One of the most powerful roles played by the federal government in the U.S. health care sector is that of regulator, and the government has historically used this role to address quality and patient safety concerns. Regulatory requirements (e.g., Medicare conditions of participation) generally focus on institutional providers, clinicians, and health plans that seek to receive payment from or deliver care under an identified program; however, these responsibilities can also be exercised by state governments that administer the programs. Therefore, once CHI and NCVHS have identified national data standards, those standards should be incorporated into the contractual and regulatory requirements of the major federal government health care programs, including those operated or sponsored by DHHS, VHA, and the Department of Defense. Broad stakeholder input into the data standards selection process should facilitate such incorporation, which will aid in rapid adoption of the identified data standards nationwide.

NLM also will need to assume new responsibilities for ensuring the establishment of national data standards for patient safety. As noted earlier in this chapter, NLM has worked to develop standardized mappings from one terminology to another through the UMLS and is therefore ideally positioned to become the primary oversight body for maintenance of the core terminology group to be established by CHI and associated patient safety data standards. The committee also recommends that NLM be designated as the responsible entity for the distribution of all national clinical terminologies related to patient safety and for assuring the quality of terminology mappings. NLM should work closely with the terminology developers to establish a more formalized development process and serve as a primary information source for CHI–NCVHS regarding available terminologies and areas in which terminologies are still needed.

Overarching Coordination

In addition to the need to strengthen the partnership and leadership of CHI, NCVHS, and NLM, the committee believes that AHRQ is an agency positioned to provide overarching coordination among all public- and private-sector organizations involved in the development, implementation, and dissemination of data standards, evidence-based guidelines, and patient safety and quality improvement programs. AHRQ is already the chief agency leading efforts in two of the three areas—evidence-based guidelines and patient safety and quality improvement programs—and as such has well-established core competencies in these areas, public–private networks, and relationships with the provider community that are critical to the suc-

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