Maria-Cornelia Wermuth is a lecturer at KU Leuven in Antwerp. She teaches terminology, German grammar and specialised (medical) translation at BA and MA level. She completed her PhD in Language and Literature at the Free University of Amsterdam (Netherlands) in April 2005. Her main areas of interest include specialised (medical) translation, terminology, translation tools, terminological computer applications, applied cognitive linguistics (medical sublanguage) and frame semantics. She heads the ‘Translation and Technology’ research group and is working on a number of translation and terminology-related projects, such as EmpathicCare4All.
What is the significance of terminology, or the standardisation of terminology, in the context of the current health crisis?
The significance of clear terminology during a crisis is not to be underestimated. At such times, all actors – for example, all health sector workers, such as the doctors, nurses, as well as all public institutions – need to be clear and, above all, unambiguous in explaining the circumstances that led to the health crisis (in this case, the COVID-19 pandemic). They have a duty to inform the public. Successful communication is only possible once all communicators can safely assume that they all mean the same thing when they use a particular term. This is true of neologisms as well as more or less well-known medical terms such as Covid-19, dead vaccine, inactivated vaccine, vaccine, aerosol and asymptomatic. Many of these terms have since found their way into everyday language. As has, for example, the term digital COVID certificate in reference to a pass granting people certain freedoms (e.g. access to large events) in the second year of the pandemic. Other crisis-related words on everyone’s lips include social distancing, PCR test centre and ‘hands, face, space’, among many others.
Your most recent publication Terminological cooperation in the biomedical field provides much food for thought. For instance, you speak about terminology as a public resource, an opportunity and a responsibility. Could you tell us a bit about this?
As part and parcel of technical language, terminology is primarily coined and used by experts. At the same time, though, it is needed to spread knowledge beyond the confines of the field. As a matter of fact, technical language and terminology are a prerequisite for knowledge transfer. All institutions that generate and document knowledge therefore have a duty to ensure that other disciplines and the general public are able to benefit from that knowledge. What this means in practice is that terminology must be not only maintained but also made accessible. Crucially, this should be done in a standardised and compatible way. To give you a specific example, medical ontologies and terminologies should, as far as possible, be in interoperable formats so the knowledge can be exchanged as widely as possible. It is the responsibility of public institutions (German Ministry of Health) to ensure that this knowledge transfer happens as it should, with the help of terminology.
Why is the electronic communication of medical information so crucial?
The use of electronic communication enables clinics and doctor’s surgeries to save a huge amount of time and make considerable efficiency gains in their day-to-day work. But electronic communication also offers distinct advantages over conventional doctor’s visits (which are notoriously cumbersome and time-consuming) when it comes to communication between patients and doctors, as they are able to keep each other up to date via email or the patient’s electronic record. Sometimes, it is also a better option than a phone call, which can often lead to confusion or misunderstanding, as the result of a bad line, mispronunciation or lack of fluency in the language.
Electronic communication allows patients and service providers to communicate when and where it suits them. This is a tremendous advantage. Of course, data security is a key concern with electronic doctor-patient communication. As a result, it should take place on systems with end-to-end encryption. This means that the message is encrypted on the sender’s device and, in principle, can only be decrypted by the recipient, hence the term ‘end-to-end’ encryption.
Medical ontologies and classifications are another type of electronic communication. They are important too, as they enable doctors and healthcare professionals to record patient data in a structured way, so that it can be exchanged domestically and internationally.
And, then, electronic data acquisition via interoperable systems is a mainstay of clinical practice. These systems mean that, nowadays, patient data and other health-related information can be accessed anytime and anywhere – something that was not previously possible. For example, if a holidaymaker in Spain ends up in hospital, interoperability will enable them to retrieve their personal data from their home country so that they get the treatment best suited to their medical history.
Standardisation, though, is about more than individual terms and concepts. It is a prerequisite for electronic terminology systems. Would you care to elaborate on this? What role does the interoperability of electronic systems play here?
The term ‘interoperability’ refers to an electronic system that can be seamlessly integrated into another for the exchange of information. In the case of electronic health records or patient data systems, it refers to the ease with which medical records, patient files and health data can be transferred from one provider or system to another. So even if two hospitals use different ontologies or classifications, the information saved in their separate systems can be exchanged. Basically, then, interoperable electronic health records (EHRs) enable the exchange of patient data between different electronic systems.
And this is where formats come to the fore once again?
Exactly. There are standards and rules to be followed. The advantage of such a system is, obviously, that procedures can be much better coordinated. As a result, doctors can take better care of their patients and treat them more efficiently. Meanwhile, patients can switch more easily between different care facilities, as their data can be accessed anywhere. Lastly, an interoperable environment naturally makes for better healthcare, as the right data is in the right hands at the right time.
What (syntactic, semantic) interoperability criteria or standards need to be met to facilitate inter-machine communication?
In a nutshell, there are four levels of interoperability determining the ability of a system to cooperate with other systems. The first level is the organisational level. This level has to do with managing inter-system processes and roles. There are only a few standards in place here.
The second level is the semantic level. The task here is to reach a common understanding of units of information. Typical standards governing the semantic level include classification systems like the International Identification of Diseases (ICD), Logical Observation Identifiers Names and Codes (LOINC), or tecom, which are used worldwide.
The syntactic level is the third level. This is about the recognition of the units of information making up the data. The standards used here are, for example, .xml and .csv., which define how something is to be syntactically represented.
The structural level is concerned with the transfer of data from one system to another. Standards include protocols or OSI layer models, data and network protocols, and IT standards such as Health Level 7 (HL 7). The last-mentioned is a set of international standards facilitating the exchange of data between IT systems in the health sector. It is also the name of the organisation that develops these standards.
What role does (interorganisational) cooperation play in the creation of terminology resources? Could you give a few examples of this kind of cooperation? SNOMED CT, for example?
SNOMED CT is the owner, holder and developer of the ‘Systematized Nomenclature of Medicine – Clinical Terminology’. The idea is to establish a terminological standard, which can be applied internationally through translation into many languages. SNOMED has both licensed members and affiliate licensees (with limited privileges). Currently, there are 25 members. A national release centre (NRC) is set up in each country as the official contact point. These contact points are responsible for all SNOMED-related activities in that country and act as the interface between the CT and national SNOMED users (hospitals, care facilities, doctor’s surgeries).
The NRCs liaise with the Ministry of Health in their respective member countries. The Ministry also decides whether the SNOMED nomenclature will be introduced at all. If it is, all stakeholders (hospitals, doctors, etc.) are called upon to get involved in translating SNOMED and expanding ontologies, i.e. by adding country-specific concepts into SNOMED. This leads to the creation of ‘subsets’.
What are the advantages of the model on which SNOMED CT is based versus a multilingual ontology-based thesaurus?
The key term here is ‘community of practice’. SNOMED CT is essentially a kind of community in which every kind of healthcare provider (institutions and individuals alike) across the different fields work together to develop a comprehensive, internationally applicable conceptual model.
What are the drawbacks of this model, particularly in relation to the translation of terminology resources?
SNOMED is a formal ontology developed in cooperation with medical experts. As a result, concepts are defined using a formal (and computer-readable) language. Each concept is represented using a code. Since this code is not much use to humans, each concept is explained in natural language. This is know as the ‘Terminus’.
Two types of relationship are used to organise entries: hierarchical relationships (ISA) and non-hierarchical relationships (attributive), of which there are 53 in total. SNOMED contains the relationships part-of, has-cause, has-purpose, and so on. This many relationships, however, often leaves laypersons unable to tell what a concept means for want of the encyclopaedic background knowledge. SNOMED CT does have linguistic definitions for some terms for which this extra-linguistic information is included, but unfortunately only a few. It is mostly medical professionals that handle the translation – or they are at least involved. Problems arise when only terminologists are enlisted who, for example, do not understand the meaning of a term. That’s why the magic word here is cooperation. The translation is done in cooperation with specialists.
EmpathicCare4All, another of your projects, was developed to teach interpreting students the art of empathetic communication in medical consultations facilitated by an interpreter. What are the project’s main aims? What lessons can be drawn?
The main aim of this project was to illustrate the importance of empathy or sensitivity among medical interpreters. The importance of empathy is, of course, old news in the field of doctor-patient communication. In the interpreting field, however, it has not yet been researched in sufficient depth. The patient-doctor-interpreter triad throws other variables into what would otherwise be a two-way conversation between doctor and patient. Laura, one of our PhD students, has researched this topic through the use of video recordings and interviews with doctors, patients and interpreters, and empirically proven the relevance of empathy in this communicative setting.
She analysed both verbal and non-verbal communication elements, such as facial expressions and tone. She concluded that the current code of conduct for interpreters is outdated. It dictates that interpreters only relay what was actually said. And that they do so without emotion, without adding or omitting anything. However, conveying empathy, whether expressed verbally or non-verbally, is central to any successful and efficient doctor-patient exchange.
The interviews also revealed that interpreters often find themselves in a bind, as they are not allowed to interpret empathetically – although they do so anyway. Respondents said that patients need to be made to feel understood. Patients also say that they often find it frustrating to receive such frosty treatment. Empathetic communication is part of the doctor training curriculum, but working with interpreters is not. Doctors would also like interpreters to convey empathy to the patients.
What are your terminology research plans? What else is on the horizon for you?
My focus area remains medical terminology and medical translation. I will continue to support and pitch in with the translation of SNOMED CT. Currently, I am also a member of the ‘Translation User Group’, which meets once a month to review translation guidelines. The Group has also devised guidelines for the translation of SNOMED CT.
In March, I will take part in a congress, organised by Gabrielle Sauberer from TermNet, to be held in Iceland. The focus will be on the state of terminology and terminology-related activities in minority languages, with the spotlight on Scandinavian languages. I’ll be attending along with NL-Term (a body of the Union for the Dutch Language, Taalunie). The aim of this body is to support and maintain Dutch terminology in the different subsectors, and to spread the word about the development of specialised terminology in these areas. Here I will sit on a panel at which NL-Term is to be presented.
I will also be guest-editing a special edition of Terminologie entitled Developing terminology in times of Corona. This issue will look at various theoretical approaches to the health crisis.
Justyna Regina Dłóciok
Interview by Justyna Dłóciok, former trainee in the Polish Translation Unit, DG TRAD, at the European Parliament. Justyna studied ‘English Language/Linguistics’ and ‘Language Industry and Specialised Translation’ at the University of Vienna, Austria. She is currently working as a research assistant at KU Leuven in Belgium. She is researching how technology is shaping the way in which technical writers work and how it affects users.