This paper describes a one-year pilot implementation of SNOMED CT in a Canadian palliative care setting. There were three phases: The design phase involved the creation of a palliative SNOMED CT subset, a real-time encoding system and relevant evaluation metrics. The trial phase had clinicians use the system to create SNOMED-encoded consult letters. The evaluation phase involved clinician interviews, case analysis and system review to identify usage, issues, lessons and implications. The initial palliative SNOMED CT subset had 1,939 terms covering most palliative diagnoses and problems at referral. Six clinicians used the system for ten weeks to create 164 SNOMED-encoded consult letters, which were perceived as more legible, professional looking and shareable. When compared with 20 manually prepared consult letters, the SNOMED-encoded letters had a similar number of clinical terms but a higher degree of consistency with a smaller range of terms selected. All clinicians felt the system "was the way to go."

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