Health informatics - Time standards for healthcare specific problems (ISO 12381:2019)

This document specifies a set of representational primitives and semantic relations required for an unambiguous representation of explicit time-related expressions in health informatics. This document does not introduce or force a specific ontology of time, nor does it force the use of a fixed representation scheme for such an ontology. Rather this document provides a set of principles for syntactic and semantic representation that allow the comparability of specific ontologies on time, and the exchange of time-related information that is expressed explicitly.
This document is applicable to:
1)   developers of medical information systems in which the need is felt to have explicit time-related concepts for internal organization (e.g. temporal data bases, temporal reasoning systems);
2)   information modellers or knowledge engineers building models for the systems mentioned in (1);
3)   experts involved in the development of semantic standards on precise subdomains in health care where time-related information need to be covered, (e.g. in the study of Pathochronology, i.e. the discipline dealing with the time course of specific diseases);
4)   developers of interchange formats for messages in which time-related information is embedded.
This document is not intended to be used directly for:
1)   representing what is true in time;
2)   reasoning about time;
3)   representation of metrological time (which is covered in other standards).

Medizinische Informatik - Zeitnormen für spezifische Probleme im Gesundheitswesen (ISO 12381:2019)

Informatique de santé - Représentation du temps dans le domaine de la santé (ISO 12381:2019)

Le présent document définit un ensemble de primitives de représentation et de relations sémantiques nécessaires à la représentation univoque des expressions relatives au temps explicites en informatique de santé. Le présent document ne présente ni n'impose aucune ontologie spécifique du temps, et il n'impose pas non plus l'utilisation d'un système de représentation fixe pour ce type ontologie. En revanche, il fournit un ensemble de principes de représentation syntaxique et sémantique permettant de comparer des ontologies spécifiques du temps et d'échanger des informations relatives au temps exprimées de manière explicite.
Le présent document s'applique à la représentation de phénomènes réels survenant dans le monde réel (enregistrements dans des dossiers médicaux, par exemple) et à la description de concepts (bases de connaissances médicales, par exemple).
Le présent document est applicable:
a) aux développeurs de systèmes d'informations médicales pour lesquels des concepts relatifs au temps explicites peuvent être nécessaires à l'organisation interne (bases de données temporelles ou systèmes de raisonnement temporel, par exemple);
b) aux modélisateurs d'informations ou cogniticiens qui créent des modèles pour les systèmes mentionnés en a);
c) aux experts impliqués dans l'élaboration de normes sémantiques concernant des sous-domaines précis de la santé dans lesquels les informations relatives au temps doivent être traitées (étude de la pathochronologie, c'est-à-dire la discipline traitant du déroulement de maladies spécifiques, par exemple);
d) aux développeurs de formats d'échange pour les messages contenant des informations relatives au temps.
Le présent document n'a pas pour objet d'être utilisé directement pour:
— représenter ce qui est vrai dans le temps;
— développer un raisonnement concernant le temps; ou
— représenter le temps métrologique.

Zdravstvena informatika - Časovni standardi za vprašanja, specifična za zdravstveno varstvo (ISO 12381:2019)

Ta dokument določa nabor nazornih primitivov in semantičnih odnosov, ki so potrebni za nedvoumno predstavitev izrecnih časovno pogojenih izrazov v zdravstveni informatiki. Ta dokument ne uvaja ali uveljavlja specifične ontologije časa in ne uveljavlja uporabe vnaprej določene sheme predstavitve za tovrstno ontologijo. Namesto tega ta dokument podaja sklop načel za skladenjsko in semantično predstavitev, ki omogoča primerljivost specifičnih ontologij časa in izmenjavo časovno pogojenih informacij, ki so izrecno izražene.
Ta dokument se uporablja za:
1) razvijalce medicinskih informacijskih sistemov, pri katerih je čutiti potrebo po izrecnih časovno pogojenih konceptih za notranjo organizacijo (npr. začasne zbirke podatkov, začasni sistemi sklepanja);
2) informacijske modelarje ali inženirje znanja, ki izdelujejo modele za sisteme, omenjene v točki (1);
3) strokovnjake, ki sodelujejo pri razvoju semantičnih standardov za natančna podpodročja v zdravstvu, pri katerih je potreben zajem časovno pogojenih informacij (npr. pri preučevanju patokronologije, tj. veda o časovnem poteku določenih bolezni);
4) razvijalce formatov za izmenjavo sporočil z vdelanimi časovno pogojenimi informacijami.
Ta dokument ni namenjen za neposredno uporabo, ki:
1) predstavlja, kaj velja v času;
2) sklepa o času;
3) predstavlja metrološki čas (ki je zajet v drugih standardih).

General Information

Status
Published
Public Enquiry End Date
30-Jan-2018
Publication Date
07-Oct-2019
Technical Committee
Current Stage
6060 - National Implementation/Publication (Adopted Project)
Start Date
03-Oct-2019
Due Date
08-Dec-2019
Completion Date
08-Oct-2019

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SLOVENSKI STANDARD
SIST EN ISO 12381:2019
01-november-2019
Nadomešča:
SIST EN 12381:2005
Zdravstvena informatika - Časovni standardi za vprašanja, specifična za
zdravstveno varstvo (ISO 12381:2019)

Health informatics - Time standards for healthcare specific problems (ISO 12381:2019)

Medizinische Informatik - Zeitnormen für spezifische Probleme im Gesundheitswesen

(ISO 12381:2019)
Informatique de santé - Représentation du temps dans le domaine de la santé (ISO
12381:2019)
Ta slovenski standard je istoveten z: EN ISO 12381:2019
ICS:
35.240.80 Uporabniške rešitve IT v IT applications in health care
zdravstveni tehniki technology
SIST EN ISO 12381:2019 en,fr,de

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

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SIST EN ISO 12381:2019
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SIST EN ISO 12381:2019
EN ISO 12381
EUROPEAN STANDARD
NORME EUROPÉENNE
September 2019
EUROPÄISCHE NORM
ICS 35.240.80 Supersedes EN 12381:2005
English Version
Health informatics - Explicit time-related expressions for
healthcare-specific problems (ISO 12381:2019)

Informatique de santé - Expressions relatives au temps Medizinische Informatik - Zeitnormen für spezifische

explicites utilisées dans le domaine de la santé (ISO Probleme im Gesundheitswesen (ISO 12381:2019)

12381:2019)
This European Standard was approved by CEN on 2 March 2018.

CEN members are bound to comply with the CEN/CENELEC Internal Regulations which stipulate the conditions for giving this

European Standard the status of a national standard without any alteration. Up-to-date lists and bibliographical references

concerning such national standards may be obtained on application to the CEN-CENELEC Management Centre or to any CEN

member.

This European Standard exists in three official versions (English, French, German). A version in any other language made by

translation under the responsibility of a CEN member into its own language and notified to the CEN-CENELEC Management

Centre has the same status as the official versions.

CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia,

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

Poland, Portugal, Republic of North Macedonia, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and

United Kingdom.
EUROPEAN COMMITTEE FOR STANDARDIZATION
COMITÉ EUROPÉEN DE NORMALISATION
EUROPÄISCHES KOMITEE FÜR NORMUNG
CEN-CENELEC Management Centre: Rue de la Science 23, B-1040 Brussels

© 2019 CEN All rights of exploitation in any form and by any means reserved Ref. No. EN ISO 12381:2019 E

worldwide for CEN national Members.
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SIST EN ISO 12381:2019
EN ISO 12381:2019 (E)
Contents Page

European foreword ....................................................................................................................................................... 3

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SIST EN ISO 12381:2019
EN ISO 12381:2019 (E)
European foreword

This document (EN ISO 12381:2019) has been prepared by Technical Committee ISO/TC 215 "Health

informatics" in collaboration with Technical Committee CEN/TC 251 “Health informatics” the

secretariat of which is held by NEN.

This European Standard shall be given the status of a national standard, either by publication of an

identical text or by endorsement, at the latest by March 2020, and conflicting national standards shall

be withdrawn at the latest by March 2020.

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

patent rights. CEN shall not be held responsible for identifying any or all such patent rights.

This document supersedes EN 12381:2005.

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

following countries are bound to implement this European Standard: Austria, Belgium, Bulgaria,

Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland,

Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Republic of

North Macedonia, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and the

United Kingdom.
Endorsement notice

The text of ISO 12381:2019 has been approved by CEN as EN ISO 12381:2019 without any modification.

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SIST EN ISO 12381:2019
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SIST EN ISO 12381:2019
INTERNATIONAL ISO
STANDARD 12381
First edition
2019-07
Health informatics — Explicit time-
related expressions for healthcare-
specific problems
Informatique de santé — Expressions relatives au temps explicites
utilisées dans le domaine de la santé
Reference number
ISO 12381:2019(E)
ISO 2019
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SIST EN ISO 12381:2019
ISO 12381:2019(E)
COPYRIGHT PROTECTED DOCUMENT
© ISO 2019

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

be reproduced or utilized otherwise in any form or by any means, electronic or mechanical, including photocopying, or posting

on the internet or an intranet, without prior written permission. Permission can be requested from either ISO at the address

below or ISO’s member body in the country of the requester.
ISO copyright office
CP 401 • Ch. de Blandonnet 8
CH-1214 Vernier, Geneva
Phone: +41 22 749 01 11
Fax: +41 22 749 09 47
Email: copyright@iso.org
Website: www.iso.org
Published in Switzerland
ii © ISO 2019 – All rights reserved
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SIST EN ISO 12381:2019
ISO 12381:2019(E)
Contents Page

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

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

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

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

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

4 Explicit semantic labelling of predicational components ......................................................................................... 5

4.1 General ........................................................................................................................................................................................................... 5

4.2 Labelling of temporal expressions ......................................................................................................................................... 5

4.3 Labelling of basic temporal links ............................................................................................................................................. 6

4.3.1 General...................................................................................................................................................................................... 6

4.3.2 has-occurrence .................................................................................................................................................................. 6

4.3.3 has-rate .................................................................................................................................................................................... 6

4.3.4 has-frequency ..................................................................................................................................................................... 6

4.3.5 has-duration ........................................................................................................................................................................ 7

4.4 Labelling of complex temporal links .................................................................................................................................... 7

4.5 Temporal comparators ..................................................................................................................................................................... 7

4.5.1 General...................................................................................................................................................................................... 7

4.5.2 Temporal comparators in combination with events ......................................................................... 8

4.5.3 Temporal comparators in combination with episodes ................................................................... 9

5 Characteristics of conformance .........................................................................................................................................................14

5.1 Provisions for conformance specification ....................................................................................................................14

5.2 Basic guidelines ...................................................................................................................................................................................14

5.3 LSS: Level of semantic specification ..................................................................................................................................15

5.3.1 LSS(0) .....................................................................................................................................................................................15

5.3.2 LSS(1) .....................................................................................................................................................................................15

5.3.3 LSS(2) .....................................................................................................................................................................................15

5.3.4 LSS(3) .....................................................................................................................................................................................15

5.4 LRE: level of recursive embedding of time-related information ...............................................................16

5.4.1 LRE(0) ....................................................................................................................................................................................16

5.4.2 LRE(1) ....................................................................................................................................................................................16

5.4.3 LRE(2) ....................................................................................................................................................................................16

5.5 LDR: level of deictic referential complexity ................................................................................................................16

5.5.1 LDR(0) ...................................................................................................................................................................................16

5.5.2 LDR(1) ...................................................................................................................................................................................16

5.6 LDC: level of relative deictic referential complexity ............................................................................................16

5.6.1 LDC(0) ....................................................................................................................................................................................16

5.6.2 LDC(1) ....................................................................................................................................................................................16

5.6.3 LDC(2) ....................................................................................................................................................................................16

5.7 LQI: level of formal rigour of temporal expressions ...........................................................................................16

5.7.1 LQI(0) .....................................................................................................................................................................................16

5.7.2 LQI(1) .....................................................................................................................................................................................16

5.7.3 LQI(2) .....................................................................................................................................................................................17

Annex A (informative) BNF description of the syntax used in the standard predications of

this document .......................................................................................................................................................................................................18

Bibliography .............................................................................................................................................................................................................................19

© ISO 2019 – All rights reserved iii
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SIST EN ISO 12381:2019
ISO 12381:2019(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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SIST EN ISO 12381:2019
ISO 12381:2019(E)
Introduction

Time is an important variable in healthcare, and standards are needed about how to represent

information with explicit references to time. This document is a first contribution to this harmonization

process, focusing on “representation” and “explicit reference”.

Indeed, a system for time-standards should have as a minimum requirement the capacity to order

temporal facts (situations, events, episodes) in three major ways, independent of any specific ontology

of time itself:
— by relating situations to a calendar;
— by relating situations to “reference” situations;
— by relating events together in “before- and after-” chains.

The main reason for this threefold organization is that our everyday temporal discourse contains

a variety of expressions that can only be regimented into a uniform style of analysis with a certain

artificiality.

The purpose of this document is to enhance, in a perspective of machine-machine and person-machine

communication, the generation of statements that are guaranteed to be understood unambiguously

with respect to the time-related expressions that are embedded within them.

The purpose of this document is not to develop a full-blown temporal logic, but a standardized way of

representing time-related expressions, such that all kinds of questions about the temporal organization

of situations can be answered on the basis of the information available. Nor is it the intention of the

framework presented here to provide a means to interpret the information in its original format.

Interpretation of the source information is the task of the provider of information itself. The framework

presented in this document allows information providers to express their time-related information in

such a way that the intended meaning can be unambiguously understood by a receiver.

This of course requires the use of a “restricted”, regimented model or language, allowing the

disambiguation of many time-related expressions uttered in natural language. The model (language)

presented in this document is restricted enough to allow such disambiguation for time-related

expressions in “traditional” medical language but is not expressive enough to account for all time

related linguistic phenomena that can be encountered in natural language.

This document provides representational tools for “explicit” time-related information. It does not allow

(nor encourage) the ad hoc interpretation of implicit temporal information. In an expression such as

“diabetes since childhood”, “since childhood” is an explicit temporal reference for the diabetes, but

the implicit information what “childhood” might mean (e.g. starting at the age of 2?), is not addressed.

However, the framework presented in this document has enough expressive power to allow a specific

provider of information to state explicitly what his or her understanding is of “childhood” is.

This document describes some conformance characteristics by means of which developers of health

care information systems can label specific modules of their systems as to the degree they are

compliant with the document. Although the framework itself does not deal with temporal reasoning,

the conformance characteristics can be used to evaluate to what level temporal reasoning is possible

with the information collected in a given system.
© ISO 2019 – All rights reserved v
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SIST EN ISO 12381:2019
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SIST EN ISO 12381:2019
INTERNATIONAL STANDARD ISO 12381:2019(E)
Health informatics — Explicit time-related expressions for
healthcare-specific problems
1 Scope

This document specifies a set of representational primitives and semantic relations needed for an

unambiguous representation of explicit time-related expressions in health informatics. This document

does not introduce or force a specific ontology of time, nor does it force the use of a fixed representation

scheme for such an ontology. Rather this document provides a set of principles for syntactic and

semantic representation that allow the comparability of specific ontologies on time, and the exchange

of time-related information that is expressed explicitly.

This document applies to both the representation of actual phenomena occurring in the real world (e.g.

registrations in medical records) and to the description of concepts (e.g. medical knowledge bases).

This document is applicable to

a) developers of medical information systems where there might be a need for explicit time-related

concepts for internal organization (e.g. temporal data bases, temporal reasoning systems),

b) information modellers or knowledge engineers building models for the systems mentioned in a),

c) experts involved in the development of semantic standards on precise subdomains in health care

where time-related information needs to be covered, (e.g. in the study of pathochronology, i.e. the

discipline dealing with the time course of specific diseases), and

d) developers of interchange formats for messages in which time-related information is embedded.

This document is not intended to be used directly for
— representing what is true in time,
— reasoning about time, or
— representation of metrological time.
2 Normative references

The following documents are referred to in the text in such a way that some or all of their content

constitutes requirements of this document. For dated references, only the edition cited applies. For

undated references, the latest edition of the referenced document (including any amendments) applies.

ISO 8601-1, Data elements and interchange formats — Information interchange — Representation of dates

and times — Part 1: Basic rules

ISO 8601-2, Data elements and interchange formats — Information interchange — Representation of

dates and times — Part 2: Extensions
ISO 80000-3, Quantities and units — Part 3: Space and time
3 Terms and definitions
For the purposes of this document, the following terms and definitions apply.
© ISO 2019 – All rights reserved 1
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SIST EN ISO 12381:2019
ISO 12381:2019(E)

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
situation

phenomenon occurring (or having the potential to occur) at a particular time or over a particular time

period, in a given world context

Note 1 to entry: Situations cover phenomena which can occur in past, present or future time.

EXAMPLE "The patient suffered from pain which occurred over night", "pain occurring overnight."

3.2
property
attribute, quality, or characteristic of something
EXAMPLE "The temperature of a person."
3.3
time interval

portion of time of which the duration in a given context is considered to be significant and relevant

3.4
time point

portion of time of which the duration in a given context is considered to be insignificant or irrelevant

Note 1 to entry: This document does not specify any requirements on what entities should occupy time points,

and what entities should occupy time intervals, users are responsible for making such decisions (Clause 5).

Temporal references such as “Friday the 13th” can thus refer to a time point or a time interval, depending on the

context.
3.5
episode
situation (3.1) considered to occupy a time interval (3.3)

Note 1 to entry: Whether a situation is to be considered an episode or an event, is a decision taken by the provider

of the information, based on his or her perception of the phenomenon in a given context.

Note 2 to entry: It is possible to further subcategorize episodes into “states”, “culminations”, “processes”,

“actions”, or other conceptual entities that can be defined using additional conceptual aspects describing

particular properties of each of the various episodes. However, there is no need to do so within the scope of this

document.

EXAMPLE A patient’s stay in the hospital, the “episode of care” related to a medical problem.

3.6
event
situation (3.1) considered to occur at a time point (3.4)
3.7
predication
representation of a situation (3.1) in a language

EXAMPLE “The removal of Mr Jones’ appendix on 21 July 1994, at 9 o’clock in the morning.”

3.8
temporal reference
component of a predication (3.7) representing information related to time
2 © ISO 2019 – All rights reserved
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SIST EN ISO 12381:2019
ISO 12381:2019(E)
3.9
propositional clause

component of a predication (3.7) to which temporal references (3.8) refer implicitly or explicitly

EXAMPLE In the expression “taking syrup three times a day for 2 weeks”, the propositional clause is “taking

syrup”. To it are attached the temporal references “three times a day” and “for 2 weeks”.

Note 1 to entry: The term propositional clause is used here in a broader sense than in formal logic where a

proposition denotes a statement on what is true in a given world. In the context of this document, propositional

clauses do not impose a truth-value on the phenomena that are represented.

Note 2 to entry: This document allows for a recursive representation of information related to time (see Annex A

for a formal description). In expressions such as “severe headache lasting for half an hour after each meal”, both

“severe headache” and “severe headache lasting for half an hour” are propositional clauses, each at a different

level in the recursion. A propositional clause that is at the deepest level of recursion, i.e. to which no temporal

references are attached, is called propositional clause zero. In this example: “severe headache” is propositional

clause zero.
3.10
temporal link

component of a temporal reference (3.8) capturing the semantic relation in a predication (3.7) between

the propositional clause (3.9) and the temporal expression (3.13)

Note 1 to entry: In natural language, the temporal link can be grammaticalized with prepositions or other

constructs, such as in “on Monday”. Often, the link is not expressed explicitly, as in “tomorrow”. In formal

representations in conformity to this document, the temporal link shall be represented explicitly, or should be

unambiguously derivable from a data model.
3.11
basic temporal link
temporal link (3.10) specifying purely time-related information
EXAMPLE Has-occurrence, has-duration (see 4.4).
3.12
complex temporal link

temporal link (3.10) composed of a basic temporal link (3.11) and an embedded propositional clause (3.9)

Note 1 to entry: Complex temporal links can be used to express the contents of relational data bases according to

the provisions of this document.

EXAMPLE The predication “Severe headache this morning” can be analyzed into the propositional

clause “severe headache” and the temporal reference “this morning”. In a database management system, such

predications can be represented in a table with fields “ProblemId”, “Problem” and “TimeOfHappening”.

Time of happen-
Problem Id Problem
ing
I1 severe headache this morning
ingestion of immediately
acetylsalicylic acid after I1

In this table, the contents of the “Problem” column refer to situations, and hence shall be considered propositional

clauses and the contents of the “Time of Happening” column are all temporal references.

Often, the time of recording of problems is also recorded as useful meta-information. According to the model

above, this should be done by adding two records in the table:
I3 recording of I1 1994-07-01:18:00:32
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I4 recording of I2 1994-07-01:18:00:35

In fact, this could be repeated for each record, even for the records in which the recording of the recording of

the ... is recorded. Because only the recording time of a problem is of interest, and not the recording event itself,

the above scheme is simplified by adding an additional field, labelled “TimeOfRecording”, which is a complex

temporal link.
Problem Id Problem Time of happening Time Of Recording
I1 severe headache this morning 1994-07-01:18:00:32
I2 ingestion of immediately after I1 1994-07-01:18:00:35
acetylsalicylic acid
...

Other examples of complex temporal links are: StartDateOfSampleCollection (laboratory context), DateOfBirth

(administrative context), StartDateOfProblem, EndDateOfProblem (clinical history or diagnostic module of

electronic medical record systems), ...
3.13
temporal expression

component of a temporal reference (3.8) specifying a time point (3.4), a time interval (3.3) or any allowed

combination of time points and time intervals.

Note 1 to entry: This document does not imply any restrictions on what combinations of time points and time

intervals are “allowed” as this depends entirely on the ontology of time defined in a parti

...

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