Inventory of Health Care Information Standards. ASTM E1460-92


Standard Specification for Defining and Sharing Modular Health Knowledge Bases (Arden Syntax for Medical Logic Systems)

V. Contact for more information

Terry Luthy

American Society for Testing and Materials (ASTM)

100 Barr Harbor Drive

West Conshohocken, PA 19428-2959

phone: (610)832-9500

fax: (610)832-9666


Harm Scherpbier, MD

Chairman ASTM E31.15


51 Valley Stream Parkway

Malvern PA 19355

phone (610)219-4762

fax: (610)219-3124


VI. Description of Standard


A. Include separate statements for:

  • objectives
  • functions
  • user environment (reimbursement, administrative,

clinical and/or other functional areas)

- systems environment (operating systems, network,

hardware or other requirements)

- Application function/domain completeness (Within the

defined scope of this standard, what functions/codes

are complete?

- In what way(s) is this standard superior to other

standards in this category/classification?

- any other relevant characteristics

Objectives: promote and facilitate the sharing of medical logic in the form of Medical Logic Modules. A Medical Logic Module contains sufficient knowledge to make a single decision. Contraindication alerts, management suggestions, data interpretations, treatment protocols, and diagnosis scores are examples of health knowledge that can be represented using MLMs.

Using the Arden Syntax, health providers and health delivery systems can share MLMs, independent of the clinical information system at their site.

Functions: The Arden Syntax is a standard syntax to represent MLMs. Each MLM contains administrative information about the author of the MLM, library information about the purpose of the MLM with links to medical reference literature, and a knowledge section containing the knowledge in a standard language. The knowledge section contains the data needed from a clinical information system to process the MLM, the trigger event causing the MLM to execute, the logic, and the action to be taken if the MLM needs to alert a clinician about a patient situation.

User Environment: primarily clinical, also administrative and research.

Systems Environment: the Arden Syntax is independent of the systems environment. Implementations exist on mainframes, PCs, client/server systems, etc.

Application function/domain completeness: the Arden Syntax 92 version is complete. Future extensions include further standardization of the data needed to process an MLM, which is dependent on other standardization efforts in clinical data modeling and vocabularies (outside the scope of this standard). Other areas of knowledge representation will be included in future versions.

In what way is standard superior to other standards in this category: There are no other standards in this category.

VII. Readiness of Standard


A. Is it a guideline? If so, does it address policy, process, practice or design?

It is an official standard.

B. Is it implementable? (If so, is it fully or partially implementable?,explain)

Several implementations exist, both in academia as well as by commercial clinical software vendors. The standard is both fully as well as partially (or incrementally) implementable. In other words, some developers choose to implement the entire Arden Syntax at once, others choose to start with commonly userd Syntax functions, adding others later (incrementally).

A. How can the standard be obtained?

Order from ASTM (address and phone see above).

D. Does it require a separate implementation guide? (If so is the guide approved by the SDO?


E. Is there only one implementation guideline (or are there major options that impact compatibility)? N/A

A. Is a conformance standard specified?

Not at this time.

A. Are conformance test tools available?

Not at this time.

A. Source of test tools?

Several commercial syntax checkers are available.

I. If the standard is under development, what parts of it are ready now?

N/A - Standard has a complete 1992 version.

A. What extensions are now under development?

See above:

A. What are the major milestones toward standards completion?


L. What are the projected dates for final ballotting and/or

implementation? N/A

M. Please note any other indicators of readiness that may be appropriate.

VIII. Indicator of Market Acceptance


A. If the standard is a guideline, how many copies have been requested and distributed?

B. If the standard is an implementable standard, how many vendors, healthcare organizations and/or government agencies are using it?

Academic institutions: approx. 7 that I'm aware of (both US and international), probably others that I'm not aware of.

Commercial software vendors: >6, including most large clinical information systems vendors, either have products on the market today or to be released 1997.

A. Is this standard being used in other countries (which are they)?

Sweden, UK, Germany. Possibly others that I'm not aware of.

D. Please note any other relevant indicator of market acceptance within

the public or private sector.

IX. Level of Specificity


A. If your standard is a guideline, how detailed is it?

Very strictly defined syntax.

B. If it is an implementable standard, describe how detailed its

framework is and its level of granularity.

Fully defined syntax for writing clinical logic. Only exception of tight definition: the definition of the data needed in an MLM is not standardized. The syntax allows local implementors to use any query language and vocabulary to retrieve the data needed in an MLM. This allows the current Arden Syntax to be used in very diverse clinical information environments. Work is in process to tighten the definition of data, but this is a long term process.

C. Does the standard(s) reference or assume other standards to achieve

more specificity? No.

A. If it includes or assumes code sets, which ones are they? N/A

E. What is the description of the code set?

F. How is the code set acquired?

G. Is there a users' guide or some other assistance available on the

code set?

H. If the code set is currently in use, what is the extent of its use

(e.g., approximate number of users)?

I. If the code set is under development, what are the projected dates

of completion and implementation?

X. Relationships with other standards

A. Identify other standards and the relationship(s) with other standards such as inclusion, dependency, interface overlap, conflict or coordination.

Currently: no dependencies

B. Identify specific standards reconciliation or coordination activities.

Future activities to further specify the data definitions: work with standards organizations to provide clinical data model ( for example HL7), query language, and vocabularies (for example LOINC, SNOMED, ICD9, etc.).

C. What portion of the specification and functionality is affected by this coordination?

The data slot - the slot where needed data are specified.

Standard is available to international users, and is currently used by international organizations.

A. What gaps remain among related standards that should be addressed?

Clinical data model: no complete clinical data model exists today.

Vocabularies: various vocabularies exist, some overlapping. For the Arden Syntax to work optimally, there needs to be a single, complete, non-overlapping standard for each vocabulary domain, for example one vocabulary for lab results, one for medications, etc.. The coordination and creation of these vocabularies is outside of the Arden Syntax scope. We rely on other SDOs to create these vocabularies.

XI. Identifiable Costs


A. Please indicate the cost or your best estimate for the following:

  • Cost of licensure
  • Cost of acquisition (if different from licensure)
  • Cost/timeframes for education and training
  • Cost/timeframes for implementation
  • Please note any other cost considerations.

License cost: none

Acquisition cost - depends on number of copies. Single copy approx. $32.00, discount on larger quantities.

Cost/ timeframes for education, training, and implementation: different for each organization.