Because they constrain what can be described

Most clinicians probably know clinical information standards as the coding systems used for representing clinical concepts. They include longstanding systems such as the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders as well as more recent systems such as the Read Clinical Classification and Snomed, though coded vocabularies themselves are only the visible tip of the standards iceberg. Work on clinical information standards is not glamorous, but such standards are fundamental for progress in health care. They are essential resources for future clinical decision support, audit, governance, research, education, and training. In a very real sense, these standards define what can be said about patient care.

In this issue Brown et al describe a crossover trial comparing the accuracy and usability of two clinical terminology standards in a setting designed to reflect tasks and circumstances commonly encountered in contemporary British general practice (p 1127).1 The paper may seem of limited relevance, in that it is focused on Britain, on primary care, and on two specific clinical standards, both of which are probably obsolescent. Also in this issue is a report describing the practical use of clinical information coding for managing diabetes in south London primary care (p …