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Vocabulary Working GroupMeeting Minutes

May 20161 Attendees

Given Name Family Name AffiliationSwapna AbhyankarMatthias Aschhoff HL7 GermanyOyrind AssaveElaine AyresSusan BarberCalvin Beebe Mayo ClinicLinda Bird IHTSDODavid Burgess LabcorpCamila CoudercJim Case NLM/ NIHJim Catan Accenture

Desirae CiraciAlex ConnorGeorge Cole Allscripts

Didi DavisGary DolinFloyd EisenbergSteve FineRick Geimer Lantana Consulting

Heather Grain eHealth EducationGreg GustafsonRuss Hamm LantanaRob Hausam Hausam ConsultingLindsey HoggleJulie JamesArvind Jayamathan Lantana

Peter JordanDaniel KarlssonTed Klein KCISimon Knee NSCIC

Austin KreislerVinayak KulkarniFang Lao EHealth OntarioAndrew Liu Canada Health Infoway

HL7 Meeting Minutes – Vocabulary January Working Group Meeting 2016

Lee Min Lau 3MMichael Lawley CSIRO, AUGenny Luensman CDC USARob McClure NLM/ONCA MacLean InfoWayCarol Macumber ApelonSusan Matney

Omid MavadatiNational Board of Helath and Welfare

Riki MerickLinda MichaelsonJean Narcisi American dental associationCraig NewmanFrank Oemig HL7 GermanyBenjamin FlessnerNick RadovMatthew RahnMartin Rosner Philips

Stefan SabutschJustine SchirleBrian Scheller Healthwize

Mark Shafarman Shaferman Consulting

Julie Skapik ONCAvinash ShanbhegElliot Silver McKessonAnne Smith National Committee for Quality AssuranceShelly SpiroAndrew StatlerSandra Stuart KaiserWalter Suarez Kaiser

Sheryl TaylorSylvia ThunTessa van StijnNat WongJon Zammit IHTSDO

2 Sunday Q3 Planning Chair: Ted KleinScribe: Heather GrainAttendees: 8


The agenda was reviewed and co-chair responsibilities were determined and an updated agenda circulated to the Vocabulary List. Jim Case updated the agenda spreadsheet and distributed to the Vocabulary List.

Action: When conference calls identify topics for discussion at the face to face meeting that the face to face agenda be updated with these items as they occur.

3 Sunday Q4 Action Items and Project ReviewChair: Ted KleinScribe: Heather GrainAttendees: 6

3.1 Action Items

There are a number of administrative items on the action list which need to be updated.Items 15, to be reassigned to HTA18, 19 have been reassigned to HTA

21. Update the wiki for TermInfo to more clearly group information (Jos) – PendingAction

Ted Klein: reassign to Rob HTed Klein: as a new Montreal action

16. Get moving on Project 1056 v2.x examples clean-up with InM (Ted) – Pending Action: Ted will prepare for the 2.9 ballot.

20 Produce a marketing document on the Terminfo work program; to be scheduled after DSTU is completed - Completed for further consideration later.

30 Develop guidance and explanations around use of Null Flavour with Grahame and Lloyd (Ted) unable to progress.

34 Extract tables project status and minutes from the vocab minutes, request to CGIT separately, validate against spreadsheet (Ted). Unable to progress. Not urgent, remove from the action list.

Draft description and proposal for table 396 issue (the ‘nnnn’ and the ‘zzz’ for vocab decision (Ted) – Wiki pending. – Stays on the list


- Draft description of HL7nnnn decisions from INM for vocab approval (Ted) – Wiki pending.

Needs a wiki page for polices – not happening.

- Put together a group to begin drafting a policy for what external organizations must do if managing HL7 value sets (Rob M) – This is about people re-- publishing HL7 content or value set.

Action HG to put on HTA action listAction - Rob McClure to lead

- Document the issue of publishing the URLs to HL7 content in implementation guides for further discussion on the 2/4 call (Russ) – This needs to be discussed with Publishing. We need a document which defines the problem clearly or we can’t progress.

Action: Re-assigned to Jim. Document issue for V3 publishing regarding the use of URLs in HL7 implementation guides. This will need to go to Structured Documents as there is no central publishing committee.

- Look into when the ISO datatype ballot is coming up for systematic review, when we may be able to look at updates for revised/replaced code systems without a new ballot (Heather) –

Action: Heather has obtained status and sent to Ted as requested. Currently in Systematic Review due to complete review – which will determine whether updates are needed – mid July.

- Add the FHIR terminology tutorial into the Vocabulary WG education pathways. Rob Hausam is developing this. Rob H to prepare course specification. Heather to overview and provide support - report progress to Vocabulary WG.

Action: HG to update Vocab education pathways and inform Rob H of HTA interest.

- Communicate with Grahame about any additional – FHIR inclusive value set – it is not clear how that should be covered in the value set definition VSD project. Ask Grahame if there is any official documentation about this – where do we find it?

Action: follow up on any VSD implications or overlap in FHIR inclusive value sets with MnM Rob McClure and Rob Hausam to provide examples in joint session

Ted Klein: documentation needed to improve understanding of the relationship of the FHIR Implicit Value Set functionality with the VSD (Ted, Carmela, Rob H) –


- Send an email request for the facilitator information to co-chairs list (Heather) – Done

- Distribute an update of the facilitators list for discussion on the 3/17 call (Heather) –

Done – awaiting updated version. Action: Recommend work group health include confirmation of project

and WG vocabulary facilitators. Action: tutorial available to be discussed in TQA call.

- Bring some proposals for webinars and distribute the documents for discussion on the first call in June (Heather) –

- Put together a list of the TC215 upcoming new items for discussion (Ted) – Action Heather and Ted to prepare this

- Request HQ send a query to the WGs to reinforce the need for update to the facilitators list and hopefully solicit a response so we can get the facilitators list updated for Montreal (Heather) –

Done

- Document the FHIR resource code system identifier issue so folks can think about it, and we will discuss further in Montreal (Grahame) –

Not documented by Grahame but on the list for Wednesday

- Add the code system identifier in the code system resource topic to our joint FHIR session in Montreal (Jim) –

Done

Contact Jean Duteau to get project 1135 Creation of an implementation guide for use of negation – this has been included in the Negation PSS (Rob H) -ed Klein:

Action: Jim will cancel the project.

3.1.1 Orlando Action Items2. Develop a policy statement on vocabulary policy for management of post coordinated concepts. Include 5656 language tags, units of measurement and SNOMED CT as the known examples (Rob McClure) –

Currently pending

3. Reorganise the document store and Wiki pages on the HL7 website so that the titles are correct and it is more appropriately labelled (Heather, Anna Orlova, Ted) –


Action: Anna to provide an outline of suggested changes and provide details to Ted and Heather to implement.

4. Verify that MnM joint project 561 was archived (Rob McClure) – Done

5. Update status to complete for Terminfo project 849 (Rob Hausam) – Done

6. Verify status update for joint project 1022 Document Ontology (Ted) – Done

8. Update status on project 1056 v2.x examples with InM (Ted) – Done

9. Update status on project 1169 Vocabulary Mining Tool (Heather) – Done - move to HTA - Heather

11. Document process for new V2 vocabulary requests (Heather) – Done

12. Extract the MIF XML XSD for the CLD and put on the HL7 website so the syntax can be pointed to by the CLD syntax element of the VSD spec before publication (Rob McClure, Ted) –

Now irrelevant 13. Take proposal for CDA to unlink vocabulary value set definition and updates from the CDA IGs to HTA for eventual Board approval for SDWG new process (Heather) –

Vocabulary item not HTA. Discuss with Structured Documents how to bring CDA IGs compliant with characteristics of a value set definition. Bring this up at the end of the joint session with SDs. This problem is associated with value sets with specific versions are identified in CDA IGs and link the updates to the IGs and it is clear that updates to regulations will mean that content is no longer value.

Action Item for joint session with SD in Baltimore.

14. Identify and list SNOMED CT content (if any) in the published V3 MIF (Ted) To be done

16. RIM modifications relative for TermInfo for the SDWG/CDA request for the RIM forking (Rob Hausam)

19. Contact publishing to get automated system in place for publishing of glossary (Heather) –


Done – draft PSS available and updated after calls. Awaiting Glossary project in Vocab WG.

20. Prepare Facilitators' Roles and Responsibilities webinar (Heather) – In progress

21. Break up Vocab 1 tutorial into 3 or 4 webinars (Heather) – In progress

23. Send clean and complete draft of VSD spec to CGIT chairs for review by CGIT and return comments to project relative to conformance (Rob McClure, CGIT)

Done – sent to co-chairs for discussion Thursday.

27. Follow up with Rob Snelick that the CGIT issues with code 'V' for table 103 have been forwarded to Frieda (Ted)

Processed through harmonization and published

28. Follow up with Andy and EST on V3 value set all codes ballot publishing issue is being resolved (Ted)

Ongoing.

29. Need to better resolve the naming and conversation issues around 'expansion set' and 'expansion and associated expansion-related metadata' for both the VSD spec and vocabulary communications in general (VSD project)

Ongoing

3.2 Project Review

All current projects were reviewed and the following actions determined.

Project 46 Action: Ted to follow up with CGIT

4 Monday Q1 Value Set Definition Chair: Ted KleinScribe: Heather GrainAttendees: 18

Rob McClure presented on this topic which is targeted at an STU Ballot after this meeting. He explained the process and the content included in the work.


This work is on a normative track. It will be out as a Standard for Trail Use then be reviewed with the intention of publishing as a Standard. The work will be referenced by activities at ISO as well (generic work being undertaken on data requirements and data development).

Changes made after comments received were discussed. There were simple clarification requests but more significant changes included:

Consistency of representation of Value Set Expansion Code Set. This is the term being used to describe the codes achieved after evaluating the concept definition. Where the intention was to talk of the expansion file it is called the Value Set Expansion File. The word enumeration is also not included in order to be clear and consistent throughout the document. There was a need to differentiate between the coded concepts represented in the expansion and the metadata associated with those codes – which are included in the value set expansion file.

It was requested that the Glossary for this work be made available to assist those reading the document – the intention is to include the glossary in the broader HL7 glossary activities such as an update to core principles document.

This work is an evolution of Core Principals which will need to be updated as a result of this work item. There is a larger issue of the glossary of terms relevant to the Vocabulary WG scope. This will need a project, but at the moment this work only includes new items and those items relevant to this specific work item.

The publication request form was completed ready for submission. The ballot reconciliation has been completed. The group agreed that an 18 month DSTU would be requested.

Motion: Rob McClure moved that this work go to publication. Elizabeth seconded. Discussion: none neededVote: Yes: 15 Abstain: 1 Against 0

Monday Q2 Terminology Quality Assurance ProjectChair Rob McClureScribe: Heather GrainAttendees: 11

Rob McClure introduced the glossary components of this project.Ted indicated that this would be a good time to work on processes to move us forward with a more consistent and visible glossary for Vocabulary WG in HL7. Heather Grain indicated that the timing is excellent as a similar though broader activity is occurring at ISO and the SKMT tooling is available to support the activity.

Rob McClure explained the scope of the TQA project, including binding issues.


Glossary DiscussionHL7 has difficulty finding terms and definitions across the organisation.Single process needed across the organisation and all products

Sources include published documents, operational documents, wiki pagesObjective – a centralised repository which moves towards improved quality.

If we want to pull together in one place all the terms we currently have, then we have to pull it together to create a glossary document. An HL7 Vocabulary Working Group document has been created in SKMT (Standards Knowledge Management Tool skmtglossary.org). The first step is to load the key documents into the SKMT. Primary leads will be Heather Grain and Susan Barber.

Calls will be 4pm Monday New York time, 6am Melbourne, 9pm England.

4.1 Vocabulary FacilitatorsWG leadership will be requested to send us the Vocabulary Facilitators – confirm your facilitator – or we will consider that you don’t have one. This request will be made at the Co-Chairs dinner tonight (Ted).

5 Monday Q3 IHTSDO Chair Russ HammScribe Heather GrainAttendees: 21

5.1 Education product support and collaborationA presentation was provided by Linda Bird on the Education Courses available from IHTSDO. These courses are free and aim to build understanding of the product and implementation. These are all elearning based courses and begin progressively through the year.

Actual content development is taught largely through the consultant terminologist program which has changed in focus. This would include taking a project from conception through modelling to construction.

Product support activities were described. Documentation migration and update is being undertaken, including update and restructuring of the Technical Implementation Guide. A new guide for Reference Sets is in development. Report on clinical decision support and terminology binding are also being developed.

Specifications this year will include:


Machine readable concept model (MRCM), SNOMED CT expression constraint language v1.1

SNOMED CT template syntax SNOMED CT query language

HL7 Collaboration with IHTSDO is managed through the IHTSDO.

IHTSDO SNOMED CT Expo will be in Wellington, New Zealand from October 27 – 28th

Another useful site is qa.snomed.org is an excellent site for information regarding SNOMED CT statistics. Use the data explorer tab to get more details.

5.2 ToolingPublically available tooling site from IHTSDO will provide access to beta tools such as refset management and translation tooling. https://Confluence.ihtsdotools.org. there is also a candidate IHTSDO authors tool. It is hoped that this tool will be used by national release centres and simplify content duplication suited for movement up into the core, and support that migration.

The current bowser allows you to browse the core and one extension. There is a beta which allows you to look at as many extensions as you want simultaneously.

A new request submission tool will also be made available. This will include early modelling and be linked to the current content authoring tool.

In summary the tooling available includes: SNOMED CT browser Component identifier service Authoring platform Identity management service Mapping tool Member licensing and distribution service (MLDS) Refset management and translation tool

https://confluence.ihtsdotools.org/display/TOOLS=

5.3 Content RoadmapThis is developed every year based upon input from the member countries. These countries submit their development priorities and these are then ranked and addressed as resources permit.

Current focus areas are


Drugs and substances. The difficulties arise in keeping this up to date, but the intention is to take the model down to the medicinal form and substance. A universal drug model will be developed to provide a detailed model of how the extensions would indicate the individual products. An analysis of all current drug extensions will be undertaken to support this modelling. This is being undertaken for those countries which do not already have such a model.

Allergies Implementation of the observables model which has been under

development for 8 years. This will be implemented in the laboratory space.

5.4 Open SNOMED CT developer portal accessJim Case reported How do people who are developing artifacts from HL7 get access to the full SNOMED CT content reference sets (from the international realm).IHTSDO have provided an authenticated portal to anyone working on an HL7 artifact may have access to this tool. You must specify what HL7 artifact you are working on and which working group undertaking the build of the artifact. This offers access to those who do not have access already.

IHTSDO are seeking to understand the scope of content potentially required to be represented using SNOMED CT. Licensing issues are defined in the HTA Policy and Guideline Licensing document. There are also currency requirements which are defined in the HTA Policy and Guideline on currency of content.

Go to https://www.hl7.org/special/committees/termauth/docs.cfm

Open portal for SNOMED CT authenticated access for HL7. Non country specific. Minor access requirements

Access for individuals who do not already have access due to restrictions on NRC license. Through IHTSDO core, not national releasesThis is to be used for development of HL7 artifacts.

6 Monday Q4 TermInfoChair Rob HausamScribe Heather GrainAttendees: 26

Lynda Bird presented progress regarding SNOMED CT - see slides


https://www.hl7.org/special/committees/termauth/docs.cfm

6.1 Proposed Approach to Binding SNOMED CT to HL7 FHIR Use case for binding SNOMED CT to information models

Querying instances of FHIR resourceso Different instances may use different amounts of pre-coordination

versus populating separate data elements.o Data elements in different RHIR resources may have the same or

similar meaningExample: General practice

Prob/dx cancerBody site lungStatus suspected

PolyclinicProb/Dx Name – suspected cancerBody site lung

Diagnosissuspected lung cancer

ApproachThat the SNOMED CT concept model be used to determine the allowed structural components and their relationships.

FHIR coded data elements would be bound to an attribute from the SNOMED CT concept model which enables decomposing of a pre-coordinated code into separate data elements. This supports querying using the attribute hierarchies.

Value Set Review Proposed Process1 valid display text2 active concepts – all concepts in international value sets are active in

current international edition of SNOMED CT 3 appropriate concepts of all concepts in the value set are consistent and

appropriate for the intended use4 no content gaps – no obvious gaps in the content of the value set (this

needs to be qualified in context of the business case being used in this situation)5 clear context and meaning – context and qualifying information is

represented consistently with no ambiguity either in the terminology or separate elements

Value set version management strategy is also required – which can handle the need e.g. to handle content which is no longer active, such as an older edition of the terminology.

Value Set Definitions work has identified a much larger range of use cases than those covered by IHTSDO. Any version of value set content – give me all of the


codes that this definition can retrieve from the code system. If it is SNOMED CT it should have all of the versions available - then the expectation will be that whatever that expression retrieves will be made available as part of the expansion.

See the slide deck for examples of tested resources such as condition.

Question on allergy intolerance resource – where are the data elements associated with attribution and authoring – these are elsewhere in other resources.

Question: how does this work impact TermInfo more generally.

6.2 Status of proposal to Patient Care WG for representing negation/exclusion in the FHIR AllergyIntolerance resource

An approach to the modelling and representation requirements was presented and is detailed in the presentation.

6.3 Future call schedule

oContinue with current day/time?oOr try again to find time(s) that better accommodate all regions (including

Australia)?

6.4 Summary document for using SCT in CDA R2

oNeed, plans?

6.5 Executive summary / marketing document

oNeed, plans?

7 Tuesday Q1 Tooling ProjectChair Russ HammScribe Heather GrainAttendees 16

7.1 Value Set Rendering in V3 ballot value setsThere are many value sets in version 3 which are incorporated into V3 ballots – these include all codes from the underlying code system. The way it is rendered in the ballot gives no real support to casual viewers.

To find an example:


Go to foundation, vocabulary, value sets, index to value sets, ActStatus15933. The way it is rendered shows the level, content type and code system with no indication that it includes all the codes in act status. The scripts that generate the rendering make it clear but to the casual viewer it is not obvious – it should indicate more clearly whether it is all codes in the code system, or a subset – in general the principal is that it is All Codes from the code system unless specifically constrained.

Tooling issue is that: Tool that generates the rendered ballot should indicate constraints (which

it does), or no constraint (which it does not). This information should be in the Table qualifiers column.

DiscussionIssues include the limited resources and people who understand or could fix this problem. A solution which requires the least intervention and resources would be acceptable.

This is an example of the need for backup for Woody and for all those who manage HL7 tooling.

Add a request for a task tracking process to the Tooling work list. This needs to be able to identify small items judged as priority for fixing for primary products which are not likely to require significant resources can be managed. The objective being that these be not lost in larger project requirements. Trying to track the issues on the radar is essential.

Action: Russ Hamm will attend EST calls to progress this request.

7.2 Wiki Editing Tool

Not everyone is comfortable editing on the wiki. Investigate plugins which might make editing easier for those who are not comfortable with delimiters etc and editing contact directly.HL7 HQ maintain the wiki infrastructure.

Consideration is being given to collaborative tools such as confluence / jura. HL7 traditionally works through email and list servers and we have tried to move to wiki for many reasons. From an architectural perspective do we want to continue with wiki approaches or evaluate tools available to change either progressively or at a point in time.

Ask HQ IT department f they would be willing to entertain a wiki plug in to enhance editing – Russ happy to assist. These are easy to install, but might not be worth it if a broader strategy is being sought and will be available shortly.

Action: Russ Hamm to discuss with HQ.


7.3 Tooling Project

7.4 A project is defining tooling requirements, including functional operations required based upon the Australian and HTA work. The current vocabulary maintenance process requires individuals requesting changes in text documents (Harmonisation proposals). This is converted at harmonisation to XML (by hand) and this is then processed and applied to the repository. This includes the V2 (now in a MS Access database) and V3 repositories. The next addition will be CDA content. There are two persistent stores – FHIR repository accesses the MIF and V2 by being supplied with an update of the vocabulary component of the V2 sources of truth. 50% of the material is FHIR specific and this lives only inside FHIR resources but it is being moved into the new code system resource and moving it into the FHIR resource.

CIMI vocabulary store and namespace will be discussed in Q3 today.

It is accepted that there is a need to replace the vocabulary management tooling.

The functional and non-functional requirements will be sent out as an RFQ or similar process to find potential tooling. Vocabulary Maintenance Language (VML) has been correlated to the CTS2 model

Action: review the requirements list Ted – then on a call – Ted. Add any missing functions from VMif.This is a priority work item for calls.

When requesting comments – indicate sequence (what is dependent upon what) and priority – which will solve the most time and problems.

There is a need to be able to provide outputs into the concept model of each product silo from a single source. Model mapping of a vocabulary resource from one concept model to the other.

A list of candidate solutions is maintained on the relevant wiki.

7.5 Glossary publishing and managementVocabulary trailing different approaches to glossary management. The tooling www.skmtglossary.org will be used to discovery of the capability using Vocab documents etc. Options include automatically loading from HL7 tooling, or Managing content in SKMT and bringing it back into HL7 from that tooling for publication.


http://www.skmtglossary.org/

8 Tuesday Q2 Joint with Structured DocumentsChair Ted KleinScribe Heather GrainAttendees 10

8.1 Handling large Value SetsNeed and engine to handle publication of large value sets.CDA implementation guides need to indicate the source of truth for vocabulary content in these documents.Governance and maintenance processes are also required.VSAC is currently being used to resolve these issues at the moment. CDA 1.1 is referenced in meaningful use. Delivery of value set content through VSAC covers a ranage of code systems.Some of these value sets are quite large and may not be perfect for their use case. VSAC machinery cannot support creation of very large value sets (hundreds of thousands of concepts). As these value sets are outside the normal VSAC process.CDA are making decisions on value sets which are changing all the time. The current VSAC tooling gives some management but does not handle deprecation very well. As new codes are added to SNOMED CT there is a need to discover new or changed content to determine whether new or changed content should be in the value set specified for the specific use case.HL7 publishes definitions for value sets not the expansions.

Issue of which version of SNOMED CT to use – the requirement to use the international release of SNOMED CT for international standards and not national extensions. Where content is required in an international standard and the content is not in the international release – there is a need to identify that content and report to the HTA who will request the inclusion of this material in the international edition of SNOMED CT.

There are also IP issues with the use of SNOMED CT – see http://www.hl7.org/documentcenter/public/wg/termauth/HTA%20Policies%20and%20Guidance%20Licensing%20V1.0.docx to access the current guide on licensing.

8.2 Terminology Binding in CDAVocabulary recommended that interested people review the current working material on binding. Binding must specify and only need specify (example) - information to define the explicit expansion set – binding exists to be conformance tested and to


http://www.hl7.org/documentcenter/public/wg/termauth/HTA%20Policies%20and%20Guidance%20Licensing%20V1.0.docx

http://www.hl7.org/documentcenter/public/wg/termauth/HTA%20Policies%20and%20Guidance%20Licensing%20V1.0.docx

provide clear guidance who will fill implementations with this implementation or further constrain the content.Define sending and receiving requirementsDetermine downstream requirements for conformance testing

Ted presented the work on binding which is explained in detail on the web site. This work covers all known use cases – or those not covered have been highlighted. This work should be stable by Baltimore and Vocab would be happy to present this work to Structured Documents at that time.

Wording around free text, and use of data types are still being resolved, but there will be some major changes.

Members of Structured Docs were invited to join this work in order to improve the unified architecture across products and approaches.

The need for specific mechanisms to cope with backward compatibility will need to be considered by SD. As model designers we need to be clear about what we are trying to do.

8.3 HL7 Business Architecture Model (PLA TSC Project) - proposed CDA product family

From a consumer perspective the product family offers a wide range of products.

A management group and governance board, vocab and management processes for the family will be established. Methodology leads will be established in different areas such as modelling and vocabulary.

Product family includesCDA R.2 – the standardCDA Implementation guides (many)CDA Implementation guides such as – quality reporting document architecture

Structured documents handle management while methodology is handled by MnM and Vocabulary in the V3 space. Implementation guides will be governed by TSC and structured documents, while management will occur through domain specific work groups and methodology still through structured documents, templates, MnM and Vocabulary.

Issue CDA base standard in implementation guides:The methodology requirements for overarching principles need to be determined. There are also issues associated with external tooling.


V2 content governance is now included in harmonisation. There have been content from CDA that went well but this needs to become more ‘standard’. Do we want to discuss ideas regarding vocabulary management in implementation guides – as a CDA product family discussion. The answer was yes in order to determine where and how this should occur. It is recognised that his is currently a major pain.

Action: any changes to a V2 code system or V3 value sets used directly where published by work from Structured Documents should come through harmonisation.

This was a ‘heads up’ to vocabulary that these changes in governance and process are coming through.

8.4 Tuesday Q3 – Joint with CIMI – CIMI HostingSee CIMI minutes for details

CIMI extension would need to be considered a separate code system.

Joint session – same quarter in Baltimore meeting.

8.5 Tuesday Q4 – Joint with Patient Care – Patient Care hostingSee Patient Care minutes for details

8.6 Wednesday Q1 – Joint with MnMsee MnM Minutes for details

8.7 Wednesday Q2 – Joint with MnM – MnM HostingSee MnM minutes for details

8.8 Wednesday Q3 – Joint with Publishing – Publishing HostingSee Publishing minutes for details

8.9 Wednesday Q4 – Pharmacy – Pharmacy HostingSee pharmacy minutes for details


9 Thursday Q0 – Co-Chairs Planning SessionChair Ted KleinScribe Heather GrainAttendees 4

9.1 Calls (all times listed as New York time and fortnightly)Activity Beginning Time LengthWorking Group Call Thursday 26th May 3:30 pm 1.5 hoursV2 Tables project Thursday 19th May 3pm 1.5 hoursValue Set Definition No further calls 1 hourBinding Syntax Tuesdays 24th May 2pm 1 hourTooling Russ to determine 1 hourTerminology Quality Assurance

Tuesday 24th May 4pm 1 hour

TermInfo Wednesday 18th May 9am 1 hour

9.2 Calls with co/sponsorsFHIR, CIC,MnM, CQI etc Lenel project

Action Update Version 2 harmonisation proposal template – Ted

Glossary work in SKMT – load TQA page, VSD Page and Core Principles content

Action; - Heather to report on glossary status and process the call on the 26th.Glossary item on first call – recommendation for what we have to do of how to set up and what to do.

9.3 Co-chair tasks and responsibilitiesThe co-chair responsibilities were reviewed and updated and follow.

Assignments:Ted Klein (TK)Russ Hamm (RAH)Heather Grain (HG)Jim Case (JC)Robert Hausam (RRH)Rob McClure (RCM)


1. Ongoinga. WG Conference calls (note requires participation by at least 2

cochairs)i. Scheduling next cycle Robii. Agenda preparationiii. Running calliv. Minutes post to list and upload to websitev. Action Items

b. Steering Division conference calls Russ (Rob H backup)c. FHIR Vocabulary Coordination (RRH backup)d. SDWG (CDA) Vocabulary Coordination RRH (primary) and RAH

(secondary)e. Standards Governance Board representation RAHf. OID Registryg. Table 396 curationh. Version 2.x vocabulary Ted and Franki. HTA Ted RCM, Heather

2. Harmonization and Vocabulary QA Processesa. Technical Review of Vocabulary Submissions Russ and Tedb. Construction of harmonization meeting materials facilitatorsc. Attendance and running vocabulary session Ted Russ backup d. Capture of decisions Karen (backup Dave Hamill)e. Terminology Services Track at FHIR connectathon RRHf. Application of approvals to vocabulary store Tedg. Overall QA Processes Development RCM Ted

3. Working Group Meetingsa. Agenda Jimb. Combined Minutes Heather confirm uploadc. Meeting Room scheduling Jimd. Attendees List (combined) Heathere. Joint meeting coordination Jimf. Thursday Facilitators’ RoundTable RRH and Ted and Russg. Steering Division Meeting Allh. Sunday planning and facilitator session Ted, Heather, RCM, RRH and

Russi. Workgroup meeting survey Russ

4. Publishing Itemsa. HL7 Glossary Update Heatherb. Ballot comment reconciliation per project team leaderc. Value Set Definition Publication RCM and Tedd. Tables project coordination for chapter 2C publishing e. V2.9 Publication

5. Projectsa. V2.x tables project (Ted, Jim, RRH, Heather)b. CNE component of v2 refactoring project (INM joint)c. Value Set Definition Project – Ted and RCM


d. Terminfo RRHe. Binding Syntax (Ted, RCM, RRH)f. Tooling Project (RAH)g. TQA project RCM

6. Education Itemsa. Education Plan Structure Heatherb. V2.x tutorials Tedc. Terminfo tutorials RRHd. FHIR Terminology tutorials RRHe. Vocab 1 and 2 RAH, RRH, Ted, Heatherf. Authoring Value Sets Heatherg. Glossary Heatherh. Vocabulary Facilitator Roles and Responsibilityi. Split up Vocab 1 into short webinars

7. Conference Callsa. Main Vocabulary WG Tedb. TQAc. Binding Semanticsd. Tables Projecte. Toolingf. Terminfo

8. Chair responsibility for cosponsor (other WG lead) Projectsa. FHIR/CIC/MnM/CQI etc (Lenel project)b. #1056 v2 examplesc. #1104 FHIR SDC RRHd. #1146 CGIT unified conformance/constrainte. #1150 CDA R2.1 RRH, RCMf. #1162 SD value set maintenance and stewardship g. #1247 HL7 vocabulary FHIR specification update RRHh. #1262 Negation RRH, RCM

9. Random Project Itemsa. Other Vocab issues that arise on the list

10 Thursday Q1 Vocabulary hosting CGIT and InMChair Ted KleinScribe Jim CaseAttendees 8

10.1 Missing data representation – Mead WalkerPHER and InM have worked out a solution.

In v2, recording death information for registry vital records reporting. In some cases the SSN is not available. What is done now is an entry of “nonsense”


numbers, but a question is whether null flavours could be added. Placement of the null flavor in the ID component of the CX datatype would meet the need. Agreed to by InM and PHER. Ted mentioned that using a coded value in the ID field causes some issues. 1) there is no place to put the code system and 2) this would be extending the meaning of the component from an instance to a class. Ted does not support the solution and Frank also expressed his reservation.The proposed solution is to either send valid data or send nothing at all, not to change the meaning of how to interpret the semantics of the CX. The problem rests with the structure of the CX datatype, in which the ID field is required. It should be possible to send the CX that identifies the type of identifier, but the value of the instance may be absent. This would allow one to say that the SSN is not available.A number of proposed solutions were discussed. Frank suggested that a new component be added that would specify the reason that data are missing and make the ID field conditional, that if the reason missing field is populated, the ID field MUST be empty. This would require a change to the datatype. Mead stated that this might be an issue in that they have not been in the habit of pre-adopting parts of the standard.

Mead stated that this would be an acceptable but may cause problems with implementers that would be resistant to making the change. This is preferable to creating a new ID type. Tony cautioned that this would require new trigger events, since you cannot change a component from R to a less constraining optionality. This caused a plethora of additional discussion items that in order to meet backwards compatibility issues, there are a number of other possible changes that would need to be resolved.This is an issue in FHIR as well, which conflates “flavors of null” with values in a value set. It was suggested that if there is not an SSN, any other ID type could be sent. Mead said this was not disallowed, but is not what people would be expecting. A question was asked as to what can we do to solve the problem today?

Motion: Add a new component to the CX datatype “Reason ID missing” for 2.9+. In the interim, allow implementers to continue with their current approach. Mead/Sandy

Discussion: It was felt that the best of the interim solutions is to not send anything in the ID field instead of sending a bogus ID field, which has its own set of issues. This must be specified in the implementation guide as something that does not cause a warning. This breaks conformance and raised the issue of not being able to determine whether the data are actually missing or whether this is an error. This would require a specific profile ID in MSH.21 that “allows” this non-conformant behavior. This profile would only be used when the ID is missing.Motion was amended to also change the optionality of the ID component. There was additional discussion about the backwards compatibility of making this


change. Rob Snelick felt that this is backwards compatible in the constraint profile.

Motion: Add a new component to the CX datatype “Reason ID missing” for 2.9+. In additional change the optionality of the ID Number component to C(R/X). In the interim, allow implementers to continue with their current approach. Mead/Sandy

VOTE: 5/0/5 For/against/abstainMotion passes with minimum required.

1. Vocabulary binding syntax representation

Not addressed2. Terminology Quality Assurance

Not addressed3. Table 211 open issue

Issue is that it is unclear if there are actual codes associated with some of the character sets. i.e. there is no “Code system”. Proposal to make this an internal HL7 table. Frank mentioned that there are a number of issues with the table as currently structured. While it doesn’t break tooling, it is inconsistent with the current rules about table content. Will ask InM to resolve the issues around the values in the table.

ACTION: InM to look at content issues with this table and bring them to July Harmonization.

ACTION: Vocab/tables project, make sure the database represents this as an HL7 code system.

Additional brief discussions occurred on issues with other tables, but no specific actions designated. Referred to the tables project.

Table 290 – do not want a code system assigned. FHIR Code datatype used for non-structural data

11 Thursday Q2 Vocabulary Hosted CGITChair: Rob McClureScribe: Russ HammAttendees: 11

11.1 Tables Project Discussion


Goals and next steps for the V2 Tables Project. How will the V2 artifacts be exposed? VSAC? Open or for sale?

It is not in the mandate of VSAC as V2 is outside the scope of their mandate.

How will the content be packaged? Currently it is in one database (Access).

The proposed investigative project to assess the viability of FHIR to manage vocabularies may be a solution.

V2 is open IP, but in PDF format. Franks Access DB is a pay for service. Also available on Android.

Board request to harmonize vocabulary between project families. Investigative project is to explore using FHIR as an SOT for archiving vocabulary artifacts.

Challenges with coordinating multiple projects on harmonizing vocabulary SOT, tooling, and product families.

Need requirements for a unified approach for vocabulary.

11.2 Vocabulary binding syntax representation (http://wiki.hl7.org/index.php?title=Binding_Syntax)

o Define the human readable expression of the vocabulary constraints in implementation guides (Model Bindings) and by Realms as published sets of Context Bindings. Define the expression of the Value Set Assertion, a Model Binding, a Context Binding, and a Context Domain constraint. Information expressed in the syntax should be isomorphic to the normative definition of the data items comprising vocabulary constraints in Core Principles and the MIF ballots.

o Binding syntax Vocabulary projectso If you are going to bind you must specify a value set that resolves to an actual

expansion set.o Review of binding rules

11.3 Terminology Quality Assurance (http://wiki.hl7.org/index.php?title=Vocabulary_Quality_Assurance_Project)

Define and communicate consistent set of QA requirements and describe processes that can be used to implement these requirements for decentralized development of terminology artifacts used across all HL7 product families, coupled with a centralized governance structure.

TQA project will focus on harmonizing the product families (as outlined in the thrash discussion above).

Need to outline issues pertaining to the following Different governance processes between product families Different tooling requirements and interactions


12 Thursday Q3 Vocabulary Hosting CGITChair Jim CaseScribe Heather GrainAttendees 9

Vocabulary Binding in syntax representationDescribe two types of binding. The binding to the specific terminology used to represent a concept, and the binding to the information model scope – the context meant in IHTSDO when they refer to binding.

Both types of binding are constrainable. The binding asserts the connection between – Asserting instance expectations

How should these different requirements be clearly defined.If you are defining something that defines scope – and does not define instance data – that is a model scope statement or a 11179 concept.

The validation that says is this constraint a legal constraining – lock down the value set to a specific version of the definition and code system. This is able to be tested for conformance and binds the instance to a terminology resource/version.

There is a need to bring forward these differences and update core principals appropriately to reflect this.

The discussion supported the need to clearly define each different type of binding more clearly to differentiate between them.

Terms needing definition and clarification include Vocabulary binding

Context binding – does not identify the codes which can or may be used in a specific field or context – that is a vocabulary binding

Model binding

There is a need to specify the value set identifier has the vocabulary binding.

Binding means that you have constructed a machine processable value set definition and the other things needed for certification, implementation completion.

There was concern that the defining in FHIR – has defined what they require but that this does not support ongoing persistence of meaning in a health record and is not considered to be binding – it may be considered as reference information.


This project seeks to untangle the issues discussed.

Fully defining a concept which is being defined for clinical use should be in the international release, while those associated with the information structure may be fully defined but these belong in the HL7 extension.

We need to know at the end what artifacts we expect implementers to consume and how they should consume them.

There may be a need for parameters for CIMI where all concepts should already have been promoted to SNOMED CT international. If SNOMED CT international the HL7 extension if that content is not considered appropriate to the scope of SNOMED CT.

Discussion occurred on the aggregation of different extensions to support implementation, such as aggregation of US and HL7 extensions.

Publishing requirement for HL7 Affiliates in non IHTSDO member countries which support their mapping efforts should be included in the tooling requirements

Action: Russ to add this requirement to the Tooling specification.

What are implementers supposed to do with what is being created. Linda Bird asked to consider this and provide details to Vocabulary WG. Take CIMI’s process and run it all the way out to a vendor, hospital, insurance company, government and identify what is expected. This will inform priorities and requirements.

FHIR work includes Model meaning binding and Templates Value Set Review process - this activity is associated with the

Terminology QA project. Outcome of the feedback from review processes. Clinical model

feedback. – bring back to vocab for input.

Figure out how and if we can align with model binding or semantic binding and where there are overlaps with domain bindings. What we call vocabulary binding IHTSDO call value set binding.

A joint publication of terms and definitions should be the aim and was agreed by the WG and IHTSDO representatives.

Meeting adjourned
