Terminology Package
5.1 Overview
This section describes the terminology package, which contains classes for accessing terminologies and code sets, including the openEHR Support Terminology, from within instances of classes defined in the reference model. The classes shown here would normally be inherited via the classes EXTERNAL_ENVIRONMENT_ACCESS and OPENEHR_DEFINITIONS, although the exact details of how this is done may vary depending on implementation language.
5.2 Service Interface
5.2.1 Code Sets
A simple terminology service interface is defined according to FIGURE 6, enabling openEHR code sets and terminology to be referenced formally from within the Reference Model. Two types of coded entities are distinguished in openEHR, and are accessible via the service interface. The first is codes from ‘code sets’, which are the kind of terminology where the code stands for itself, such as the ISO 639-1 language codes. The identifiers themselves of these code sets do not appear to be standardised, but names such as “ISO_639-1” are expected to be used (see below).
In any case, code sets needed within the openEHR models themselves (e.g. for attributes whose value is a language code) are not referred to directly by an external name such as “ISO_639-1”, but via an internal constant, in this case, the constant Code_set_id_languages, whose value is defined to be “languages”. These constants are defined in the class OPENEHR_CODE_SET_IDENTIFIERS in FIGURE
- The mapping between the internal identifiers and external names should be done in configuration files. The service function TERMINOLOGY_SERVICE.code_set_for_id() is used to retrieve code sets on the basis of a constant. The current mapping and external identifiers assumed in openEHR is defined in the openEHR Support Terminology document. This use of indirection is employed to ensure that the obsoleting and superseding of code-sets does not directly affect openEHR software.
For code sets not mapped to internally used constants, i.e. code sets not required in the openEHR model itself, but otherwise known in the terminology service, the function TERMINOLOGY_SERVICE.code_set() can be used to retrieve these code sets by their external identifier.
5.2.2 Terminologies
Terminologies, including the openEHR Support Terminology are accessed via the TERMINOLOGY_SERVICEfunctions terminology() and terminology_identifiers(), where the argument includes “openehr”, “centc251” (for CEN TC/251codes) and names from the US NLM terminologies list (see below). The openEHR Terminology supports groups, and the set of groups required by the reference model is defined in the class OPENEHR_TERMINOLOGY_GROUP_IDENTIFIERS. These groups correspond to coded attributes found in the openEHR Reference Model.
5.2.3 Terms and Codes in the openEHR Reference Model
True coded attributes in the Reference Model (i.e. attributes of type DV_CODED_TEXT), such as FEEDER_AUDIT.change_type are defined by an invariant in the enclosing class, such as the following:
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terminology
OPENEHR_TERMINOLOGY_GROUP_IDENTIFIERS
const Terminology_id_openehr: String is “openehr” const Group_id_audit_change_type: String is “audit change type” const Group_id_attestation_reason: String is “attestation reason” const Group_id_composition_category: String is “composition category” const Group_id_event_math_function: String is “event math function” const Group_id_instruction_states: String is “instruction states” const Group_id_instruction_transitions: String is “instruction transitions” const Group_id_null_flavours: String is “null flavours” const Group_id_property: String is “property” const Group_id_participation_function: String is “participation function” const Group_id_participation_mode: String is “participation mode” const Group_id_setting: String is “setting” const Group_id_term_mapping_purpose: String is “term mapping purpose” const Group_id_subject_relationship: String is “subject relationship” const Group_id_version_lifecycle_state: String is “version lifecycle state”
valid_group_id(an_id: String): Boolean
TERMINOLOGY_SERVICE
OPENEHR_CODE_SET_IDENTIFIERS
const Code_set_id_character_sets: String is “character sets” const Code_set_id_compression_algorithms: String is “compression algorithms” const Code_set_id_countries: String is “countries” const Code_set_id_integrity_check_algorithms: String is “integrity check algorithms” const Code_set_id_languages: String is “languages” const Code_set_id_media_types: String is “media types” const Code_set_id_normal_statuses: String is “normal statuses”
valid_code_set_id(an_id: String): Boolean
CODE_SET_ACCESS <<interface>>
id: Stringall_codes: Set<CODE_PHRASE> has_lang (...): Boolean has_code (...): Boolean terminology (name: String): TERMINOLOGY_ACCESS code_set (name: String): CODE_SET_ACCESS code_set_for_id (id: String): CODE_SET_ACCESS has_terminology (name: String): Boolean has_code_set (name: String): Boolean terminology_identifiers: List<String>openehr_code_sets: Hash<String, String> code_set_identifiers: List<String>
| TERMINOLOGY_ACCESS <<interface>> |
| id: Stringall_codes: Set<CODE_PHRASE> codes_for_group_id (...): Set<CODE_PHRASE> codes_for_group_name (...): Set<CODE_PHRASE> has_code_for_group_id (...): Boolean rubric_for_code (...): String |
FIGURE 6 rm.support.terminology Package
Support Information Model Terminology Package Rev 1.6.0
Change_type_valid:terminology(Terminology_id_openehr).has_code_for_group_id (Group_id_audit_change_type, change_type.defining_code)
This is a formal way of saying that the attribute change_type must have a value such that its defining_code (its CODE_PHRASE) is in the set of CODE_PHRASEs in the openEHR Terminology which are in the group whose indentifier is Group_id_audit_change_type.
A similar invariant is used for attributes of type CODE_PHRASE, which come from a code_set. The following invariant appears in the class ENTRY (rm.composition.content.entry package):
Language_valid: media_type /= Void and then code_set(Code_set_languages).has_code(language)
5.3 Identifiers
In openEHR, the identifier of a terminology or code set is found in the terminology_id attribute of the class CODE_PHRASE (Data Types Information Model, text package).
5.3.1 Code Set Identifiers
Internal code set identifiers (such as “languages”) used in openEHR are defined in the class OPENEHR_CODE_SET_IDENTIFIERS; assumed external identifiers (such as “ISO_639-1”) for code sets used by the openEHR Reference Model are defined in the openEHR Support Terminology document.
5.3.2 Terminology Identifiers
Valid identifiers that can be used for this attribute for terminologies include but are not limited to the following:
- “openehr”
- “centc251”
- an identifier value from the first column of the US National Library or Medicine (NLM) UMLS terminology identifiers table below, in either of two forms:
-as is, e.g. “ICD10AM_2000”, “ICPC93”; -with any trailing section starting with an underscore removed, e.g. “ICD10AM”.
Other identification schemes are used in some standards, such as ISO Oids. These are not specified for direct use in openEHR for various reasons:
- they are not currently used by the NLM, and no definitive published list of terminology identifiers is available;
- ISO Oids are long identifiers and may significantly increase the size of persisted information due to the ubiquity of coded terms;
- determing the identity of the terminology in data always requires a request to a service containing the Oid / name mapping;
- there is a safety factor in having human readable terminology identifiers in the data.
The use of Oid-based or other terminology identification schemes is not however incompatible with openEHR; all that is required is a terminology identifier / name mapping service or table.
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The following table is a snapshot of the US National Library of Medicine UMLS terminology identifiers list. A definitive up-to-date list may be found on the NLM website at http://www.nlm.nih.gov/research/umls/metaa1.html .
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| UMLS 2003 Terminology Identifiers | |
| Identifier | Description |
| AIR93 | AI/RHEUM,1993 |
| ALT2000 | Alternative Billing Concepts, 2000 |
| AOD2000 | Alcohol and Other Drug Thesaurus, 2000 |
| BI98 | Beth Israel Vocabulary, 1.0 |
| BRMP2002 | Portuguese translation of the Medical Subject Headings, 2002 |
| BRMS2002 | Spanish translation of the Medical Subject Headings, 2002 |
| CCPSS99 | Canonical Clinical Problem Statement System, 1999 |
| CCS99 | Clinical Classifications Software, 1999 |
| CDT4 | Current Dental Terminology(CDT), 4 |
| COSTAR_89-95 | COSTAR, 1989-1995 |
| CPM93 | Medical Entities Dictionary, 1993 |
| CPT01SP | Physicians' Current Procedural Terminology, Spanish Translation, 2001 |
| CPT2003 | Physicians' Current Procedural Terminology, 2003 |
| CSP2002 | CRISP Thesaurus, 2002 |
| CST95 | COSTART, 1995 |
| DDB00 | Diseases Database, 2000 |
| DMD2003 | German translation of the Medical Subject Headings, 2003 |
| DMDICD10_1995 | German translation of ICD10, 1995 |
| DMDUMD_1996 | German translation of UMDNS, 1996 |
| DSM3R_1987 | DSM-III-R, 1987 |
| DSM4_1994 | DSM-IV, 1994 |
| DUT2001 | Dutch Translation of the Medical Subject Headings, 2001 |
| DXP94 | DXplain, 1994 |
| FIN2003 | Finnish translations of the Medical Subject Headings, 2003 |
| HCDT4 | HCPCS Version of Current Dental Terminology(CDT), 4 |
| HCPCS03 | Healthcare Common Procedure Coding System, 2003 |
| HCPT03 | HCPCS Version of Current Procedural Terminology(CPT), 2003 |
| HHC96 | Home Health Care Classification, 1996 |
| HL7_1998-2002 | Health Level Seven Vocabulary, 1998-2002 |
| HLREL_1998 | ICPC2E-ICD10 relationships from Dr. Henk Lamberts, 1998 |
| HPC99 | Health Product Comparison System, 1999 |
| ICD10AE_1998 | ICD10, American English Equivalents, 1998 |
| ICD10AMAE_2000 | International Statistical Classification of Diseases and Related Health Problems, Australian Modification, Americanized English Equivalents, 2000 |
| ICD10AM_2000 | International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification, January 2000 Release |
| ICD10_1998 | ICD10, 1998 |
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| UMLS 2003 Terminology Identifiers | |
| Identifier | Description |
| ICD9CM_2003 | ICD-9-CM, 2003 |
| ICPC2AE_1998 | International Classification of Primary Care, Americanized English Equivalents, 2E, 1998 |
| ICPC2E_1998 | International Classification of Primary Care 2nd Edition, Electronic, 2E, 1998 |
| ICPC2P_2000 | International Classification of Primary Care, Version2-Plus, 2000 |
| ICPC93 | International Classification of Primary Care, 1993 |
| ICPCBAQ_1993 | ICPC, Basque Translation, 1993 |
| ICPCDAN_1993 | ICPC, Danish Translation, 1993 |
| ICPCDUT_1993 | ICPC, Dutch Translation, 1993 |
| ICPCFIN_1993 | ICPC, Finnish Translation, 1993 |
| ICPCFRE_1993 | ICPC, French Translation, 1993 |
| ICPCGER_1993 | ICPC, German Translation, 1993 |
| ICPCHEB_1993 | ICPC, Hebrew Translation, 1993 |
| ICPCHUN_1993 | ICPC, Hungarian Translation, 1993 |
| ICPCITA_1993 | ICPC, Italian Translation, 1993 |
| ICPCNOR_1993 | ICPC, Norwegian Translation, 1993 |
| ICPCPAE_2000 | International Classification of Primary Care ,Version2-Plus, Americanized English Equivalents, 2000 |
| ICPCPOR_1993 | ICPC, Portuguese Translation, 1993 |
| ICPCSPA_1993 | ICPC, Spanish Translation, 1993 |
| ICPCSWE_1993 | ICPC, Swedish Translation, 1993 |
| INS2002 | French translation of the Medical Subject Headings, 2002 |
| ITA2003 | Italian translation of Medical Subject Headings, 2003 |
| JABL99 | Online Congenital Multiple Anomaly/ Mental Retardation Syndromes, 1999 |
| LCH90 | Library of Congress Subject Headings, 1990 |
| LNC205 | LOINC, 2.05 |
| LOINC | LOINC |
| MCM92 | McMaster University Epidemiology Terms, 1992 |
| MDDB99 | MasterDrug DataBase, 1999 |
| MDR51 | Medical Dictionary for Regulatory Activities Terminology (MedDRA), 5.1 |
| MDRAE51 | Medical Dictionary for Regulatory Activities Terminology (MedDRA), American English Equivalents, 5.1 |
| MDREA51 | Medical Dictionary for Regulatory Activities Terminology (MedDRA), American English, with expanded abbreviations, 5.1 |
| MDREX51 | Medical Dictionary for Regulatory Activities Terminology (MedDRA), with expanded abbreviations, 5.1 |
| MDRPOR51 | Medical Dictionary for Regulatory Activities Terminology (MedDRA), 5.1, Portuguese Edition |
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| UMLS 2003 Terminology Identifiers | |
| Identifier | Description |
| MDRSPA51 | Medical Dictionary for Regulatory Activities Terminology (MedDRA), 5.1, Spanish Edition |
| MIM93 | Online Mendelian Inheritance in Man, 1993 |
| MMSL01 | Multum MediSource Lexicon, 2001 |
| MMX01 | Micromedex DRUGDEX, 2001-08 |
| MSH2003_2002_10_24 | Medical Subject Headings, 2002_10_24 |
| MTH | UMLS Metathesaurus |
| MTHCH03 | Metathesaurus CPT Hierarchical Terms, 2003 |
| MTHHH03 | Metathesaurus HCPCS Hierarchical Terms, 2003 |
| MTHICD9_2003 | Metathesaurus additional entry terms for ICD-9-CM, 2003 |
| MTHMST2001 | Metathesaurus Version of Minimal Standard Terminology Digestive Endoscopy, 2001 |
| MTHMSTFRE_2001 | Metathesaurus Version of Minimal Standard Terminology Digestive Endoscopy, French Translation, 2001 |
| MTHMSTITA_2001 | Metathesaurus Version of Minimal Standard Terminology Digestive Endoscopy, Italian Translation, 2001 |
| NAN99 | Classification of Nursing Diagnoses, 1999 |
| NCBI2001 | NCBI Taxonomy, 2001 |
| NCI2001a | NCI Thesaurus, 2001a |
| NCISEER_1999 | NCISEER ICD Neoplasm Code Mappings, 1999 |
| NDDF01 | FirstDataBank National Drug DataFile, 2001-07 |
| NEU99 | Neuronames Brain Hierarchy, 1999 |
| NIC99 | Nursing Interventions Classification, 1999 |
| NOC97 | Nursing Outcomes Classification, 1997 |
| OMIM97 | OMIM, Online Mendelian Inheritance in Man, 1997 |
| OMS94 | Omaha System, 1994 |
| PCDS97 | Patient Care Data Set, 1997 |
| PDQ2002 | Physician Data Query, 2002 |
| PPAC98 | Pharmacy Practice Activity Classification , 1998 |
| PSY2001 | Thesaurus of Psychological Index Terms, 2001 |
| QMR96 | Quick Medical Reference (QMR), 1996 |
| RAM99 | QMR clinically related terms from Randolph A. Miller, 1999 |
| RCD99 | Clinical Terms Version 3 (CTV3) (Read Codes), 1999 |
| RCDAE_1999 | Read thesaurus, American English Equivalents, 1999 |
| RCDSA_1999 | Read thesaurus Americanized Synthesized Terms, 1999 |
| RCDSY_1999 | Read thesaurus, Synthesized Terms, 1999 |
| RUS2003 | Russian Translation of MeSH, 2003 |
| RXNORM_03AA | RXNORM Project, META2003AA |
| SNM2 | SNOMED-2, 2 |
| SNMI98 | SNOMED International, 1998 |
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| UMLS 2003 Terminology Identifiers | |
| Identifier | Description |
| SNOMED-CT | SNOMED International Clinical Terms, 2002 |
| SPN02 | Standard Product Nomenclature, 2002 |
| SRC | Metathesaurus Source Terminology Names |
| ULT93 | UltraSTAR, 1993 |
| UMD2003 | UMDNS: product category thesaurus, 2003 |
| UMLS | UMLS: National Library of Medicine, USA |
| UWDA155 | University of Washington Digital Anatomist, 1.5.5 |
| VANDF01 | Veterans Health Administration National Drug File, 2001 |
| WHO97 | WHO Adverse Reaction Terminology, 1997 |
| WHOFRE_1997 | WHOART, French Translation, 1997 |
| WHOGER_1997 | WHOART, German Translation, 1997 |
| WHOPOR_1997 | WHOART, Portuguese Translation, 1997 |
| WHOSPA_1997 | WHOART, Spanish Translation, 1997 |
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5.4 Class Definitions
5.4.1 TERMINOLOGY_SERVICE Class
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| CLASS | TERMINOLOGY_SERVICE | |
| Purpose | Defines an object providing proxy access to a terminology service. | |
| Inherit | OPENEHR_CODE_SET_IDENTIFIERS, OPENEHR_TERMINOLOGY_GROUP_IDENTIFIERS | |
| Functions | Signature | Meaning |
| terminology (name: String): | Return an interface to the terminology | |
| TERMINOLOGY_ACCESS | named name. Allowable names include | |
| require | • “openehr” | |
| name /= Void and then has_terminology (name) ensure Result /= Void | • “centc251” • any name from are taken from the US NLM UMLS meta-data list at http://www.nlm.nih.gov/research/umls/metaa1.html | |
| code_set (name: String): CODE_SET_ACCESS require name /= Void and then has_code_set (name) ensure Result /= Void | Return an interface to the code_set identified by the external identifier name (e.g. “ISO_639-1”). | |
| code_set_for_id(id: String): CODE_SET_ACCESS require id /= Void and then valid_code_set_id (id) ensure Result /= Void has_terminology (name: String): Boolean require name /= Void and then not name.is_empty | Return an interface to the code_set identified internally in openEHR by id. True if terminology named name known by this service. Allowable names include • “openehr” • “centc251” • any name from are taken from the US NLM UMLS meta-data list at http://www.nlm.nih.gov/research/umls/metaa1.html | |
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| CLASS | TERMINOLOGY_SERVICE | |
| has_code_set (name: String): Boolean require name /= Void and then not name.is_empty | True if code_set linked to internal name (e.g. “languages”) is available. | |
| terminology_identifiers: List<String> | Set of all terminology identifiers known in the terminology service. Values from the US NLM UMLS meta-data list at http://www.nlm.nih.gov/research/umls/metaa1.html | |
| code_set_identifiers: List<String> | Set of all code set identifiers known in the terminology service. | |
| openehr_code_sets: Hash<String, String> | Set of all code sets identifiers for which there is an internal openEHR name; returned as a Hash of ids keyed by internal name. | |
| Invariants | ||
5.4.2 TERMINOLOGY_ACCESS Class
| CLASS | TERMINOLOGY_ACCESS | |
| Purpose | Defines an object providing proxy access to a terminology. | |
| Functions | Signature | Meaning |
| id: String | Identification of this Terminology | |
| all_codes: Set<CODE_PHRASE> | Return all codes known in this terminology | |
| codes_for_group_id (group_id: String): Set<CODE_PHRASE> | Return all codes under grouper ‘group_id’ from this terminology | |
| has_code_for_group_id (group_id: String; a_code: CODE_PHRASE): Boolean codes_for_group_name (name, lang: String): Set<CODE_PHRASE> | True if ‘a_code’ is known in group ‘group_id’ in the openEHR terminology. Return all codes under grouper whose name in ‘lang’ is ‘name’ from this terminology | |
| rubric_for_code (code, lang: String): String | Return all rubric of code ‘code’ in language ‘lang’. | |
| Invariants | id_exists: id /= Void and then not id.is_empty | |
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5.4.3 CODE_SET_ACCESS Class
| CLASS | CODE_SET_ACCESS | |
| Purpose | Defines an object providing proxy access to a code_set. | |
| Functions | Signature | Meaning |
| id: String | External identifier of this code set | |
| all_codes: Set<CODE_PHRASE> | Return all codes known in this code set | |
| has_lang (a_lang: CODE_PHRASE): Boolean | True if code set knows about ‘a_lang’ | |
| has_code (a_code: CODE_PHRASE): Boolean | True if code set knows about ‘a_code’ | |
| Invariants | Id_valid: id /= Void and then not id.is_empty | |
5.4.4 OPENEHR_TERMINOLOGY_GROUP_IDENTIFIERS Class
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| CLASS | OPENEHR_TERMINOLOGY_GROUP_IDENTIFIERS | |
| Purpose | List of identifiers for groups in the openEHR terminology. | |
| Constants | Signature | Meaning |
| Terminology_id: Stringis “openehr” | Name of openEHR’s own terminology | |
| Group_id_audit_change_type: String is “audit change type” | ||
| Group_id_attestation_reason: String is “attestation reason” | ||
| Group_id_composition_category: Stringis “composition category” | ||
| Group_id_event_math_function: String is “event math function” | ||
| Group_id_instruction_states: Stringis “instruction states” | ||
| Group_id_instruction_transitions: String is “instruction transitions” | ||
| Group_id_null_flavours: String is “null flavours” | ||
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| CLASS | OPENEHR_TERMINOLOGY_GROUP_IDENTIFIERS | |
| Group_id_property: Stringis “property” | ||
| Group_id_participation_function: Stringis “participation function” | ||
| Group_id_participation_mode: String is “participation mode” | ||
| Group_id_subject_relationship: String is “subject relationship” | ||
| Group_id_setting: String is “setting” | ||
| Group_id_term_mapping_purpose: String is “term mapping purpose” | ||
| Group_id_version_lifecycle_state: Stringis “version lifecycle state” | ||
| Functions | Signature | Meaning |
| valid_terminology_group_id (an_id: String): Boolean | Validity function to test if an identifier is in the set defined by this class. | |
| Invariants | ||
5.4.5 OPENEHR_CODE_SET_IDENTIFIERS Class
| CLASS | OPENEHR_CODE_SET_IDENTIFIERS | |
| Purpose | List of identifiers for code sets in the openEHR terminology. | |
| Constants | Signature | Meaning |
| Code_set_id_character_sets: String is “character sets” | ||
| Code_set_id_compression_algorithms: Stringis “compression algorithms” | ||
| Code_set_id_countries: String is “countries” | ||
| Code_set_id_integrity_check_algorithms: Stringis “integrity check algorithms” | ||
| Code_set_id_languages: String is “languages” | ||
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| CLASS | OPENEHR_CODE_SET_IDENTIFIERS | |
| Code_set_id_media_types: String is “media types” | ||
| Code_set_id_normal_statuses: String is “normal statuses” | ||
| Functions | Signature | Meaning |
| valid_code_set_id (an_id: String): Boolean | Validity function to test if an identifier is in the set defined by this class. | |
| Invariants | ||
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Support Information Model Measurement Package Rev 1.6.0
