Call for a Standard Clinical Vocabulary

The medical informatics community—vendors and users—have been seeking a common, comprehensive clinical vocabulary for the past decade. New models for health care and new reporting requirements increase the necessity and desirability of such a vocabulary set. Much of the negotiation time between systems interested in exchanging data is related to matching vocabulary and code sets. Unfortunately, that is only the beginning and on-going work is required to keep the vocabulary sets synchronized. At the same time, increased emphases on decision support, clinical guidelines, integrated delivery systems, and data reporting for performance evaluation require more precise and understandable vocabulary terms. Much work has been done on creating controlled vocabularies. There are more than 100 vocabulary sets defined internationally for some purpose. In this country, institutions are forced to deal with at least 5–10 of these sets to meet reporting or reimbursement requirements. The two vocabulary-related papers published in this issue of the journal1,2 highlight problems in trying to use existing controlled-vocabulary sets or even combinations of sets in representing clinical data. Both papers make it clear that existing controlled-vocabularies are unable to meet the requirements for clinical data representation. There are many reasons that existing controlled vocabularies do not …