Highlights of Moving Toward International Standards in Primary Care Informatics: Clinical Vocabulary
The Agency for Health Care Policy and Research (AHCPR) and the American Medical Informatics Association (AMIA) cosponsored an international conference on November 1-2, 1995, in New Orleans, Louisiana. This conference is the beginning of a process to move toward international standards in the clinical vocabulary used in primary care. One of AHCPR's requirements in the collection of health services research data is reliance on documentation provided by primary care practitioners. Without data standards and vocabulary, researchers will not be able to capture the content of primary care practice. With increasing utilization of medical informatics and the medical record, the need for standard vocabularies becomes even greater.
A framework of vocabularies was successfully developed during the conference. The participants reached consensus on three vocabularies—the International Classification of Primary Care (ICPC), the Read Codes, and the Systematized Nomenclature of Human and Veterinary Medicine (SNOMED)—as the necessary building blocks of a primary care clinical standard. The attendees recognized that no existing vocabulary is currently sufficient for the many needs of primary care, health statistics, billing, and health services research. In addition, the group recommended that all primary care vocabularies be added to the National Library of Medicine's Unified Medical Language System (UMLS).
The participants developed an excellent framework to further the process of development, testing, dissemination, international collaboration, and utilization of primary care vocabularies. They also developed a plan to integrate primary care clinical vocabularies into other ongoing government and private efforts. In this conference summary report, the strengths and weaknesses of the current primary care vocabularies are identified, and targets are set for future research.
The Center for Information Technology and the Center for Primary Care Research within AHCPR were pleased to facilitate this international meeting of primary care specialists to begin the process of identifying vocabulary standards. Standards are important to our Agency mission of collecting health and cost data in large databases, for achieving our primary care research agenda, for supporting a national information infrastructure, for developing decision support systems using the electronic medical record, for evaluating telemedicine applications, and for promoting their use in private sector organizations and government agencies.
By examining the vocabulary standards available, this group effectively critiqued current standards and developed a framework for needed future products. These future products include a glossary of terms in primary care informatics, a minimum data set of elements for an ambulatory medical record, and a methodology and process for adding to, deleting from, and maintaining a primary care vocabulary. The conference was unique because it included multidisciplinary international health care professionals who could specify the need for a clinical primary care vocabulary.
This is the beginning of a series of conferences to convene international experts in primary care for developing their own agenda for the informatics infrastructure of the next century. It is through public-private partnerships such as this that progress toward the research and dissemination of standards necessary to advance health services care, delivery, and research can be achieved. We wish to recognize the important work of Kathleen A. McCormick, Ph.D., R.N., in coordinating this partnership, and Maggie Rutherford in preparing this document for publication and dissemination.
J. Michael Fitzmaurice, Ph.D.
Center for Information Technology
Carolyn Clancy, M.D.
Center for Primary Care Research