vendors for specific system implementations; or broad international terminologies (e.g., the International Classification of Diseases [ICD]) that are often modified at the local level. Thus, one laboratory system has not been able to communicate with another without great difficulty. This “custom” approach incurs high costs and inhibits efforts to reuse clinical data to understand and prevent patient safety events. For computer interoperability, data must be recorded in a terminology that is recognized and understood by the receiving computer; local terms are not interoperable. Adoption of a set of core terminologies for use in clinical information systems will accomplish this task, and such terminologies are in the process of being selected through public–private partnerships. Vendor compliance with the standards will ensure the interoperability of products for buyers, users, and regulators. Box 3-2 and the following subsections provide a brief overview of the processes used by these organizations to develop their terminology data standards.

International Organizations

Some international organizations (i.e., World Health Organization [WHO] for ICD codes and International Classification of Functioning, Disability and Health [ICF], and the World Organization of National Colleges, Academies and Academic General Practice and Family Physicians for the International Classification of Primary Care [ICPC]) engage in terminology development through a relatively formalized consensus process that requires approval by a governing oversight or steering committee (Institute of Electrical and Electronics Engineers, 2001; World Health Organization, 1999). For WHO terminologies, submissions for changes are accepted by the heads of the WHO collaborating centers established around the world. If accepted by the WHO regional office, they are then circulated to the other centers no later than 6 months in advance of the official WHO annual meeting, where they may receive final approval upon consensus of the group.

Federal Government

Development of clinical modifications for the ICD codes is accomplished through the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC) using an open and formal process that accepts suggestions by the public and private sectors and is managed by the Coordination and Maintenance Committee. Proposals for a new code must include a description of the code, why it is needed, and supporting



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