ASTM E2087-00
(Specification)Standard Specification for Quality Indicators for Controlled Health Vocabularies (Withdrawn 2009)
Standard Specification for Quality Indicators for Controlled Health Vocabularies (Withdrawn 2009)
SCOPE
1.1 This specification covers the documentation of the principal notions necessary and sufficient to assign value to a controlled health vocabulary. This specification will serve as a guide for governments, funding agencies, terminology developers, terminology integration organizations, and the purchasers and users of controlled health terminology systems working toward improved terminological development and recognition of value in a controlled health vocabulary. It is applicable to all areas of health care about which information is kept or utilized. It is intended to complement and utilize those notions already identified by other national and international standards bodies.
1.2 This specification will provide vocabulary developers and authors with the guidelines needed to construct useful, maintainable controlled health vocabularies. These tenets do not attempt to specify all of the richness that can be incorporated into a health terminology. However this specification does specify the minimal requirements, which, if not adhered to, will ensure that the vocabulary will have limited generalizability and will be very difficult, if not impossible, to maintain. This specification will provide terminology developers with a sturdy starting point for the development of controlled health vocabularies. This foundation serves as the basis from which vocabulary developers will build robust, large-scale, reliable and maintainable terminologies.
1.3 This specification explicitly does not refer to classifications or coding systems (for example, a simple list of pairs of rubrics and codes) that are not designed to be used clinically.
WITHDRAWN RATIONALE
This specification covers the documentation of the principal notions necessary and sufficient to assign value to a controlled health vocabulary. This specification will serve as a guide for governments, funding agencies, terminology developers, terminology integration organizations, and the purchasers and users of controlled health terminology systems working toward improved terminological development and recognition of value in a controlled health vocabulary. It is applicable to all areas of health care about which information is kept or utilized. It is intended to complement and utilize those notions already identified by other national and international standards bodies.
Formerly under the jurisdiction of Committee E31 on Healthcare Informatics, this specification was withdrawn in February 2009 in accordance with section 10.5.3.1 of the Regulations Governing ASTM Technical Committees, which requires that standards shall be updated by the end of the eighth year since the last approval date.
General Information
Standards Content (Sample)
NOTICE: This standard has either been superseded and replaced by a new version or withdrawn.
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An American National Standard
Designation: E 2087 – 00
Standard Specification for
Quality Indicators for Controlled Health Vocabularies
This standard is issued under the fixed designation E 2087; the number immediately following the designation indicates the year of
original adoption or, in the case of revision, the year of last revision. A number in parentheses indicates the year of last reapproval. A
superscript epsilon (e) indicates an editorial change since the last revision or reapproval.
INTRODUCTION
In 1839, William Farr stated in his First Annual Report of the Registrar-General of Births, Deaths,
and Marriages in England, “The nomenclature is of as much importance in this department of inquiry,
asweightsandmeasuresinthephysicalsciences,andshouldbesettledwithoutdelay.”Sincethattime
this theme has been heard resounding from an in increasingly large group of scientists (seeAppendix
X1). Today, the need for controlled vocabularies to support health record systems has been widely
recognized (see Specification E 1238, Guide E 1239, Guide E 1384, Specification E 1633, and
EN 12017). Controlled vocabularies provide systems with the means to aggregate data. This
aggregationofdatacanbedoneatmultiplelevelsofgranularityandthereforecanenhancetheclinical
retrieval of a problem oriented record, data pertaining to a classification for billing purposes, or
outcomes data for a given population. Maintenance of large-scale vocabularies has become a
burdensome problem as the size of term sets has escalated (IS 15188). Without a well-structured
backbone, large-scale vocabularies cannot scale to provide the level of interoperability required by
today’s complex electronic health record applications.
The solution rests with standards (1). Over the past ten or more years, Medical Informatics
researchers have been studying controlled vocabulary issues directly. They have examined the
structure and content of existing vocabularies to determine why they seem unsuitable for particular
needs, and they have proposed solutions. In some cases, proposed solutions have been carried forward
into practice and new experience has been gained(2).As we prepare to enter the twenty-first century,
it seems appropriate to pause to reflect on this experience, and publish a standard set of goals for the
development of comparable, reusable, multipurpose, and maintainable controlled health vocabularies
(IS 12200, IS 12620) (3).
This specification represents the initial input taken from the ANSI-HISB Framework Paper by
Chute, et al(4), the Desiderata from Cimino(3), the ToMeLoArchitecture and Terminology Paper by
Rossi-Mori and Zanstra, and the Compositionality Paper by Elkin, et al (5). Other useful references
include, “GALEN Generalized Architecture for Language, Encyclopedias and Nomenclatures in
Medicine: Univ. of Manchester” (6, 7) and “Unified Medical Language System (UMLS) Knowledge
Sources” (8).
1. Scope of value in a controlled health vocabulary. It is applicable to all
areasofhealthcareaboutwhichinformationiskeptorutilized.
1.1 This specification covers the documentation of the
It is intended to complement and utilize those notions already
principal notions necessary and sufficient to assign value to a
identified by other national and international standards bodies.
controlled health vocabulary. This specification will serve as a
1.2 This specification will provide vocabulary developers
guide for governments, funding agencies, terminology devel-
and authors with the guidelines needed to construct useful,
opers, terminology integration organizations, and the purchas-
maintainable controlled health vocabularies. These tenets do
ersandusersofcontrolledhealthterminologysystemsworking
not attempt to specify all of the richness that can be incorpo-
toward improved terminological development and recognition
rated into a health terminology. However this specification
does specify the minimal requirements, which, if not adhered
to, will ensure that the vocabulary will have limited general-
This specification is under the jurisdiction of ASTM Committee E31 on
Healthcare Informatics and is the direct responsibility of Subcommittee E31.35 on
izability and will be very difficult, if not impossible, to
Healthcare Data Analysis.
maintain. This specification will provide terminology develop-
Current edition approved May 10, 2000. Published July 2000.
ers with a sturdy starting point for the development of
The boldface numbers in parentheses refer to the list of references at the end of
this standard. controlled health vocabularies. This foundation serves as the
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.
E2087–00
basis from which vocabulary developers will build robust, tiple terms (linguistic representations) may have the same
large-scale, reliable and maintainable terminologies. meaning if they are explicit representations of the same
1.3 This specification explicitly does not refer to classifica- concept. This implies non-redundancy, non-ambiguity, and
tions or coding systems (for example, a simple list of pairs of non-vagueness.
rubrics and codes) that are not designed to be used clinically.
3.1.1.1 Non-redundancy—Terminologies must be internally
consistent. There must not be more than one concept in the
2. Referenced Documents
terminology with the same meaning (IS 704, Guide E 1284).
2.1 ASTM Standards:
This does not exclude synonymy; rather, it requires that this be
E 1238 Specification for Transferring Clinical Observations
explicitly represented.
Between Independent Computer Systems
3.1.1.2 Non-Ambiguity—No concept should have two or
E 1239 Guide for Description of Reservation/Registration-
more meanings. However an entry term (some authors have
Admission, Discharge, Transfer (R-ADT) Systems for
referred to this as an “interface terminology”) can point to
Automated Patient Care Information Systems
more than one concept (for example, MI as a myocardial
E 1284 Guide for Construction of a Clinical Nomenclature
infarction and mitral insufficiency).
for Support of Electronic Health Records
3.1.1.3 Non-Vagueness—Concept names must be context
E 1384 Guide for Content and Structure of the Electronic
free (some authors have referred to this as “context laden”).
Health Record (EHR)
For example “diabetes mellitus” should not have the child
E 1633 Specification for Coded Values Used in the Elec-
concept “well controlled,” instead the child concept’s name
tronic Health Record
should be “diabetes mellitus, well controlled.”
E 1712 Specification for Representing Clinical Laboratory
3.2 Purpose and Scope—Any controlled vocabulary must
Procedure and Analyte Names
have its purpose and scope clearly stated in operational terms
2.2 Other Standards:
so that it its fitness for particular purposes can be assessed and
ISO/DIS 860 International Harmonization of Concepts and
evaluated (IS 15188). Where appropriate, it may be useful to
Terms
illustrate the scope by examples or “use cases” as in database
EN 12017 Medical Informatics—Vocabulary
models and other specification tools. Criteria such as coverage
EN 12264 Medical Informatics—Categorical Structure of
and comprehensiveness can only be judged relative to the
Syntax of Concepts—Model for Representation of Se-
intended use and scope. For example, a vocabulary might be
mantics
comprehensive and detailed enough for general practice with
ICD-9-CM
respect to cardiovascular signs, symptoms, and disorders, but
IS 704 Principles and Methods of Terminology
inadequate to a specialist cardiology or cardiothoracic surgery
IS 1087-1 Terminology—Vocabulary—Part 1: Theory and
unit. Conversely, a vocabulary sufficiently detailed to cope
Application
with cardiology and cardiothoracic surgery might be totally
IS 1087-2 Terminology—Vocabulary—Part 2: Computer
impractical in general practice.
Applications
3.3 Coverage (3)—Each segment of the healthcare process
IS 11179-3 Terminology—Data Registries
must have explicit in-depth coverage and not rely on broad
IS 12200 Terminology—Computer Applications-Machine
summary categories that lump specific clinical concepts to-
Readable Terminology Interchange Format
gether.Forexample,itisoftenimportanttodistinguishspecific
IS 12620 Terminology—Computer Applications—Data
diagnosis from categories presently labeled Not Elsewhere
Categories
Classified (NEC), or to differentiate disease severity such as
IS 15188 Project Management for Terminology Standard-
indolent prostate cancer from widely metastatic disease. The
ization
extent to which the depth of coverage is incomplete must be
IS 2382–4 Information Technology—Vocabulary—Part 4:
explicitly specified for each domain (scope) and purpose as
Organization of Data
indicated in 3.2.
ISO TR 9789 Guidelines for the Organization and Repre-
3.4 Comprehensiveness (9)—All segments of the healthcare
sentation of Data Elements for Data Interchange—Coding
process, such as physical findings, risk factors, or functional
Methods and Principles
status, must be addressed for all related disciplines, across the
3. General Information breadth of medicine, surgery, nursing and dentistry. This
criterion applies because decision support, risk adjustment,
3.1 Basic characteristics of a terminology influence its
outcomes research, and useful guidelines require more than
utility and appropriateness in clinical applications.
diagnoses and procedures. Examples include existing AHCPR
3.1.1 Concept Orientation (3)—The basic unit of a vocabu-
guidelines and the HCFAmortality model.The extent to which
lary must be a concept, which is the embodiment of some
the degree of comprehensiveness is incomplete must be explic-
specific meaning and not a code or a character string. Repre-
itly specified for each domain (scope) and purpose as indicated
sentations of a concept must correspond to one and only one
in 3.2.
meaning, and in a well-ordered vocabulary only one concept
3.5 Mapping (10)—Government and payers mandate the
may have that same meaning (ISO/DIS 860). However, mul-
form and classification schema for much clinical data ex-
change. Thus, comprehensive and detailed representations of
Annual Book of ASTM Standards, Vol 14.01. patient data within computer-based patient records should be
E2087–00
able to be mapped to those classifications, such as ICD-9-CM. concept, modifier concept, and qualifier (also called “status”)
Thisneedformultiplegranularitiesisneededforclinicalhealth concept. These terms are being specifically defined in a
care as well (ISO TR 9789). For example, an endocrinologist document on meta-terminology currently being written under
mayspecifymoredetailaboutapatient’sdiabetesmellitusthan the auspices of ISO TC 215 Working Group 3.
ageneralistworkinginanurgentcaresetting,eventhoughboth
NOTE 1—The term “concept” in this specification is used to refer to the
may be caring for the same patient. The degree to which the
representation of a concept rather than the thought itself.
terminology is isolated from other classifications must be
4.2.1 Atomic Concept—Arepresentation of a concept that is
explicitly stated.
3.6 Systematic Definitions (4)—In order for users of the not composed of other simpler concept representations within
a particular terminology. In many cases “atomic concepts” will
vocabulary to be certain that the meaning that they assign to
concepts is identical to the meaning which the authors of the correspond to what philosophers call “natural kinds.” Such
entities cannot be meaningfully decomposed. Concepts should
vocabulary have assigned, these definitions will need to be
explicit and available to the users. Further, as relationships are be separable into their constituent components, to the extent
that it is practical.These concepts should form the root basis of
built into vocabularies, multiple authors will need these defi-
nitions to ensure consistency in authorship. all concepts. For example, in the UMLS Metathesaurus, colon
3.7 Formal Definitions—A compositional system should is a synonym for large bowel, and cancer is a synonym for
contain formal definitions for non-atomic concepts and formal neoplasm, malignant. Colon cancer is non-atomic, since it can
rules for inferring subsumption from the definitions (Specifi- be broken down into “large bowel” and “neoplasm, malig-
cation E 1712). nant.” Each of these two more atomic terms has a separate and
3.8 Explicitness of Relations—The logical definition of unique Concept Unique Identifier (CUI).
subsumption should be defined. The formal behavior of all
4.2.2 Composite Concept—A concept composed as an ex-
links/relations/attributes should be explicitly defined. The pri-
pression made up of atomic concepts linked by semantic
mary hierarchical relation should be subsumption (“kind of”)
representations (such as roles, attributes, or links).
asdefinedbylogicalimplication:“BisakindofA”means“All
4.2.2.1 Pre-coordinated Concept—An entity that can be
Bs areAs.” If a looser meaning such as “broader than/narrower
brokenintopartswithoutlossofmeaning(canbemeaningfully
than” is used, it should be explicitly stated.
decomposed) when the atomic concepts are examined in
3.9 Reference Terminology—The set of canonical concepts,
aggregate. These are representations, which are considered
their structure, relationships, and, if present, their systematic
single concepts within the host vocabulary. Ideally, these
and formal definitions. These features define the core of the
concepts should have their equivalent composite concepts
controlled health terminology.
explicitlydefinedwithinthevocabulary(thatis,thevocabulary
3.10 Atomic Reference Terminology—Areference terminol-
should be normalized for content). For example, colon cancer
ogy consisting of only atomic concepts and their systematic
isnon-atomic,howeverithasasingleCUI,whichmeanstothe
andformaldefinitions.Inthistypeofreferenceterminology,no
Metathesaurus that it represents a single concept. It has the
two or more concepts can be combined to create a composite
same status in the vocabulary as the site “large bowel” and the
expression as the same meaning as any other single concept
diagnosis “neoplasm, malignant.”
contained in the atomic reference terminology.
4.2.2.2 Post-coordinated Concept—A composite concept is
3.11 Colloquial Terminology—The set of terms that consist
not pre-coordinated and therefore must be represented as an
of commonly used entry points and which map to one or more
expression of multiple concepts using the representation lan-
canonical terms within the vocabulary. These have been called
guage. This is the attempt of a system to construct a set of
“entry terms” or “interface terminologies” by different authors.
concepts from within a controll
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