The development of CCAM: the new French coding system of clinical procedures.

A new French coding system of clinical procedures, the Classification Commune Des Actes Medicaux (CCAM), has been developed at the turn of the millennium (between 1996 and 2001). Two methodologies were used: a traditional domain-experts consensus method, and an artificial-intelligence-based semantic representation. An economic evaluation of clinical procedures was also undertaken for the rating for fee-for-service payment. We present the methodologies used and stress how the European Union research project, 'European Consortium, Generalised Architecture for Languages, Encyclopaedias and Nomenclatures in Medicine' (GALEN), facilitated the sharing and maintaining of consistent medical knowledge. This country case study highlights the significant cost to individual countries in developing their own classifications in isolation. It also demonstrates the benefits of contributing to international efforts such as GALEN that enable harmonisation, yet still allow for diversity.