College of Nursing, Seoul National University, Seoul, South Korea.
Stud Health Technol Inform. 2022 Jun 6;290:101-105. doi: 10.3233/SHTI220040.
South Korea has a public and single-payer system for healthcare services based on fee-for-service payments. The National Health Insurance (NHI) reimbursement claim codes are used by all healthcare providers for reimbursement. This study mapped NHI reimbursement claim codes for therapeutic and surgical procedures to the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to facilitate semantic interoperability and data reuse for research. The Source codes for mapping were 2,500 reimbursement claim codes for therapeutic and surgical procedures such as surgery, endoscopic procedures, and interventional radiology. The target terminology for mapping was the 'Procedure' hierarchy of the international edition of SNOMED-CT released in July 2019. We translated Korean terms into English, clarified their meaning, extracted characteristics of the source codes, and mapped them to pre-coordinated concepts. If a source concept was not mapped to a pre-coordinated concept, we mapped it to a post-coordinated expression. The mapping results were validated internally using dual independent mapping and group discussion by trained terminologists, and by two physicians with experience of SNOMED-CT mapping. Out of 2,500 source codes, 1,298 (51.9%) codes were mapped to pre-coordinated concepts, and 1,202 (48.1%) codes were mapped to post-coordinated expressions. The mapping of the NHI reimbursement claim codes for therapeutic and surgical procedures to SNOMED-CT is expected to support clinical research by facilitating the utilization of health insurance claim data.
韩国的医疗保健服务采用基于按服务项目付费的公共单一支付者体系。所有医疗服务提供者都使用国家健康保险（NHI）报销索赔代码进行报销。本研究将治疗和手术程序的 NHI 报销索赔代码映射到医学术语系统命名法（SNOMED-CT），以促进语义互操作性和研究的数据重用。映射的源代码是 2500 个治疗和手术程序的报销索赔代码，如手术、内镜程序和介入放射学。映射的目标术语是 2019 年 7 月发布的 SNOMED-CT 国际版的“Procedure”层次结构。我们将韩语术语翻译成英语，阐明其含义，提取源代码的特征，并将其映射到预先协调的概念。如果源概念未映射到预先协调的概念，则将其映射到后协调表达式。通过由经过培训的术语学家进行的双重独立映射和小组讨论以及具有 SNOMED-CT 映射经验的两名医生对映射结果进行内部验证。在 2500 个源代码中，有 1298 个（51.9%）代码被映射到预先协调的概念，有 1202 个（48.1%）代码被映射到后协调的表达式。将治疗和手术程序的 NHI 报销索赔代码映射到 SNOMED-CT，有望通过促进健康保险索赔数据的利用来支持临床研究。
