Chair:  @ Julie

Scribe: @ Julie


Attendee type:

H - HTA Member

O - observer

L - liaison


P - present

A - Apologies



HPJulie JamesBlue Wave Informatics LLP

Roel Barelds

ICT Group

HASusan MatneyIntermountain Health
HPSylvia ThunHL7 Germany
HPCarol MacumberApelon Inc.
HPReuben DanielsSaludax
HPDavera GabrielJohns Hopkins University Institute for Clinical and Translational Research

Wayne Kubick


Jane MillarSNOMED International
Andrea MacLeanCanada Health Infoway
OPSoraya AssarMotive Medical Intelligence

Minutes of Teleconference 2019-10-01 

Motion to accept proposed RB, seconded RD; carried unanimously

Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion



Minutes Approval

Quorum is met.

Motion to accept proposed 

ManagementNew HTA List Serve

WGs can have a list serve for the community (open and public and then there is a co-chair list wgname-cc.  For HTA members only, we can use this -cc mechanism - – members only.

We will update our Confluence page about this.  

Note: RB has only received an update for the open list - Davera only the closed one. (Julie will check with Dave)

TopicURLs for External Code Systems

There is a document started with the framework Initial Code System Request Letter

Members are welcome to start adding text to this for each paragraph, especially the paragraph about 'Brief description of the FHIR requirement for a URL'

NB: Julie to update template for code system information

TopicCode system statement for specifications

"...require use of terminologies and vocabularies that are owned by non-HL7 entities (known as "external code systems"). Appropriate use of these is likely to be subject to intellectual property usage policies and may be protected under copyright law. "

Roel: has checked - there is nothing explicit.  Suggest we take the X12 wording and put something similar at the top of the External Terminologies - Information page in a "black box" and also draft a short statement to put in the Policies page

Julie will work on a draft of wording for a generic statement for the External Terminologies page as a sort of black box warning and circulate on the list.  Carol has got content from US IGs; the FHIR spec probably has something for SNOMED.

TopicISO Country Codes  

Update from German enquiry to ISO [Sylvie]  

Patricia Cook from ISO Central Secretariat (responsible for 3166): "You don’t need any permission to include the ISO 3166 country codes in lists or software, this is fine."

Communicate this back to FHIR community via the Zulip chat and possibly more widely.  Sylvie will also communicate this through IHIC.  Also add to the HTA External Terminologies page (Roel)

Could also ask about 639X the Language codes (spoken/written).  Action: Julie will ask ISO about this too.

TopicFHIR Naming system resource

Carol and Reuben gave an update  Naming System resource : It identifies the existence of a code or identifier system, and its possible and preferred identifiers.  This resource is frequently defined by third parties that encounter the code system in use, and need to describe the use, but do not have the authority to define the features and content. Additionally, there may be multiple authoritative NamingSystem resources for a code system, but there should only be one CodeSystem resource.

The maturity level is still low (2) and the UTG project is implementing it.  It's a risk to be implementing at so low a level.  Missing a title element (TK should be adding Tracker for this).  

Fluidity for "canonical URLs" - more than one for a single code system (in different IGs) so possibility to use a "Linkage" resource which would essentially asserts that two Naming Resources are the same and representing a single code system and both URLs are in use.  The Linkage resource is still very new though.  

Carol notes that there is an extension on Naming System which describes a "replacement" so that could be used to manage the duplicates, IF a new URL replaces the old one.

GG suggested a Connecthon focused on Terminology/Naming System but timing for this may be an issue because UTG needs to be using something very soon, which will likely be Naming System.

It sort of feels like there are two ways to formally identify a code system in FHIR (the Code System resource and the Naming System resource), especially if the Code System resource just contains code system metadata rather than content.  But the fundamental use case for Naming System is to be able to convert between different identifier forms (e.g. OIDs and URLs).  It feels as if at least currently Naming System is aimed at organisations providing terminology services rather than general FHIR implementers.  Suggest there needs to be good guidance and examples for the use of Code System versus Naming System (possibly NZ example). Vocabulary WG

CDA doc referencing a URL or OID, could query a registry of Naming Systems to find out the entity being referenced.

AdjournmentMeeting adjournedAt 22.01 pm BST  
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  1. Here is the statement found on US Realm VS that use SNOMED content. Likely this statement was drafted long ago (based on the year and the use of IHTSDO and no mention of SNOMED International). Example can be found here

    "Copyright Statement: This value set includes content from SNOMED CT, which is copyright © 2002+ International Health Terminology Standards Development Organisation (IHTSDO), and distributed by agreement between IHTSDO and HL7. Implementer use of SNOMED CT is not covered by this agreement"

    FHIR specifically notes the following for SNOMED on the Using SNOMED CT with FHIR page:

    "This specification includes content from SNOMED Clinical Terms® (SNOMED CT®) which is copyright of the International Health Terminology Standards Development Organisation (IHTSDO) (trading as SNOMED International). Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact  or"