Health informatics -- Workforce roles and capabilities for terminology and terminology services in healthcare (term workforce)

This document specifies the tasks, roles, and key skills, requirements and competencies for personnel involved in terminology services in healthcare organizations. This document specifies — terminology services in healthcare organizations including the selection, authoring, and deployment and use of terminology subsets and maps; developing and managing terminology management processes and health information management related policies; performing terminology business analysis; and supporting the adoption, planning, and deployment of terminologies, — workforce needs to perform these services — job roles in the healthcare organizations and related organizations responsible for performing terminology related tasks, and NOTE Examples of these roles include terminologist, terminology standards developer/manager, mapping specialist, data conversion analyst, interface analyst, coding specialist, data developer/designer, data modeler, and content manager (including Clinical Documentation Improvement [CDI] specialist). — skill and competency level requirements to safely and effectively undertake each task, taking into account the focus of the task from the perspectives of HICT, information management, information governance including information privacy and security, clinical practice, and healthcare decision making.

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Status
Published
Publication Date
14-May-2019
Current Stage
6060 - International Standard published
Start Date
25-Apr-2019
Completion Date
15-May-2019
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ISO/TS 22287:2019 - Health informatics -- Workforce roles and capabilities for terminology and terminology services in healthcare (term workforce)
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TECHNICAL ISO/TS
SPECIFICATION 22287
First edition
2019-05
Health informatics — Workforce roles
and capabilities for terminology and
terminology services in healthcare
(term workforce)
Reference number
ISO/TS 22287:2019(E)
ISO 2019
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ISO/TS 22287:2019(E)
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© ISO 2019

All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part of this publication may

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Published in Switzerland
ii © ISO 2019 – All rights reserved
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ISO/TS 22287:2019(E)
Contents Page

Foreword ........................................................................................................................................................................................................................................iv

Introduction ..................................................................................................................................................................................................................................v

1 Scope ................................................................................................................................................................................................................................. 1

2 Normative references ...................................................................................................................................................................................... 1

3 Terms and definitions ..................................................................................................................................................................................... 1

4 Abbreviations........................................................................................................................................................................................................... 3

5 Terminology and terminology services in healthcare ................................................................................................... 4

6 Healthcare terminology professionals .......................................................................................................................................... 5

6.1 Workforce shortage and impact ............................................................................................................................................... 5

6.2 Terminology specialists: Roles, job and skills requirements, and qualifications .......................... 5

6.2.1 Terminology technical specialist .................. ...................................................................................................... 6

6.2.2 Terminology specialist ................................................................................................................................................ 9

6.2.3 Terminology advanced specialist ...................................................................................................................12

7 Competencies, educational objectives and content ......................................................................................................16

7.1 Competencies ........................................................................................................................................................................................16

7.2 Learning outcomes per competency .................................................................................................................................17

Annex A (informative) HIT, HIM and informatics workforce needs: Examples from Canada,

UK, and US .................................................................................................................................................................................................................31

Annex B (informative) Roles within healthcare organizations that work with or support

terminology services .....................................................................................................................................................................................32

Annex C (Informative) Bloom’s Taxonomic Level .................................................................................................................................33

Bibliography .............................................................................................................................................................................................................................34

© ISO 2019 – All rights reserved iii
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ISO/TS 22287:2019(E)
Foreword

ISO (the International Organization for Standardization) is a worldwide federation of national standards

bodies (ISO member bodies). The work of preparing International Standards is normally carried out

through ISO technical committees. Each member body interested in a subject for which a technical

committee has been established has the right to be represented on that committee. International

organizations, governmental and non-governmental, in liaison with ISO, also take part in the work.

ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of

electrotechnical standardization.

The procedures used to develop this document and those intended for its further maintenance are

described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the

different types of ISO documents should be noted. This document was drafted in accordance with the

editorial rules of the ISO/IEC Directives, Part 2 (see www .iso .org/directives).

Attention is drawn to the possibility that some of the elements of this document may be the subject of

patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details of

any patent rights identified during the development of the document will be in the Introduction and/or

on the ISO list of patent declarations received (see www .iso .org/patents).

Any trade name used in this document is information given for the convenience of users and does not

constitute an endorsement.

For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and

expressions related to conformity assessment, as well as information about ISO's adherence to the

World Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT), see www .iso

.org/iso/foreword .html.

This document was prepared by Technical Committee ISO/TC 215, Health informatics.

Any feedback or questions on this document should be directed to the user’s national standards body. A

complete listing of these bodies can be found at www .iso .org/members .html.
iv © ISO 2019 – All rights reserved
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ISO/TS 22287:2019(E)
Introduction

Countries that began the adoption of Health Information and Communication Technology (HICT)

products have reported shortfalls in the quantity and skills of the workforce in Health Information

Technology (HIT), Health Information Management (HIM), and Health Informatics (HI).

This document addresses workforce needs when implementing terminology resources (products)

in healthcare organizations and related supporting organizations, including regional, national, and

international HICT programs.

The purpose of this document is to enable healthcare organizations and related supporting

organizations that deploy HICT products to safely and effectively support semantic interoperability

within systems and between systems locally, nationally, or globally. Semantic interoperability, the

ability of computer systems to exchange data with unambiguous and shared meaning, is impacted by

the generation, management and sharing of health-related data and information.

Implementation and operation of complex terminologies in healthcare organizations and related

supporting organizations without proper knowledge and skills of personnel in those terminological

resources is a contributing factor in the resulting failure to deliver expected care outcomes, in delays in

Electronic Health Record (EHR) and Health Information Systems (HIS) implementations, and in some

cases, in injury caused to patients. Employers need to be able to hire workers with confidence that they

have the right skill set for the job.

This document specifies tasks associated with electronic capture, management, sharing, and use of

health record content in EHR and HIS in the context of clinical care, business processes, and information

governance activities in healthcare.

This document is targeted to stakeholders involved in HICT products development, deployment, and

use. Specific value includes:

— Healthcare organizations and HICT vendors: Requirements and guidance for tasks and the skills

for human resource staff to guide hiring of terminology standards personnel.

— Professional associations: Guidance for terminology skill requirements, training and certification

of HIT, HIM, and Informatics professionals, as well as accreditation of terminology services programs.

— Academia: Guidance for (a) the overall curricula development to support semantic interoperability

education under HIT, HIM, and informatics programs, and (b) terminology competencies to support

course development.

— eHealth, HIM, HIT, Informatics professionals and others: Provide a mechanism to consistently and

accurately indicate career pathways and skill expectations.

— Consumers (patients, clinicians, governments, society): Safe, quality information is available.

This document supports the deployment of semantic content standards developed by TC 215 in

healthcare organizations and governmental entities involved in electronic information sharing using

interoperable standards-based HICT products. It provides direction on workforce needs for deployment

and operation of terminological resources as well as the roles, competencies and skills to support these

needs. Consideration of a business case development and potential numbers needed (i.e. terminology

workers) would also be helpful in determining workforce requirements.

It also supports the development of the TC 215 reference standards portfolio (an assembly of individual

standards) for interoperable HICT solutions in specific health domains, by identifying specific content

area(s) for which a qualified terminology services workforce is needed.

ISO 21298 also describes a number of roles in healthcare. It is possible that some staff with roles as

described in ISO 22287 roles might also undertake roles as described in ISO 21298 roles, or there might

be naming collisions.
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TECHNICAL SPECIFICATION ISO/TS 22287:2019(E)
Health informatics — Workforce roles and capabilities for
terminology and terminology services in healthcare (term
workforce)
1 Scope

This document specifies the tasks, roles, and key skills, requirements and competencies for personnel

involved in terminology services in healthcare organizations.
This document specifies

— terminology services in healthcare organizations including the selection, authoring, and deployment

and use of terminology subsets and maps; developing and managing terminology management

processes and health information management related policies; performing terminology business

analysis; and supporting the adoption, planning, and deployment of terminologies,

— workforce needs to perform these services

— job roles in the healthcare organizations and related organizations responsible for performing

terminology related tasks, and

NOTE Examples of these roles include terminologist, terminology standards developer/manager,

mapping specialist, data conversion analyst, interface analyst, coding specialist, data developer/designer,

data modeler, and content manager (including Clinical Documentation Improvement [CDI] specialist).

— skill and competency level requirements to safely and effectively undertake each task, taking

into account the focus of the task from the perspectives of HICT, information management,

information governance including information privacy and security, clinical practice, and

healthcare decision making.
2 Normative references
There are no normative references in this document.
3 Terms and definitions
For the purposes of this document, the following terms and definitions apply.

ISO and IEC maintain terminological databases for use in standardization at the following addresses:

— ISO Online browsing platform: available at https: //www .iso .org/obp
— IEC Electropedia: available at http: //www .electropedia .org/
3.1
adoption
act of taking up or following something
3.2
author
entity or set of entities that create and might modify an asset
3.3
classification

terminology which aggregates data at a prescribed level of abstraction for a particular domain

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ISO/TS 22287:2019(E)
3.4
code set

set of codes used for encoding data elements, such as tables of terms, medical concepts, medical

diagnostic codes, or medical procedure codes
3.5
code system extension

set of code system components and derivatives that add to and are dependent on a published code system

3.6
competency

ability of an individual to perform a job properly through a combination of training, demonstrated skills

and accumulated experience
3.7
conformity
conformance
fulfilment of specified requirements
3.8
interface terminology
collection of commonly used terms to support user entry of health information
3.9
information management

planning, collection, control, distribution and exploitation of information resources within an

organization, including systems development, and disposal or long-term preservation

[SOURCE: ISO 5127:2017, 3.2.1.23, modified — Note 1 to entry has been removed.]
3.10
information governance

processes by which an organization obtains assurance that the risks to its information, and thereby the

operational capabilities and integrity of the organization, are effectively identified and managed

3.11
information privacy

rights and obligations of individuals and organizations with respect to the collection, use, retention,

disclosure and disposal of personal information
[SOURCE: ISO/TS 14441:2013, 3.26]
3.12
information technology

resources (especially computers and telecommunication) used to acquire, process, store, and

disseminate information
[SOURCE: ISO/IEC 38500:2015, 2.12]
3.13
mapping

process of defining a relationship between concepts in one coding system to concepts in another coding

system in accordance with a documented rationale, for a given purpose
3.14
safety
freedom from unacceptable risk
3.15
security
combination of confidentiality, integrity, and availability
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ISO/TS 22287:2019(E)
3.16
semantic interoperability

ability of computer systems supporting health care practice and management to correctly and

consistently interpret the information being exchanged
3.17
skill

ability to perform a task or activity with a specific intended outcome acquired through education,

training, experience or other means
[SOURCE: ISO/IEC/TS 17027:2014, 2.74]
3.18
standards developing organization
organization one of whose functions is to create and/or publish standards
[SOURCE: ISO/TS 27790:2009, 3.70]
3.19
subset

set that contains only elements that are also contained in the set from which it is derived

Note 1 to entry: The subset may be identical to the set from which it is derived.

[SOURCE: ISO/IEC 14496-10:2014, G.3.60, modified — Part of the definition was moved to Note 1 to entry.]

3.20
terminology
language, words and terms used in a specific domain
3.21
terminology service

service that lets healthcare applications make use of codes and value sets (3.23) without having

to become experts in the fine details of code system, value set and concept map resources, and the

underlying code systems and terminological principles
3.22
terminology standards certification

general accomplishments, competences or skills that fulfil the requirements as outlined in a terminology

standards’ program
3.23
value set

uniquely identifiable set of values consisting of concept representations drawn from one or more

code system
3.24
workforce

people who provide a service or labour to contribute to business or organizational outcomes

[SOURCE: ISO 30400:2016, 10.1]
4 Abbreviations
CDA Clinical Document Architecture
CDI Clinical Documentation Improvement
CPT Current Procedural Terminology
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ISO/TS 22287:2019(E)
CT Controlled Terminology
DICOM Digital Imaging and Communications in Medicine
EHIS Electronic Health Information Systems
EHR Electronic Health Record
FHIR Fast Healthcare Interoperability Resources
HI Health Informatics
HIM Health Information Management
HICT Health Information and Communication Technology
HIT Health Information Technology
HL7 Health Level Seven
ICD International Classification of Diseases
LOINC Logical Observation Identifiers Names and Codes
SNOMED SNOMED International
SNOMED CT Systematized Nomenclature of Medicine Clinical Terms
WHO World Health Organization
5 Terminology and terminology services in healthcare

The use of clinical terminologies, such as SNOMED CT and LOINC, has been increasing as part of the

growing investments in health information technologies. There is a business need in health care

organizations to establish services to support the implementation and maintenance of e-health

solutions including electronic capture, management, sharing and use of health record content in the

context of clinical care, business processes, and information governance activities. The following

“terminology” roles, activities, and products have been identified as in demand or anticipated to be in

demand in healthcare organizations:

— Terminology subsets: Create, maintain, extend, quality assure, and distribute and/or publish

subsets and supporting derivatives.

— Terminology maps: Create, maintain, extend, quality assure, and distribute and/or publish maps

and supporting material.

— Terminology management processes/policies: Develop, manage, and update health information

management related policies and processes to manage terminologies including how to create

subsets and terminology maps, how to maintain terminologies and requests for change, how to

engage clinical experts for validation, and overall decision making processes related to terminology

management.

— Terminology business analysis: Gathering terminology requirements and defining terminology

needs for e-health solutions and/or other tools (e.g. terminology tools, tools to support health

analytics), development of recommendations for adopting, adapting or developing terminologies

to meet specific business needs, supporting the definition of functional requirements, evaluating

requirements as part of a procurement process, documenting workflow, providing terminology

guidance to support configuration as required, support deployment of solutions from a terminology

perspective (e.g. may include development of training manuals, development of test scenarios,

testing).
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ISO/TS 22287:2019(E)

— Adoption planning and deployment of terminologies: Support adoption planning and deployment

of terminologies within an organization, region, or jurisdiction as part of an overall strategic plan or

solution deployment including communication, education, change management, etc.

— Data retrieval and analysis: Utilize terminologies for effective meaning-based retrieval to support

epidemiology, research, evidence gathering and service planning (clinical and administrative), and

ensuring the organization is using health information standards appropriately and effectively.

— Decision support protocols, guidelines and other knowledge resources: Provides guidance

from a health information management perspective on how to integrate terminologies into these

resources (e.g. policy requirements, patient care outcome improvements).

— Research of clinical terms and definitions: Provide an understanding of clinical terms and how

context plays a role in selecting the correct concept or term for the right usage or setting.

Healthcare organizations and supporting organizations need a trained and experienced workforce to

support terminology activities.
6 Healthcare terminology professionals
6.1 Workforce shortage and impact

Healthcare terminology professionals are those members of the workforce who are involved in the tasks

associated with the terminology services described above. Countries that have begun HICT adoption

have reported shortfalls in the quantity and skills of the workforce in health information technology,

health information management and health informatics. Specific examples of countries’ workforce

needs are presented in Annex A.

Annex A indicates the human resource competencies and skills impact on adoption of HICT technologies,

investments in HICT, and workforce impact have been identified as the following two key demand

drivers in various countries:
a) the “employment effect” - increases the number of professionals required;

b) the “skill broadening effect” - many professionals require additional training or experience to meet

terminology services demands.

The occupational group of terminology specialist was specifically identified as needing to grow in

[22]

number and also requiring broader skills . Organizations such as SNOMED International have begun

investing in developing educational materials to promote the effective deployment and use of its

product – SNOMED CT.

6.2 Terminology specialists: Roles, job and skills requirements, and qualifications

Annex B provides the list of specific roles related to terminology and terminology services in healthcare

organizations and related supporting organizations. These include, but not limited to

— terminologist,
— terminology author,
— terminology standards developer/manager,
— mapping specialist,
— data conversion analyst,
— user interface analyst,
— coding specialist,
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ISO/TS 22287:2019(E)
— data developer/designer,
— data modeler, and
— content manager (including clinical documentation improvement specialist).

These various roles can be consolidated under the three levels of specialists performing terminology

services:
Level 1 — Terminology technical specialist
Level 2 — Terminology specialist
Level 3 — Terminology advanced specialist

The following sections describe the roles, job requirements, terminology skill requirements, general

skills and qualifications for each level. Specific tasks under these roles have to take into account the

focus of the task from the perspective of HICT, information management, information governance

(including information privacy and security), clinical practice and healthcare decision making.

6.2.1 Terminology technical specialist
6.2.1.1 Role

The role of the Terminology technical specialist is to be responsible for the technical and/or

tooling aspects of terminology development, mapping, terminology analytics, maintenance and

implementation. The Terminology technical specialist will work in a team setting with clinicians,

project teams, operational teams, business analysts, mapping specialists and terminology specialists

providing knowledge transfer to clients and team members, implementation support, development of

terminology deliverables and overall maintenance of mappings or other products. A key function of this

role is the ability to contribute to data quality development and maintenance by enabling the primary

and secondary functional aspects of developing, implementing, and managing terminology products.

6.2.1.2 Job requirements

— Responsible for technical management of healthcare data including but not limited to the following:

— Data export from a database to a terminology tool;

— Design and execution of queries on data within a terminology tool or database to support

terminology business functions including data analytics;

— Configuration and maintenance of terminology tools including application rules engine(s);

— Installation of version upgrades and managing database functions;
— Provision of backups and ensuring redundancy of data holdings.

— Participate in the selection of tools for mapping, terminology searching, browsing and selecting

terminology authoring, and maintenance.
— Provide terminology tool training, installation, and updates.
— Manage subscription services.

— Support both the clinical, business and technical resources within a project and program.

— Provide the liaison between both types of resources;
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ISO/TS 22287:2019(E)
— Provide mentorship to junior resources and other team members.

— Provide support in the terminology use and requirements for implementation of data content in

HL7 and DICOM standards and/or value sets including messaging, data content, and documents.

— Provide continuous knowledge transfer with clients and other resources on the team, including

knowledge transfer for new members to the project or team.
— Governance:

— Ensure the standards, guidelines, procedures, health information management related policies

and process are aligned with client’s existing policies and standards development organizations

and assist with development of new health information management related policies.

— Identify potential issues and the impact of existing regulations to the project, and for continued

use of the program.

— Responsible for documentation related to terminology work which will include the following:

— Status updates;
— Assumptions, risks, issues, principles, and decisions;
— Roles, responsibilities, and processes for sustained use of mappings.

— Develops or utilizes a quality assurance framework for terminology deliverables including the

following:
— Quality assurance process for procedures and deliverables;

— Developing evaluation methods including development of scripts to verify data integrity;

— Manages the use of terminology testing tools and associated processes;
— Versioning as part of maintenance and sustainability.
— Communication:
— Provides updates to the team and client (tailored to the specific audience).
— Develops material to enable a good understanding of options analysis.
— Work to ensure a high level of client satisfaction.
6.2.1.3 Skills requirements for terminology services

— An understanding of the distinction between classifications and clinical terminologies.

— Experience with developing processes for managing unstructured and structured data.

— Experience with and knowledge of terminology tools and tooling requirements.

— Experience with and understand natural language processing, data mining and artificial intelligence.

— Understand how the coded data is represented in HL7 standards such as Version 2.x, V3, CDA, FHIR.

— Understanding of terminology and mapping principles, terminology business functions, and best

practices.

— Understand concept representation and links to alternative terms (synonyms) including terms in

different languages.
— Expertise and understanding of healthcare clinical information systems.
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ISO/TS 22287:2019(E)

— Broad understanding and experience with healthcare vocabularies including the World Health

Organizations Family of Classifications and national code system extensions and standards.

— Broad understanding and knowledge of clinical terminologies such as SNOMED CT, LOINC.

— Understanding of standards development organizations and their role in and ownership of

terminologies.

— Knowledge of healthcare industry and current global healthcare informatics standards.

— Database query knowledge and experience.
— Experience working with transactional databases and data warehouses.

— Experience with extract, transform, and load of data from databases and data warehouses.

— Understand effective practical and strategies for search and data capture.

— Experience and understanding of the various options from a technical perspective of the possible

terminology solutions to support an implementation.

— This would include understanding of the types of limitations that might occur in some clinical

systems (such as limitations in field length and data element structure) and the ways that these

limitations can be addressed.

— Understanding of licensing requirements for terminologies and clinical information systems,

electronic medical and electronic health records.

— Understanding of retrieval and analysis approaches to meet different business needs.

— Awareness of meaning-based retrieval and the value of description logics in supporting this is

also required at least for the advanced roles.
...

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