of a single standard for chemical names, ingredient listings, and dosage sizes associated with NDCs, resulting in variation from one organization to another.

Professional Associations and Academic Institutions

Many terminologies in use are developed by professional associations and academic institutions. The processes for terminology development vary, generally depending on the size of the organization and the purpose of the standard. Organizations such as the College of American Pathologists (which produces the Systemized Nomenclature of Human and Veterinary Medicine [SNOMED]) and the American Medical Association (which produces Current Procedural Terminology [CPT]) have relatively formal sets of processes for developing and refining terminology concepts that rely on an editorial board for final approval. SNOMED technical subgroups evaluate and model terminology and then advise the editorial board regarding scope of coverage, creation of hierarchies, semantic definitions, and scientific accuracy (SNOMED International, 2000). Because CPT codes are used for reimbursement, new codes are not based on technical criteria but on the need to code new medical procedures. These updates are incorporated quarterly once approved by the American Medical Association editorial board. Processes used by other terminology development organizations, such as nursing groups, are very informal, with general group approval occurring annually.

Standards Development Organizations and Other Private Entities

IEEE has a highly formal approach to developing standards based on due process, openness, consensus, balance, and right of appeal. The membership of working groups is defined. Three-quarters of the members of a group must vote on ballots of official documents, and of those who vote, three-quarters must support the document for it to be accepted.

The HL7 process for obtaining consensus on terminologies is not as formal as that for data interchange standards since HL7 is not actually a terminology developer per se but maps registered terminologies for encoding in its messaging formats. Participants in the HL7 terminology special interest group agree to the additions, mappings, and technical specifications. However, sign-off by the HL7 steering committee is still required.

Private companies developing terminologies, such as Medicomp, create new terms at will without a formal or open process and as required by cli-



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