Systems, methods, and apparatus provide clinical terminology services including a controlled medical vocabulary supplemented by local clinical content. An example method includes accessing an initial controlled medical vocabulary including at least one external terminology via a vocabulary management server; processing local clinical content including unstructured local clinical content provided via an importer framework; analyzing and extracting the unstructured local clinical content using a text analyzer and extraction tool to generate one or more proposed terms; identifying one or more synonyms for the one or more proposed terms and placing the one or more synonyms into a queue to be added to the controlled medical vocabulary; reviewing the one or more synonyms; and adding one or more synonyms to the controlled medical vocabulary with placement and relationship based on analyzing unstructured local clinical content to automatically map between the at least one external terminology and the local clinical content.