1.2Minutes of Previous Meeting

HL7 Terminology Authority

Meeting

Location: Face to Face - Madrid
Teleconference - not used this meeting / Date: 2017-05-12
Time: 9:00 - 12:30
Timezone, Madrid, Spain
Facilitator / Heather Grain / Note taker(s) / Heather Grain
Attendee type H - HTA Member
O - observer
L - liason / Attendance
P - present
A - Apologies
N - not present without apologies / Name / Affiliation
H / P / Heather Grain / Global eHealth Collaborative
H / P / Rob McClure / MD Partners
H / P / Sandy Stuart / Kaiser Permanente
H / P / Jean Narcisi / American Dental Association
H / A / Ted Klein / KCI Inc.
H / P / Julie James / Blue Wave Informatics
L / P / Jim Case / National Library of Medicine/IHTSDO
L / P / Wayne Kubick / HL7 (CTO)
L / P / Robert Hausam / Vocabulary Co-chair
O / P / Patricia Van Dyke / HL7 Board
Quorum Requirements Met: Yes 10 people present - 6 voting members including the chair

1Q1

1.1Agenda Confirmation

1.2Minutes of Previous Meeting

Minutes of meeting 4 April 2017

Sandy proposed that these minutes be accepted, seconded by Jean.

Abstention: Julie James

In Favour: 3

Approved.

2SNOMED CT

2.1Free Sub-Set

2.1.1Definition of sub-set requirements and specification

Need to make sure that we respond to the criteria set out in the eMail from December and the DICOM agreement. We must define a given use case - HTA is considering all international FHIR resources.

Action: HTA to put together our request for the free subset content request draft - HG requested information from Jane Millar of SNOMED International. If International Patient Summary has a broad content set which is likely to be significant as part of the HL7 Free Subset request.

Issues and Discussion

Ted is concerned at the idea of calling it a subset. The frequency of change to value set content in HL7 standards is large. The agreement (based upon LOINC’s agreement) allows the creation of anew subset each SNOMED CT core release.

There is also the option to make use of the hL7 name space to create new content that doesn’t exist that we will ask to become part of the international core.

-We would request that that content be included in the HL7 free subset.

-Free use of content in the hL7 namespace

• If we put something in the HL7 namespace – do we have to worry about IP for those things we could using it internationally. No restriction on extension content confirmed by Jim. If there is content put in to the international core and can then no longer be used in HL7 standards unless it is put into the free subset.
• There is the opportunity to move to core to add to the subset – requests for promotion and new content needs to be coupled with request to go to the core.
• We could be in the middle of a ballot finishing up and there is content that can’t go in because it is not in the free subset.
• Once we have the extension we can publish content in the extension and it is free to our members

Principle if we do request content promotion, that content should also be included in the next release of the HL7 free subset. If it doesn’t go into the free subset we will have to reconsider the request to promote.

Does HL7 need a process to add content and if it is SNOMED then we request that it be added it to the free subset?

HTA would need to regularly review requests for promotion or inclusion in the free subset.

All subsets are example bindings in FHIR – they are part of the published release.

Rob Hausam provided an update on the scope of content includedin the International Patient Summary project which is a set which might also be considered.

We could tell FHIR that they can’t put anything into FHIR core that is not in the free subset – i.e. we shouldn’t put things in that are not available at the time it goes to ballot. The lack of availability puts the utility of the standard at risk.

We need to right the Rationale for the free subset request – and how we will use it.

Action: Heather to produce a first draft

Action: Heather request confirmation of the method of specifying the subset content – does this include the ability to include intensional definitions. Include in action around request to SNOMED International,

From HL7’s perspective it is highly desirable that a new releases will automatically generate a new version of the free subset based upon intensional definitions. Include the clinical case – that if a person has a problem which is not common and holes occur this could be dangerous to patient care. And impact badly both on HL7 and SNOMED ct.

2.1.2International Patient Summary (IPS)

Rob Hausam explained how IPS is progressing:

IPS is not yet finished. We should have an official list within the next two weeks. Trying to hit a timeline for material ready for ballot in September.

Action: Rob Hausam to provide list of content to Heather Grain when available.

It is likely that 95% of the IPS ask will already be in FHIR.

IPS includes all clinical concepts and there is an awareness that HL7, a long time ago, chose to publish specific code lists. When HL7 international provides a service, which supports the expansion then we have to consider:

-Any restrictions on services

-IP problem when/if we publish standards for eneurmerated value sets

IPS has both intensional and extensional definitions. Implementation and process for requesting the subset content are not yet clear.

Action: Next call agenda – include determine scope of free subset

2.1.3Generation of Free Subset content

How do we generate the content request for inclusions in the subset? The issue of whether the request should be for all FHIR content (except that which specified all of SNOMED) or limited to the international Patient Summary was discussed.

Action: when the iPS data set is known do an analysis of the difference between that content and the existing FHIR core

2.2HL7 International namespace request

2.2.1Update to the namespace metadata

There are use cases which require HL7 International to be able to create its own SNOMED CT content – potentially with the intention to progressively move that content to the SNOMED CT core. Users of FHIR include, corporate entities including HSPC - providers and ARGONaughts. HSPC has a namespace to hold content

We need to formally ask to change the name of the namespace from CIMI to HL7 international.

Update the Namespace Reference 1000160

• Name HL7 International
• Phone: +1 (734) 677-7777 (phone)
• Address:

3300 Washtenaw Avenue, Suite 227
Ann Arbor, MI 48104
USA

• Description of Purpose To support content development and distribution for HL7 standards. This is for content needed prior to promotion into the international release.

Action: Heather to develop and Submit with copy of these minutes.

Process: if an HL7 work group or product has content needed in the international publications of HL7 they must include HTA in that process.

2.2.2Management issues

Rob Hausam asked how we will go about using the HL7 extension. In the unified terminology governance process, we seek to reverse the direction of the source of truth being in the unified terminology resource which pushes out to the publications.

Do we want the hL7 extension to be a silo?

The process could be to add to the terminology central service then pushed to the HL7 extension.

Ted would like to propagate from the central terminology source to publications. Anything in the extension should be formally modelled appropriately. To start with our initial approach (if we use the extension) is to put things in as primitive but if the desire emerges for people to do formal modelling in the extension Grahame and Ted are designing federated processes to support such modelling.

It is desirable to put the content in the right place. An additional set of information in the unified terminology governance request process may be needed if we want to model the data appropriately.

Where is an extension housed? We currently do not have a database or persistent store for the HL7 extension. Within the next month if you want to add codes you need to build the extension

Action: Rob Hausam to build interim extension to manage current requirement until the prototype for unified terminology

2.3Content Requests

2.3.1FHIR

Jim informed the meeting that the initial request from FHIR will be in the next international release.

There is no current communication process around promotion.

Action: Heather to notify FHIR that the requested content will be in the next release of SNOMED CT international (July 31st 2017), Heather to ask Grahame how the FHIR resources will be impacted and report back to HTA.

Issue: how do we give access to content that is in request for promotion? How have FHIR ‘published’ this content?

3Q2

3.1Tooling

Ted has reviewed the requirements. A prototype is being developed and when available the HTA should review our requirements and see which still exist as it is known that some are solved by the approach being taken in building the prototype. A review of remaining requirements will be undertaken to confirm need and effort required.

Action: HG move tooling to known issues rather than active item for discussion when the prototype is available

3.2Publishing

3.2.1External Terminology Web Page

Vocabulary will add an item under Infrastructure and Assets

The page will include:

- policy on use of external terminologies (simple explanation)

- link to existing HTA policies and guidance

- link to HTA - with short explanation of when to use them

- link to terminology 'owners' and products

Action: Ted to create the page and let Heather know when it is done

Action: HG to put some information in the page for review by HTA.

With unified terminology, there will be content from external terminologies.

-Currently when a ballot is created for V3 only definitions are published not expansions.

-In core MIF Rosetree dynamically expands when you click on things if it has the source.

3.3Harmonizationfront page under resources is the possible place to go – terminology in HL7

Reviewed Harmonization Instruction page

Action: Ted to

• Link external terminology (point 6 under required data elements) to the new external terminology page.

Wayne reported that confluence may be the preferred

In the mean time have a page added to resources titled: HL7 Terminology

-We should develop the content

Action: HTA to develop content – heather will produce a first cut at the page content.

Action: Ted will discuss with HQ about getting it put up once we have the content done.

3.3.1‘hole’ digging problem associated with Harmonization (Ted)

3.3.2Publishing issues of a shared terminology content (Ted)

3.4Process Guidance to FHIR

• Rapid prototyping development vs mature quality processes need to be addressed
• Content issues - identified because we were looking at content and identified problems
• How to retain speed but improve quality

3.4.1policy statement on SCT allowed binding strengths (Rob Hausam)

Action: Heather to contact Rob for more information.

3.5Other Business

3.5.1Next Meeting and Call Times

Calls will alternate with the regular vocabulary calls at 4pm on Thursday New York time which is 6am Melbourne time on Fridays. Calls will be fortnightly starting on the 1st of June (2nd in Australia).

Teleconference -

Host: (who ever arrives first is to host)

Password: hl7termauth

3.5.2Conference calls process

Anyone who gets onto the call before others and before the allotted time log in as host. If you login and there is no one on the call log out and log back in as host.

Heather to include the host details on the agenda.

Heather to make room booking for San Diego Friday Q1 and Q2.

Appendix : Known issues and Watch Items

3.6Publishing

• LOINC survey instrument attribution
• Policy for publishing value set definitions referencing external terminologies (current and future)
• Ted list of additional issues associated with publishing for HTA.
• Inclusion of maps in publications

3.7Value Set Specification Projects