ASTM_E_2457_-_07_2013.pdf

Designation:E245707(Reapproved 2013)An American National StandardStandard Terminology forHealthcare Informatics1This standard is issued under the fixed designation E2457;the number immediately following the designation indicates the year oforiginal adoption or,in the case of revision,the year of last revision.A number in parentheses indicates the year of last reapproval.Asuperscript epsilon()indicates an editorial change since the last revision or reapproval.1.Scope*1.1 This terminology is intended to name and document theprincipal concepts,and their associated terms,that are utilizedin the healthcare information domain and all of its specializedsubdomains.It is applicable to all areas of healthcare aboutwhich information is kept or utilized.It is intended to comple-ment and utilize those concepts already identified by othernational and international standards bodies.It will identifyalternate accepted terms for the same concept and its electedterm.Its terms are intended to clarify and simplify usage in thedialog and documentation about the concepts,processes anddata that are used to schedule,conduct and manage all phasesof healthcare.This common usage will improve the quality andmanagement of all facets of healthcare by means of explicitinformation used in referring to each of these facets.Thesehealth informatics terms have been collected here specificallyin order to facilitate the consistent use of common concepts ininformatics standards development and use throughout health-care.A separate process from this standard that is described inISO 15188 will manage the approval of biomedical andhealthcare terms.1.2 This standard does not purport to address all of thesafety concerns,if any,associated with its use.It is theresponsibility of the user of this standard to establish appro-priate safety and health practices and determine the applica-bility of regulatory limitations prior to use.2.Referenced Documents2.1 ASTM Standards:2E1239 Practice for Description of Reservation/Registration-Admission,Discharge,Transfer(R-ADT)Systems forElectronic Health Record(EHR)SystemsE1284 Guide for Construction of a Clinical Nomenclaturefor Support of Electronic Health Records(Withdrawn2007)3E1384 Practice for Content and Structure of the ElectronicHealth Record(EHR)E1633 Specification for Coded Values Used in the ElectronicHealth RecordE1762 Guide for Electronic Authentication of Health CareInformationE1869 Guide for Confidentiality,Privacy,Access,and DataSecurity Principles for Health Information Including Elec-tronic Health RecordsE1985 Guide for User Authentication and AuthorizationE1986 Guide for Information Access Privileges to HealthInformationE1987 Guide for Individual Rights Regarding Health Infor-mation(Withdrawn 2007)3E2087 Specification for Quality Indicators for ControlledHealth Vocabularies(Withdrawn 2009)3E2147 Specification for Audit and Disclosure Logs for Usein Health Information Systems2.2 CEN Standards:4EN-12017 Medical Informatics Vocabulary(MIVoc)EN-12264 Categorical Structure of Syntax of ConceptsModel for Representation of Semantics(MOSE)2.3 ISO Standards:5ISO 704 Principles and Methods of TerminologyISO/DIS 860 International Harmonization of Concepts andTermsISO/DIS 1087-1 TerminologyVocabularyPart 1 Theoryand ApplicationISO/DIS 1087-2 TerminologyVocabularyPart 2 Com-puter ApplicationsISO2382/4 InformationTechnologyVocabularyOrganization of DataISO 10241 TerminologyStandards Representation andLayoutISO12200 TerminologyComputerApplicationsMachine Readable Terminology Interchange Format1This terminology is under the jurisdiction of ASTM Committee E31 onHealthcare Informatics and is the direct responsibility of Subcommittee E31.35 onHealthcare Data Analysis.Current edition approved March 1,2013.Published March 2013.Originallyapproved in 2006.Last previous edition approved in 2006 as E2457 07.DOI:10.1520/E2457-07R13.2For referenced ASTM standards,visit the ASTM website,www.astm.org,orcontact ASTM Customer Service at serviceastm.org.For Annual Book of ASTMStandards volume information,refer to the standards Document Summary page onthe ASTM website.3The last approved version of this historical standard is referenced onwww.astm.org.4Available from European Committee for Standardization(CEN),36 rue deStassart,B-1050,Brussels,Belgium,http:/www.cenorm.be.5Available from American National Standards Institute(ANSI),25 W.43rd St.,4th Floor,New York,NY 10036,http:/www.ansi.org.*A Summary of Changes section appears at the end of this standardCopyright ASTM International,100 Barr Harbor Drive,PO Box C700,West Conshohocken,PA 19428-2959.United States1 ISO/IEC 12207 Life Cycle ProcessesISO 12620 TerminologyComputer ApplicationsDataCategoriesISO 15188 Project Management Guidelines for TerminologyInterchange Format2.4 Other Documents:American National Standard Dictionary of InformationTechnology(ANSDIT)http:/www.incits.orgCEN PrENV 11994 Medical Informatics VocabularyGALEN GeneralizedArchitecture for Language,Encyclope-dias