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subject to various interpretations; (3) clinical concepts are created and used for spe-
cific purposes and must be interpreted in the context of these purposes; and (4)
clinical concepts evolve over time. In this section, we describe a semiotic approach
to modeling of medical concepts.
Originally, the term 'semiotics' (from a Greek word for sign “semaion”) was in-
troduced in the second century by the famous physician and philosopher Galen (129-
199), who classified semiotics (the contemporary symptomatology) as a branch of
medicine [19]. The use of the term semiotics to describe the study of signs was de-
veloped by the Swiss linguist, Ferdinand de Saussure (1857-1913) and the American
logician and philosopher Charles Sanders Peirce (1839-1914). Today, semiotics can
be broadly defined as the study of signs. Since signs, meaning-making, and repre-
sentations are all present in every part of human life, the semiotic-based methods
have been used in many disciplines, from mathematics through literary studies and
library studies to information sciences. A semiotic paradigm is associated with dif-
ferent traditions and with a variety of empirical methodologies. Our intention in this
paper is to define the basic terminology needed to present the need for the semiotic
approach to the modeling of medical concepts. The examples of the operationaliza-
tion of
OSA
illustrate that the meaning of a sign arises in its interpretation or even
in multiple possible interpretations.
Peirce defined “sign” as any entity carrying some information and being used in
a communication process. Peirce, and later Charles Morris, divided semiotics into
three categories [2] : syntax (the study of relations between signs), semantics (the
study of relations between signs and the referred objects), and pragmatics (the study
of relations between the signs and the agents who use the signs to refer to objects in
the world). This triadic distinction is represented by Peirce's semiotic triangle: the
representamen (the form which the sign takes), an interpretant (the sense made of
the sign), and an object (an object to which the sign refers).
We base our approach to concept modeling on the traditional Piece's triangle.
However, we have used Peirce's triadic model (object, representamen, interpretant)
rather loosely since our emphasis is on the process of sense-making (process of
semiosis in Peirce's theory). Furthermore, we emphasize the communication pro-
cess and the role of the interpreter in the creation (construction) of meaning. Thus,
in semiotic terminology, the meaning of the sign (representamen) arises in its in-
terpretation. Our model uses the notions of conceptualization, operationalization,
and utilization. The notions of conceptualization and operationalization have their
roots in social sciences. The notion of utilization of measures has been added by us
to model the pragmatic aspects. We introduce a triplet for the representation of the
concept and use the terms: conceptualization (what to measure), operationalization
(how to measure), and utilization (how to use the measure). We observe a strong
parallelism between the semiotic triangle (object, representamen, interpretant) and
the triplet: conceptualization, operationalization, and utilization. In many ways, the
semiotic approach presented here is oversimplified and does not reflect the richness
of multiple semiotic traditions. However, we believe that a semiotic approach al-
lows for modeling of complex medical concepts. We focus on the pragmatic aspects
(utilization) of the models. Therefore, we have introduced a notion of “pragmatic
