1 Introduction

The International Classification of Nursing Practice (ICNP) to SNOMED CT International Release Nursing Interventions equivalency table is a product of an ongoing programme of work carried out under a pre-existing collaboration agreement between the International Council of Nurses (ICN) and the International Health Terminology Standards Organisation (IHTSDO). The work commenced in 2015 and the first joint release of the equivalency table took place in April 2016.

2 Background

The overarching aim of the collaboration agreement, first established in 2010 and updated in September 2014, was to advance terminology harmonisation and foster interoperability in health information systems. Joint work would build on previous efforts, culminating in joint publication of: 

a) An equivalence table between the International Classification for Nursing Practice (ICNP®) and SNOMED Clinical Terms (SNOMED CT®) for nursing diagnoses 

b) An equivalence table between ICNP and SNOMED CT for nursing interventions. 

The initial effort centred on nursing diagnoses, specifically problems. The focus of this release document is on the identification of SNOMED CT equivalencies for ICNP nursing interventions.

3 Motivation

ICNP, a product of the ICN, is a terminology that enables nurses to describe and report their practice in a systematic way. The resulting information is used to support care and effective decision-making, and to inform nursing education and health policy. 

SNOMED CT is the most comprehensive and precise clinical health terminology product in the world, owned and distributed around the world by The International Health Terminology Standards Development Organisation (IHTSDO). 
The equivalency table is intended for use by nurses, and other interested professional groups. Robust systems and processes within ICN and IHTSDO assure the integrity of both terminologies. 

As ICNP is intended for use by and for nurses, ICN has been able to focus attention on the development of ICNP specifically for nursing practice. This has resulted in a rich and comprehensive resource that nurses can use to describe and report in detail the things that they assess (diagnoses e.g. nausea) and the things that they do (interventions e.g. counseling). The potential benefits of a consistent approach to capturing nursing data are far-reaching. However, nurses do not practice in isolation; they practice alongside many other disciplines. One of the potential risks of a specific nursing-focus is that nursing will be somehow disconnected from a larger health information landscape. 

The table of equivalence provides a vehicle for transforming ICNP-encoded data into SNOMED CT (e.g. an ICNP concept in a local system can be transformed via the table to the equivalent SNOMED CT concept for use in a multidisciplinary record). By providing a robust pathway from ICNP to SNOMED CT, the table of equivalence helps to ensure that users of ICNP can continue to use their preferred terminology while remaining a central part of the bigger picture and wider implementation of SNOMED CT globally.

4 Design

Decisions concerning source concepts, target concepts and validity of equivalencies were made by consensus of all parties (ICN, IHTSDO and the IHTSDO Nursing Special Interest Group (SIG)). In addition, the Nursing Derivatives Editorial Group provides international validation of the content included in the equivalence table prior to publication.

4.1 Versions

The version of ICNP used is the May 2017 release. The version of SNOMED CT used is the January 2018 International Release.

4.2 Source

The source is a subset of 1063 ICNP interventional concepts.

4.3 Target

All target concepts are drawn from SNOMED CT Procedures. 

4.4 Direction

The direction is from the ICNP classification to SNOMED CT International Release procedures in line with the stated use case in section 3.

4.5 Cardinality

The cardinality for all equivalents in the table is one-to-one.

5 Content

The ICNP to SNOMED CT nursing interventions equivalency table covers just one semantic type – nursing interventions – with equivalent ICNP and SNOMED CT concepts for each intervention. The table comprises 992 equivalents, representing a subset of ICNP and a subset of SNOMED CT – equivalents have not been identified for all ICNP interventions, or for all SNOMED CT Procedures. 

5.1 Changes for the January 2018 release

As a result of inactivation of the SNOMED CT code as duplicate, the following member has been removed from the equivalency table as ICN did not consider the replacement to be a match for their code:

6 Obtaining the equivalency table

The equivalency table was released in April 2016 as a full release and is subsequently being maintained according to the release schedules of ICNP and SNOMED CT. 
Access within IHTSDO member countries is provided by the Member National Release Centre in each country, via the relevant Member web page. Affiliates of IHTSDO in non-member countries can access the table in IHTSDO Release Format 2 (RF2) through their MLDS (Member Licensing & Distribution Service) account https://mlds.ihtsdotools.org. Please contact info@ihtsdo.org for more information if required. 

The equivalency table is available for download in human readable format from the ICNP website:
http://www.icn.ch/what-we-do/icnp-download/

Users of the table should comply with licensing arrangements for both ICN and SNOMED International.

7 Feedback

ICN and IHTSDO are keen to receive feedback on this product – from both a clinical content perspective and from an implementer's perspective. Feedback should be sent jointly to info@ihtsdo.org and aamherdt@uwm.edu. Feedback should include any issues relating to implementation, suggestions for future content inclusion or general comments regarding the equivalence table.

8 Technical Notes

RF2 package format

The RF2 package convention dictates that it contains all relevant files, regardless of whether or not there is content to be included in each particular release.  Therefore, the package contains a mixture of files which contain both header rows and content data, and also files that are intentionally left blank (including only a header record).  The reason that these files are not removed from the package is to draw a clear distinction between:

1. ...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in this or future releases, and 
2. ...files that just happen to contain no data in this particular release (and are therefore included in the package but left blank, with only a header record), but are still relevant to RF2, and could therefore potentially contain data in future releases.

This allows users to easily distinguish between files that have purposefully been removed or not, as otherwise if files in option 2 above were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.