Available from: https://vsac.nlm.nih.gov/ ]
- 44 Knowledge Base workgroup of the Observational Health Data Sciences and Informatics collaborative. Large-scale adverse effects related to treatment evidence standardization (LAERTES): an open scalable system for linking pharmacovigilance evidence sources with clinical data. J Biomed Semantics 2017; 8 (01) 11
- 45 Patient-Centered Clinical Research Network. PCORnet, the National Patient-Centered Clinical Research Network 2018 [Available from: http://www.pcornet.org/ ]
- 46 U.S. Food & Drug Administration. National Drug Code Directory 2018 [Available from: https://www.accessdata.fda.gov/scripts/cder/ndc/ ]
- 47 Observational Health Data Sciences and Informatics. RxNorm Extension - an OHDSI resource to represent international drugs 2018 [Available from: http://www.ohdsi.org/web/wiki/doku.php?id=documentation:international_drugs ]
- 48 National Library of Medicine. Drug Interaction API 2018 [Available from: https://rxnav.nlm.nih.gov/InteractionAPIs.html# ]
- 49 National Library of Medicine. RxClass 2018 [Available from: https://mor.nlm.nih.gov/RxClass/ ]
- 50 International Organization for Standardization]. Revised IDMP standards to improve description of medicinal products worldwide 2018 [Available from: https://www.iso.org/news/ref2234.html ]
- 51 Fast Healthcare Interoperability Resources. Resource Medication - Content 2018 [Available from: https://www.hl7.org/fhir/medication.html ]
- 52 Adamusiak T, Bodenreider O. Quality assurance in LOINC using Description Logic. AMIA Annu Symp Proc 2012; 2012: 1099-108
- 53 Object Management Group. About the Common Terminology Services 2 Specification version 1.2 2018 [Available from: https://www.omg.org/spec/CTS2/ ]
- 54 Health Level 7. FHIR - Terminology module 2018 [Available from: https://www.hl7.org/fhir/terminology-module.html ]
- 55 National Library of Medicine. FHIR¯ Terminology Service for VSAC Resources 2018 [Available from: https://cts.nlm.nih.gov/fhir/ ]
- 56 SOLOR. SOLOR 2018 [Available from: http://solor.io ]