of health-care information and clinical data in interoperable computer-based systems necessitates use of controlled health-care terminologies. In a world in which it is too expensive for every group to develop its own comprehensive health-care terminology, and to create translations to every other group’s terminology, shared terminologies are essential. However, local sites that adopt a shared clinical terminology have local needs that prompt the local-terminology maintainers to make changes to the local version of that terminology. For a local site, there is a tradeoff between having autonomy over a local terminology and conforming to a shared terminology to obtain the benefits of interoperability. If the local site is motivated to conform, then the burden lies with the local site to manage its own changes and to incorporate the changes of the shared version at periodic intervals. We call this process synchronization. A common understanding of the terminology model, the change model, and the log model of a shared terminology and of its local extension will facilitate the process of synchronization. If divergence is handled in a controlled fashion, and if the benefits of sharing outweigh the costs of updating, then synchronization should be feasible. We survey current approaches that address problems of sharing and local modification, and we present our approach.
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