Date: 30 AUG 2018

Presiding Co-chair:  Heather Grain

Minutes Author:  Heather Grain

Meeting Coordinates


Password: hl7termauth


Attendee type H - HTA Member

O - observer

L - liaison



P - present

A - Apologies

N - not present without apologies




Heather Grain

Global eHealth Collaborative


Rob McClure

MD Partners


Sandy Stuart

Kaiser Permanente


Jean Narcisi

American Dental Association


Julie James



Ted Klein

KCI Inc.


Roel Barelds

ICT Group



Jim Case

National Library of Medicine/IHTSDO



Wayne Kubick




Robert Hausam

Vocabulary Co-chair



Jane Millar

SNOMED International



Carol Macumber

Vocabulary Co-Chair

Russell HammVocabulary Co-Chair


Quorum Requirements Met (3):  Yes

16:00  Agenda Confirmation

16:01  Minutes of Previous Meeting

Minutes of conference call on 2019 Aug 16

16:03    Actions not covered below

    Instructions for metadata required about external code systems - HG to share with Ted and bring to next call  - shared July but this was the middle of harmonisation - HG will resend to all.

    HG to update SNODENT details on external terminologies page - done

    Jean to confirm SNODENT CD2 information changes required to Ted.  Ted to make the changes to table 396  - Jean sent.  Ted to apply still - update 396 and update ballot copy for 2.9.

    HG to send copy of request for and procedure for promotion to SNOMED International release to Susan Matney CIMI.  - Sent and receipt note provided.

    Heather Grain find out how to use the macro for actions required. - still being followed up.

16:10 SCT Content Request Process 

SCT Content Request process review status (HG)

  • load the instructions for content request into confluence  Heather Grain to load the document and send an email to the members.  members to review prior to the next call and include this on the next call agenda.
  • Actions:  
    • HTA request for new content needs to be loaded in a way that supports download and upload for submissions.  Rob will update the site to achieve this.
    • Roel noted that he cannot edit the HTA content on confluence - RB and HG to request access for him of VJ.
    • The content request policy document was updated on the call.

Where does content request process fit with UTG (TK)

Ted is updating the tooling workflows and we will discuss this in more detail on the next call.  There are multiple potential places where content requests should appear.

Related to this publication of external releases within UTG need to be considered.  the URIs are elsewhere and we need people to be able to browse out and get to them.  Is the HTA external terminologies page the place   Needs further discussion.  Need to make sure that when people are working in a particular area they need to be able to go quickly and easily to the information they need. is being developed.

16:20  Currency Guidance

Document review status (HG)

See   Members to review this document and provide comments to Heather.  

Confluence not providing documents - download timed out - unable to review.  HG to contact DavidJ about this.

New documents page created - terminology authority documents - all documents are now in this area which can be maintained.  

16:30  Harmonisation

Report from Harmonisation - Ted

We continue to have external content bought to harmonisation - nothing new this time other than the updates to SNODENT which came from the last Harmonization process.  There were issues raised at ballot associated with code system updates.

  • need a better set of processes to deal with updates to our copies of external code systems.  This has been highlighted during the last ballot cycle.
  • Problems include:
    • updates where we don't know that a change has been made - nothing comes to Harmonization
    • updates on regular cycle
    • updates on irregular cycle and we don't know
    • How do other users find out?
      • this is a particular issue for meaningful use information maintained by the CDC, known issue for public health at the moment.
      • some repositories have functionality which support sign up to be notified of change.
  • We may need a boilerplate statement on currency for value sets where this is a known problem?   Request such a statement from Public Health WG.
  • Are we expected to review EVERY code system at EVERY ballot to make sure things haven't changed?  Doing this is not practical.  We expect that any WG sending documents through to ballot have a responsibility to review the currency of all external code system content prior to EVERY ballot.
    • Update the currency document to make clear:
      • who is responsible for checking and updating the content?
        • THE WORK GROUP
        the content policy document was updated to reflect this requirement more clearly.
      • need statement at co-chairs dinner to inform all.  HG request to be on agenda.
  • Standards Governance Group
    • HTA request that SGG follow through on our behalf asking for:
      • Any organisation that we have a copy of their code system content or metadata in our published documents
        • where that organisation does not notify nor have a method of push notification when changes are made (no subscription mechanism to notify of changes).
      • These organisations include (we are not yet aware of all organisations that might be involved but we do know of):
        • VSAC provides support to electronic Clinical Quality Measures that are part of CMS quality programs.  In addition value sets for C-CDA (derivatives of CDA based on CCD) - these value sets needed for a particular template (health story) are maintained in VSAC except for those where the code system is not clearly available to us (e.g. US postal codes, US States).   Code systems may be available in other sources such as UMLS.  
        • CDC - have factions who use VSAC to manage their value sets in support of their programs, there are others who use PHIN-VADS.  PHIN-VADS creates and maintains CDC 'owned' code systems.  These codes are only supported by PHIN-VADS.    There will continue to be content which is only available in PHIN-VADs that are only used and referenced by public health systems.  People think PHIN-VADs is up to date with code systems, but it is not.
    • HG to contact SGG regarding this issue to inform them and request their support and action where possible.

16:45 Clarification of Legal situation

See document from Christof  - to be carried over.

16:55  Other Business

Next meeting:  30th August

17:04 Adjourn Meeting


Not planned for discussion this call

FHIR SNOMED CT Free Subset  

HG to report on recent contact with Grahame Grieve on this topic.  - not covered this meeting.


Policy for publishing value set definitions referencing external terminologies (current and future) (Ted)

When a value set definition refers to external terminologies without listing the content we need to:

  • Ensure licensing requirements for use is appropriately attributed and defined
  • When value set definitions are published there is a need to automatically reference the page of external terminologies and licensing links for use.
  • Every published document will include that information.
  • Include in this policy and process in the external terminology web page.




1         Appendix: Known issues and Watch Items

1.1        Publishing

  • LOINC survey instrument attribution – attribution information included in web and publishing guidance (listed above).


  • Additional issues associated with publishing for HTA. 
    • 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. 

7/12/17 steward is included – but need to consider the owner (who is responsible for the value set).  There is a need to indicate the purpose or scope of the value set content.   This is a Vocabulary issue rather than HTA.

Additionally, tooling in the MIF does not permit publication of the steward of the value set.  It is held in the database, but the tooling is not captured for V3 value sets.  This is being addressed in the UTG.  V2 has the steward and owner is algorithmic according to the chapter the content is used in, but where tables are used in multiple chapters.  Not for further discussion in HTA as Vocabulary will work on these issues

  • Inclusion of maps in publications.


1.2        Tooling

1.3        FHIR content request updates

Awaiting information from Grahame G about how FHIR will update terminology resources to match the international release.

1.4        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.

1.5        External Web Page Content

Reference to HTA – link  - Done.

Link to the document on external vocabularies (policy document) – to be submitted to TSC for their endorsement.

List of terminology products and organizations with whom we have agreements:


              SNOMED International

              American Dental Association SNODENT

List of known external terminology products and organizations used in HL7 products:

     ICD (WHO)

     Others….., including content from V2 tables 396 (external code systems used in V2 standards), link to V3/CDA and FHIR external terminology pages.  These are known terminologies and this information is known to be incomplete and less than what is required. 


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


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