The lack of nationally uniform, multipurpose standards for the structure, content, and transmission of automated health data creates a "Tower of Babel" that seriously impairs the development of integrated information systems to support population-based public health. In this environment, states wishing to move forward must promulgate their own standards, negotiating with major health care payers and providers, as well as other parties whose data are critical to meeting health information needs. These duplicative efforts are time-consuming and costly, and risk the adoption of standards that are more suitable for paying claims than for meeting the needs of clinicians, researchers, and the public health community. Moreover, they inevitably lead to differing state standards that impede the collection of regional and national health statistics, and complicate public health surveillance in the many major metropolitan areas that cross state lines.
Achieving nationally uniform standards for health data that support population health is complicated by several factors. To date, there has been little direct public health participation in the standards development process, and few in the public health community are well informed about national efforts to develop consensus standards for health data. At the same time, there is uneven knowledge about projects that could lead to standardized nomenclatures for multipurpose health information systems in the near future. For example, with the expansion of the UMLS into a health vocabulary, a nomenclature may soon be available which can record data in integrated information systems in the same detailed and meaningful form in which it is entered in computerized patient and public health records. Because the UMLS Metathesaurus makes it possible to map terms in the health vocabulary to multiple classification systems, information recorded once at the point of service can be used for many different purposes. Integrated information systems designed with the flexibility to accept information in this form will be able to capitalize on the increasing use of the UMLS by the clinical and public health communities.