title: Development and application of a framework for maintenance of medical terminological systems.
abstract: OBJECTIVE
  Terminological Systems (TSs) need to be maintained in order to sustain their utility. This paper describes a study aiming at the standardization of the maintenance processes of medical TSs by capturing the criteria for the management of the maintenance processes into a framework. Furthermore, this paper describes application of the framework, which sheds light on the current practice of TS maintenance.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  By means of a literature study, criteria for the maintenance of TSs were obtained and categorized into a framework. The current practice of TS maintenance was explored by a survey among organizations that maintain a TS. Results were stratified by the size of the TS being maintained.
  
  
  RESULTS
  From Sixty-three relevant articles, criteria for the maintenance processes of TSs were extracted and organized into four components. The primary component "Execution" concerns the core activities of the maintenance process. The other three components "Process management," "Change specifications," and "Editing tools" support the core activities of the component "Execution." The survey had a response rate of 40% (37 of 93). The answers reflect the large variation in the number of criteria that are satisfied for the participating organizations. Overall, maintenance of larger TSs seems to satisfy more criteria.
  
  
  CONCLUSIONS
  The framework is an important step towards standardization of the maintenance of medical TSs and can be used to eliminate shortcomings in this process. Surveying the current practice showed that there is ample room to improve the maintenance processes of medical TSs, especially for the smaller TSs.
authors.affiliation: Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. f.raiez@amc.uva.nl
authors.forename: Ferishta
authors.initials: F
authors.lastname: Bakhshi-Raiez
authors.forename: Ronald
authors.initials: R
authors.lastname: Cornet
authors.forename: Nicolette F
authors.initials: NF
authors.lastname: de Keizer
mesh_terms: D003625:Data Collection; D004282:Documentation; D005069:Evaluation Studies as Topic; D006801:Humans; D009426:Netherlands; D012015:Reference Standards; D009626:Terminology as Topic; D018875:Vocabulary, Controlled