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Title of item up for approval w/linkVoteDecision

PSS - Withdraw HL7 Version 3 Standard: Common Terminology Services (CTS), Release 2

Vocab has discussed with organizations known to have implemented CTS-2 (Mayo) and no concerns were raised with withdrawal of the standard. No development is occurring.

Project Approval Request

Choices Your Vote Current Result: (10 Total Votes)
abstain Project Approval Request
0 Votes , 0%
affirmative Project Approval Request
8 Votes , 80%
negative Project Approval Request
2 Votes , 20%
refer to telecon Project Approval Request
0 Votes , 0%



Moved-SecondRob McClure-Vocab/Lloyd McKenzie - FHIR-I
Affirm-Negative-Abstain8-1-0; 2020-07-15

Jul 01, 2020 14:08

Project Insight ID1612


  1. No discussion from  GDolin - SDWG

  2. SOA was a co-sponsor on CTS2 but has not been consulted about this proposed withdrawal as far as I am aware.

    We understand there were implementations of CTS2 in France and Germany as well as at Mayo and are investigating what their current status is, however this is likely to take longer than this vote allows.

    Happy to withdraw the negative if the vote can be delayed in order to complete inquiries.

    Vincent McCauley

  3. Vincent McCauley Carmela A. Couderc I thought we discussed this with SOA at the last actual F2F WGM where the decision to withdraw was discussed, so apologies if that did not occur, or at least was not documented. What is needed is that any group still working on updating or improving CTS2 should become involved at HL7 to keep the standard fresh, particularly regarding alignment with FHIR. If that occurs then we would agree that the standard is still active and should be re-affirmed. But if the standard is simply a stable standard that was used in the past to create something that is currently being used but is not impacting the changes and maintenance of the standard, then we would not re-affirm leaving us only able to withdraw (from ANSI) and then Retire (at HL7). An Affirmed (re-affirmed) standard is intended to be actively worked on and given the aggressive emergence of FHIR terminology functions, continuing to affirm a standard that is not aligned and not being worked on is counter productive. Hl7 has recently improved access to its list of standards: a Withdrawn standard is not gone from the list of HL7 standards (but would no longer be active at ANSI) but is instead listed as retired in order to point folks coming into the Hl7 spectrum to look to current Active standards, in this case FHIR. But, if other entities are actively working on CTS2, then that needs to be communicated and they need to pick up the standards improvement mantle. Running a ballot to withdraw allows entities to tell us exactly what is needed and if they say "we'll work on it" the ballot will fail.

  4. I can confirm the current use of CTS2 from the French company Phast  ( for it’s cloud services.

    The company have a full implementation of the CTS2 HL7 functional spec, with complete support of its three defined profiles “Query”, “Terminology Administration” and “Terminology Authoring” and support a FHIR interface. Phast provides a French National terminology service.

    There is also a German implementation from Fraunhofer FOKUS ( the implementation (CTS2-LE) is distributed on commercial license. The last update was in 2020.

    Stefano Lotti (SOA Co-chair) is also aware of  other academic/research implementations in Germany and Italy.

    CTS2 is also referenced by OMG standards – Mayo and Phast originally implemented it as part of the OMG process as per the  SOA/OMG Heath Services Specification Project (HSSP) – I should have those references for you shortly

    The move to retire this standard may reflect a misunderstanding of the purpose of  a Service Functional Model  – it is implementation independent. As noted above, implementation of CTS2 in FHIR is possible but it has also been implemented in more traditional service architectures as well.

    If Vocab/FHIR feel that the CTS2 service functional model needs to be updated in light of usage experience since it was published, SOA would be happy to work with Vocab on that.

    Does retiring an HL7 Standard that has active current commercial international implementations send an appropriate signal?

    As far as I am aware the current Terminology functionality in FHIR is aligned with the CTS2 model, although CTS2 is much broader than the current FHIR spec in this area. The FHIR spec. for Services could reasonably be extended to include this.

    If Vocab is no longer interested in CTS2 then perhaps we should talk to OMG about taking this standard over.

  5. Retiring says "we don't plan to maintain this going forward".  That statement would be based on the fact that the degree of market uptake was low and is forecast to be negligible going forward, plus the fact that HL7 has a different technology with much greater market acceptance that we would now recommend to anyone newly entering the space .  It's a statement to the market that "if you haven't implemented anything yet, this probably isn't what you want to look at" - and I think that's a very true statement.  In no way does it say that you can't continue to use it if you have it in production, nor does it prevent you from adopting it if you really want to.  We're just no longer recommending it.

    I don't think there's any interest in updating the service functional model for FHIR - I don't know anyone who's implemented FHIR terminology services who has identified such a need.

    1. Thanks Lloyd and Vincent for your comments. Vincent accurately points out that CTS2 is a functional model - implementation independent, therefore HL7 having a different technology with greater market acceptance, while interesting, doesn't mean that as a functional specification, CTS2 isn't of value. The intent of Vocab's proposal to withdraw the specification is to communicate that there are not any plans (nor have there been any requests from the community) to update the specification, however as a functional model it is still valuable and useful to the community.  Vincent McCauley Have you reviewed the Guidelines for a Standardized Terminology Knowledgebase project scope statement?  

      1. Vincent McCauley  The proposal to withdraw CTS-2 will move forward unless the community (possibly the community you mention above) is willing to take responsibility for CTS2 not becoming stale. Do you have any suggestions about how to accomplish that. other than contacting someone at OMG? 

  6. The vote passes. recoded 2020-07-15