We have translated the ContSys, i.e., ISO 13940:2015 System of Concepts to Support Continuity of Care. No English literature exists on translating the ContSys. We aim to fill this gap by sharing our experience and suggestions. All chapters were translated into Estonian and published as a national standard in February 2023.

Translating is the first step to adopting the standard in Estonia. The ContSys provides an abstract system of core concepts describing healthcare processes. Continuity of care relies on healthcare processes to be inter-connectable; therefore, process standardization needs more attention. For process standardization to happen, clear communication between a wide range of stakeholders is required – from policymakers to software developers. Effective communication needs a mutual understanding of the core concepts of healthcare processes. 

Implementing and bringing the ContSys into wide use will require significant effort, including concept harmonization between the stakeholders. Our gray literature review made a contradictive finding: on the one hand, more information relating to local circumstances is needed to explain the otherwise too abstract neutral concepts. On the other hand, it was found that Sweden had too much adapted its translation to local circumstances, resulting in non-compliance with the original standard.

To find a balance, we have introduced country-specific notes. They add local information without burdening or adapting the standard’s concept system.

But, healthcare evolves and its digitalization continues to progress, country-specific notes need to be added continuously. To remedy this, our suggestions for a two-phase translation method center on a mapping process to feed the country-specific notes. We identified the integration and interoperability framework (ISO 23903) to support the mapping process after translation. We share our experiences relating our translation to the framework’s three dimensions.

Finally, we share our challenges in mapping the ContSys with local legislative terminology, showing the potential use of the standard for concept harmonization.

The Estonian ContSys translation has already proven helpful by reusing its terms in other ongoing terminology translations, like the Estonian HL7 FHIR, SNOMED CT, and the European Health Data Space regulation.