ISO 21667:2010

INTERNATIONAL ISO
STANDARD 21667
First edition
2010-12-01
Health informatics — Health indicators
conceptual framework
Informatique de santé — Cadre conceptuel d'indicateurs de santé

Reference number
©
ISO 2010
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ii © ISO 2010 – All rights reserved

Contents Page
Foreword .iv
Introduction.v
1 Scope.1
2 Terms and definitions .1
3 Health indicators conceptual framework.2
Annex A (informative) Correspondence with OECD health indicator initiatives.7
Annex B (informative) Rationale for a common health indicators conceptual framework .9
Annex C (informative) Background on the health indicators conceptual framework.10
Annex D (informative) Health status .12
Annex E (informative) Determinants of health.13
Annex F (informative) Health system performance.14
Annex G (informative) Community and health system characteristics (contextual indicators).15
Annex H (informative) Equity.16
Bibliography.17

Foreword
ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies
(ISO member bodies). The work of preparing International Standards is normally carried out through ISO
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International Standards are drafted in accordance with the rules given in the ISO/IEC Directives, Part 2.
The main task of technical committees is to prepare International Standards. Draft International Standards
adopted by the technical committees are circulated to the member bodies for voting. Publication as an
International Standard requires approval by at least 75 % of the member bodies casting a vote.
Attention is drawn to the possibility that some of the elements of this document may be the subject of patent
rights. ISO shall not be held responsible for identifying any or all such patent rights.
ISO 21667 was prepared by Technical Committee ISO/TC 215, Health informatics.
This first edition of ISO 21667 cancels and replaces ISO/TS 21667:2004, of which it constitutes a technical
revision.
iv © ISO 2010 – All rights reserved

Introduction
Heightened interest in the measurement and monitoring of the performance of health care systems, as well as
accountability and responsiveness to payors and stakeholders is now evident on an international scale.
Consequently, many countries have begun the systematic definition and collection of health information for
monitoring health system performance. This trend has also concomitantly driven, and is driven by, an
enhanced data infrastructure that allows for more explicit and rigorous examination of the health of
populations and their health care systems. More often than not, this has taken the form of the collection of
specific health indicators with which to describe a variety of health and health system-related trends and
factors.
The term health indicator refers to a single summary measure, most often expressed in quantitative terms,
that represents a key dimension of health status, the health care system or related factors. A health indicator
must be informative, and also must be sensitive to variations over time and across jurisdictions. Indicators are
able to flag issues that require more in-depth examination to determine causes for variation, and to identify
opportunities for improvement, as well as establishing the most effective use of research resources. They may
also be used as a rapid means to evaluate the effects of interventions or to make comparisons as health
systems evolve.
In order for them to be useful for monitoring health or health system performance, however, explicit criteria
must be applied to choosing and defining health indicators. This framework is intended to inform the selection
of health indicators that can be used to monitor and manage the health care system and overall performance
improvements. The selection must be based on some agreement about what is to be measured, and for what
purpose, and be informed by a clear conceptual framework. This implies a common framework, to be used
internationally, for structuring the way health and health system performance is measured. This International
Standard describes a comprehensive, high-level taxonomy of the key types of indicators that are useful for
assessing population health and health services. While, in many cases, health indicators may be best
constructed from readily available data, in other situations a health indicators conceptual framework may
inform additional data collection initiatives that are required for understanding health and health system
performance. It is important to note that any data collection must be carried out according to privacy and
confidentiality legislation and ethical principles.
Working toward a standard health indicators framework will undoubtedly foster a common language for
communication between countries and ultimately lead to greater commonalities for indicator development.
This ought to lead to greater potential for generating internationally comparable health data in the long term,
and so permit consistent reporting, dissemination and analysis.
This initiative can also be seen as complementary to work currently underway in other organizations, such as
the Organization for Economic Cooperation and Development (OECD). The adoption of a common health
indicators conceptual framework will further stimulate efforts to develop and collect common health indicators
internationally. Furthermore, a harmonized effort to develop an internationally accepted health indicators
conceptual framework will not only foster increasingly robust cross-national comparisons and analyses, but
may also facilitate the development of comparable data that can be used as a basis for the setting of
international benchmarks. The results of such endeavours may be invaluable for informing national health
policy related to health expenditures, health human resources requirements or the organization of health and
social systems. Ultimately, these developments may facilitate an improved global understanding about
variations in health, variations in health care and the effect of other determinants of health in the context of
other essential factors. Furthermore, indicator collection, benchmarking and analysis can lead to continuous
quality improvement, the identification of factors requiring further analysis and, ultimately, improvements in
health within countries and internationally.
NOTE See Annex A for more information regarding the OECD initiative and its relationship to this International
Standard's health indicators conceptual framework.

INTERNATIONAL STANDARD ISO 21667:2010(E)

Health informatics — Health indicators conceptual framework
1 Scope
This International Standard establishes a common health indicators conceptual framework and is intended to
foster a common vocabulary and conceptual definitions for the resultant framework. The framework
a) defines the appropriate dimensions and sub-dimensions required to describe the health of the population
and performance of a health care system,
b) is sufficiently broad (high-level) to accommodate a variety of health care systems, and
c) is comprehensive, encapsulating all of the factors related to health outcomes and health system
performance and utilization, as well as regional and national variations.
NOTE 1 See Annex B for a more complete discussion of the underlying rationale for this framework.
NOTE 2 Many countries have already developed their own models for directing the collection and analysis of health
indicators. For the purposes of national reporting, these existing frameworks are not expected to change. Rather, this
framework can be viewed as a complement to currently existing frameworks. For example, if a particular health indicators
framework currently focuses only on health system performance, the comprehensive approach proposed here can serve
to augment and/or supplement the currently used model or models.
NOTE 3 Individual jurisdictions may elect to operationalize the conceptual framework differently. Because the
conceptual dimensions represent a high-level taxonomy, this provides considerable discretion and leeway in the selection
of specific indicators by individual countries. This focus on a high-level taxonomy also allows for sufficient flexibility for the
inclusion of new indicators in the future, as new issues emerge and additional data become available. Because specific
data elements are not defined, jurisdictions have the freedom to populate this framework with the most relevant, and
available, indicators for their specific situations.
This International Standard does not identify or describe individual indicators or specific data elements for the
health indicators conceptual framework; nor does it address needs analysis, demand analysis or the range of
activities that need to be supported for health system management.
The definition of benchmarks and/or approaches used in the definition of benchmarks is outside the scope of
this International Standard.
2 Terms and definitions
For the purposes of this document, the following terms and definitions apply.
2.1
health
resource for everyday life, not the objective of living, and a positive concept emphasizing social and personal
resources, as well as physical capacities
[Ottawa Charter for Health Promotion, World Health Organization (WHO), 1986]

2.2
health indicator
single summary measure, most often expressed in quantitative terms, that represents a key dimension of
health status, the health care system, or related factors
NOTE A health indicator must be informative, and also be sensitive to variations over time and across jurisdictions.
3 Health indicators conceptual framework
3.1 Framework
The health indicators conceptual framework shall be as outlined in Table 1. See Annex C for background
information relating to the framework outlined in Table 1.
Table 1 — Health indicators conceptual framework
Dimensions Sub-dimensions
Health status Well-being Health conditions Human function Deaths
Determinants Socio-economic Social and Environmental Genetic
Health behaviours
of health factors community factors factors factors
Health system Acceptability Accessibility Appropriateness Competence
performance
Continuity Effectiveness Efficiency Safety
Community and Resources Population Health system
health system characteristics
characteristics
3.2 Framework dimensions
3.2.1 Health status
The dimension of health status is described in Table 2. See Annex D for further information.
2 © ISO 2010 – All rights reserved

Table 2 — Health status dimension
Sub-dimensions Description Examples of indicators
Well-being Broad measures of the physical, mental and social — Self-rated health
well-being
— Self-esteem
Health conditions Alterations or attributes of health status which may Prevalence of:
lead to distress, interference with daily activities, or
— arthritis
contact with health services; it may be a disease
(acute or chronic), disorder, injury or trauma, or
— diabetes
reflect other health-related states such as
— chronic pain
...