In healthcare, as well as in biomedicine, representation of concepts occurs primarily through symbols manifested as vocabularies in a wide range of languages of the world. How to communicate common concepts relating to observed phenomena recorded in patient care records, and now the EHR, is a major problem area. This section of the EHR Overview Segment describes the key vocabulary issues, the work activities relating to vocabulary, and the achievements in dealing with concept representation not only for healthcare but also for its related subject areas. First, we must identify basic informatics concepts used in healthcare settings then we must deal with the full biomedical terminology that has been condensed by means of classification and coding systems into the familiar administrative vocabularies and how these concept representations are used in the EHR as an element of the full domain of experience in healthcare to manage both patient care and resources. In this treatment we will also probe the implementation issues of how such vocabularies become incorporated into the products and services that are found in the marketplace and employed in the conduct of healthcare.

The full set of terms representing concepts in biomedicine is much more extensive than the common coding schemes used in administrative and resource management functions of healthcare. In fact the widely used International Classification of Diseases was created for statistical and epidemiologic purposes and is a classification scheme rather than a terminology. Recently approved ASTM E-31 Standard Guide for Constructing Quality Health Vocabularies (E-2087), ref D1, is available for managing such vocabularies.