Health informatics - Vocabulary - Maintenance procedure for a web-based terms and concepts database

This document describes the general requirements on a terms and concepts database. This document also proposes a maintenance procedure for CEN/TC 251, the content, structure and user interface to a web-based terms- and concepts database that will compile the defined concepts with their preferred terms and definitions from the standards developed by CEN/TC 251. These are terms from the health informatics field and not all terms and concepts used in healthcare.
It also describes an example of an implementation and ends with a proposal for CEN/TC 251 for the establishment and maintenance of such a terms and concepts database.

Medizinische Informatik - Vokabular - Verfahren zur Pflege von webbasierten Datenbanken für Benennungen und Begriffe

Informatique de santé - Vocabulaire Informatique Médical - Procédure de maintenance

Zdravstvena informatika - Slovar - Postopek vzdrževanja za spletno bazo izrazov in pojmov

General Information

Status
Published
Publication Date
30-Nov-2006
Technical Committee
Current Stage
6060 - National Implementation/Publication (Adopted Project)
Start Date
01-Dec-2006
Due Date
01-Dec-2006
Completion Date
01-Dec-2006

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SLOVENSKI STANDARD
SIST-TP CEN/TR 15212:2006
01-december-2006
1DGRPHãþD
SIST ENV 12017:2003

Zdravstvena informatika - Slovar - Postopek vzdrževanja za spletno bazo izrazov in

pojmov

Health informatics - Vocabulary - Maintenance procedure for a web-based terms and

concepts database
Medizinische Informatik - Vokabular - Verfahren zur Pflege von webbasierten
Datenbanken für Benennungen und Begriffe

Informatique de santé - Vocabulaire Informatique Médical - Procédure de maintenance

Ta slovenski standard je istoveten z: CEN/TR 15212:2006
ICS:
01.040.35 Informacijska tehnologija. Information technology.
Pisarniški stroji (Slovarji) Office machines
(Vocabularies)
35.240.80 Uporabniške rešitve IT v IT applications in health care
zdravstveni tehniki technology
SIST-TP CEN/TR 15212:2006 en

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

---------------------- Page: 1 ----------------------
TECHNICAL REPORT
CEN/TR 15212
RAPPORT TECHNIQUE
TECHNISCHER BERICHT
October 2006
ICS 01.040.35; 35.240.80 Supersedes ENV 12017:1997
English Version
Health informatics - Vocabulary - Maintenance procedure for a
web-based terms and concepts database

Informatique de santé - Vocabulaire Informatique Médical - Medizinische Informatik - Vokabular - Verfahren zur Pflege

Procédure de maintenance von webbasierten Datenbanken für Benennungen und
Begriffe

This Technical Report was approved by CEN on 8 August 2005. It has been drawn up by the Technical Committee CEN/TC 251.

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

Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania,

Slovakia, Slovenia, 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

© 2006 CEN All rights of exploitation in any form and by any means reserved Ref. No. CEN/TR 15212:2006: E

worldwide for CEN national Members.
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CEN/TR 15212:2006 (E)
Contents Page

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

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

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

2 Abbreviations.........................................................................................................................................5

3 Strategy for defining a Terms and Concepts database.....................................................................5

4 General requirements on a language for notation of concept models............................................6

5 Proposal for a CEN/TC 251 Terms and Concepts database .............................................................9

Annex A .............................................................................................................................................................11

Annex B A semantic model for terminology (semantic meta model) .........................................................18

Annex C Explanatory comments to Figure 1.................................................................................................20

Annex D Definitions of concepts for healthcare, from a healthcare record

perspective...........................................................................................................................................21

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CEN/TR 15212:2006 (E)
Foreword

This Technical Report (CEN/TR 15212:2006) has been prepared by Technical Committee

CEN/TC 251 “Health Informatics”, the secretariat of which is held by NEN.
This document supersedes ENV 12017:1997.
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CEN/TR 15212:2006 (E)
Introduction

The need for a coherent and precise terminology in health informatics is obvious. The overall

problem of supplying concept systems and reference terminologies with international scope

for all of healthcare information is gigantic but is approached by different organisations and

strategies where formal standardization aims for a facilitating role.

This document addresses the much more limited problem of the terminology of informatics

and in particular the terminology used in health informatics standards. Vocabulary

harmonisation across standards in the field is an important quality requirement and with the

growing complexity of health informatics, easy to use tools are needed to manage this. We

have to accept that in some aspects terminology and definitions of the associated concepts

are developing over time. It is therefore important for the vocabulary to be continuously

updated with new terms and unambiguous definitions with references to the normative

documents where they are approved.

In ENV 12017 a procedure was described in which a published standard would regularly be

issued with the most recent terminology. Given the fast development and requirement for

easy access, CEN/TC 251 decided in March 2000 to instead target a freely available

database with web access, which would present the terms and definitions of the CEN/TC 251

standards. The intended capacity to present concept models graphically when available,

together with the traditional verbal definitions, makes it extra valuable.
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CEN/TR 15212:2006 (E)
1 Scope

This document describes the general requirements on a terms and concepts database. This

document also proposes a maintenance procedure for CEN/TC 251, the content, structure

and user interface to a web-based terms- and concepts database that will compile the defined

concepts with their preferred terms and definitions from the standards developed by CEN/TC

251. These are terms from the health informatics field and not all terms and concepts used in

healthcare.

It also describes an example of an implementation and ends with a proposal for CEN/TC 251

for the establishment and maintenance of such a terms and concepts database.
2 Abbreviations
T&C Terms and concepts
3 Strategy for defining a Terms and Concepts database

Definitions of concepts reached by graphic modelling are in some situations preferable to text-

only definitions. By concept modelling, the relation to other concepts can become clearer and

possible overlaps and circular definitions become overt. In many CEN/TC 251 standards,

graphic models are used to define concepts, especially when full information models are

presented but there are also many concepts in the existing standards that are defined with

verbal definitions only. CEN/TC 251 should seek to develop concept models in the future

work.

The database should therefore have the capacity to present the definitions both verbally and

graphically.

This document starts with an introduction to graphic modelling where general requirements on

different types of models are described.

However, terms as identifiers of concepts are of course also essential. By mapping preferred

terms and synonyms to concepts defined by their links to surrounding concepts, it is possible

to create a dictionary. The synonyms can also be national terms. In the multilingual Europe

this would be of special interest. The database can also hold synonyms intended for technical

use in ICT-systems such as XML-tags in addition to terms intended for human reading.

If the field of usage of a term mapped to a certain concept is specified, it is possible to use the

same term in some other specified context mapped to another concept. If implemented in the

database, handling of homonyms and versions is made possible. By indicating the status and

source for terms and concepts, inclusion of normative information from other standardisation

bodies than CEN is made possible.

The intended content of terms and concepts will be collected from existing normative

documents with reference to it’s source and domain.

A meta-model for the relations in between terms and concepts and the usage and source of

terms is presented in Annex B.

Functional demands on a web-based, graphical terms- and concepts database has been

described by STG (Swedish General Standards Group) within SIS – Swedish Standards

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CEN/TR 15212:2006 (E)

Institute in relation to its work on geographical information systems. This work is presented in

Annex A.

An investigation and enquiry was made during this project on available tools that met these

requirements. The result of this is presented below under Clause 4.11 Available tools.

Finally, essential aspects of the maintenance procedure required are presented. Please note

that the important issue of resources for such work is outside the scope of this document.

4 General requirements on a language for notation of concept models
4.1 Different models have different purposes

To be able to understand and interpret a model, it is necessary to know for what purpose the

model is made and what it describes. It is important to distinguish between concept models

and data models, since they describe two separate phenomena.
4.2 Concept models

Concept models describe the language (terms and concepts) that is used when people

communicate within and about a certain activity. The purpose with a concept model is to

explain the meaning of a concept that is to be denominated by a certain term.
4.3 Information models

Information models are different collections of models used in connection to production of

information systems. They depict the information to be handled in the information system. The

purpose of a information model is to show how the information to be handled is structured and

processed.

Concept modelling is a prerequisite for making a correct information model, since the

information model is described by terms; and if they are not unambiguously defined by

concept modelling, we don’t know exactly what we are describing.

The relations in between concept-, process- and information models are illustrated in Figure 1.

4.4 Languages for modelling

The structure of natural languages people are using in between themselves differ a lot from

the structure of data to be handled automatically. Modelling languages intended for concept

modelling offer simple descriptions of the linguistic constructions people use. But since

natural language constructions can not simply be implemented in an information system,

information and data modelling languages are not primarily intended for simple depiction of

these linguistic constructions.

A language for concept modelling should be as simple as possible to learn for a person not

used to read models, since concept modelling is mostly involving skilled professionals from

the floor with no previous experience in modelling. It should preferably contain as few

components as possible, and a restricted amount of syntax.

A language for information modelling is on the contrary intended to be used and read by

system professionals, needing a rich and more complicated syntax. UML – Unified Modelling

Language is the de facto standard for this purpose used in CEN/TC 251 standards. A

restricted set of UML syntax can be used for concept modelling but in some examples of

concept models other syntaxes are used, as shown in the examples in Annex D.
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CEN/TR 15212:2006 (E)
Perceived Present catch of Terms
needs enterprise terms used
selection of
formulating process analyse
terms
Specified Process
directs
Term list
needs model
selection
delimitation of area
formulating BPR concept analysis
Specified New process
directing Concept model
objective (target process)
published in
meaning
T&C
iinformation modelling mapping of terms
database
stored in
Information model
content Terminologi
systemazing
System model
programming
Prototype
testing
Parts of process which is
performed together with
Product
representatives from the
(data system)
working floor
Figure 1 — Working process for development of enterprise supporting datasystems
(for explanatory comments, see Annex C)
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CEN/TR 15212:2006 (E)
4.5 Semantic meta model

There is a need for a semantic meta model that defines the relations in between terms and

concepts, the usage of terms, and how concepts relate to each other, thus defining their

meaning.

Predefined types of relations combined with a set of cardinalities enables dynamic link

creation, and solves the previous problems with vast number of links in other term systems.

In real life the same term often applies to different concepts (homonyms) depending on the

context. It is important that the model offers a method to circumscribe the usage of terms in a

relevant manner. In healthcare this could be the specialty and/or professional group using the

term. Or it could be a local application, or a period of time.

In Annex B a semantic meta model is presented developed by Sven-Bertil Wallin during the

CEN/TC 251 WG II work on a standard for Semantic Links (see working documents
WGII/N01-09 and WGII/N01-08).
4.6 Data model

The data model for the T&C database should be based on the semantic meta model, to be

able to handle both terms of different kinds and their use, as well as the concepts and their

relations. The data model also must handle the verbal normative definitions from the

standards of each concept (possibly in versions), together with a verbal structured definition

expression; which will –derived from the graphic modelling one for each concept.
4.7 Graphic interface

It is suggested that each concept is presented in one image, containing a textual part to the

left and a graphic part to the right. On top of the textual column the recommended term for the

concept will be the headline. Accepted synonyms can be listed below the recommended term.

Below that, the normative definition of the concept (i.e. the traditional verbal definition) will be

presented, with the verbal structured expression underneath. At the bottom clarifying notes

and references to related concepts will be added when needed.

The graphic part will be interactive with the textual part and with other concept graphs. This

means that when a concept is clicked upon in a graph, it will centre itself in the picture and the

relations to surrounding concepts will be drawn. Simultaneously the corresponding text is

presented in the left column as described above.

Thus it will be possible to move around in the graphic part, step by step. Together with this,

overview graphs of variable magnification will ease the navigation, when chosen.
In Annex D an example is given to illustrate this.
4.8 Expressions for cardinality

When graphs are transcribed into textual structural definitions it is important to express

cardinality in a consistent way. Below is a recommendation for such expressions:
1:1 exactly one
0:1 may one
1:* at least one
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CEN/TR 15212:2006 (E)
0:* may several

It is imperative that cardinality can be bi-directionally depicted in graphs for definition purpose.

4.9 Specialisation

When a concept is specialised into sub concepts it is imperative that the aspect of division is

specified in the graph, together with notation of if it is an extensive or non-extensive,

overlapping or non-overlapping specialisation, as well as any combination thereof.

4.10 Text formatting conventions

Concepts should be written in bold and relations should be written in italics. Specialisations

should be written in Arial, if Times is generally used in the document, otherwise in some other

differing font.
4.11 Available tools

The only terms and concept database made known to the working group - compliant to the

general functions and demands mentioned above – was developed for the Stockholm County

Council- SLL (regional health authority). It exists on the intranet of SLL, and is also available

at www.terms.ks.se. It is based on a commercial, internationally available application tool,

suitable for the purpose.

A valuable source for the work of CEN/TC 251 is an Access database run by Dr. B. Hayes as

a working tool for a CEN/TC 215 Ad Hoc Group on terminology containing some 915 terms

and their verbal definitions, and versions from different documents.
5 Proposal for a CEN/TC 251 Terms and Concepts database
5.1 Development tool

It is suggested that the terms and concept database tool used in the Stockholm County

Council is further developed to meet the intentions and specification given in this Technical

Report.

The development tool is based on repositories that can be approached in different ways,

depending on which on top user application module chosen. One of these is an UML module.

An application tool for customized solutions is also available, and with this a module for

concept modeling compliant to the demands above has been developed. From the repository

web pages can be generated by a few keystrokes.

However, at the time of purchasing a tool for CEN/TC 251 a renewed investigation into

available solutions is recommended since the field is rapidly developing.
5.2 Implementation

Since the input of terms, concepts and their relations collected from various standard

documents requests access to a customized module for this purpose, it is preferable that the

T&C-base is installed where support is easily available. The database engine is free to

choose from common commercial products.
5.3 Maintenance
The maintenance of the T&C database requires a central management function.
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CEN/TR 15212:2006 (E)
The input of te
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