Design Guidelines for Clinical Coding

Healthcare Human Factors


The interoperability between electronic medical record (EMR) systems is crucial to ensure that health care providers have shared access to complete and accurate health information. Although reference terminologies, including the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) have been advocated, designing user interfaces such that they allow primary health care providers to enter coded data at the point of care in a seamless and intuitive manner has been a tremendous challenge. Canada Health Infoway engaged Healthcare Human Factors to develop design guidelines to address this gap.

The team conducted an environmental scan to understand previous efforts, both nationally and internationally. The scan consisted of four phases:

  1. Literature review
  2. Assessment and gap analysis of existing guidelines, in particular the Common User Interface (CUI) Guidelines that pertain to SNOMED CT
  3. Interviews with eHealth researchers, implementers, and innovators
  4. Heuristic review of existing coding implementations

A number of themes arose from the environmental scan concerning emerging trends, best practices, and challenges. For example, one leading best practice was implementing single concept searching with contextual limitation, progressive matching, and elaboration. Findings from the environmental scan were used to develop design guidelines for EMR user interfaces, surrounding context and display, structured forms, concept searches, elaboration, and free-text entry.


Both the environmental scan findings and the design guidelines have been published in Canada Health Infoway’s InfoCentral. The guidelines will be available to vendor communities, developers, and implementers. Although an initial set of guidelines has been created, the integration of updates and feedback into the guidelines is encouraged as systems progress and evolve.