Clinical terminologies. The federal government should move expeditiously to identify a core set of well-integrated, nonredundant clinical terminologies for clinical care, quality improvement, and patient safety reporting. Revisions, extensions, and additions to the codes should be compatible with, yet go beyond, the federal government’s initiative to integrate all federal reporting systems.

• AHRQ should undertake a study of the core terminologies, supplemental terminologies, and standards mandated by the Health Insurance Portability and Accountability Act to identify areas of overlap and gaps in the terminologies to address patient safety data requirements. The study should begin by convening domain experts to develop a process for ensuring comprehensive coverage of the terminologies for the 20 IOM priority areas.

• The National Library of Medicine should provide support for the accelerated completion of RxNORM² for clinical drugs. The National Library of Medicine also should develop high-quality mappings among the core terminologies and supplemental terminologies identified by the CHI and NCVHS.

Knowledge representation. The federal government should provide support for the accelerated development of knowledge representation standards to facilitate effective use of decision support in clinical information systems.

• The National Library of Medicine should provide support for the development of standards for evidence-based knowledge representation.

• AHRQ, in collaboration with the National Institutes of Health, the Food and Drug Administration, and other agencies, should provide support for the development of a generic guideline representation model for use in representing clinical guidelines in a computer-executable format that can be employed in decision support tools.