Presiding Co-chair:  Heather Grain

Minutes Author:       Heather Grain

Meeting Coordinates   

Teleconference Phone Number: 

Teleconference Internet Info:   


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

Sylvia Thun



Julie James



Susan Matney



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):  Quorum not met


16:00  Agenda Confirmation

16:01  Minutes of Previous Meeting

Minutes of conference call on 2019 Aug 16th

16:05    Actions not covered below

SCT Content Request process review status (HG)

  • load the instructions for content request into confluence - members to review  - not reviewed this meeting - no quorum met.

Where does content request process fit with UTG (TK)- not covered as quorum not met

Issues for Discussion at San Antonio

SNOMED International

Discussion on SNOMED International and IPS request.


  • the HL7 requirement is beyond what is being proposed - there is some case for pushing for more
  • there is a genuine need for what is in IPS


  • Relationship to Vocab
  • Relationship to FHIR
  • Relationship to SNOMED International
  • Need for Quality assurance gate with HTA for project proposals and harmonisation
  • Elect 2 Co-chairs recognising international requirements

Request from Vocabulary regarding Retired content

Wording Suggested:

The following polices are set forth by the HL7 Vocabulary Work Group with regards to continued use of the HL7 Code Systems with Retired or Legacy status.

  • For existing implementers of these inactive code systems, HL7 respects the right of active implementations to determine the appropriate course of action, if any.
  • For net new implementers, HL7 strongly advises against the adoption and use of these code systems and value sets and recommends that implementers look to other vocabularies or reference terminology that better support the clinical and/or business requirements.
  • HL7 will:
    • no longer add new content to these code systems or their respective value sets
    • no longer maintain or deprecate content in these code systems or their respective value sets
    • not provide maps of these legacy code systems and/or value sets to newer vocabularies as it is impossible to verify the accuracy of the mappings or correct semantics without knowing all the details of any clinical and/or business implementation; to do so, may lead to patient safety risk(s)
    • continue to publish these code systems and value sets to support legacy implementations 

Please note that further work is being done in the Vocabulary work group to determine the go forward policies and procedures related to the larger issues surrounding code system and value set maintenance.

This request fits into the problem of governance between Vocabulary and HTA.  
There is also an issue of how domain specific code systems such as dose form are sustained.  HL7 should not be providing domain specific code systems ( the HTA will discuss this specifically)  we do not have the resources to maintain them.  We have to move into an environment where we have sustainable standards 

Currency Guidance

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

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

16:45 Clarification of Legal situation

See document from Christof and following communication from Jane.

16:55  Other Business

Agenda for Baltimore

Next call:  suggest no call as some will already be travelling.  HG to cancel the call.  

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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