The article addresses the need to co-ordinate efforts to develop clinical coding systems and pragmatic clinical terminologies like SNOMED CT. In the first part, a description is given of the current context of divergent and replicated efforts. Then is presented a “reference terminology representation” approach based on a formal terminology representation as an open source available in the public domain with diversity in the linguistic expressiveness of end users let to competing developers and researchers. The last part is devoted to the contribution of the standardisation process in healthcare terminology initiated by CEN/TC251 and supported now by the work of CEN/TC215/WG3 to this new approach which can be summarised as the practical realisation of an ontology.