Buried in my day-to-day news feeds, I almost missed this one. But I’m glad I took a second look.

The U.S. Department of Health and Human Services (HHS) announced recently that the Department will participate in an international effort to promote the more rapid adoption of standard clinical terminology, which, in turn will promote the worldwide development of electronic health records.

This decision will allow the U.S. to join Australia, Canada, Denmark, Lithuania, the Netherlands, New Zealand, Sweden, and the United Kingdom as members of the new International Health Terminology Standards Development Organization (IHTSDO) which has acquired Systemized Nomenclature of Medicine (SNOMED) Clinical Terms (SNOMED CT) from the College of American Pathologists (CAP). Membership is open to all countries.

“International implementation of SNOMED CT is good for everyone engaged in developing electronic health records, and it will open up new opportunities for international collaboration in research and public health surveillance,” HHS Secretary Leavitt said. “This use of a standard terminology will enable the use of health information across borders, facilitate public health surveillance and support evidence-based research.”

SNOMED CT bills itself as a “core terminology” providing a “common language” that enables a consistent way of indexing, storing, retrieving, and aggregating clinical data across specialties and sites of care.

According to the SNOMED CT January 2007 fact sheet, the system has more than 308,000 active concepts (with formal logic-based definitions organized into top-level hierarchies), more than 777,000 active English language descriptions (for flexibility in expressing clinical concepts) and more than 924,000 defining relationships ( to enable consistency of data retrieval and analysis).

Did I mention that it’s also available in Spanish and German language editions?

I sent an email to SNOMED asking about any efforts to engage China. They couldn’t speak specifically to China’s needs, but, the rep said the new IHTSDO was “a significant step towards SNOMED being adopted as an international terminology standard for global interoperability. While China is currently not apart of the IHTSDO member countries, we (SNOMED) hope they would join the effort with many other countries to make this a reality.”

Ahh, well said.

There could be a couple problems here, however. One is that core terminology and common language may not be so “core” and “common” on the other side of the lake. The “lost in translation” effect has always been a bit more problematic for Chinese than, say, Spanish or German. Second, if it can be adapted to China, there is, of course, the tremendous upside: the possibility of furthering the interoperability of electronic medical information across international borders. This is a noble (and tremendously difficult) agenda, not one to be trivialized.

There may be a down side that’s harder to articulate, but still important to recognize. In my limited experience I’ve come to see China as a country where local or cultural meaning is invested in just about everything. Every rock, stream, forest, plant, building, street, town, word or saying, it seems, is invested with a narrative. The country hangs together on these delicate strands of “true fiction” (a Paul Veyne term).

Given China’s extensive historical and cultural contribution to healing — Traditional Chinese Medicine (TCM) or acupuncture, for example — what impact does the wholesale insertion of such a massive, Western-centric (should I use that term?), molecular-level, linguistic medical architecture do to that which is uniquely Chinese and still culturally opaque to others? Logic and hierarchies may be of a different intuitive order. Definitions, shaped by vernacular inclusions over time, may harbor hidden aspects only to rise under specific circumstances. Will the embedded nature of that which is characteristically Chinese, be smothered by this muscular medical terminology?

I understand that whenever the philosophical confronts the technical, we tend to end up with one less philosopher. But, if these concerns have any place in the discourse on the globalization of medicine, the way forward for the meaningful integration of what is valuable may be a little less clear, a little more uncertain, a little less exact. But it may be much more fruitful. Quixotic overconfidence only provokes cultural combat rather than mutual engagement. And no one — philosopher or SNOMED — wants to see that happen.