Health informatics - A syntax to represent the content of medical classification systems (CIaML)

Describe a standard for representing the content of classification systems, especially in a medical context, to enable a XML representation of a classification. The syntax will be limited to mono hierarchical systems. Major part of the work involved will be
in determining how fine-grained and detailed the syntax needs to be. For illustration purposes in the annex a sample is given, but this by no means is meant to denote the scope.

Medizinische Informatik - Syntax zur Darstellung des Inhalts medizinischer Klassifikationssysteme (ClaML)

Zdravstvena informatika – Sintaksa predstavitve vsebine klasifikacijskih sistemov v medicini (CIaML)

General Information

Status
Withdrawn
Publication Date
08-Jul-2003
Withdrawal Date
14-Nov-2007
Current Stage
9960 - Withdrawal effective - Withdrawal
Due Date
15-Nov-2007
Completion Date
15-Nov-2007

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SLOVENSKI STANDARD
SIST-TS CEN/TS 14463:2006
01-april-2006

Zdravstvena informatika – Sintaksa predstavitve vsebine klasifikacijskih sistemov

v medicini (CIaML)

Health informatics - A syntax to represent the content of medical classification systems

(CIaML)
Medizinische Informatik - Syntax zur Darstellung des Inhalts medizinischer
Klassifikationssysteme (ClaML)
Ta slovenski standard je istoveten z: CEN/TS 14463:2003
ICS:
01.140.20
11.020
35.240.80
SIST-TS CEN/TS 14463:2006 en

2003-01.Slovenski inštitut za standardizacijo. Razmnoževanje celote ali delov tega standarda ni dovoljeno.

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TECHNICAL SPECIFICATION
CEN/TS 14463
SPÉCIFICATION TECHNIQUE
TECHNISCHE SPEZIFIKATION
July 2003
ICS 01.140.20; 11.020; 35.240.80
English version
Health informatics - A syntax to represent the content of medical
classification systems (CIaML)

This Technical Specification (CEN/TS) was approved by CEN on 26 April 2002 for provisional application.

The period of validity of this CEN/TS is limited initially to three years. After two years the members of CEN will be requested to submit their

comments, particularly on the question whether the CEN/TS can be converted into a European Standard.

CEN members are required to announce the existence of this CEN/TS in the same way as for an EN and to make the CEN/TS available. It

is permissible to keep conflicting national standards in force (in parallel to the CEN/TS) until the final decision about the possible

conversion of the CEN/TS into an EN is reached.

CEN members are the national standards bodies of Austria, Belgium, Czech Republic, Denmark, Finland, France, Germany, Greece,

Hungary, Iceland, Ireland, Italy, Luxembourg, Malta, Netherlands, Norway, Portugal, Slovakia, Spain, Sweden, Switzerland and United

Kingdom.
EUROPEAN COMMITTEE FOR STANDARDIZATION
COMITÉ EUROPÉEN DE NORMALISATION
EUROPÄISCHES KOMITEE FÜR NORMUNG
Management Centre: rue de Stassart, 36 B-1050 Brussels

© 2003 CEN All rights of exploitation in any form and by any means reserved Ref. No. CEN/TS 14463:2003 E

worldwide for CEN national Members.
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CEN/TS 14463:2003 (E)
Contents
Page

Foreword......................................................................................................................................................................3

Introduction .................................................................................................................................................................4

1 Scope ..............................................................................................................................................................5

2 Normative References ...................................................................................................................................5

3 Abbreviations .................................................................................................................................................5

4 Classification mark-up language..................................................................................................................6

Annex A (informative) Examples of usage of ClaML ..............................................................................................9

Annex B (informative) Suggested Usage of ClaML-attributes .............................................................................20

Bibliography ..............................................................................................................................................................21

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CEN/TS 14463:2003 (E)
Foreword

This document (CEN/TS 14463:2003) has been prepared by Technical Committee CEN /TC 251, "European

Standardization of Health Informatics", the secretariat of which is held by SIS.
Annexes A and B are informative.

According to the CEN/CENELEC Internal Regulations, the national standards organizations of the following

countries are bound to announce this CEN Technical Specification : Austria, Belgium, Czech Republic, Denmark,

Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Luxembourg, Malta, Netherlands, Norway,

Portugal, Slovakia, Spain, Sweden, Switzerland and the United Kingdom.
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CEN/TS 14463:2003 (E)
Introduction

Many classification systems are still distributed in a form suitable for direct text processing like MSWord etc. This is

a very dangerous format, because unwanted and unspotted mistakes are easily made. For example, the accidental

deletion of a tab, makes a sibling rubric into a parent.

Industry is faced with a variety of formats in which classification systems are delivered. Many different parsers have

to be maintained, and yet, due to the informal nature of texts, a 100% guarantee for correct parsing into more

formal structures is hard to give.

For work on classification systems, revision work and especially when terminological tools are used for work on

classification systems there is a need to store and transfer classification systems while maintaining the structure of

codes, rubrics, comments, inclusion/exclusion criteria etc. A neutral format like plain ASCII files with comma

separated value fields is widely used, but has insufficient structuring capabilities. XML is the chosen format for this

Prestandard as a) XML provides the necessary structuring elements, and b) there are many readily available XML

parsers in existence.
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CEN/TS 14463:2003 (E)
1 Scope
1.1 Main purposes

The main purpose of this Technical Specification is to support the transfer of the majority of hierarchical healthcare

classification systems between organisations and dissimilar software products. The Prestandard should therefore

be rich enough to uniquely identify and describe the structure and the relevant elements in those systems. This

Prestandard does not intend to prescribe the meaning of structuring elements in classification systems. This

Prestandard is not meant to be a direct format for printing or viewing the contents of a classification system. Views

and prints can be derived from this representation by post processing.
1.2 Target groups of this Technical Specification
This Technical Specification is applicable by

a) developers of classification systems and terminologies, to assist in the dissemination and maintenance of a

particular system, as well for comparisons among different versions;

b) developers of information systems to assist in inclusion of mechanisms for unambiguous loading of

classification systems in their applications;
c) organisations responsible for updating classification systems;
d) institutions receiving updated classification systems;
1.3 Topics considered outside the scope of this Technical Specification
This Technical specification is not intended for

a) providing a normative syntax on how a classification system should be constructed;

b) supporting full mark-up information for final printed delivery of classification systems;

c) defining link types between elements in a classification system, this is left to the developers of classification

systems;
d) providing a representation for direct viewing or printing.
2 Normative References

This Technical Specification incorporates by dated or undated reference, provisions from other publications. These

normative references are cited in the appropriate places in the text, and the publications are listed hereafter. For

dated references, subsequent amendments and revisions of any of these publications apply to this Technical

Specification only when incorporated in it by amendment and revision. For undated references, the latest edition of

the publication referred to applies.
Not applicable.
3 Abbreviations
ClaML Classification Markup Language
XML Extensible Markup Language 1.0
DTD Document Type Definition
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CEN/TS 14463:2003 (E)
4 Classification mark-up language
4.1 Basis of the syntax

The basis of the syntax is to represent the content of medical classification systems. The syntax defined in this

Prestandard is called Classification Mark-up Language. It is defined here in the form of a Document Type Definition

(DTD). The reference to this syntax will be headed to ClaML in the remainder of this document

4.2 Document Type Definition






















]
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CEN/TS 14463:2003 (E)

NOTE xml:lang - defines the language code in which the content of the element is written in. The attribute values of

xml:lang should follow ISO-639-2 if they are three-letter codes, and ISO-3166 if they contain two-letter sub codes. Language

identifiers registered with the IANA should contain the prefix "I-" or "i-". Any privately used codes should contain the prefix "X-"

or "x-".
4.3 Explanation
A coding scheme consists of:
an optional name, this is a piece of free text
an optional version identification, this can be a number or a piece of text
an optional date, this is a piece of free text
an optional title, this is a piece of free text
an optional list of rubric kinds
zero or more modifiers
zero or more modifier classes
zero or more classes
A list of rubric kinds consists of:
zero or more rubric kinds
A modifier consists of:
a mandatory symbol, this is a piece of free text
zero or more rubrics
A modifier class consists of:
a mandatory symbol, this is a piece of free text
exactly one mandatory super class, which identifies an existing modifier
zero or more rubrics
A class consists of:
a mandatory kind identifier, e.g. chapter, block, category
a mandatory symbol

zero or more super classes, which identify existing classes within the same coding scheme

zero or more ‘modified by’ statements, which identify existing modifiers
zero or more ‘excludemodifier’ statements, which identify existing modifiers
zero or more rubrics
A rubric consists of:
a mandatory language identifier
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CEN/TS 14463:2003 (E)
a mandatory kind identifier, e.g. preferred, includes, excludes
free text, which may include:
references to other codes within the coding scheme
references to other codes in other coding schemes
italic formatted text
bold formatted text
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CEN/TS 14463:2003 (E)
Annex A (informative) Examples of usage of ClaML
A.1 Introduction

A coding scheme is a mapping between a set of code values and a set of code meanings. Central overall aspects

of the coding scheme is described by metadata, using the tags Name, Version, Title, Date

In this standard, each code value is represented as a Symbol element and the related code meaning is

represented by a set of Rubric elements. Each such relation is represented in a Class element along with optional

links to more general classes (pointed to by SuperClass elements), and optional modifiers (pointed to by

ModifiedBy elements). The Class is further specified by a class kind which is specific for the classification in

question and typically represents the Class's level in the hierarchy .

A rubric may contain text formatted in italics and bold, it may also contain references to classes within the same

classification or in other, external classifications. It is mandatory to specifiy the kind (e.g. ’includes’, ’excludes’,

’preferred’, etcetera) of rubric, and the language of the rubric.

Classes can in some cases be further specified by one or more modifiers, referred to by a ModifiedBy element, and

described in a Modifier element. Allowable values of such a modifier are described by ModifierClass elements,

each of which has a symbol and a set of Rubric elements describing its meaning.
A.2 References to different languages

The next piece of ClaML demonstrates how the same rubric in different languages would be represented.


ICD
10
2000-12-01
International Codes for Diseases, version 10

A00-B99

Certain infectious and parasitic diseases

Bepaalde infectieziekten en parasitaire aandoeningen

Bestimmte infektiöse und parasitäre Krankheiten



A.3 Representing hierarchy

The hierarchy in a classification system is represented by the SuperClass tag, as is demonstrated in the next piece

of ClaML.

A00-A09
For example, Class kinds used in ICD might include Chapter, Section and Block.
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CEN/TS 14463:2003 (E)
A00-B99
Intestinal infectious diseases

A.4 Representing internal references

The next piece of ClaML demonstrates how references to another class in the same classification system would be

represented.

A04
A00-A09

Other bacterial intestinal infections

foodborne intoxications, bacterial (A05)

tuberculous enteritis (A18.3)


A.5 Representing the use of modifiers

Several classification systems contain subclassifications that define codes and rubrics that may be added to

specific categories in the main classification. For example, Chapter XIII of the ICD-10 defines the subclassification

"Site of musculo-skeletal involvement" as follows:
Site of musculoskeletal involvement

The following subclassification to indicate the site of involvement is provided for optional use with appropriate

categories in Chapter XIII. As local extensions or specialty ad
...

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