Development of a Framework for Redesigning a Terminology Maintenance Process - Case Study in the Netherlands.

Structuring clinical data in electronic health records supports reuse of data to improve quality of care, reduce costs and perform research. This requires terminologies to assign terms from language used in a specific domain to medical concepts. Given the developing character of medical knowledge, these terminologies need continuous maintenance. Nonetheless, little is known about terminology maintenance processes. To specify the (re)design of a terminology maintenance process, we first merged and adapted two static theoretical frameworks that consisted of criteria relating to using a terminology, divided among relevant stakeholders. Following, we applied the framework to the healthcare terminology maintenance process in the Netherlands. We held interviews with relevant stakeholders and used the framework as checklist to identify missing criteria and bottlenecks. Saturation in interviews and fulfilment of the criteria indicated that all bottlenecks were discovered, therefore the framework was considered useful for redesigning a terminology maintenance process. Other countries could benefit from this framework as well to discover and resolve any unfulfilled maintenance criteria.