Semantic Interoperability Issue of Standardizing Medical Vocabularies

Semantic Interoperability Issue of Standardizing Medical Vocabularies

W. Ed Hammond (Duke University, USA)
DOI: 10.4018/978-1-61520-777-0.ch002


Semantic interoperability is the key to achieving global interoperability in healthcare information technology. The benefits are tremendous – the sharing of clinical data for multiple uses including patient care, research, reimbursement, audit and analyses, education, health surveillance, and many other uses. Patient safety, higher quality healthcare, more effective and efficient healthcare, increased outcomes, and potentially improved performance, higher quality of life and longer lifetimes are potential results. Decision support and the immediate linking of knowledge to the care process become easier. Semantic interoperability is a worthy goal. There are many barriers to achieving semantic interoperability. Key among these is the resolution of the many issues relating to the terminologies used in defining, describing and documenting health care. Each of these controlled terminologies has a reason for being and a following. The terminologies conflict and overlap; the granularity is not sufficiently rich for direct clinical use; there are gaps that prevent an exhaustive set; there are major variances in cost and accessibility; and no one appears eager or willing to make the ultimate decisions required to solve the problem. This chapter defines and describes the purpose and characteristics of the major terminologies in use in healthcare today. Terminology sets are compared in purpose, form and content. Finally, a proposed solution is presented based on a global master metadictionary of data elements with a rich set of attributes including names that may come from existing controlled terminologies, precise definitions to remove ambiguity in use, and complete value sets of possible values. The focus is on data elements because data elements are the basic unit of data interchange.
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The need for communication and the ability to communicate among humans is perhaps one of the most important human characteristics that define who and what we are. Without the ability to communicate among like creatures, we would be unable to share experiences and knowledge. The Biblical Book of Genesis makes this point very well. The opening sentence in Chapter 11 states: “Now the whole world had one language and a common speech.” The story goes on to relate that the men of the community decided to build a tower, the Tower of Babel, to reach heaven. God saw this work and said “If as one people speaking the same language have begun to do this, then nothing they plan to do will be impossible for them.” God then confused the language of the people, and they were unable to complete the building. Today’s world of health care uses a confused language and, as a result, we cannot build the best healthcare system.

The evolution of the many different sets of controlled vocabularies is further confounded by the labels attached: vocabulary, terminology, nomenclature, classification, taxonomy, and more recently, ontologies. Are the products of these differently named sets the same or different? Clearly the intent and purposes of each are slightly different. On the other hand, the terms that appear are similar. These terms are defined and discussed below.


Vocabulary is perhaps the most frequently used, everyday term to describe the words we use in defining and documenting the health care process. Simply defined, a vocabulary is a set of words used to express concepts or thoughts. We frequently use the words “controlled vocabulary” to mean that some group has placed some constraints, organization and control on the set of words and manages content and provides maintenance. A controlled vocabulary includes an organized list of words and phrases that identify concepts and content. An example of a controlled vocabulary is LOINC ® (Logical Observation Identifiers Names and Codes).

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