The authors summarize their experience in iteratively testing the adequacy of three versions of the Health Level Seven (HL7) Logical Observation Identifiers Names and Codes (LOINC) Clinical Document Ontology (CDO) to represent document names at Columbia University Medical Center. The percentage of documents fully represented increased from 23.4% (Version 1) to 98.5% (Version 3). The proportion of unique representations increased from 7.9% (Analysis 1) to 39.4% (Analysis 4); the proportion reflects the level of specificity in the document names as well as the completeness and level of granularity of the CDO. The authors shared the findings of each analysis with the Clinical LOINC committee and participated in the decision-making regarding changes to the CDO on the basis of those analyses and those conducted by the Department of Veterans Affairs. The authors encourage other institutions to actively engage in testing healthcare standards and participating in standards development activities to increase the likelihood that the evolving standards will meet institutional needs. © 2009 J Am Med Inform Assoc.
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