Thematic Network EHR-QTN
CIP-ICT PSP-238912
Status Report on the
Translations
of the EuroRec Statements
D6.3 Status Report on the Translations
1/12
CIP-ICT PSP-238912
Thematic Network EHR-QTN
1 Content
1
2
3
4
5
6
7
8
9
Content ................................................................................................................. 2
Introduction........................................................................................................... 3
Executive Summary ................................................................................................ 3
Why translations? ................................................................................................... 4
Translations and National Customisation ................................................................... 4
Translations at the start of the project ...................................................................... 5
Translation Tools – Translation Manual ...................................................................... 5
Translations Validation ............................................................................................ 5
Translation Maintenance .......................................................................................... 6
9.1
Deleted Statement ........................................................................................... 6
9.2
New Statement ................................................................................................ 6
9.3
Modified Statement .......................................................................................... 7
10
Status at the end of the project ............................................................................ 9
11
Future of the Translations................................................................................... 11
12
Estimated budget required ................................................................................. 11
Tables
Table 1 Translations at the start of EHR-QTN ..................................................................... 5
Table 2 Status of translations at the end of the EHR-QTN project ....................................... 10
Table 3 Budget for maintaining and expanding the repository and the translations ............. 12
Figures
Figure
Figure
Figure
Figure
Figure
Figure
1
2
3
4
5
6
Interface, statements identified as translated or to be translated ........................... 7
Decide if a new version needs to be created ........................................................ 7
Is there a need to check the translations? ........................................................... 8
Message that a translation should be reviewed .................................................... 8
Translation to be reviewed due to a modification of the original statement .............. 9
Version overview of an item highlighting the translation to be reviewed .................. 9
D6.3 Status Report on the Translations
2/12
CIP-ICT PSP-238912
Thematic Network EHR-QTN
2 Introduction
This deliverable was originally numbered D6.1 and is now numbered D6.3. The actual
deliverable D6.1 contains the reports of the Workshops and Conferences organised during
the third year of the project.
The deliverable was split in two separately submitted documents; Deliverable D6.3a with
the status report on the translations of the EuroRec Statements and Deliverable D6.3b
documenting the translation tools used. The second document should be considered as
confidential.
3 Executive Summary
Translating original EuroRec Descriptive Statements into the different national languages
represented in the project was one of the first objectives of the project. This was needed
in order to be able to promote at national level quality labelling and certification of EHR
systems.
8.596 new translations were added to the EuroRec Repository during the lifetime of the
project.
The main objective regarding translations was not to produce as much translations as
possible but to have a sufficient number of statements translated in all languages
represented.
The minimal set included the Generic Statements (indexed A09) defining basic quality
requirements of any EHR system, focusing on reliability and trustworthiness of the
systems and their content.
The partners were asked to complement their set of translations at least with all the
criteria included in the EuroRec Seal Level 1 and Level 2. The statements of the
EuroRec Seal Level 1 are now available in 21 languages, the statements of the
EuroRec seal Level 2 in 201 languages.
Most partners completed the set of translated criteria most/all the criteria related to
medication: medication management, prescription, administration, effects and
medication related decision support.
Some partners translated much more statements than the minimum required because
they were interested in using these complete set of statements for setting up a national
program for quality labelling and certification or for use in procurement procedures.
Four partners from Croatia, Estonia, Slovakia and Spain translated more than 1.000
original statements to their national language. The Estonian and Slovakian partners
were the most active.
We are further describing in this deliverable why and how translation of the EuroRec
Statements was addressed during the project.
The deliverable starts with a motivation, the status before project and with a description
of the tools made available to the translators.
1
Only the Seal Level 1 were translated to Russian.
D6.3 Status Report on the Translations
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Thematic Network EHR-QTN
CIP-ICT PSP-238912
We are addressing then the validation and maintenance related issues, ending with the
status at the end of the project and some issues related to the future of these
translations.
A proposal is finally made regarding what we consider as a mandatory investment to
enable and to maintain a comprehensive multilingual functional and interoperability
verifiable requirements definition for EHR systems, safeguarding the survival of a reliable
and high quality European Health IT and e-Health industry.
4 Why translations?
Translations are needed for legal purposes in most of the European countries2.
It is the ambition of the EHR-QTN project to promote EHR Systems Certification to
authorities, suppliers, users and other interested parties. Not all of them understand
English.
Certification should be an “authority driven” process. It is in most of the countries
mandatory for authorities to use the national language in all documents and
regulations they produce.
The EuroRec Descriptive Statements need to be in the local language also to avoid
misinterpretations and most of all to avoid contestation during a quality assessment
process.
Some partners were particularly interested in providing a large set of translated
statements to their national community, not only for certification purposes but also for
procurement, product documentation and as source of inspiration for the development of
new products or upgrading existing products.
Translating the EuroRec Statements within the EHR-QTN project also resulted in a large
number of corrections, requests for clarification and suggestions for improvement.
Translating the EuroRec Statements was therefore considered as a first level validation of
the statements.
5 Translations and National Customisation
Translations can’t be used to customise the original statements in order to comply with
national regulations.
There is sometimes a need to formulate a EuroRec Statement in a slightly different
way, e.g. to specify different ways to identify a person or to specify a drug database to
be used or to document required compliance with a National or International syntax
standard.
EuroRec developed
Deliverable D4.4.
2
therefore
the
National
Variants
functionality,
documented
in
Norway seems to be an exception.
D6.3 Status Report on the Translations
4/12
Thematic Network EHR-QTN
CIP-ICT PSP-238912
6 Translations at the start of the project
We started the project with 2.927 translations for 10 different languages, the total
number of languages being 11 at that moment, English included.
This was partially the result of the Q-REC project and partially efforts done by ProRec
centres, members of the EuroRec network.
Bulgarian
325
Danish
121
Dutch
463
French
325
German
266
Italian
325
Romanian
265
Serbian
205
Slovakian
460
Slovenian
172
2927
Table 1 Translations at the start of EHR-QTN
7 Translation Tools – Translation Manual
Translation tools were developed and documented in a “Translation Manual”.
The January 2012 version of the manual is added to the documentation submitted at the
end of the EHR-QTN project, as Deliverable D6.3b.
8 Translations Validation
We need to clearly distinguish the validation of the original criteria and the validation of
the translations.
The validation of the original (English) criteria addresses issues like technical
correctness, content and relevance as well as the original formulation.
Is the criterion content-wise correct?
Does the criterion correctly express what’s meant?
Is the formulation clear and unambiguous?
The validation of the translated statements is limited to the question: does the
translation perfectly reflect the original statement?
The translation needs to match 100% with the original statement. If this isn’t
possible because the original doesn’t perfectly match with the local
requirements, then one should create a “variant” of the original statement, first
in English and then translate that variant.
Validation of the translations is mainly done during the workshops, more specifically the
workshops addressing the validation of the EuroRec Statements.
D6.3 Status Report on the Translations
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CIP-ICT PSP-238912
Thematic Network EHR-QTN
Validation of the translations has therefore only been addressed in a few languages
and for a limited number of statements, mainly the Seal Level 2 statements.
The Workshops addressing the validation of the criteria (also the translations) were
the Spanish, Slovakian, Greek, Italian, Bulgarian, Hungarian workshops and for a
limited number of statements related to security and patient safety, the Estonian
workshops respectively.
These workshops confirmed the need of clinical as well as a technical validation of the
translations. More interpretation problems were identified with the translations than
with the original statements.
Validation of the translations remains anyway an important issue and needs to be
addressed. This requires resources that aren’t available at European level and mostly
neither at national level.
National and European authorities should take the lead (and responsibility), if they really
want functional harmonisation and quality of EHR systems across borders, resulting in
interoperability of the systems when completed with semantic harmonisation.
9 Translation Maintenance
The EuroRec Repository is in permanent evolution. This means that new statements are
added, deprecated statements are removed and – most of all – statements modified,
corrected, split or merged.
Maintaining consistency between the ‘original’ English valid statement
translations is important and essential. Strict procedures were implemented.
and
the
9.1 Deleted Statement
Translations of deleted items will not be available anymore. They remain physically in
the database but they are no longer displayed nor exported.
9.2 New Statement
A new statement is displayed as to be translated to all the translators identified for that
language, as illustrated in the figure below.
D6.3 Status Report on the Translations
6/12
Thematic Network EHR-QTN
CIP-ICT PSP-238912
Figure 1 Interface, statements identified as translated or to be translated

Statement GS001591 is not translated in Dutch,

Statement 1606 is neither translated in Dutch and also not in French. This is the
interface for a translator accepted as translator to Dutch as well as to French.
9.3 Modified Statement
Each time a EuroRec Statement is modified a version management function is activated.
Step 1 is to decide if the modification needs to be considered as a new version. Only
“corrections” like typos should not be considered as new versions.
Figure 2 Decide if a new version needs to be created
D6.3 Status Report on the Translations
7/12
Thematic Network EHR-QTN
CIP-ICT PSP-238912
If the user decides that a new version is needed, that new version will be added to the
version history.
Step 2: The system asks the author of that new version if the national language
versions need to be updated.
Figure 3 Is there a need to check the translations?
Step 3: A message is automatically sent to all translators of the original statement that
a new version has been introduced and that the translation needs to be reviewed.
Figure 4 Message that a translation should be reviewed
Step 4: The translation to be reviewed is highlighted in the interfaces of the translator,
enabling the translator to update the translated version or to confirm the actual version.
D6.3 Status Report on the Translations
8/12
CIP-ICT PSP-238912
Thematic Network EHR-QTN
Figure 5 Translation to be reviewed due to a modification of the original statement
The translation is always linked to a version of the statement. The last translation is
linked to the last version of the statement.
The translation is highlighted as “to be reviewed” in case of change of the original
English version.
Figure 6 Version overview of an item highlighting the translation to be reviewed
This procedure enables a synchronisation between the original (English language)
statements and the translators.
This procedure also enables to identify translations that aren’t updated in time.
10 Status at the end of the project
The status of the translations is the same as the one reported in the Third Annual Report,
Deliverable D6.5, repeated here.
EuroRec statements now exist in 21 different European languages. This is more
specifically the case for the EuroRec Seal Level 1 and Level 2 statements.
Most of the partners completed the set of translated criteria most/all the criteria
related to medication: medication management, prescription, administration, effects
and medication related decision support.
Up to 8.596 new translations were provided during that third year of the project.
D6.3 Status Report on the Translations
9/12
Thematic Network EHR-QTN
CIP-ICT PSP-238912
Some partners translated much more statements than the minimum required because
they were interested in using these complete set of statements for setting up a national
program for quality labelling and certification or for use in procurement procedures.
Four partners from Croatia, Estonia, Slovakia and Spain translated more than 1.000
original statements to their national language. The Estonian and Slovakian partners
were the most active.
A Russian expert translated the EuroRec Seal Level 1 statements, the 21 st language for
these statements.
The total number of available translations is now 12.379 translations. This is less than
the expected 15.000, due to reorienting the focus of the project more towards the main
deliverables (Roadmap and Validation of the Procedures) and towards the involvement
of health authorities.
Please find hereby a table with:







Number of Fine Grained Statements translated per February 1 st 2009.
Number of Fine Grained Statements translated per January 31 st 2012.
Number of Fine Grained Statements translated during the 3 years.
Number of Good Practice Requirements translated per February 1 st 2009.
Number of Good Practice Requirements translated per January 31 st 2012.
Number of Good Practice Requirements translated during the 3 years.
Total number of translations during the 3 years of the project.
FGS 09
Bulgarian
Croatian
Czech
FGS 12
325
348
0
966
0
158
Danish
121
150
Dutch
463
607
0
1686
French
325
530
German
Estonian
266
286
Greek
0
201
Hungarian
0
686
325
344
Lithuanian
0
416
Polish
0
116
Portugese
0
252
Romanian
265
479
Italian
Russian
0
19
Serbian
205
351
Slovakian
460
1694
Slovenian
172
204
0
1131
2927
10624
Spanish
New
FGS
23
966
158
29
144
1686
205
20
201
686
19
416
116
252
214
19
146
1234
32
1131
7697
GPR 09
GPR 12
91
92
0
179
0
0
32
33
118
161
0
179
99
98
62
62
0
42
0
86
131
144
0
95
0
15
0
24
104
104
0
0
46
60
125
179
48
47
0
155
856
1755
New
GPR
1
179
0
1
43
179
-1
0
42
86
13
95
15
24
0
0
14
54
-1
155
899
Total in
3 Years
24
1145
158
30
187
1865
204
20
243
772
32
511
131
276
214
19
160
1288
31
1286
8596
Table 2 Status of translations at the end of the EHR-QTN project
D6.3 Status Report on the Translations
10/12
CIP-ICT PSP-238912
Thematic Network EHR-QTN
11 Future of the Translations
As for many things in life, questioning the future is questioning resources availability to
perform a number of tasks. These resources are actually not available.
We are trying to estimate a budget that may be required on one hand to upgrade the
actual status, to maintain yearly the database and to expand the repository in order to be
more exhaustive.
Limiting ourself to the European Union and associated countries we identified the
following tasks
1. Completing the translations for 20 languages
2. Initiate and complete translation for five new languages: Albanese, Finnish, Icelandic,
Latvian and Maltese. There might be a need to expand the number of languages with
some “regional” languages (e.g. Catalan) or to distinguish some versions of country
specific languages (e.g. to distinguish Belgian Dutch and Netherlands Dutch). We are
actually not considering this cost.
3. Maintaining consistency between the original statements and the yet translated
statements.
4. Supporting integration of national variants and their translations.
12 Estimated budget required
We estimated the budget required to complete the translations of the complete actual
repository while adding the 5 new (national) languages at 525.000 €. This does not
include “regional” languages or national variants of languages of e.g. Dutch.
The budget required to render the EuroRec Statements compliant by creating national
variants, translation of the variants included is estimated to be 225.000 €.
The annual maintenance cost for all the translated statements is estimated at 187.500 €.
This includes upgrades, corrections and all kind of changes to the existing statements and
their translations.
The cost for expanding the actual repository to a more comprehensive coverage of
functionalities, including interoperability requirements but excluding the test tools is
estimated at 600.000 €
D6.3 Status Report on the Translations
11/12
CIP-ICT PSP-238912
Thematic Network EHR-QTN
Budget for completion of the translation of the actual repository
Number of
Cost per
Total
languages
language
Completing actual sets of translations
20
15.000
300.000
New Languages
5
20.000
100.000
Coordination and Consistency
25
5.000
125.000
Management
525.000
Supporting integration of national specific variants
Defining the national variants and
30
5.000
150.000
translating them
Coordination and Consistency
30
2.500
75.000
Management
225.000
Annual Maintenance Costs
Number of
Cost per
Total
languages
language
Maintenance of the translated statements
25
5.000
125.000
Coordination and Consistency
25
2.500
62.500
Management
187.500
Expanding the repository to be more comprehensive (3.000 statements)
Central Repository Maintenance and
225.000
Expansion
Translating to the different languages
25
15.000
375.000
600.000
Table 3 Budget for maintaining and expanding the repository and the translations
D6.3 Status Report on the Translations
12/12