ISO/TS 17439:2014

TECHNICAL ISO/TS
SPECIFICATION 17439
First edition
2014-11-01
Health informatics — Development
of terms and definitions for health
informatics glossaries
Informatique de santé — Développement des termes et définitions
pour les glossaires d’informatique de santé
Reference number
ISO/TS 17439:2014(E)
©
ISO 2014

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ISO/TS 17439:2014(E)

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ISO/TS 17439:2014(E)

Contents Page
Foreword .v
Introduction .vi
1 Scope . 1
2 Normative References . 1
3 Terms and Definitions . 1
4 Principles, rules, and content . 3
4.1 Overview . 3
4.2 Term entry . 4
4.3 Term definition . 5
4.4 Context description . 6
4.5 Source . 6
4.6 Usage comment . 7
4.7 Image . 7
4.8 Document/s in which the term/definition is used . 7
4.9 Category . 7
4.10 Version . 8
4.11 Version Date . 8
4.12 Rationale for change. 8
Annex A (informative) Collaboration on glossary development processes and content .9
Annex B (informative) Template for harmonization proposals in balloted documents .13
Annex C (informative) Template for harmonization proposals to the SKMT
Governance Committee .15
Bibliography .17
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ISO/TS 17439:2014(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 on the meaning of ISO specific terms and expressions related to conformity
assessment, as well as information about ISO’s adherence to the WTO principles in the Technical Barriers
to Trade (TBT) see the following URL: Foreword - Supplementary information
The committee responsible for this document is ISO/TC 215, Health informatics.
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ISO/TS 17439:2014(E)

Introduction
General Introduction
Health Informatics is serviced by multiple Standards Development Organizations, each with their
own need for consistent definitions of the terms they use. The evolution of glossaries across these
organizations has resulted in standards products where, increasingly, terms are defined and/or used
in different ways. This situation leads to a lack of clarity in the use and meaning of health informatics
around the world.
There are many national and international efforts to write and use clear standards to support the
development of electronic health care initiatives. There are many standards and terms defined,
however, finding the relevant standard, recording suggested improvements, and encouraging the use
of standard terms is an ongoing issue to all involved in the development of these documents and in
their use. This Technical Specification provides details of the metadata and requirements for inclusion
and construction of quality terms and definitions in health informatics glossaries. In the context of the
recognised requirement for a single international health informatics glossary, the following are the
purposes of this Technical Specification:
— to collate relevant standards and guidance for the development of quality terms and definitions;
— to provide procedural standards for the introduction and management of terms in health informatics
standards products in order to rationalize the use of these terms;
— to reduce the effort required for standards development to create and decide upon terms and
definitions used in the documents produced by health informatics standards organizations;
— to support the development of international e-health initiatives through a consistent approach to
development and use of terms and definitions.
Quality definitions and term specification includes the following:
— consistent structure of terms, synonyms, and acronyms to support lookup;
— representation of definitions in a manner which is clear and fulfills the purpose of a definition;
— consistent provision and structure of metadata to explain further, provide examples and links to
standards documents and standards processes to support maintenance of terms and definitions in
an ongoing improvement environment.
The shared online tool of the Joint Initiative Council of Health Informatics Standards Development
Organization’s (JIC) which uses these metadata is the Standards Knowledge Management Tool Glossary
(www.skmtglossary.org). The Standards Knowledge Management Tool (SKMT) is an Internet-based tool
designed to assist in finding and managing standards documents, products, terms, and definitions. Each
term and associated definition can be linked back to the document/s within which it is used (even if
that link is simply to an organizations glossary). This Technical Specification provides metadata which
supports the SKMT or any other similar functional need in the body of the document, while details
of emerging procedures of the SKMT Governance Committee of the JIC are in Annex A, Annex B, and
Annex C.
Business Need
When a new standard is developed, the terms used in that standard are defined and explained. Over
time, there have been an increasing number of terms used with a variety of definitions. There are single
terms with multiple definitions and different terms with synonymous definitions. The rapid evolution
of health informatics is demonstrated by the emergence of terms and increasing confusion over their
meaning and use. There is a need to clearly define the terms and where these terms are used in a specific
context. When there is a specific context to identify how that context represents a meaning which is
different to the more general use of the term. This Technical Specification describes a consistent
approach to term usage and structure and defines the mechanism for ongoing management.
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The availability of a readily accessible tool to identify accepted definitions will make standards
development an easier process and provide a resource to the health informatics community that will
assist communication and understanding of the complex issues of health informatics. Such a tool will
equally assist the ongoing management of the glossary and the standards in which the terms are used.
This Technical Specification
— provides a standardized metadata construct for the representation of glossary information for
health informatics,
— provides procedural standards for the introduction and management of terms in health informatics
standards publications in order to rationalize the use of these terms,
— supports a consistent approach to the use of terms and definitions in health informatics standards,
— reduces the effort required in standards development by providing a document available to all who
develop terms and definitions for health informatics projects, and
— supports the development of international e-health initiatives through a consistent approach to
development and use of terms and definitions.
This work stems from the following three needs:
a) to improve communication and understanding within the international health informatics
community, within and outside the standards environment. Consistent and clear use of terms and
understanding of the definitions of these terms can significantly enhance the ability for health
informatics programs around the world to deliver their required outcomes. Open availability of
this information in a quick and simple manner can reduce confusion and encourage both the use
of standards and the appropriate use of language within the community, thereby increasing re-
usability and information sharing;
b) to improve and simplify the standards development process by giving access to existing definitions,
thereby encouraging harmonization (or the movement towards a single definition or the clear
statement of the context within which a specific alternative definition applies). There is also a need
to be able to identify the terms in a given document and to update them to agreed definitions over
time;
c) to enhance the standing of the standards community by providing clear guidance on terms to be
used. This represents leadership of the community through provision of a public good, as well as a
tool to assist their own operations.
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TECHNICAL SPECIFICATION ISO/TS 17439:2014(E)
Health informatics — Development of terms and
definitions for health informatics glossaries
1 Scope
This Technical Specification provides details of the metadata and requirements for quality terms and
definitions in health informatics for inclusion in health informatics glossaries.
This Technical Specification does not cover specification of terminological content in systems, such as
that represented in terminological resources, such as SNOMED, CT, or, ICD. It is limited to terms and
definitions included in standards documents.
This Technical Specification is applicable to the following groups:
— Health informatics standards developers and standards development organizations.
Standards developers and organizations are direct beneficiaries of this work as standardized
representation of terms and definitions readily available through the SKMT can make standards
development faster and more consistent. The metadata also support maintenance functions for
review and update of standards publications.
— Developers, implementers, and managers of health information systems, clinical information
systems, and clinical decision support systems.
This audience is a beneficiary of this work through more consistent terminology in standards
documents, making them clearer and easier to implement.
— All users of health information systems clinical data, such as health statisticians, researchers,
public health agencies, health insurance providers, health risk organizations, data analysts, and
data managers.
2 Normative References
The following documents, in whole or in part, are normatively referenced in this document and are
indispensable for its application. For dated references, only the edition cited applies. For undated
references, the latest edition of the referenced document (including any amendments) applies.
ISO 704:2009, Terminology work — Principles and methods
ISO/IEC 2382-1:1993, Information technology — Vocabulary — Part 1: Fundamental terms
3 Terms and Definitions
For the purposes of this document, the following terms and definitions apply.
NOTE Where there are terms used in this Technical Specification that are not defined in this section, they
are considered to be generic to the English language and not specific to this Technical Specification. Additional
definitions and terms can be found at the international health informatics Standards Knowledge Management
Tool and Glossary website www.skmtglossary.org.
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3.1
abbreviation
designation formed by omitting words or letters from a longer form and designating the same concept
[SOURCE: ISO 1087-1:2000]
EXAMPLE HL7 is an abbreviation of Health Level Seven.
Note 1 to entry: An abbreviation does not define the meaning of the word it replaces; it functions as a specific type
of synonym.
3.2
acronym
abbreviation made up of the initial letters of the components of the full form of the designation or from
syllables of the full form and pronounced syllabically
[SOURCE: ISO 1087-1:2000]
EXAMPLE UNICEF - United Nations Children’s Fund
3.3
concept
unit of knowledge created by a unique combination of characteristics
[SOURCE: ISO 1087-1:2000]
Note 1 to entry: A concept can be represented using one or more terms, pictures, icons, or sounds.
Note 2 to entry: Informally, the term “concept” is often used when what is meant is “concept representation”.
However, this leads to confusion when precise meanings are required. Concepts arise out of human individual
and social conceptualizations of the world around them. Concept representations are artefacts constructed of
symbols. [SOURCE: ISO 17115].
Note 3 to entry: Concepts are not necessarily bound to particular languages. They are, however, influenced by the
social or cultural background which often leads to different categorizations. [SOURCE: ISO 1087-1:2000]
Note 4 to entry: For the purposes of health informatics glossaries, a term (in a given language and context) is
considered to represent a concept uniquely and therefore, term and concept are synonymous in their intent.
These words are not synonyms in a terminological resource context.
3.4
context
text which defines the use case, situation, or environment of a specific definition for a term
EXAMPLE Noun, verb, country (e.g. UK), area of healthcare (e.g. Pharmacy), or organization (e.g. HL7).
Note 1 to entry: This definition differs from ISO 1087-1:2000 as there is a business need in the environment of
standards development organizations sharing health informatics glossary content to make context explicit and to
move towards having a single definition for a term in a specified context.
3.5
definition
representation of a concept by a descriptive statement which services to differentiate it from related
concepts
[SOURCE: ISO 1087-1:2000]
3.6
designation
representation of a concept by a sign which denotes it
[SOURCE: ISO 1087-1:2000]
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3.7
synonym
one or more words of the same language that have the same meaning in some or all senses
Note 1 to entry: A synonym replaces a word in a sentence and is of similar size to that word. It does not necessarily
explain the meaning intended. A synonym is not a shortened form of the original word, such as an abbreviation.
Note 2 to entry: Taken from Webster’s Dictionary, modified.
3.8
synonymy
relation between or among terms in a given language representing the same concept
[SOURCE: ISO 1087-1:2000]
Note 1 to entry: Appendicectomy and appendectomy.
Note 2 to entry: Terms which are interchangeable in all contexts are called synonyms; if they are interchangeable
only in some contexts, they are called quasi-synonyms.
3.9
term entry
linguistic representation of a concept being defined in the glossary
Note 1 to entry: In this Technical Specification, the word “term” is used to indicate term entry.
Note 2 to entry: A term can contain symbols and have variants, e.g. different forms of spelling.
3.10
term and definition harmonization
activity leading to the establishment of a correspondence between two or more closely related or
overlapping concepts
Note 1 to entry: The purpose of concept harmonization is to improve communication. Concept harmonization
occurs where a term has professional, technical, scientific, social, economic, linguistic, cultural, or other
differences, in order to eliminate or reduce minor differences between them. (See ISO 860:2007.)
3.11
term family
group of defined terms that are related in that each assists in the definition of other members of the
group
EXAMPLE Health record, healthcare record, electronic health record. The health record could be considered
the least specific, healthcare records relate not to health in any context, but to the care provided in relation to
health and could be considered a synonym of medical record, while electronic health record implies a format
or functionality of the health record. Once health record is defined, it is easier to define healthcare record and
electronic health record, as it is not necessary to define the base from which the definition begins.
Note 1 to entry: Guidance is provided later in this Technical Specification on what terms are appropriate to a
family. It is acknowledged that further testing of this process will be required through the implementation of this
Technical Specification.
4 Principles, rules, and content
4.1 Overview
A term can occur many times, each time with different identifying characteristics/metadata. These
characteristics include: the definition of the term (4.3), the description of context in which that definition
applies (4.4), the original source of the definition (4.5), examples and comments on the use of the term
(4.6).
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To support harmonization, definitions in health informatics glossaries should be linked to the documents
in which they occur (4.8). Metadata requirements to support glossary maintenance include categories
for the status of the definition (4.9) and rationale for modifications made (4.12).
No organization or standard “owns” a term. Definitions are linked to documents which are owned,
or created by standards development organizations. In the SKMT Glossary tool, organizations can
determine their definitions and create their own glossary by searching by organization for terms linked
to their documents. The processes of the SKMT Glossary are not defined here, as they are provided in
detail in the User Guide.
The process for harmonization of terms/definitions in each individual standards development
organization is different. Procedures are currently in trail and administered by the SKMT Governance
Committee of the Joint Initiative Council of the Health Informatics Standards Development Organizations.
4.2 Term entry
The term is the word or group of words being defined in the glossary. An organizational health informatics
glossary should include an entry for any term that would normally be included in terms and definitions or
glossary section/s of a document or product. More extensive explanations of the principles and processes
for development of quality definitions are provided in ISO 704:2009. A summary of these requirements
is provided in this Technical Specification. ISO/IEC 2382-1:1993 provides guidance on abbreviations,
definitions, and representation, and though this relates more specifically to terminologies in general,
these principles apply through this Technical Specification. This Technical Specification supports but
does not override the requirements specified in ISO 10241-1:2011 but it does encourage consistency,
which will support database application of term/definition content which is not a primary objective of
this Technical Specification.
A term/definition cannot be recorded without a term. A term entry is therefore a required element and
should include any term that would normally be included in a terms and definitions or glossary section
of a document or product.
A term is mandatory and should be
— a word or group of words,
— written in full,
— singular,
— in sentence case (leading capital then lower case throughout), and
— positive rather than negative, though negative concepts may be included if essential to clear
meaning.
For example,
— Policy - not policies, and
— Electronic health record – not EHR.
Reference: ISO 11179-4
An entry of the name of an organization shall be written in full and the definition shall be a description of
that organization, while the abbreviation or acronym of the organization should be listed as a synonym
of the full name.
Terms can be defined in different languages. Where required, alternative forms of English can be
indicated as specific languages (e.g. US English is not the same as English).
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Figure 1 — The relationship between the “core term” and terms/definitions in other languages.
The term is the preferred term in the language being used. Synonyms, related terms, and abbreviates
can also be included but are not the “core” term.
4.3 Term definition
Each term entry may have many definitions, but there should be just one definition for a term in any
given context. The definition is a textual description of the meaning of the term. Images may be included
to more clearly describe what is intended.
Where a term is to be defined, this shall be done in consideration of not only this term but other terms to
which this term relates (other terms in the family of terms). For example, do not define electronic health
record alone. To accurately define this concept, it is necessary to understand the “family” to which it
belongs. The electronic health record family of terms could include health record, healthcare record,
medical record, and personal health record. The “term family” should be defined as a group rather than
individually, as the understanding and consistent definition of the whole significantly improves the
understanding and utility of the individual members of the family.
The definition shall (extracted and summaries from ISO 704:2009)
a) Establish difference between existing concepts.
For example, what is the difference between terminological system and code system or classification
system? The logical difference is that a code system is not necessarily human readable, i.e. a code
system does not have to contain terms, while a classification is a terminological system but has
additional characteristics for specific purposes in healthcare. These additional differentiating
elements should be included and clear in the definition.
b) The definition shall define the concept, while the Usage Comment should give examples, and describe
in more detail what is meant. Definitions shall not include long rambling examples or inclusions.
Inclusion of examples and comments will make harmonization more difficult
c) Not include the term or its synonym/s or abbreviations or other forms (noun instead of verb) in the
definition
d) Use dictionary style. Phrases such as “Word means” or “This describes a situation” in which
definition development can begin with full sentences or explanations, but these additional words
shall be edited out of your final definition.
e) Use correct grammar. For example, write the definition to match the part of speech. If the term is a
verb, the definition will probably begin with “to” while nouns are likely to begin with “a” or “the”.
f) Use simple language. For example, “use” rather than “utilize”. Also consider where there is a highly
complex definition used by a specialist area of the community, this should be given the context –
Formal (as in formal definition), while the simple, plain language version of the definition should be
the one used as the “core definition”, the one used across all contexts not declared.
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g) Be able to replace the term in context. Additional information shall be given only in the Usage
Comments as examples or notes to the entry. For example,
1) The definition of terminology might be: structured human-readable and machine-readable
representation of concepts and relationships,
2) The definition of mapping might be: The process of associating concepts from one terminology
to concepts in another terminology.
3) Can the definition of terminology be used in the mapping definition and have meaning retained?
The process of associating concepts from one structured human-readable and machine-readable
representation of concepts and relationships to concepts in another structured human-readable and
machine-readable representation of concepts and relationships.
In this definition, the replacement of the word terminology works well and therefore, this definition of
terminology meets the requirement of being able to appropriately replace the term in a sentence.
h) Be a single phrase specifying the concept, and if possible, reflecting the position of the concept in
the concept system.
4.4 Context description
This makes the situation or organization to which this definition of the term applies clear. This is also
called specialization context. This is a free text field that is r
...