One glaring issue related to vocabulary needs is that there are no computer systems currently available in the world that have the ability to integrate vocabulary, classifications, and language from the point of service to network to universal levels. Integrated medical centers and managed care industries are beginning to demonstrate that health care vocabularies can be merged through transcriptionists, scanners, and object-oriented open systems using Internet technology, although given the potential of computer systems, this manner of merging vocabulary is time-consuming and fragmented.

The use of information technology requires uniform, accurate, and automated patient care data to conduct analyses to improve the quality of care. While there are certainly confidentiality and other ethical concerns that are beyond the scope of this paper, these analyses nevertheless would facilitate the assessment of effectiveness and cost-effectiveness of care. The former Center for Information Technology (CIT) within the Agency for Health Care Policy and Research (AHCPR), has funded cooperative agreements with the NLM to examine applications of the Electronic Medical Record, and research on Computerized Decision Support Systems for Health Providers, both of which have stressed the need for developing, refining, and implementing the use of structured vocabulary.

AHCPR has participated in developing vocabulary standards and tools for improving research and policy utilization of content stored in the computer-based patient record. Between 1994 and 1997, the AHCPR and the NLM funded the only horizontal and vertical systems study to strengthen electronic medical record systems, by developing, updating, and maintaining terminology models. This collaborative study took place within the Mayo Foundation (led by Dr. Christopher Chute) and Kaiser Permanente (led by Dr. Simon Cohn). The study measured the relative merits of terminology additions and changes as they affect clinical practice guideline development and patient data retrieval (Chute, et al, 1996). This study also evaluated the impact of terminology variations on physician practice and satisfaction.

The development of an electronic toolkit for transmitting and linking laboratory data was also supported by AHCPR research funds. Under the direction of Dr. Clem McDonald, principal investigator, this study developed naming conventions and assigned a fully specified unique name and code for laboratory results reporting, and many clinical measurements (AHCPR, 1996). The system developed, Logical Observations Identifiers, Names and Codes system (LOINC), is available online to the public at: http://www.mcis.duke.edu/standards/termcode/loinclab/loinc.html.

Finally, AHCPR collaborated with the NLM in a large-scale vocabulary test of the use of controlled vocabularies in health care applications (Humphreys, 1996). This study analyzed the combination of vocabularies currently in the UMLS to determine the extent to which existing vocabularies serve as an accurate source of vocabulary for health data systems and their clinical applications.