an IDS, industry-adopted standards must be defined for interfaces between components (AMIA, 1994; Hammond, 1994).

Health systems must have a unique health identifier (UHI) to accurately and reliably link all the data on a single individual. Until last year, striving for a national UHI had been an elusive goal. Public Law 104-191 (The Insurance Portability and Accountability Act of 1996) calls for the secretary of Health and Human Services ''to adopt standards for unique health identifiers, confidentiality policies, and terminology." To build support for addressing these pivotal issues, in November 1996, CPRI convened a national Summit of over 80 senior executives representing health care providers, health systems, government agencies, information systems vendors, businesses, regulators, and quality assurance professionals. The organizations participating in the Summit developed consensus recommendations regarding a unique health identifier, confidentiality legislation and policies, and standard health terminology. CPRI was charged with follow-up actions to work with government agencies and industry groups to implement the recommendations.

The need for standards governing the content, vocabulary, and format of data remains a high priority. So far, most of the progress has been made in the development of messaging standards. Standards for data exchange have continued to be expanded and are increasingly being adopted by provider organizations and vendors. Standards now exist for exchanging clinical data (Health Level Seven [HL-7], 1994), images (ACR/NEMA), clinical observations (ASTM Committee E-31), bedside instrument data (IEEE, 1995), prescription data (NCPDP, 1992), and administrative data associated with claims (Accredited Standards Committee X12N). It is important to note, however, that even with standards that define message formats, implementation of messaging standards may differ among vendors. The next step is to call on industry to provide standard implementations for messaging standards such as HL-7. That would be a major step toward "plug-and-play" capability.

Although there has been progress in developing individual coding standards for data elements, none has emerged as a comprehensive standard. More than 150 different coding sets defining terms for use with the medical record have been created. Among these coding sets are ICD9-CM, ICD10, SNOMED III, CPT, NANDA, Read Classification, LOINC, and MEDRA, to name a few. Not only findings, but also results of laboratory tests must have standard terms (e.g., results of a Pap smear or mammogram). Additional coding sets are being defined by specialty groups that recognize the need for a common vocabulary. The NLM has expanded its UMLS to map many of these coding sets into a common set. Names for every element that must be exchanged among systems should be standardized. For the CPR, a clinically rich vocabulary that accurately describes patient problems and findings is mandatory. In addition, physicians must feel comfortable with the standard vocabulary if they are to use it for entering data. CPRI has published an evaluation of existing comprehensive codes (Chute et al., 1996).

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