An exploration of the properties of the CORE problem list subset and how it facilitates the implementation of SNOMED CT

J Am Med Inform Assoc. 2015 May;22(3):649-58. doi: 10.1093/jamia/ocu022. Epub 2015 Feb 26.


Objective: Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) is the emergent international health terminology standard for encoding clinical information in electronic health records. The CORE Problem List Subset was created to facilitate the terminology's implementation. This study evaluates the CORE Subset's coverage and examines its growth pattern as source datasets are being incorporated.

Methods: Coverage of frequently used terms and the corresponding usage of the covered terms were assessed by "leave-one-out" analysis of the eight datasets constituting the current CORE Subset. The growth pattern was studied using a retrospective experiment, growing the Subset one dataset at a time and examining the relationship between the size of the starting subset and the coverage of frequently used terms in the incoming dataset. Linear regression was used to model that relationship.

Results: On average, the CORE Subset covered 80.3% of the frequently used terms of the left-out dataset, and the covered terms accounted for 83.7% of term usage. There was a significant positive correlation between the CORE Subset's size and the coverage of the frequently used terms in an incoming dataset. This implies that the CORE Subset will grow at a progressively slower pace as it gets bigger.

Conclusion: The CORE Problem List Subset is a useful resource for the implementation of Systematized Nomenclature of Medicine Clinical Terms in electronic health records. It offers good coverage of frequently used terms, which account for a high proportion of term usage. If future datasets are incorporated into the CORE Subset, it is likely that its size will remain small and manageable.

Keywords: SNOMED Clinical Terms; controlled medical terminology; electronic health record; medical vocabulary; problem list; problem-oriented medical record.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Intramural

MeSH terms

  • Clinical Coding / methods*
  • Disease / classification*
  • Electronic Health Records*
  • Humans
  • International Classification of Diseases*
  • Medical Records, Problem-Oriented
  • Systematized Nomenclature of Medicine*