ISO/TC 215/WG 3 - Semantic content

This document specifies a number of metadata elements that describe resources containing medical knowledge, primarily digital documents provided as web resources, accessible from databases or via file transfer, but can be applicable also to paper documents, e.g. articles in the medical literature. The metadata elements — support unambiguous and international understanding of important aspects to describe a resource, e.g. purpose, issuer, intended audience, legal status and scientific background, — are applicable to different kinds of digital resources, e.g. recommendation from consensus of a professional group, regulation by a governmental authority, clinical trial protocol from a pharmaceutical company, scientific manuscript from a research group, advice to patients with a specific disease, review article, — are possible to present to human readers including health professionals as well as individuals/patients, and — are potentially usable for automatic processing, e.g. to support search engines to restrict matches to documents of a certain type or quality level. The metadata elements defined in this document are not intended to — describe documents about a single patient, such as medical records, — describe details of the medical content of the resource (but some idea of the content can be described via keywords or codes), or — prescribe criteria for the quality of the resource content.

This document defines the components (benchmarks) of capability of terminological resources implementation in healthcare software products, including electronic health record systems. It is intended that these benchmarks form the basis of a maturity model. The document will support analysis of requirements to meet use cases in the implementation of terminological resources in healthcare. This document does not specify requirements for any specific terminological resource. It is intended to provide a basis from which requirements for terminological resources capabilities can be specified in the future. The tooling being used can impact the level of maturity reached but is not covered in detail in this document. Terminological resources include code systems of all types, terminologies, classifications, value sets, and value domains. The impact of tooling (computer–assisted coding, speech recognition, template development) on the capability of the terminological resources is not covered in detail in this document.

This document provides details of the metadata and requirements for quality terms and definitions in health informatics for inclusion in health informatics glossaries. This document 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 concepts represented as terms and definitions included in standards. This document is applicable to the following groups: — Health informatics standards developers and standards development organizations. — Developers, implementers, and managers of health information systems, clinical information systems, and clinical decision support systems. — 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.

This document describes the high-level concepts required for representation of 3D data in health information systems from a terminological perspective. It is intended to be used in analysing, developing and managing terminologies in HBPS. The use cases include clinical findings, disorders, problem lists and procedures. Topics considered in the scope of this document: — description of terminological concepts for representation of 3D data for human body; — establishing of the relationships needed for 3D data in terminological systems; — use cases. Topics considered outside the scope of this document: — 3D data structure, implementation and software functionality.

The purpose of this document is to a) define a set of basic concepts required to describe formal concept representation systems, especially for health sciences, b) describe representation of concepts and characteristics, for use especially in formal computer-based concept representation systems, c) describe the characteristics which synthetically describe the organisation and content of a terminological system in health, d) support the development of specific standards on categorial structures for particular healthcare subject fields with the minimum requirements to support meaningful exchange of information. This document is not suitable for, or intended for use, by individual clinicians or hospital administrators. It is not the purpose of this document to standardize the end user classification or to conflict with the concept systems embedded in national practice and languages. Topics considered outside the scope of this document include — enumeration of axiomatic concepts and semantic links, and — detailed content of health terminology systems (classifications, nomenclatures or reference terminology of health concepts).

This document describes requirements for collections of metadata about data elements and their containing models and datasets in a healthcare environment. The collection can serve as a repository or as dictionary describing a set of items in use in a particular domain, organisation or product for reference, or it can additionally serve as a registry, supporting the development and communication of standard items to an audience with shared goals. This document specifies standard refinements that account for the detailed governance and administration requirements that are particular to healthcare data. It focuses on the description of data that is persisted in healthcare systems rather than the specification of messages between these systems. It describes necessary extensions to the ISO/IEC 11179 series and to other International Standards on metadata originating from ISO/IEC JTC 1/SC 32 to address the wider variety of value domain types found in healthcare. Where appropriate, it also suggest restrictions/simplifications to the ISO/IEC 11179 series that promote wider adoption without compromising interoperability between metadata registries and opportunities for the development of tooling that consumes metadata for the generation or the parameterization of code.

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.

This document provides quality requirements for producing a quality map between terminological systems. This document establishes measures which can be used to assess the quality and utility of a map between terminological resources in order to determine the types and levels of measure required for common use cases in healthcare. NOTE Examples of such cases include conformity assessment.

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.

The main purpose of ClaML is to formally represent the content and hierarchical structure of healthcare classification systems in a markup language for the safe exchange and distribution of data and structure between organizations and dissimilar software products. The scope of healthcare classification systems covered by this document encompasses terminologies, and is constrained to traditional paper-based systems (like ICD-10) and systems built according to categorial structures and a cross thesaurus (like ICNP)[2]. ClaML is intended for representation of healthcare classification systems in which classes have textual definitions, hierarchical ordering, named hierarchical levels (such as "chapter", "section"), inclusion and exclusion criteria, and codes. It is not intended to cover any formal representation, neither for definition or composition of concepts, nor for specification of classification rules. Systems with such formal specifications can at best be partially represented using ClaML, and are hence out of scope. Most of the notes and examples in this document relate to ICD. This is because ICD is the most common classification system in the scope of this document. As a highly complex classification system it is an inexhaustible source for examples of nearly any kind. But all these notes and examples represent also other similar classification systems, if applicable, which are usually less complex. An overview of currently known classification systems using ClaML is provided in a separate document which is electronically available (see 7.3). This document is not intended to: a) provide a normative syntax on how a healthcare classification system is to be constructed; b) define link types between elements in a healthcare classification system (this is left to the developers of healthcare classification systems); c) provide a representation for direct viewing or printing.

This document aims to specify categorial structure in the field of cupping by defining a set of domain constraints for use within terminological resources. This document describes a concept system detailing the domain constraints of sanctioned characteristics, each composed of a semantic link and applicable characterizing categories.

ISO 17117-1:2018 defines universal and specialized characteristics of health terminological resources that make them fit for the purposes required of various applications. It refers only to terminological resources that are primarily designed to be used for clinical concept representation or to those parts of other terminological resources designed to be used for clinical concept representation. ISO 17117-1:2018 helps users to assess whether a terminology has the characteristics or provides the functions that will support their specified requirements. The focus of this document is to define characteristics and functions of terminological resources in healthcare that can be used to identify different types of them for categorization purposes. Clauses 4 and 5 support categorization according to the characteristics and functions of the terminological resources rather than the name. NOTE Categorization of healthcare terminological systems according to the name of the system might not be helpful and has caused confusion in the past. The target groups for this document are: a) organizations wishing to select terminological systems for use in healthcare information systems; b) developers of terminological systems; c) developers of terminology standards; d) those undertaking independent evaluations/academic reviews of terminological resources; e) terminology Registration Authorities. ISO 17117-1:2018 contains general characteristics and criteria with which systems can be evaluated. The following considerations are outside the scope of this document. - Evaluations of terminological resources. - Health service requirements for terminological resources and evaluation criteria based on the characteristics and functions. - The nature and quality of mappings between different terminologies. It is unlikely that a single terminology will meet all the terminology requirements of a healthcare organization: some terminology providers produce mappings to administrative or statistical classifications such as the International Classification of Diseases (ICD). The presence of such maps would be a consideration in the evaluation of the terminology. - The nature and quality of mappings between different versions of the same terminology. To support data migration and historical retrieval, terminology providers can provide maps between versions of their terminology. The presence of such maps would be a consideration in the evaluation of the terminology. - Terminology server requirements and techniques and tools for terminology developers. - Characteristics for computational biology terminology. Progress in medical science and in terminology science will necessitate updating of this document in due course.

ISO/TS 18062:2016 aims to a) specify the minimal characterizing generic concepts in herbal medicament (3.2) within terminological systems (3.8), that are required for terms used to identify of herbal medicines regulated by medicine regulatory agencies (3.10), and b) facilitate the consistency and interoperability of the terms and their designating concepts in terminological systems. In order to achieve these goals, this document specifies the minimal compositional concept representation of herbal medicament for use in terminological systems (3.8), while expressing semantic links and characterizing categories for formal definitions, with a set of domain constraints in the subject field[6] [7]. Herbal medicaments (3.2) can be classified into 1) single herbal medicament (SHM), and 2) herbal medicament composed of several kinds of SHM. NOTE Single herbal medicament is composed of only one herbal medicament. Herbal medicament composed of several kinds of SHMs is conventionally called "formula." This document is not intended to include the mixture of formulae. The specific intended use of this compositional concept representation is to - provide a well-structured backbone for terminological systems, - clarify the synonymy, homonymy and polysemy across different clinical specialties and terminological resources, - promote meaningful exchange of information among different terminological systems, - promote consistency and interoperability or re-use of terms among different terminological systems, - facilitate the representation of herbal medicines in a manner suitable for computer processing, - support developers and maintainers of terminological resources (3.7) to facilitate conformance, - support knowledge management on herbal medicines with facilitating analysis of concerned data, and - support the reduction of confusion in trade and of health hazard in consequence. The following topics are out of scope for this document: - any implementation models or database schemas, and manufacturing models; - any models or frameworks for quality control, and models for chemical and physical characteristics; - any individual pharmaceutical or medicinal products, and combinations use with modern medicines.

ISO 16278:2016 defines the characteristics required to synthetically describe the organization and content of human anatomy within a terminological system. It is intended primarily for use with computer-based applications such as clinical electronic health records, decision support and for various bio-medical research purposes. ISO 16278:2016 will serve to - facilitate the construction of new terminological systems in a regular form which will increase their coherence and expressiveness, - facilitate maintenance of human anatomy within terminological systems, - increase consistency and coherence of existing terminological system, - allow systematic cross-references between items of human anatomy in different types of terminological systems, - facilitate convergence among human anatomy within terminological systems, - make explicit the overlap for human anatomy between different health care domains terminological systems, - provide elements for negotiation about integration of different terminological systems into information systems between the respective developers, and - enable the systematic evaluation of human anatomy within terminological systems. ISO 16278:2016 itself is not suitable or intended for use by, individual clinicians or hospital administrators. The target groups for this International Standard are the following: - designers of specialized standard healthcare terminological categorial structures; - developers of healthcare terminological systems including classifications and coding systems; - producers of services for terminological systems and designers of software including natural language processing; - information modellers, knowledge engineers, and standards developers building models for health information management systems; - developers of information systems that require an explicit representation of healthcare terminological systems; - developers of marked-up standards for representation of healthcare documents. ISO 16278:2016 does not include categorial structure that might be necessary for the description of developmental anatomy during the human life cycle, which includes prenatal development, post-natal growth and aging. ISO 16278:2016 has been developed for use as an integrated part of computer-based applications and for the electronic healthcare record. It would be of limited value for manual use. It is not the purpose of this International Standard to standardize the end user classification of human anatomy terminology or to conflict with the concept systems embedded in national practice and languages.

ISO 13940:2015 defines a system of concepts for different aspects of the provision of healthcare. The core business in healthcare is the interaction between subjects of care and healthcare professionals. Such interactions occur in healthcare/clinical processes and are the justification for the process approach of ISO 13940:2015. To be able to represent both clinical content and clinical context, ISO 13940:2015 is related to a generic healthcare/clinical process model as well as comprehensive concept definitions and concept models for the clinical, management and resource aspects of healthcare services. In practice ISO 13940:2015 covers the concept definitions needed whenever structured information in healthcare is specified as a requirement. The definitions are intended to refer to the conceptual level only and not to details of implementation. ISO 13940:2015 will cover all levels of specifications in the development of logical reference models within the information viewpoint as a common basis for semantic interoperability on international, national or local levels, information systems, and information for specified types of clinical processes.

ISO/TS 13582:2015 specifies the mandatory and optional information to be recorded in any registry of OIDs, using an information model. It specifies which parts of that information are to be regarded as public and which parts are to be subject to security and privacy requirements. All registries support the recording of mandatory information, but the recording of any specific object identifier in one or more repositories is always optional. In some cases, security and privacy requirements are more stringent for e-health applications. In detail, this Technical Specification: - specifies an information model and a corresponding XML format for the export of the contents of an OID registry, suitable e.g. for import to a different OID registry; - references common Use Cases for OID registries/repositories; - references an Object Identifier Resolution System (ORS) which provides a look-up mechanism for information related to an object identifier, with guidance on the use of that facility.

The purpose of ISO/TS 16843-2:2015 is to specify categorial structures within the subject field of acupuncture by defining a set of domain constraints for use within terminological resources. This Technical Specification describes a concept system detailing domain constraints of sanctioned characteristics, each composed of a semantic link and an applicable characterizing category. The potential benefits of ISO/TS 16843-2:2015 include: a) support for developers of new terminology systems concerning acupuncture needling; b) support for developers of new detailed content areas of existing terminology systems concerning acupuncture needling procedures to ensure accuracy, repeatability and comparability; c) facilitating the representation of acupuncture needling procedures using a standard core model in a manner suitable for computer processing; d) providing a conceptual framework for the generation of compositional concept representation of acupuncture needling; e) facilitating the mapping and improved semantic correspondence between different terminologies by proposing a core specification for acupuncture needling; f) providing a core model to describe the structure of acupuncture, and facilitate improved semantic correspondence with information models; g) providing a tool for acupuncture text mining, database construction, ancient documents processing and wide area of acupuncture information collection and processing; h) providing a new method for researchers to conduct relevant research, and ideas for the development of acupuncture disciplines. Target groups include: - stakeholders such as companies that offer systems that incorporate Electronic Categorial Structures, by helping building knowledge databases or automatic processing of medical literature, and - doctors, who can be better assisted with knowledge and documentation of needling procedures. This Technical Specification can also be used in clinical decision support and to help in data mining for researchers.

ISO/TR 12310:2015 is to define a framework of good practices for terminology system maintenance and the principles for which conformance can be demonstrated. The primary focus is the application of terminology system to Electronic Health Record (EHR) systems, although the principles and guidelines can be applied broadly in health informatics The scope of ISO/TR 12310:2015 will include, at a minimum, the following considerations for keeping terminology systems and associated reference material clinically and/or technically relevant and valid: ? governance models and practices; ? high level processes; ? requirements for managing the change.

1.1 General Traditional Chinese Medicine (TCM) is a form of traditional medicine that originated in China, and is characterized by holism and treatment based on pattern identification/syndrome differentiation. The Technical Specification establishes common concepts and a vocabulary for describing the complex domain of various Traditional Chinese Medicine (TCM) informatics standards initiatives and their supporting artefacts. It provides a useful profiling framework to align existing and developing TCM informatics standards and to reference health informatics standards. It promotes the reuse of TCM informatics knowledge and improves the identification of opportunities for TCM informatics standards alignment, collaboration, and coordination. Topics considered outside the scope of this Technical Specification include: — profiling framework and classification for informatics standards of Kampo, Korean medicine, and other traditional medicine. 1.2 Main purpose The framework has been developed to address different needs of TCM informatics and compare with health informatics standards. The specific needs addressed in this Technical Specification are the following: — provide the capability to comprehensively define and classify TCM informatics standards artefacts; — facilitate the coordination, communication, and comparability of TCM informatics standards through a common understanding of intended users and content; — help identify and coordinate TCM informatics standards development; — promote TCM informatics standards integration and alignment within and between standards from different Standards Development Organizations (SDOs); and — provide a framework to assist with the coordination of ISO/TC 215 work items both within the technical committee and with related TCs, including ISO/TC 249 and ISO/TC 46. 1.3 Benefits The potential benefits of the Technical Specification include the following: — introduction of classification concepts and terminology for TCM informatics standard artefacts; — enhancement of TCM informatics standards development coordination through the identification of potential duplication between standards initiatives;  — enhancement of global understanding of TCM informatics standards in support of their knowledge management. 1.4 Target groups The target groups include the following: — managers and reviewers of TCM informatics standards; — developers of TCM informatics standards; — users of TCM informatics standards.

ISO/TS 16277-1:2015 defines a categorial structure for clinical findings in terminological systems for Traditional Chinese Medicine, Traditional Japanese Medicine, and Traditional Korean Medicine (TM-CJK). This Technical Specification defines three subcategories: pattern-TM, disorder-TM and sign&symptom-TM. Concept representations within these three categories are used to describe the states of patients in clinical records and communications. This Technical Specification is not applicable to: - a comprehensive categorial structure for TM-CJK; - an exhaustive list of all possible characterizing concepts that could be used to describe clinical findings; - terms/descriptions for individual TM-CJK concepts; - a detailed terminology of clinical findings in TM-CJK; - categorical structure of diagnosis and treatment on clinical findings in TM-CJK. NOTE This Technical Specification is limited to a subpopulation of clinical findings in traditional medicine. Other types of clinical findings are represented in ISO/TS 22789 although it has not been tested for this purpose.

ISO/TR 12300:2014 provides guidance for organizations charged with creating or applying maps to meet their business needs. It explains the risks inherent in the mapping process and discusses the issues that need to be considered in the development, maintenance, and use of maps in health care. This Technical Report also identifies variations in process, precision, and administration when mapping for different purposes and in different environments. Importantly, this Technical Report establishes and harmonizes the basic principles for developing, maintaining, and using maps and gives guidelines for good practice that underpin the mapping process. Terminological resources includes terminologies, classifications, and code systems used in the regulatory environment as it relates to healthcare and reporting requirements in healthcare. This Technical Report is general in nature and does not describe the specific methods applied in the mapping process nor does it describe maps between databases and data sets, even though many of the principles stated here will apply to those types of maps. This Technical Report does not include consideration of the intellectual property rights and expectations of the owners of terminologies or classifications. It is the responsibility of the mapper and process to ensure that these legal rights are protected and acknowledged as part of the mapping processes.

ISO 18104:2014 specifies the characteristics of two categorial structures, with the overall aim of supporting interoperability in the exchange of meaningful information between information systems in respect of nursing diagnoses and nursing actions. Categorial structures for nursing diagnoses and nursing actions support interoperability by providing common frameworks with which to analyse the features of different terminologies, including those of other healthcare disciplines, and to establish the nature of the relationship between them, develop terminologies for representing nursing diagnoses and nursing actions, develop terminologies that are able to be related to each other, and establish relationships between terminology models, information models and ontologies in the nursing domain. It is applicable to the following user groups: developers of terminologies that include nursing diagnosis and nursing action concepts; developers of categorial structures and terminologies for other healthcare domains, to support clarification of any relationship to or overlap with nursing concepts; developers of models for health information management systems such as electronic health records and decision support systems, to describe the expected content of terminological value domains for particular attributes and data elements in the information models; developers of information systems that require an explicit system of concepts for internal organization, data warehouse management or middleware services; developers of software for natural language processing, to facilitate harmonization of their output with coding systems. It is not intended for use by clinical nurses without health informatics expertise. However, it provides an introduction to categorial structures to assist those without health informatics expertise to contribute to its development, review, implementation and evaluation. Topics considered outside the scope of ISO 18104:2014 include complete categorial structures that would cover all the potential details that could appear in expressions of nursing diagnoses and nursing actions, a detailed terminology of nursing diagnoses or nursing actions, a "state model" for diagnoses or actions ? for example, provisional diagnosis or absent diagnosis, planned action or action not to be done ? diagnoses made and actions undertaken by nurses working in other professional roles, and knowledge relationships such as causal relationships between concepts.

ISO 1828:2012 specifies the minimal characteristics of a categorial structure for terminological systems of surgical procedures and the minimal domain constraints to support interoperability, comparability and the exchange of meaningful information on surgical procedures, independently of the language, insofar as the significant differences are specified by the system. ISO 1828:2012 is applicable to terminological systems of surgical procedures in all surgical disciplines. It covers only the terminology part, as defined in ISO 1087-1:2000, of the terminological systems of surgical procedures. ISO 1828:2012 is intended to be used as an integrated part of computer-based applications and for electronic health care records.

The purpose of ISO/TS 22789:2010 is to specify a categorial structure, within the subject field of patient findings and problems, by defining a set of common domain constraints for use within terminological systems including a classification, coding scheme, coding system, reference terminology and clinical terminology. Clinical findings are concepts that are recorded in clinical records and can describe any state observed directly or indirectly concerning a patient and their relationship with the environment. ISO/TS 22789:2010 is focused on a sub-population of these findings concerning in vivo descriptions of state (structure and function) directly related to the patient. ISO/TS 22789:2010 describes a concept system detailing a domain constraint of sanctioned characteristics each composed of a semantic link and an applicable characterizing category.

ISO/TR 12309:2009 specifies principles and processes that should be exhibited by developers of healthcare terminologies in support of international healthcare terminology standardization. The primary target group for ISO/TR 12309:2009 is those establishing or reviewing organizations, and those evaluating the services or products maintained by such organizations, in the context of international healthcare terminology standardization. It complements standards such as ISO 17115 and ISO 17117 (which address the content of terminologies) by specifying good governance requirements for the lifecycle of those terminologies.

ISO/TS 17439:2014 provides details of the metadata and requirements for quality terms and definitions in health informatics for inclusion in health informatics glossaries. ISO/TS 17439:2014 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.

The main purpose of ISO 13120:2013 is to formally represent the content and hierarchical structure of healthcare classification systems in a markup language for the safe exchange and distribution of data and structure between organizations and dissimilar software products. The scope of healthcare classifications systems covered in ISO 13120:2013 encompasses terminologies, and is constrained to traditional paper-based systems (like ICD-10) and systems built according to categorial structures and a cross thesaurus (like ICNP). ISO 13120:2013 is intended for representation of healthcare classification systems in which classes have textual definitions, hierarchical ordering, named hierarchical levels (such as "chapter", "section"), inclusion- and exclusion criteria, and codes. It is not intended to cover any formal representation, either for definition or composition, of concepts, or for specification of classification rules. Systems with such formal specifications can at best be partially represented using ISO 13120:2013, and are hence out of scope. ISO 13120:2013 is not intended to: provide a normative syntax on how a healthcare classification system is to be constructed; define link types between elements in a healthcare classification system; this is left to the developers of healthcare classification systems; provide a representation for direct viewing or printing.

ISO/TS 13582:2013 specifies the mandatory and optional information to be recorded in any registry of OIDs, using an information model. It specifies which parts of that information are to be regarded as public, and which parts are to be subject to security and privacy requirements.

ISO 13119:2012 specifies a number of metadata elements that describe resources containing medical knowledge. It is primarily applicable to digital documents provided as web resources, accessible from databases or via file transfer, but can be applicable also to paper documents, e.g. articles in medical literature.

ISO 17115:2007 defines a set of basic concepts required to describe formal concept representation systems, especially for health sciences, and describes representation of concepts and characteristics, for use especially in formal computer-based concept representation systems. A main motivation is to make it possible to precisely describe content models described in other International Standards. ISO 17115:2007 does not include enumeration of axiomatic concepts and semantic links, or detailed content of health terminology systems (classifications, nomenclatures or reference terminology of health concepts).

The purpose of ISO 18104:2003 is to establish a nursing reference terminology model consistent with the goals and objectives of other specific health terminology models in order to provide a more unified reference health model. This International Standard includes the development of reference terminology models for nursing diagnoses and nursing actions and relevant terminology and definitions for its implementation. The potential uses for this reference terminology model are to support the intensional definition of nursing diagnosis and nursing action concepts reflective of a broad range of roles and practice settings, facilitate the representation of nursing diagnosis and nursing action concepts and their relationships in a manner suitable for computer processing, provide a framework for the generation of compositional expressions from atomic concepts within a reference terminology, facilitate the construction of nursing terminologies in a regular form which will make mapping among them easier, facilitate the mapping among nursing diagnosis and nursing action concepts from various terminologies including those developed as interface terminologies and statistical classifications, enable the systematic evaluation of terminologies and associated terminology models for purposes of harmonization, and provide a language to describe the structure of nursing diagnosis and nursing action concepts in order to enable appropriate integration with other reference terminology models and with information models.