The advancement of computer technologies has opened up a world of opportunities for nursing and health care. While computer or electronic servers cannot, by virtue of their construction and purpose, be used to aggregate vocabulary to higher and higher levels of abstraction, or from the point of care (interface), to network (reference), to universal (administrative) levels, they can be used, however, to store content created and retrieved by any number of access methods. These access methods involve the use of additional technologies known as chunkers, matchers, mappers, and routers, and are similar to UMLS mechanisms described earlier. For example, information entered manually or into the electronic patient record is sent (virtually) to a router, where information is tagged or categorized, and text and/or objects are channeled to either a chunker or mapper.

For example, information entered into the record for a patient who presents with vague, nonspecific symptoms would likely be routed to a chunker. The chunker electronically extracts units of information, such as terms and concepts, from computerized text. The chunker then sends information to a matcher, which collapses words and nominal phrases into lexical and semantic classes. On the other hand, more specific patient information is sent from the router to a mapper, which further specifies information by referencing routed terms with any and all possibly related terms; these related terms alert the clinician to information that should be considered in clinical decision-making. Finally, information from the matcher or mapper is channeled to the server, which houses information within a database for analysis and evaluation purposes (Tuttle, 1998).

Together servers, chunkers, matchers, mappers and routers can be used to

1. link nursing literature with a data repository of nursing information extracted, for example, from an academic medical center, a nursing home, and a community care clinic;
2. integrate into NIC, NOC, NANDA, Omaha, and/or the Home Health Classification system; and
3. include all CINAHL terms, and the Metathesaurus of UMLS to form a nursing knowledge server in the U.S.

The Internet provides additional technological capabilities. Through the Internet, vocabularies and classifications from different health care organizations, institutions, or systems are being merged in different ways to create data repositories that provide the basis for measuring cost, quality, patient access to care, and outcomes of care. These new repositories incorporate servers containing various data elements which allow the convergence of data from a variety of sources. Techniques such as data mining and Knowledge Data Discovery (KDD) might be used to determine, with knowledge robots, intelligent clients, or administrative agents, where data and vocabulary similarities and discrepancies exist (Fayyad, U, et al, 1996). The use of KDD versus natural language processors or text readers is yet undetermined.

Extensible Markup Language (XML) is being used as an integrator of terms at the point of data convergence. XML is an extremely simple dialect of the Standard Generalized Markup Language (SGML), as is Hypertext Markup Language (HTML), all of which are languages of the Internet (http://www.w3.org/XML/). XML is intended for large-scale Web applications, vendor-neutral data exchange, and processing of Web documents by intelligent clients. The XML documents are made up of storage units called entities, which can contain either parsed or unparsed data. Parsed data is made up of characters, some of which form the character data in the document, and some of which form markup. Markup encodes a description of the document's storage layout and logical structure.

The use of these technologies is leading to quicker convergence of knowledge sources and the identification of terms used in one vocabulary, yet missing from another. The potential of these technologies is to create a feedback loop so that data extracted from computer-based records can be used to identify new terms when, for example, a nurse uses a term that has not been previously used but should be added to the vocabulary or classification scheme.

Object-oriented technology is also advancing the way that vocabularies and classifications are converging from different sources. At the Internet level, XML and HTML are being fit into a Document Object Model (DOM) (http://www.w3.org/DOM/). The DOM is a platform- and language-neutral interface what allows programs and scripts to dynamically access and update content, structure and style of all documents. The DOM provides a set of objects for representing HTML and XML documents, a standard model of how these objects can be combined, and a standard interface for accessing and manipulating them. Vendors can support the DOM as an interface with their proprietary data structures, thus increasing interoperability on the Web.

Collectively, XML and the Object Models render content on the Web a meta-data syntax that fits easily within the framework of the World Wide Web. XML has provided a mechanism for defining and documenting object classes. XML can be used for describing terms that are strictly syntactic, or those which indicate concepts and relations among concepts with relational databases. Therefore, all vocabularies and classifications used at the point of care can be converged within networks, and converged yet again at the universal level. The universal level of taxonomy can be a convergence of many into a unicode or single taxonomy or remain several taxonomies that are linked but not assembled at the global level.

For nursing, the simple solution is to have a single unicode taxonomy at the universal level. While it can be argued that the taxonomy may differ across countries, if convergence at a universal or global level of nursing is desired, different languages must be converged and translated into a single taxonomy. Several nursing taxonomies have already been translated into multiple languages. Through the years, they have served as the unifying concept of the nursing profession, and the use of these taxonomies across numerous countries testifies to their ability to capture nursing information for application in several countries. The International Council of Nursing may represent the logical avenue through which to begin examining these taxonomies and to develop an open universal taxonomy for nursing.