Chair: Rob Hausam, Scribe: Riki Merrick

TermInfo Conference Call Minutes Wednesday, June 3, 2015 - Time: 9:00 AM Eastern Time (1300 UTC)

Chair: Rob Hausam, Scribe: Riki Merrick Attendees: Rob Hausam, Yongsheng Gao, Carmela Couderc, Daniel Karlsson, Riki Merrick, Roberta Severin, Heather Patrick Regrets: Jos Baptist

 Announcements o Linda Bird will be joining us on July 15th to present and discuss SNOMED CT Terminology Binding and Expression Constraints . The call for that day will be rescheduled to 2100 UTC (5:00 PM EDT, 11:00 PM CEST, 7:00 AM Brisbane) o SNOMED CT Expo 2015 set for October 29 – 30th, 2015 in Montevideo, Uroguay – call for papers – due by Friday July 10, 2015 Possible topics: . Update on TermInfo document . New efforts – FHIR? . RDF efforts

 Review and approve minutes from May 27 (if time for adequate review on the call - thanks again, Carmela!) – reviewing on call – approve as distributed by Carmela Couderc, Yongsheng Gao, against:0, abstain:3, in favor: 3 – fix the time error on the call date announcement in retrospect – Rob H will post after call

 Introduction to Roberta Severin, Terminology strategist for Cerner Corp, Michelle Miller who attended HL7 in Paris suggested for her to attend this call – explaining the set up of TermInfo as project under HL7 Vocabulary WG, which meets every other week

 Action items review and update (if possible, please send your updates in advance) o Review the new items from last week (bold) and adjust as needed o Need to review and update the TermInfo PSS (still pending) o Negation (still pending) . Review and update Core Principles negation guidance (section 6.6 etc.) . Consider preparing Help Desk article on negation - when Negation update in Core Principle is completed (are further updates still planned?), then this will be the follow up project to promote and make more accessible to general audience (?) . Reach out to Jean Duteau, Larry McKnight and others . Recent FHIR observation value negation discussion in OO plus proposed addition of indicator elements for action "not done" in PCWG . New discussion in PCWG on negation for AllergyIntolerance resource . Reach out to Joe Kunisch to determine when to restart this discussion (Rob) o Update TermInfo Wiki and HL7 TermInfo project site information (Jos) . Determine content and format for TermInfo Wiki page for "TermInfo in FHIR" discussion (Rob) o "Assertion pattern" in CDA and FHIR (still pending) . Recommend not supporting use of ASSERTION (or equivalent) in FHIR? o Invite Linda Bird to join a call to discuss the IHTSDO "Terminology Binding and Expression Constraints" work (Rob) - done (invite has been made) - done! . Will schedule call at 2100 UTC to accommodate Linda's location (Australia) - date TBD - will be July 15 . Determine if this is a separate call or replaces an existing call? - will reschedule the call to 2100 UTC o Create an executive summary / marketing document . State stakeholder value o Create 1-2 page summary document for using SCT in CDA R2 o Complete the DSTU updates (Rob) . Consistently represent standalone examples with brackets, or with agreed upon solution (as below) . Move the statement about the brackets (color or font) out of the SNOMED CT section and put it in 1.7 Documentation Conventions . Identify and implement a convention to delineate the examples when they are in-line (brackets, color, font) o Ask HL7 to make TermInfo easier and more logical to find (Jos) . Determine content and placement - target mid-June o Add decisions for representing SNOMED CT compositional grammar examples (standalone and in-line) to the DSTU Documentation conventions section (1.7) (Rob) o Add decision for representing hyperlinks to the DSTU Documentation conventions section (1.7) (Rob) o Find out from FHIR Management Board what to recommend to IHTSDO to use for a value set URL document reference (Rob H) o Add item to Vocab call agenda to discuss IHTSDO/HL7 FHIR Terminology Binding Collaboration document issues and concerns (Rob H) . This is on the agenda for tomorrow - listed as "Terminfo Issues" in the agenda email that Ted sent on Monday (Ted may not be on ) . Send additional email today to Vocab list clarifying this agenda item (Rob)  DSTU document updates o Review status and work on updates as needed – not ready  - if Rob cannot find time to get this done this round, may cancel next week’s call

 Update on Patient Care decision on negation in FHIR AllergyIntolerance resource (from PCWG call last week) o Develop consistent FHIR negation strategy? (vs. "ad hoc" with each resource) o Cerner getting significantly involved in FHIR o Discussed possibilities in Paris and brought back to PCWG call: add a negation indicator to the resource that means “not allergic to” – more use case driven than in v3 to avoid the confusion o PCWG decided to:

. Handle using the value set to cover not allergic to – with several levels – high level vs specific substances – but should not be common to have to state “NOT allergic to substance X” – but that should be able to be added to the supported terminology

. Looking for feedback on this approach

. Roberta - Cerner currently creates terms that mean: No known allergies, no known drug allergies, no known environmental allergies, no known food allergies – these live separately from the actual substances o In SNOMED CT concept model can deal with the negation of allergy to substance

. Still need to look in more detail as for allergens drawn from substance hierarchy, some are in product, but the no known allergy terms are in the situation hierarchy – needs some more thinking

. Though in some value sets are drawn from different hierarchies…every time this happens, this should be specifically evaluated for support of the semantic logic

. Action: Pass this on to Rob McClure’s project group working on value set QA (“ review for semantic consistency “) o Still need to consider an overarching approach to the issue of negation:

. Should we do that, and if so, how?

. The alternative is to continue with an “ad hoc” approach for each resource, which likely will lead to an inconsistent and potentially confusing situation, which would be best to avoid

. At least in FHIR “negation” elements are or will be more explicitly specified and tailored to the specific use cases, which should help avoid the problems with overly broad negation that we’ve encountered in V3/CDA

. One possibility for FHIR is to make an explicit rule that negation will be done in the terminology

. SNOMED CT, in particular, does include partial (limited) support for negation

. Is this a workable approach?

. What are the potential pitfalls and concerns

. Needs further discussion . Can we apply this (or any) approach across the board (for all resources)?

 Further discussion on various items (as needed and time permits) o TermInfo on FHIR o Use of SNOMED CT qualifier values: . Need to be allowed to be used in information models . Discussed in Paris that: . David Markwell will make IHTSDO statement available in the near future, though may be important to also have official verbiage included in the implementation guide . Current policy in SNOMED CT is to avoid pre-coordinated terms including laterality but rather using post-coordination to deal with that, but users send feedback, that the pre-coordinated terms are still needed; last meeting we reviewed FHIR value sets – anatomy related value set = body site is very large and not enumerated in FHIR, but they are using bodysite.modifier to deal with laterality etc - does not include the relationship type from the SNOMED CT – only implies it based on the code chosen in the value set, though it does support some form of post- coordination in this information model – so FHIR users should use this approach rather than using the pre-coordinated bodysite . Specimen DAM had asked question about modeling laterality etc outside of target and approach site – would need to be applied to the standard used – also need to compare to BRIGD biologic specimen model that was just published – specimen project group to take this up again . constructs in v3 – in CDA example of CD datatype R1 to use the qualifier – this has been removed in the CD datatype R2, which supports post-coordination in the code, but folks don’t want to use this. Also found this wiki which list wrong example for CD datatype R2: http://wiki.hl7.org/index.php?title=Datatypes_R2_Issue_103 – last updated in 2007 - bring this to MnM – Rob to do . In v2 for specimen we have bodysite modifier, but none for the approach site . In FHIR: have the above example of “.modifier” and then in the definition will restrict the types of modifiers that can be used – is that enough? This approach leaves it somewhat open for misinterpretation, though most of the time it will be obvious – look for example, where there could be issues? . Yongsheng will finalize his internal IHTSDO project, and reach out to this group when advice is needed . ACTION ITEMS: . Bring back research on Specimen DAM, BRIDG – Riki . Notify MnM about the incorrect wiki link here: http://wiki.hl7.org/index.php?title=Datatypes_R2_Issue_103 – Rob . Consider FHIR “.modifier” generic approach over requesting more specific element name – all Call adjourned 10: 28 AM EDT Future agenda items - pending  Update on TermInfo webinar and tutorial o TermInfo tutorial and Webinar need coordination with the new Implementation of Terminology tutorial o Consider when the TermInfo tutorial will be presented again at WGM (September 2015?) o Need to consider plans for webinar "Parked" action items - pending  From May 2014 (Phoenix) WGM TermInfo and Vocab quarters o Check with MnM if they want to Co-sponsor (Rob) - will hold pending TermInfo planning  Finalize updates to TermInfo PSS (Rob) - will hold pending TermInfo planning  Ask HQ if there is a way to give an introduction to TermInfo at a FHIR Connectathon (Rob) o example exercises o use of post-coordinated expressions o ASSERTION pattern issues . including query responses in FHIR o Observables discussion in IHTSDO . PRID property in LOINC  Coordinate with Linda Bird on IHTSDO work on allergies and adverse reactions (for potential TermInfo implications) (Rob)  Coordinate with Kirstine Rosenbeck Gøeg (from Denmark) on her IHTSDO SNOMED CT Implementation Advisor program work item that overlaps with TermInfo – use of SNOMED CT with different information models (HL7) - met and began discussion at the IHTSDO meeting (October 2014) (Rob)