aggregation and dissemination of existing and future health care data mandate the development of standards, both to exchange health care data and to encourage more consistent medical vocabulary, especially in those portions of the CPR containing natural language text. Developing such standards requires a coordinated approach.

Efforts to develop data-exchange standards for components of the CPR have only recently gained significant momentum in the United States. Because so much is at stake in this sizable medical market—a market that remains largely untapped from the vendors' point of view—standards take on an even more prominent role in fostering the evolution of the required technologies. Currently, there are several related efforts to standardize and facilitate the exchange of health data. HL 7 and Medix, as well as standards from the American Society for Testing and Materials (ASTM), the American College of Radiologists/National Electrical Manufacturers Association (ACR/NEMA), and others are representative of the current movement to formulate data-exchange standards.4

Several promising vocabulary developments are relevant to CPR systems. These include a planned new edition of the Systematized Nomenclature of Medicine (SNOMED); the Read Clinical Classification in Great Britain; the ASTM Standard Guide for Nosologic Standards and Guides for Construction of New Biomedical Nomenclature, which is now completed and ready for distribution (ASTM, 1989); and the NLM's UMLS project. The overall goal of UMLS is to help users retrieve relevant biomedical


HL 7 is a specification for a health data interchange standard designed to facilitate the transfer of health data resident on different and disparate computer systems in a health care setting. For example, HL 7 facilitates the transfer of laboratory results, pharmacy data, and other information for a patient to a central hospital system without concern for whether such systems are supplied by the same vendor or manufacturer. HL 7 is not, however, designed to support the transfer of the entire patient record. For example, it does not address the transfer of image data (such as those from a PACS).

The Institute of Electronic and Electrical Engineers (IEEE) has begun to develop Medix, a comprehensive health data-exchange standard. It is the only standard for which its developers have stated an objective of eventually supporting transfer of the entire patient record, although it is not yet mature enough to do so routinely in a health care setting. Medix is also the only health care data standard that has declared an intention to support the International Standards Organization's (ISO) Open Systems Interconnect (OSI) model.

ASTM has sponsored committees (e.g., E 31.12 and E 31.14) on computerized systems that are dedicated to standards directly related to the transfer of clinical data, such as those found in the patient record. Among other topics, these ASTM standards committees have focused on naming conventions and have proposed data element names for clinical data found in the patient record. They have also addressed specifications for transferring clinical laboratory data messages between independent computer systems.

ACR/NEMA have joined together to establish a functioning standard designed to transfer images between disparate computer systems (especially different PACSs).

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