title: Rigor in electronic health record knowledge representation: Lessons learned from a SNOMED CT clinical content encoding exercise.
abstract: Rigor in clinical knowledge representation is necessary foundation for meaningful interoperability, exchange and reuse of electronic health record (EHR) data. It is critical for clinicians to understand principles and implications of using clinical standards for knowledge representation within EHRs.
  
  
  OBJECTIVE
  To educate clinicians and students about knowledge representation and to evaluate their success of applying the manual lookups method for assigning Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) concept identifiers using formally mapped concepts from the Omaha System interface terminology.
  
  
  METHODS
  Clinicians who were students in a doctoral nursing program conducted 21 lookups for Omaha System terms in publicly available SNOMED CT browsers. Lookups were deemed successful if results matched exactly with the corresponding code from the January 2013 SNOMED CT-Omaha System terminology cross-map.
  
  
  RESULTS
  Of the 21 manual lookups attempted, 12 (57.1%) were successful. Errors were due to semantic gaps differences in granularity and synonymy or partial term matching.
  
  
  CONCLUSIONS
  Achieving rigor in clinical knowledge representation across settings, vendors and health systems is a globally recognized challenge. Cross-maps have potential to improve rigor in SNOMED CT encoding of clinical data. Further research is needed to evaluate outcomes of using of terminology cross-maps to encode clinical terms with SNOMED CT concept identifiers based on interface terminologies.
authors.affiliation: a School of Nursing, University of Minnesota , Minneapolis , MN , USA .
authors.forename: Karen A
authors.initials: KA
authors.lastname: Monsen
authors.affiliation: a School of Nursing, University of Minnesota , Minneapolis , MN , USA .
authors.forename: Robert S
authors.initials: RS
authors.lastname: Finn
authors.affiliation: b Gillette Children's Specialty Healthcare , St. Paul , Minneapolis , MN , USA , and.
authors.forename: Thea E
authors.initials: TE
authors.lastname: Fleming
authors.affiliation: a School of Nursing, University of Minnesota , Minneapolis , MN , USA .
authors.forename: Erin J
authors.initials: EJ
authors.lastname: Garner
authors.affiliation: a School of Nursing, University of Minnesota , Minneapolis , MN , USA .
authors.forename: Amy J
authors.initials: AJ
authors.lastname: LaValla
authors.affiliation: c Consultant , Riverside , CA , USA.
authors.forename: Judith G
authors.initials: JG
authors.lastname: Riemer
mesh_terms: D059019:Clinical Coding / Q000592:standards*; D057286:Electronic Health Records; D006801:Humans; D013338:Students, Nursing; D039061:Systematized Nomenclature of Medicine; D014584:User-Computer Interface
keywords: Education; Omaha System; SNOMED CT; informatics; interoperability; knowledge representation; terminologies