Vocabulary Working Group
Meeting Minutes
September 2013
1 Attendees
Given Name / Family Name / Affiliation / eMailTariq / Altaf / Hi3 Solutions /
Elaine / Ayres
Bruce / Bray /
Nathan / Bunker / AIRA /
Nicolas / Canu / L’Atelier du Soft /
Jim / Case / NLM/ NIH /
Lorraine / Constable /
Carmela / Couderc / Seimens / carmela.couderc@siemens
Margaret / Dittloff / ??
Jean / Duteau /
Ana / Estelrich /
Taf / Fattai / Hi Solutions /
Isobel / Frean / BUPA
Heather / Grain / eHealth Education /
Russ / Hamm / Lantana /
Eric / Haas / HASS /
Rob / Hausam / Hausam Consulting /
Peter / Hendler / Kaiser Permanente /
Catherine / Hoang / VA / Program manger Health standards /
Lindsey / Hoggle /
Wendy / Huang / CHI /
Stan / Huff / Intermountain Health Care /
Daniel / Karlsson / phone
Ted / Klein / KCI /
Charlie / McCay / Ramsey Systems Ltd /
Frank / McKinney /
Tim / McNeil / Surescripts /
Rob / McClure / MD Partners Inc /
David / Markwell / IHTSDO /
Susan / Matney / 3M HIS / ???
Riki / Merrick / APHC /
Perry / Mur / Partners Healthcare /
Lisa / Nelson / LOTS /
Frank / Oemig / HL7 Germany /
Vasfaan / Patel / NCQA /
Lori / Reed-Fourquet
John / Roberts / TNDOH /
Roberto / Rocha / Partners Healthcare /
Mark / Roche / ONC /
Rita / Scichilone / AHIMA /
Robert / Snelick / NIST /
Andy / Stechishin / Cana Stechishin /
Sara / Stewart / BAH/NIST /
Sandra / Stuart / Kaiser /
Asif / Syed / AMA /
Sheryl / Taylor / NIST /
Robert / Turnbull / IHTSDO /
Lee / Unangst /
Daniel / Vreeman / Reigenstrief /
2 Sunday Q3 Co Chair Assignments and V2 Tables
Chair: Ted Klein
Scribe: Heather Grain
2.1 Co Chair Assignments
Chairs and scribes for each session were established and the agenda confirmed.
2.2 V2 Tables
2.2.1 Case Sensitivity
The case used in representation of concepts in implementations will be the case as published by the particular terminology. Currently HL7 tables have a mixture of upper and lower case and implementations should use what is published in these standards.
It has been recognised that due to tooling issues the case in some published standards has been inadvertently changed in the publishing process (particularly when MS Word is used). For certification purposes the required representation is what is published as the standard.
Example: If you are using a 2.31 published table which is all lower case, and in 2.4 the first character has become upper case then the upper case leading character is required if software is to be considered compliant
Action: The style guide for codes in V2 and V3 should be updated to reflect rules identified and warning of issues found.
2.3 FHIR issues
Issues have been identified with the definition of code systems. These definitions are loose in the current specification. Some things are local and need to be able to be managed locally.
Intra vs. Inter Organisational Terminology Resources
Loose definitional rigor is intended to be used for
· local concepts relevant within an organisations without a need for persistence over time.
· Concepts used between organisations such as labels where there is no need for meaning interpretation or persistence over time.
Where meaning is to be maintained or communicated across organisations and persisted over time. Such semantic interoperability requires concepts to be drawn from national or internationally recognised code specifications and appropriately bound to an information model which is similarly rigorous and standardised.
2.4 Planning
The agenda had to be modified for Tuesday Q3 as 4 of the Vocabulary Co-Chairs have been summoned to the Board to discuss the Terminology Authority. This session was modified to general vocabulary discussions and TermInfo and namespace discussion was moved to the first quarter on Tuesday at the start of the TermInfo discussion.
Objectives of Q4 Monday – Binding Discussion
Much of the problem with understanding of binding comes from the lack of consistent descriptions and the variety of context assumptions made (usually based upon a person’s background)
There is a need to explain this better and to make each use case clearer.
Definitions:
The notion of binding – the designs definitions and data items to make it work with the HL7 data types in V3 are a complex set of data items, definitions and relationships and that complexity makes a high level definition.
2.5 Sunday Q4: Facilitator Discussion on facilitation
Chair: Jim Case
Scribe: Heather Grain
USCRS – vocabulary submission process using the NLM vocabulary request submission tool – review of the evaluation by Russ to be presented but Russ was not in town yet so delayed.
The Facilitator Training Outline was reviewed and updated including:
· The tutorial - What is Metadata – needs to be core not optional and needs a tutorial prepared on this topic.
Collection of FAQs.
Potentially collect 2 or 3 examples of problem harmonisation proposals and list the issues associated with it, to prepare a training session based upon problems.
Action: HG follow up with Ted, Russ and Woody to collect the example.
Define the issues and answers to those issues
Prepare presentation on these examples.
Action: HG to update the Facilitator Training Outline including objectives and update of diagram and content for circulation to the list for comment and confirmation of outline.
3 Monday Q3 Agenda Planning and Project Review
Chair: Jim Case
Scribe: Rob Hausam
3.1 Planning
Wednesday (9/25)
Q1, Q2
Topic: Joint meetings with MnM
Will cover the common issues and then discuss FHIR. The common issues with MnM are the harmonization process and tooling needs. We need a specific plan for the harmonization tooling to take forward to John Quinn. The priorities are editing and maintenance. This affects many people in the organization and has a broad impact. The history is that two tools have been developed, but have not been used. The biggest cost is in translating proposals to implementable logic.
Action: Consider scheduling further time-boxed discussion on a series of upcoming calls
Action: Russ has an action item to send a requirements proposal to John Quinn (Russ)
Action: Russ is writing a letter to Vivian Auld to inquire regarding the availability of USCRS source code
Q3
Topic: Joint meeting with V2 Publishing
Will discuss the outstanding V2.8 issues. Ted provided a brief report. Vocab is the steward of the coded datatypes. Some of the examples have not been updated. The V2 tables project – will discuss what needs to be published from that. We could use some additional help.
Q4
Topic: Joint meeting with InM
Discussion is needed regarding the coded datatypes. How do we specify the bindings? To this point the bindings have been stated in prose. We need to formalize jurisdictional issues – i.e. the German implementation uses the German translation rather than English.
Thursday (9/26)
Q1
Topic: Joint meeting with CGIT
Ted has talked with Rob Snelick and Frank Oemig. Rob has ONC-driven requirements. Frank has needs in Germany. People have expressed the need for a human readable syntax.
Q2
Topic: Role of VSAC HL7 value set representation
Need to obtain agreement on the issues regarding value sets.
Q3
Topic: WG planning
Need to plan the future Vocab call times.
Q4
Topic: Nutrition terminology discussion
The nutrition messages use ODS and ODT segments rather than OBX. In the ODS and ODT segments there is no place to put all of the necessary information. One option is to ignore code system and use free text. Jim recommended using LOINC observation codes. Current systems have been implemented using ODS and ODT and they do not want to change – so what are the terminology options? In the SNOMED CT International Edition the nutrition concepts are findings rather than regimes/therapies. The US edition has recreated the diet hierarchy as regimes. Ted stated that there are multiple issues with ODS. In 2.5.1 the datatype was CE, but it became CWE in 2.6 – the 4th component is text. The V3 nutrition models have handled this pretty well using procedures. They can use SNOMED CT – they won’t need LOINC codes. This is an old spec in V2, with no substantive change since 2.2. They want to use coded values, but the segments don’t support it. An alternative is to modify ODS and ODT with the needed attributes – the would be a 2.9 proposal that they might pre-adopt? There are no V3 implementations yet.
Facilitators roundtable
Ted and Rob plan to attend.
Friday (9/27)
Q1 and Q2
Topic: Finish the V2 tables project
3.2 Project review
Reviewed of the status of the Vocabulary WG projects listed in Project Insight.
3.2.1 Potential new project
Discussion of new project for expression of value set definitions
Rob McClure suggested that a normative standard is needed for expression of value set definitions. Ted agreed that this is a useful project, with considerable interest and need. To do this a project leader is needed.
Action: Rob McClure agreed to lead a new Vocabulary project to develop a normative standard for the expression of value set definitions.
This is also needed by CIMI and FHIR. Rob needs help with the technical capabilities. The first step is to create a project scope statement. Ted suggested to start with a logical model (a normative list of elements). Then in the future considered re-structuring the MIF? An ITS is also needed – Rob M. agrees that we want both. CTS 2 would have to align with this. We don’t want to lock in to a specific technology.
3.2.2 Existing Projects
Project 998 – Vocabulary conceptual model
Develop document to support HL7 v3 terminology implementations; Finalize and ballot as a standard a conceptual model for concept domains, value sets, and binding syntax.
This may need to be part of the bigger project. The PSS has not been submitted yet. Ted was able to locate the as yet not submitted PSS for the unified terminology model project (998). One of the 4 existing terminology models is the current vocabulary representation in the MIF.
Project 948: Facilitator Training:
The foundation of this has been established and project scope statement accepted and we will meet with Education at this meeting.
Action: Covered later in the week – retain or regular call list
Project 947 Vocabulary Maintenance in the IHTSDO Workbench.
The progress of this item needs review, particularly the milestone date. Rob Hausam will send the date to Lynn.
Action: Review the status on a conference call
Project 946 CTS 2 incorporation of SVS
This will be discussed later this meeting.
Action: review the milestone and end dates
Project 874: V2 code table versioning and alignment to V3 vocabulary model.
This project identifies code systems and versions used in V2 and have been working their way backwards to review the quality and content of these. There are over 500 tables to review, we are currently up to Table 150.
Issues identified are taken back to publishing and code set standards related to harmonisation. The intent is to allow the V2 content to be represented in the V3 structure and to look at the longer term actions such as identification of standard approaches for standard terminology representations.
HL7 user defined tables don’t include context or value definition .Versions are also an issue. Documentation of the issues found is being maintained and will be categorised. The steward of the data is the chapter owner.
Project 839 Term Info
Discussed Tuesday
Project 806 Development of policies and procedures of an HL7 terminology authority
Not discussed. The Terminology Authority is now established. This project can be completed.
Action: Include discussion on next call
Project 798 Refactor HL7 Confidentiality concept domain, code system and value sets
Not discussed
Project: 761 Information Model metadata Definitions
Not discussed – but related to discussions on definitions required which occurred later in the week.
Project 743: Guidance for the use of terminology post-coordinated expressions in HL7
Not discussed.
Project 630: Develop and publish principles and guidelines to specify the syntax for binding in implementation guides
Not discussed – active at ISO. For general oversight.
Project 999 Review ISO Principles and Guidelines of Terminology Maintenance
Continue as ISO project? If this project continues in ISO, we should also continue it here in parallel.
Action: Ted will report back on the status of this in ISO.
Project 497 Harmonise the V2 and V3 vocabulary
This project is dependent upon and cannot begin until 874 is complete
Project 495 Glossary Project
Reported on Thursday
Project 324 Common Terminology Services Release 2
The model changes are not major, there may be editorial changes. There may be further modifications to enhance the document, but even without that the document is viable. There are 22 outstanding ballot reconciliation comments left. Need to decide whether to publish now or re-ballot? Ted asked where the code system version is identified. He assumed that it must be there, but hasn’t found it. Will discuss this further Tuesday. A fully specified concept identifier includes code/code system/code system version.