SIST EN 12381:2005

SLOVENSKI STANDARD
SIST EN 12381:2005
01-september-2005
1DGRPHãþD
SIST ENV 12381:2003
=GUDYVWYHQDLQIRUPDWLND±ýDVRYQLVWDQGDUGL]DYSUDãDQMDVSHFLILþQD]D
]GUDYVWYHQRYDUVWYR
Health informatics - Time standards for healthcare specific problems
Medizinische Informatik - Zeitnormen für spezifische Probleme im Gesundheitswesen
Informatique de santé - Représentation du temps dans le domaine de la santé
Ta slovenski standard je istoveten z: EN 12381:2005
ICS:
35.240.80 Uporabniške rešitve IT v IT applications in health care
zdravstveni tehniki technology
SIST EN 12381:2005 en
2003-01.Slovenski inštitut za standardizacijo. Razmnoževanje celote ali delov tega standarda ni dovoljeno.

---------------------- Page: 1 ----------------------

SIST EN 12381:2005

---------------------- Page: 2 ----------------------

SIST EN 12381:2005



EUROPEAN STANDARD
EN 12381

NORME EUROPÉENNE

EUROPÄISCHE NORM
February 2005
ICS 35.240.80 Supersedes ENV 12381:1996
English version
Health informatics - Time standards for healthcare specific
problems
Informatique de santé - Représentation du temps dans le Medizinische Informatik - Zeitnormen für spezifische
domaine de la santé Probleme im Gesundheitswesen
This European Standard was approved by CEN on 20 January 2005.

CEN members are bound to comply with the CEN/CENELEC Internal Regulations which stipulate the conditions for giving this European
Standard the status of a national standard without any alteration. Up-to-date lists and bibliographical references concerning such national
standards may be obtained on application to the Central Secretariat or to any CEN member.

This European Standard exists in three official versions (English, French, German). A version in any other language made by translation
under the responsibility of a CEN member into its own language and notified to the Central Secretariat has the same status as the official
versions.

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, 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
© 2005 CEN All rights of exploitation in any form and by any means reserved Ref. No. EN 12381:2005: E
worldwide for CEN national Members.

---------------------- Page: 3 ----------------------

SIST EN 12381:2005
EN 12381:2005 (E)
Contents Page
Foreword.3
Introduction .4
1 Scope .5
2 Normative references .5
3 Terms and definitions .5
4 Explicit semantic labelling of predicational components .10
4.1 General.10
4.2 Labelling of propositional clauses.10
4.3 Labelling of temporal expressions: .10
4.4 Labelling of Basic temporal links.11
4.4.1 General.11
4.4.2 “has-occurrence”.11
4.4.3 “has-rate” .11
4.4.4 “has-frequency”.11
4.4.5 “has-duration”.11
4.5 Labelling of complex temporal links.12
4.6 Temporal comparators.12
4.6.1 General.12
4.6.2 Temporal comparators in combination with events. .13
4.6.3 Temporal comparators in combination with episodes. .14
5 Characteristics of conformance.19
5.1 Provisions for conformance specification.19
5.2 Basic guidelines.19
5.3 LSS: Level of semantic specification .20
5.3.1 LSS(0).20
5.3.2 LSS(1).20
5.3.3 LSS(3).21
5.4 LRE: level of recursive embedding of time-related information.21
5.4.1 LRE(0) .21
5.4.2 LRE(1) .21
5.4.3 LRE(2) .21
5.5 LDR: level of deictic referential complexity .21
5.5.1 LDR(0) .21
5.5.2 LDR(1) .21
LDC: level of relative deictic referential complexity .22
5.6.1 LDC(0) .22
5.6.2 LDC(1) .22
5.6.3 LDC(2) .22
5.7 LQI: level of formal rigour of temporal expressions.22
5.7.1 LQI(0).22
5.7.2 LQI(1).22
5.7.3 LQI(2).22
Annex A (informative) BNF description of the syntax used in the standard predications of this
document.23
Bibliography .24

2

---------------------- Page: 4 ----------------------

SIST EN 12381:2005
EN 12381:2005 (E)
Foreword
This document (EN 12381:2005) has been prepared by Technical Committee CEN/TC 251 “Health
informatics”, the secretariat of which is held by SIS.
This European Standard shall be given the status of a national standard, either by publication of an identical
text or by endorsement, at the latest by August 2005, and conflicting national standards shall be withdrawn at
the latest by August 2005.
This document supersedes ENV 12381:1996.
According to the CEN/CENELEC Internal Regulations, the national standards organizations of the following
countries are bound to implement this European Standard: Austria, Belgium, Cyprus, Czech Republic,
Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania,
Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland
and United Kingdom.
3

---------------------- Page: 5 ----------------------

SIST EN 12381:2005
EN 12381:2005 (E)
Introduction
Time is an important variable in healthcare, and standards are needed about how to represent information
with explicit references to time. This document is a first contribution to this harmonization process, focusing on
“representation” and “explicit reference”.
Indeed, a system for Time-Standards must have as a minimum requirement the capacity to order temporal
facts (situations, events, episodes) in three major ways, independent of any specific ontology of time itself:
 by relating situations to a calendar;
 by relating situations to “reference” situations;
 by relating events together in “before- and after-” chains.
The main reason for this threefold organization is that our everyday temporal discourse contains a variety of
expressions that only with a certain artificiality can be regimented into a uniform style of analysis.
The purpose of this document is to enhance, in a perspective of machine-machine and man-machine
communication, the generation of statements that are guaranteed to be understood unambiguously with
respect to the time-related expressions that are embedded within them.
The purpose of this document is not to develop a full-blown temporal logic, but a standardized way of
representing time-related expressions, such that all kinds of questions about the temporal organization of
situations can be answered on the basis of the information available. Nor is it the intention of the framework
presented here to provide a means to interpret the information in its original format. Interpretation of the
source information is the task of the provider of information itself. The framework presented in this document
allows information providers to express their time-related information in such a way that the intended meaning
can be unambiguously understood by a receiver.
This of course requires the use of a “restricted”, regimented model or language, allowing the disambiguation
of many time-related expressions uttered in natural language. The model (language) presented in this
document is restricted enough to allow such disambiguation for time-related expressions in “traditional”
medical language, but is not expressive enough to account for all time-related linguistic phenomena that can
be encountered in natural language.
This document provides representational tools for “explicit” time-related information. It does not allow (nor
encourage) the ad hoc interpretation of implicit temporal information. In an expression such as “diabetes since
childhood”, “since childhood” is an explicit temporal reference for the diabetes, but the implicit information
what “childhood” might mean (e.g. starting at the age of 2 years ?), is not addressed. However, the framework
presented in this document has enough expressive power to allow a specific provider of information to state
explicitly what his understanding is of “childhood”.
This document describes some conformance characteristics by means of which developers of health care
information systems can label specific modules of their systems as to the degree they are compliant with the
document. Although the framework itself does not deal with temporal reasoning, the conformance
characteristics can be used to evaluate to what level temporal reasoning is possible with the information
collected in a given system.

4

---------------------- Page: 6 ----------------------

SIST EN 12381:2005
EN 12381:2005 (E)
1 Scope
This document specifies a set of representational primitives and semantic relations required 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 is applicable to:
1) developers of medical information systems in which the need is felt to have explicit time-related
concepts for internal organization (e.g. temporal data bases, temporal reasoning systems);
2) information modellers or knowledge engineers building models for the systems mentioned in (1);
3) experts involved in the development of semantic standards on precise subdomains in health care
where time-related information need to be covered, (e.g. in the study of Pathochronology, i.e. the
discipline dealing with the time course of specific diseases);
4) developers of interchange formats for messages in which time-related information is embedded.
This document is not intended to be used directly for:
1) representing what is true in time;
2) reasoning about time;
3) representation of metrological time (which is covered in other standards).
2 Normative references
The following referenced documents are indispensable for the application of this document. For dated
references, only the edition cited applies. For undated references, the latest edition of the referenced
document (including any amendments) applies.

EN 28601, Data elements and interchange formats - Information interchange - Representation of dates and
times (ISO 8601:1988 and its technical corrigendum 1:1991)
ISO 31-1, Quantities and units – Part 1: Space and time

3 Terms and definitions
For the purposes of this document, the following terms and definitions apply.
3.1
situation
phenomenon occurring (or having the potential to occur) at or over a time in a given world context
NOTE 1 situations cover phenomena which may occur in past, present or future time
NOTE 2 This document applies both to the representation of actual phenomena occuring in the real world (e.g.
registrations in medical records), as to the description of concepts (eg medical knowledge bases).
5

---------------------- Page: 7 ----------------------

SIST EN 12381:2005
EN 12381:2005 (E)
EXAMPLE “The patient suffered from pain which occurred over night”, “pain occurring over night”,
3.2
time interval
portion of time of which the duration in a given context is considered to be significant and relevant
3.3
time point
portion of time of which the duration in a given context is considered to be insignificant or irrelevant
NOTE This document does not specify any regulations on what entities should occupy time points, and what entities
should occupy time intervals. Decisions of this kind are explicitly to be made by the user of this document (Chapter 5). As
a consequence, temporal references such as “Friday the 13th” may refer to a time point or a time interval, depending on
the context.
3.4
episode
situation considered to occupy a time interval
NOTE 1 Whether a situation is to be considered an episode or an event, is a decision taken by the provider of the
information, based on its perception of the phenomenon in a given context.
NOTE 2 It is possible to further subcategorize episodes into “states”, “culminations”, “processes”, “actions”, or other
conceptual entities that can be defined using additional conceptual aspects describing particular properties of each of the
various episodes. However there is no need to do so within the scope of this document.
EXAMPLE a patient’s stay in the hospital, the “episode of care” related to a medical problem
3.5
event
situation considered to occur at a time point
3.6
predication
representation of a situation in a language
EXAMPLE “The removal of Mr Jones’ appendix on 21 July 1994, at 9 o’clock in the morning.”
3.7
temporal reference
component of a predication representing information related to time
EXAMPLE “on 1994-07-21”, “at 9 o’clock”, “on 1994-07-21 at 9 o’clock”
3.8
propositional clause
component of a predication to which temporal references implicitly or explicitly refer
EXAMPLE in the expression “taking syrup three times a day for 2 weeks”, the propositional clause is “taking syrup”.
To it are attached the temporal references “three times a day” and “for 2 weeks”.
NOTE 1 The term propositional clause is used here in a broader sense than in formal logic where a proposition
denotes a statement on what is true in a given world. In the context of this document, propositional clauses do not impose
a truth-value on the phenomena that are represented.
NOTE 2 This document allows for a recursive representation of information related to time (see Informative Annex A for
a formal description). In expressions such as “severe headache lasting for half an hour after each meal”, both “severe
headache” and “severe headache lasting for half an hour” are propositional clauses, each at a different level in the
recursion. A propositional clause that is at the deepest level of recursion, i.e. to which no temporal references are attached,
is called propositional clause zero. In this example: “severe headache” is propositional clause zero.
6

---------------------- Page: 8 ----------------------

SIST EN 12381:2005
EN 12381:2005 (E)
3.9
ambiguous temporal reference
temporal reference whose temporal link with the propositional clause of the predication is ambiguous, or which
does not unambiguously refer to a unique, identifiable time point or time interval on a calendar.
NOTE 1 In the predication “He died on Monday”, “on Monday” is a time point expression. A person can only die once.
In the predication “He operates on Monday”, “on Monday” may be considered a frequency expression. However, in the
context of this document, the meaning of a propositional clause is not known, and as a consequence, “on Monday” cannot
unambiguously be identified as a time point expression or a frequency expression, unless the provider of the information is
explicit about this. Hence, it is an ambiguous temporal reference.
NOTE 2 Ambiguity is in this context related to “lacking knowledge” on the exact interpretation of a predication, i.e. the
intended meaning by the provider of the information is not known. Phenomena that are “planned” for the future do not
necessarily introduce ambiguity. In an expression such as “He will probably operate next Monday”, the temporal reference
“next Monday” is not ambiguous.
NOTE 3 From the definition it follows that it is specifically the nature of the temporal link that makes a temporal
reference ambiguous or not, and not the fact whether the temporal reference is explicitly categorised as being a time point
or a time interval. In the expression “He will probably operate next Monday”, “Monday” might indeed as well be a time
point as a time interval.
3.10
temporal link
component of a temporal reference capturing the semantic relation in a predication between the propositional
clause and the temporal expression
NOTE In natural language, the temporal link may be grammaticalized with prepositions or other constructs, such as
in “on Monday”. Often, the link is not expressed explicitly, as in “tomorrow”. In formal representations compliant to this
document, the temporal link needs to be represented explicitly, or should be unambiguously derivable from a data model.
3.11
basic temporal link
temporal link specifying purely time-related information
EXAMPLE has-occurrence, has-duration (Subclause 4.4)
3.12
complex temporal link
temporal link composed of a basic temporal link and an embedded propositional clause
NOTE Complex temporal links can be used to express the contents of relational data bases according to the
provisions of this document.
EXAMPLE The predication “Severe headache this morning” can be analysed into the propositional clause “severe
headache” and the temporal reference “this morning”. In a database management system, such predications can be
represented in a table with fields “ProblemId”, “Problem” and “TimeOfHappening”:
Time of
Problem Id Problem
happening
I1 severe headache this morning
ingestion of immediately after
I2
acetylsalicylic acid I1
…

In this table, the contents of the “Problem” column refer to situations, and hence are to be considered
propositional clauses and the contents of the “Time of Happening” column are all temporal references.
7

---------------------- Page: 9 ----------------------

SIST EN 12381:2005
EN 12381:2005 (E)
Often, also the time of recording of problems is also recorded as useful meta-information. According to the
model above, this should be done by adding two records in the table:
I3 recording of I1 1994-07-01:18:00:32
I4 recording of I2 1994-07-01:18:00:35

In fact, this could be repeated for each record, even for the records in which the recording of the recording of
the . is recorded. Because only the recording time of a problem is of interest, and not the recording event
itself, the above scheme is simplified by adding an additional field, labeled TimeOfRecording, which is a
complex temporal link.
Problem Id Problem Time of happening Time Of Recording
I1 severe headache this morning 1994-07-01:18:00:32
I2 ingestion of immediately after I1 1994-07-01:18:00:35
acetylsalicylic acid
...

Other examples of complex temporal links are: StartDateOfSampleCollection (laboratory context), DateOfBirth
(administrative context), StartDateOfProblem, EndDateOfProblem (clinical history or diagnostic module of
electronic medical record systems), .
3.13
temporal expression
component of a temporal reference specifying a time point, a time interval or any allowed combination of time
points and time intervals.
NOTE This document does not imply any restrictions on what combinations of time points and time intervals are
“allowed” as this depends entirely on the ontology of time defined in a particular context. However, such an ontology can
only be claimed to conform to this document when such combinations can be represented by the temporal expressions
described in this document.
3.14
absolute temporal expression
temporal expression whose exact meaning in a given context can directly be derived from the temporal
expression itself
EXAMPLE “9’oclock”, “1994-04-12”, “Christmas”
NOTE “exact meaning” refers here to the fact that absolute temporal expressions (by definition) contain all the
information required to relate the situation to a calendar.
3.15
relative temporal expression
temporal expression whose exact meaning in a given context can only be derived from the temporal
references of the predications referred to in the temporal expression
EXAMPLE “headache starting after eating chocolate”. When the headache starts, can only be known if it is known
when he eating of chocolate takes place.
NOTE The “relativeness“ or “absoluteness” of a temporal expression does not imply any qualitative preference. For
pure temporal reasoning issues, absolute temporal expressions are to be preferred, but for medical reasoning, this is not
true. Reducing the two predications “eating chocolate at three o’clock” and “headache after eating chocolate”, to
“headache after three o’clock” would imply a dramatic loss of information from the clinical point of view.
8

---------------------- Page: 10 ----------------------

SIST EN 12381:2005
EN 12381:2005 (E)
3.16
deictic temporal expression
temporal expression whose exact meaning in a given context only can be derived from information outside
that context
EXAMPLE Expressions such as “now”, “yesterday”, “last Monday”, “in three weeks”, can only be given precise
meaning if the time of utterance is known.
3.17
temporal expression
denoting a time point
3.18
time interval expression
temporal expression denoting a time interval
3.19
duration expression
temporal expression referring to the length of a time interval
EXAMPLE “three years”, “a long time”
3.20
rate expression
temporal expression denoting the change of a property over a time interval
NOTE The change of the property is to be considered the situation on which information related to time is given.
EXAMPLE For the variable “velocity”: “3 m/s”.
3.21
frequency expression
temporal expression denoting the number of repetitions of a phenomenon during a time interval
NOTE 1 A frequency may be considered a special case of a rate (“number rate”).
NOTE 2 The time interval does not need to be represented explicitly as is the case in some of the following examples.
EXAMPLE “twice a day”, “every 5 minutes”, “often”, “frequently”, “after each meal”, “never” “always”.
3.22
time series expression
temporal expression denoting the occurrence of a situation in a series of time points or time intervals
3.23
temporal comparator
specifier of the temporal relation expressed by the temporal link between the propositional clause and a
temporal expression
EXAMPLE Temporal comparators that may be added to the temporal link has-occurrence are amongst others: “AT,
BEFORE, AFTER,.” (Subclause 4.6)
3.24
temporal operator (synonym: temporal function)
component of a temporal expression further specifying or restricting its exact meaning
EXAMPLE StartMoment of a time interval, FirstElement of a time series
9

---------------------- Page: 11 ----------------------

SIST EN 12381:2005
EN 12381:2005 (E)
4 Explicit semantic labelling of predicational components
4.1 General
Temporal references do not necessarily give unambiguous meaning to the temporal relationship they bear
with the propositional clause of the predication. Also, from expressions in natural language, it can not always
be deduced whether the situations described are to be considered events or episodes. For this reason, this
document requires the explicit labelling of the various components of a predication. In this document a frame-
based notation is used to represent predications in a more formal way. A full syntactic specification of the
notation is given in Annex A (informative). In this chapter the semantic building blocks (normative) are
presented. Predications that are represented according to the syntactic-semantic rules of this notation, are
called standard predications.
4.2 Labelling of propositional clauses
Each propositional clause shall be labelled by the originator of the information as referring to a situation (if the
exact temporal nature is not relevant), an event or an episode.
The labels to be used for propositional clauses in standard predications are: “SIT” for propositional clauses
referring to situations, “EVENT” for propositional clauses referring to events, and “EPISODE” for propositional
clauses referring to episodes.
EXAMPLE 1 SIT(“dying”): represents a situation of dying without indication whether or not the dying has a significant
or relevant duration in the context given.
EXAMPLE 2 EPISODE(“eating chocolate”): represents a situation of eating chocolate for which it is indicated that a
relevant and significant duration is (or may be) attributed to it.
EXAMPLE 3 EVENT(“fall from stairs”): represents a situation of falling from stairs, the duration of which is considered
to be irrelevant or insignificant.
4.3 Labelling of temporal expressions:
Each temporal expression shall be labelled by the originator of the information as being a time point
expression, time interval expression, frequency expression, rate expression, t
...