Most Electronic Health Records (EHRs) are designed and developed using one or more information models, which describe the information that is collected, stored, communicated and displayed. Some information models are designed for a specific proprietary system, while others are based on a common health information standard (e.g. HL7 FHIR resource, HL7 CDA template, ISO 13606 archetype). Information models may also be defined using a wide variety of representations (e.g. UML class diagram, database table design, Archetype Definition Language, or XML Schema). Irrespective of the purpose, design and representation of the information models, however, the use of clinical terminology is an important part of making the models complete and useful.

Terminology binding provides the links between the information model and the terminology. These links may be used to constrain the set of possible values which can populate a given coded data element in the information model, or they may define the meaning of an information model artefact using the terminology. Terminology binding is an important part of supporting the following clinical information system functions:

  • Data capture;
  • Retrieval and querying;
  • Information model library management; and
  • Semantic interoperability.

To enable terminology binding to be defined using intensional rules, a formal language must be used. The SNOMED CT Expression Constraint Language can be used in this way to define terminology bindings which constrain the set of possible coded values within an information model.