Evaluation of the VA/KP problem list subset of SNOMED as a clinical terminology for electronic prescription clinical decision support.

A standardized terminology for medical indications is essential for building e-prescription applications with decision support. The FDA has adopted the Veteran Administration and Kaiser Permanente (VA/KP) Problem List Subset of SNOMED as the terminology to represent indications in electronic labels. In this paper, we evaluate the ability of this subset to represent the text phrases extracted from a medication decision support system and the indications section of existing drug labels. We compiled a test set of 1265 distinct indication phrases and mapped them to (1) UMLS, (2) Entire SNOMED, (3) All Precoordinated concepts from the "Clinical Finding" hierarchy of SNOMED, and (4) VA/KP Subset. 95% of the phrases mapped to concepts in UMLS, 90.3% to SNOMED, 79.5% to SNOMED Precordinated and 71.1% mapped completely or partially to concepts in the VA/KP subset. Our study suggests that the VA/KP Subset has significant limitations for coding drug indications; however, when focusing on indications as medical conditions only, the coverage seems more adequate.