Direct terminology binding allows nodes in archetypes and templates to be bound to specific terms or term sets. However, direct binding has issues including incomplete terminology coverage and requiring terminology expertise. Guidance suggests concentrating on current requirements, using internal value sets, and adding external bindings where needed. Term set binding applies constraints at the template level but usually requires an "out clause" to allow for flexibility. Examples show binding nodes for family history information to appropriate SNOMED CT and local terminology terms and term sets.

1. Making openEHR Terminology
binding practice
Jussara Rötzsch
Adapted from Ian McNicoll

2. Terminology binding patterns
• Direct node‐binding
– e.g. ‘Urine color’ node
• Node name e.g.. “Urine color”
– Automatically has unique internal term ‘at0007’
– Can be ‘run‐time’ coded by external term
– Can be ‘run‐time’ mapped to an external term
• Node value e.g.. ‘Red, yellow, purple’
– Unique term provided by Internal value set ‘at0009’
– External term mapped to term from Internal value set
– External term used as the value

3. Direct‐binding issues
• Incomplete terminology / translation coverage
– e.g.. SNOMED
– 50‐70% for histopathology
• Effort
– Requires very good terminology skills
• Can be challenging to choose correct bindings
– Some concepts require post‐coordination to capture
correctly
– Is it worth trying to achieve complete node binding?

4. “BP 120/78, sitting, large cuff”
Candidate SNOMED CT term bindings:
• Blood pressure finding - ... (finding) – 392570002
• Sitting blood pressure - ... (observable entity) – 163035008
• Blood pressure - ... (observable entity) – 75367002
• Blood pressure taking - ... (procedure) – 46973005
• Diastolic blood pressure - ... (observable entity) – 271650006
• O/E - blood pressure reading - On examination - blood pressure
reading (finding) – 163020007
• Blood pressure cuff - ..., device (physical object) – 70665002

5. Direct‐binding guidance
• Concentrate on current requirements
– Archetypes and templates ‘fix’ the semantics
• Initial efforts guided by actual requirements
• More bindings can be added later as requirements
evolve
– Node bindings
• Use internal value sets. Consider leaving ‘open to allow
for local variation.
• Add External terminology bindings where required and
available

6. Termset‐binding issues
• Very little at Archetype‐level
– Scope of the termset binding is often too broad to
be meaningful at implementation
• E.g. ‘All procedures’ in ACTION.procedure archetype
– Very few examples of sensible termset‐bindings in
international archetypes
– Much more applicable at national level
• esp. National terminologies

7. Termset‐binding guidance
• Almost all at Template‐level
– Layered constraint approach
• All procedures
– Orthopedic procedures
» Knee specialist procedures
– But generally have to provide option to override
the constraint for unusual clinical situations
• e.g.. Non‐orthopedic procedure carried out in
Orthopedic department.

8. Termset‐binding guidance
• Microsoft / NHS Common User Interface
(CUI)
– Layered constraint with ‘termset filters
– ‘Get‐out clause’ where constraint is too tight

9. Example: “Family history”

10. Example: “Family history”
Term bound to node Name
? 371534008 |Summary report (record artifact)
? 422735006 |Summary clinical document (record artifact)
Termset-bound to node Value: (Is_a genetic relation)
444148008 | Person in family of subject
Term bound to node Name:
408732007 | Subject Term bound to node internal Value set:
relationship context
[at0004|Not known] =365873007|Gender unknown (finding)
(attribute) [at0004|Not known] =UNK|Gender unknown
[at0005|Male] = SNOMEDCT::248153007 | Male (finding)
[at0005|Male] = KITH-SEX::M| Male
[at0006|Female] = 248152002 | Female(finding)
[at0006|Female] = KITH-SEX::F | Female
Term bound to node Name:
184100006 | Patient sex
(observable entity OR
Termset-bound to node Value: (??????)
429019009 | Finding related to biological sex

11. Assessed risk : Family history
No matches
found in
SNOMED CT

12. Local terminologies ‐ England

13. Local terminologies ‐ Scotland