Inter-terminology mapping of nursing problems

Area of Science:

• Nursing Informatics
• Health Terminology Standards
• Clinical Data Management

Background:

• The International Classification for Nursing Practice (ICNP®) and Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) are crucial for standardizing nursing data.
• Harmonizing these terminologies is essential for seamless data exchange and improved patient care.
• Previous mapping efforts have highlighted the need for a comprehensive analysis of their overlap and differences.

Purpose of the Study:

• To quantify the degree of overlap between ICNP® and SNOMED-CT, focusing on nursing problems.
• To assess the feasibility of harmonizing content between these two major terminologies.
• To identify specific areas of divergence and convergence for future integration strategies.

Main Methods:

• A two-subset approach was used for mapping ICNP® diagnosis/outcome concepts to SNOMED-CT.
• The first subset (n=238) utilized semi-automated mapping via the Unified Medical Language System (UMLS) with expert review.
• The second subset (n=565) involved manual mapping by two independent reviewers, with differences resolved through discussion and inter-rater reliability calculated using Cohen's Kappa (κ).

Main Results:

• Semi-automated mapping showed a high agreement (91.6%) between ICNP® and SNOMED-CT, with good reviewer agreement (κ=0.7).
• Manual mapping revealed that a significant portion of ICNP® concepts (61.4%) could not be mapped to SNOMED-CT, with moderate reviewer agreement (κ=0.45).
• Difficulties in mapping were attributed to content coverage differences, lexical variations, and semantic ambiguities within both terminologies.

Conclusions:

• A notable degree of overlap exists between ICNP® and SNOMED-CT, particularly for established ICNP® content.
• Significant differences in content coverage were identified, necessitating further development in both terminologies.
• Enhancing SNOMED-CT content and exploring harmonization mechanisms are crucial next steps for integrating nursing terminologies.