1.1 Agenda Confirmation

O HL7 Terminology Authority Call Minutes https://www.freeconferencecall.com/wall/hl7termauth#/ Date: 2017-09-28 Host: [email protected] Time: 4pm Password: hl7termauth Timezone, USA, New York

Facilitator Heather Grain Note taker(s) Heather Grain

Attendee type Attendance H - HTA P - present Member A - Apologies O - observer N - not Name Affiliation L - liaison present without apologies H P Heather Grain Global eHealth Collaborative

H P Rob McClure MD Partners

H A Sandy Stuart Kaiser Permanente

H P Jean Narcisi American Dental Association

H P Julie James BlueWave H Ted Klein KCI Inc.

L Jim Case National Library of Medicine/IHTSDO

L P Wayne Kubick HL7 (CTO)

L P Robert Hausam Vocabulary Co-chair

L P Jane Millar SNOMED International O Roel Barelds HL7 Netherlands

P Allan Abila

Quorum Requirements Met: Yes

1 Opening

1.1 Agenda Confirmation Agenda confirmed

1.2 Minutes of Previous Meeting Minutes of meeting 14 Sept 2017. Jean moved and Julie seconded that the minutes be accepted. Approved by all

2 Membership Action: Review the GOM section 9.10 regarding - Membership - Affilliate council attendee - Non-english speaker - There are currently observers and members, it was suggested that we have a membership type between observer and member for those who are required as they are on the agenda. Such attendees are not considered voting members. This could be appointments ‘ex-officio’.

Action: Wayne to make recommendation to change the GOM based upon the advice provided by the HTA on membership. A call for nominations went out last week and will follow the usual process. Julie, Ted and Jean are the positions up for nomination. The Board will also review the charter of the HTA prior to Membership Review. Action: Wayne will forward the current charter and operational information to the HTA for input, to be discussed next meeting.

2.1 Free Sub-Set

2.1.1 Request for free subset Action: Wayne will need to communicate to the Board and to SNOMED International o Having been informed by SNOMED International representatives that a request for a ‘free subset’ such as that required for IPS would be too large to receive agreement . HL7 will not be requesting a ‘Free Subset’. . HL7 strongly supports the use of SNOMED CT . We encourage the development of standards which include SNOMED CT content – but will not pursue a free subset. . We will continue to publish licensing requirements as already agreed – there is no proposed change.

Action: We will need to talk to IPS o Rob H has been informed and closes this item Asked if there was any flexibility in the decision or specific boundaries. Rob M suggests that this not be revisited. It was also suggested that we formally ask SNOMED International what the upper limit would be.

Options suggested from HTA to the IPS project – neither of which are seen as ideal:  That the EU might choose to discuss with SNOMED International and that IPS could align with any decisions out of such discussions. This option may take a long time.  That IPS create their own concepts – IF HL7 codes are chosen HTA strongly recommends that a map be established and maintained at the highest quality conformance level. Option was put forward to have ONC discussions with EU raise this issue with the IPS as the exemplar use case. Sylvia Thun headed the report to the EU and should be appraised of this use case to assist in ammunition to action the existing report.

It is acknowledged that this is a significant issue and that it is up to SNOMED International to address the issue if they want their tool used in this project.

Action: Heather to directly inform Sylvia and Kai of the situation and issues.

Action: Message to International Council – that though we wish you to use SNOMED CT – a license is needed. o Heather offered to gather previous documentation on our suggestions and expectations and share with HTA to confirm and then inform Affiliate council. – for review on next call. We have previously notified them, but need to inform them that there will be no ‘free subset’. Heather to draft email to international council members and circulate to HTA. We may need to re-think the binding strengths in FHIR to meet this requirement – Ted to report if / when a resolution on this is identified.

2.2 Content Requests

2.2.1 Allergy request Actions: Rob Hausam to complete the request documentation. This additional information is not worth pursuing without a free subset.

2.3 Publishing

2.3.1 External Terminology Web Page Review Content Document and next stages - appendix attached.

2.4 Harmonization

2.5 Process 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 Action: When this activity, the subset specification process, and the harmonization with the latest version of SNOMED CT is trialed the guidance documentation will be created (progressive notes are to be kept)  Status: this is active as part of UTG project.  Heather asked if UTG is dealing with management of processes where e.g. SNOMED CT information is updated (new content in a new release of SNOMED CT). Ted indicated that they are not. ACTION: heather to check with Grahame to see if there is any progress on procedure for updates (e.g. the nutrition value set).

2.6 Other Business

2.6.1 Watch List procedure Watch list items to be discussed and reviewed every 4 meetings (2 months).

2.6.2 Call schedule Fortnightly – beginning 28th September at 4pm Eastern USA. It was agreed that this call would be on the opposite week from the regular Vocab WG call. If we use free conference call have it not use the HL7 conference call number so that it is clear that the free conference call phone number is to be used if not using VOIP.

Action: ted to follow up with Wayne how to achieve this – and let Heather know.

Action: Heather to set up the call on the HL7 conference call system. 3 Appendix: Known issues and Watch Items

3.1 SNOMED CT HL7 International namespace use HTA to determine method of operation Decision: until the UTG project determines the method of handling new content there will be no use of the namespace.

3.2 Publishing LOINC survey instrument attribution Policy for publishing value set definitions referencing external terminologies (current and future) 1. When a value set definition refers to external terminologies without listing the content we need to: 1. Ensure licensing requirements for use is appropriately attributed and defined 2. When value set definitions are published there is a need to automatically reference the page of external terminologies and licensing links for use. 3. Every published document will include that information. 4. Include in this policy and process in the external terminology web page. 2. Move this item to the active agenda as this is achievable. Additional issues associated with publishing for HTA. 3. The way value set definitions are persisted in the families do not have populated content about the source/owner. This field is often not populated at the moment. This is not part of the value set definition but is part of the code system specification. This includes use of reference sets or sub sets of code systems. 4. When producing published documents – it is necessary to identify the code system used and when this is an external code system there is a need to provide the link to the external owner. 5. The way the V3 ballots work – has the publishing tooling not expanding the value sets. CCDA does but others do not. 6. ACTION: include on agenda for publishing meeting discussion in San Diego – Heather to request this be added to the Vocab. Agenda. HTA to request this discussion. We will request that this be highlighted on the agenda for HTA. Currently Wednesday Q3 is the meeting with Vocabulary and Publishing (focusing on general publishing of vocabulary). Inclusion of maps in publications

3.3 Value Set Specification Projects

3.4 Tooling 3.5 FHIR content request updates Awaiting information from Grahame G about how FHIR will update terminology resources to match the international release.

3.6 policy statement on SCT allowed binding strengths in FHIR for clarification (Ted) On hold at the moment until other processes are determined more clearly. Ted suggested this be moved to the watch list. We need to determine semantic implications of binding strength of expansions which are subject to profiles. This issue is not restricted to FHIR. 4 External Web Page Content Reference to HTA – link Link to the document on external vocabularies List of terminology products and organizations with whom we have agreements LOINC SNOMED International American Dental Association SNODENT External content should be brought through Harmonization. The Harmonization and balloting process will be the trigger updates to the information provided on this page. If these requests go through harmonization the HTA can be informed and take on the liaison and organization of licensing agreements. Working Groups are not empowered to make such arrangements. The tooling below aims to provide a quick reference to find tooling and information about external terminologies used in HL7 standards. This provides a traceable process to assist standards users. Develop a table of information about each code system including:  Formal name of the code system  Short name or abbreviation of the code system  Owner of the code system  Technical identifier/s of the code system  Link to information about the code system – this should contain information about how to obtain the content.  IP information and Licensing - link  HL7 users of this information – e.g. HL7 product use link?  Information current as at

SNOMED CT This is a code system with regularly released editions, an international edition, and national editions. HL7 international realm specifications shall only use the SNOMED CT international release. Realm specific specifications shall use either the international or the edition of that Realm. Use of a Realm specification outside that Realm will require specific additional licensing from SNOMED International or the National Release Centre/s of that Realm. Full title: SNOMED Clinical Terms Owner: SNOMED International Scope of content (semantic space) all content relevant to healthcare Technical Identifiers: note: this terminology requires identification of the code system and the version of the code system being used. The identifiers shown here are for the code system (and do not indicate the version) o OID - 2.16.840.1.113883.6.9 o URL - http://snomed.info/sct Link to information about the code system: www.snomed.ord Licensing information http://www.snomed.org/snomed-ct/get-snomed-ct  HL7 users of this information – V2.x, V3, CDA, FHIR  Information current as at: 2017 September 15 LOINC Full title: Logical Observation Identifiers, Names and Codes Owner: Regenstrief Institute Scope of content (semantic space) LOINC is a common language (a set of identifiers, names, and codes) for identifying health measurements, observations, and documents. Technical Identifiers: note: this terminology requires identification of the code system and the version of the code system being used. The identifiers shown here are for the code system (and do not indicate the version) o OID - 2.16.840.1.113883.6.1 o URL - https://loinc.org/downloads Link to information about the code system: https://loinc.org/ Licensing information http://loinc.org/terms-of-use  HL7 users of this information – V2.x, V3, CDA, FHIR  Information current as at: 2017 September 15