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Chair:  @ Carol Macumber

Scribe: @ 

Attendees

Attendee type:

H - HTA Member

O - observer

L - liaison

Present

P - present

A - Apologies

Name

Affiliation

HPJulie JamesBlue Wave Informatics LLP
H

Roel Barelds

Precipius b.v.

HASusan MatneyIntermountain Health
H
Sylvia ThunHL7 Germany
H
Carol MacumberApelon Inc.
HPReuben DanielsSaludax
HPDavera GabrielJohns Hopkins University Institute for Clinical and Translational Research
L

Wayne Kubick

HL7 (CTO)

LPSuzy RoySNOMED International
O
Andrea MacLeanCanada Health Infoway
O
Soraya AssarMathematica
O
Rob McClureMD Partners
O
Joshua ProciousHL7 International

Minutes of Teleconference 2020-03-04

Motion to accept proposed 

Agenda Topics


Agenda Outline

Agenda Item

StatusLead

Meeting Minutes from Discussion

Management

Quorum

Minutes Approval

N/ACarol

Quorum is met

Motion to approve Minutes proposed

DG moves, RD seconds: Motion passes 3-0-0

Apologies from Julie who arrived very late and Roel also: the unsynchronised time zone shift caused the Europeans some issues.

Topic HTA JIRA queue to manage requests and workflowIn ProgressReuben 

Last meeting Reuben provided the draft workflow. Requests again that the HTA members provide feedback.

Meeting that Josh had expected with Wayne has been postponed in favor of creating a governance process over the process to creating new JIRA projects. Recommended to Julie that we press forward as soon as possible, perhaps independently of the HL7 process for an overarching process.

Wayne has asked for additional patience. Melva has been sent our current proposed workflow in advance. Doing so puts us in a precarious position as we are expected to provide a demonstration for the membership in May (though it is still unknown if that meeting will be held in-person)

In summary, we are at a stand still until HQ has a governance process in place. Notedly, this is also holding up additional vocabulary projects such as VSD-P, in which items for update have been identified for the normative standard but have no where to be official recorded. 

TopicExternal SDO Issues or addtional topicsContinuous

Carol and Suzy Roy 

April SNOMED business meeting has been cancelled due to COVID-19. Some virtual meetings are being arranged.

COVID-19 concepts and descriptions have been updated and released in a March interim release. Anticipate country specific releases in the upcoming weeks. All are available under common licensing and in the Global Patient Summary.

New member country - Armenia

TopicExternal Code Systems Statement for IGs

Complete with possible future action

item for HTA to meet with TSC

Julie

HTA policy states that "Any publication or draft HL7 specification or implementation guide that references an external code system in any way must:

  1. Clearly identify the external content governed by IP restrictions beyond those of HL7
  2. Provide a web-link to the licensing information for the content and/or provide a short description of the requirements
  3. Reference the code system version when the artifact is published, and whether the version for use is important for the artifact
  4. If translations are involved...???
  5. Include, at minimum the following statement, prominently placed (e.g., black box warnings at the beginning of Structured Product Labels in the United States) :
    "This HL7 specification contains and references intellectual property owned by third parties ("Third Party IP"). Use of any HL7 specification and it's associated licensing terms does not grant any rights with respect to Third Party IP. The licensee alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize Third Party IP in connection with the specification or otherwise."

A proposal has been made to TSC that the following wording should be used:

"Implementers and testers of this specification SHALL abide by the license requirements for each terminology content artifact utilized within a functioning implementation. Terminology licenses SHALL be obtained from the terminology authority for each code system or other specified artifact used. It is the sole responsibility of each organization deploying or testing this specification to ensure their implementations comply with licensing requirements."

TSC are not entertaining this proposal until the HTA has discussed it

The wording is designed to go into HL7 products but is regarding use of external terminologies in those specs.  The HTA would prefer not to have such a heavy handed approach both of language and format.  Caroline Macumber has proposed an updated (as now shown on the HTA policy page) version as an attempt to integrate the two.

"This HL7 specification contains and references intellectual property owned by third parties ("Third Party IP").  Implementers and testers of this specification SHALL abide by the license requirements for each terminology content artifact utilized within a functioning implementation. Terminology licenses SHALL be obtained from the  Third Party IP owner for each code system and/or other specified artifact used. It is the sole responsibility of each organization deploying or testing this specification to ensure their implementations comply with licensing requirements of each Third Party IP."

Julie will communicate the views of the HTA back to the TSC and/or someone from HTA will attend the TSC meeting on Monday March 16th.

Motion to accept this verbiage/policy and send on to TSC - Roel/Susan - Motion passes 5-0-0

Julie has emailed TSC 19Mar20

TopicSOU with AHA ReviewIn ProgressJulie

At the request of Mary Kay McDaniel and Paul Knapp, The HTA has worked with HL7 HQ to review the Statement of Understanding (SOU) with the American Hospital Associatoin (AHA). The current copy is shown here.

Carol has asked membership to review the document and comment today or tomorrow so we can provide final feedback to HL7 HQ

TopicUTG UpdateCompleteCarol

Testing continues, JIRA voting process is being further specified (weighting of votes, criteria for quorum etc)/drafted and sent to SGB for approval.

Content testing has completed with lots of feedback provided. Ted is targeting April 1st for the first release of UTG content, ready for pilot testing of the UTG tools and workflow through JIRA.

There is a list of "next up" items, one of them includes integration with external codesystem owner engagement with HTA JIRA.

TopicISO Codes  - updateIn ProgressDavera

STILL OPEN: Other ISO standards to check

 The current ask within BCP47 is

  • Davera Gabriel will look up more information about BCP-47 (a document authored by the IETF trust) for language codes in the US Core FHIR IG.  Davera will check if this is actually a "nested reference" and is actually a syntax using ISO

It still unclear what the implications of the difference are. The applicable section to review is "2.2 Language Subtag Sources and Interpretation" in https://tools.ietf.org/html/bcp47. Davera will look at the US Core FHIR IG to determine if they are referencing the ISO set for Language Codes and/or another set or a syntax

Previous commentary is shown below:

Process comment: Meeting minutes from meeting in which these items were originally discussed were updated after the fact. Requesting that assignments are tagged with a user name so users can be notified. 

  • FHIR also uses the IANA Time Zones https://www.iana.org/time-zones
  • Davera Gabriel will look up more information about BCP-47 (a document authored by the IETF trust) for language codes in the US Core FHIR IG.  Davera will check if this is actually a "nested reference" and is actually a syntax using ISO codes https://tools.ietf.org/html/bcp47
  • (follow-up from Davera) Appologies for needing to step away & then not getting back to this in the meeting.  In the document linked above is the answer to the question.  On Page 8, under the section: "2.2. Language Subtag Sources and Interpretation" there is an explanation of the name spacing used to construct the BCP-47 "tags."  It is my read that the answer to the question as posited is a hybrid of the two options you propose in your question.  There is structure within the tags, but Im not sure that includes your posited definition of "syntax."  One would have to parse the tags to derive syntax, but as this is standard it could be done.  As such, what I intended to do in the meeting is discuss what was meant by question created the amended meeting minutes and NOT in the original meeting minutes: "Davera will check if this is actually a "nested reference" and is actually a syntax using ISO codes" to see if the tag / subtag structure fit your intended question definition of "syntax."  In practice, the subtags are intended to designate corollaries to portions of ISO 639.x designating spoken or written languages. 
  • I would further suggest we consult with the folks that suggested the use of BCP-47 as to their intentions.  I'd be very interested to learn whether they are interested in capturing a written versus spoken language.  My hunch is that there's a much simpler explanation than that, in which case splitting the BCP-47 tags is not implied, nor necessary for their use case, and if so:  we are overthinking a bit


TopicFHIR Tracker Items#2 in progress stillReuben/Carol

Current status: Julie has sent a note to FMG to engage in this discussion and likely attend the next FMG meeting to present the policy that we have established with SNOMED and feel applies to other external standards with regards to usage.

2) Graeme  Grieve is (allegedly) dealing with new SNOMED content for Vital Signs to go into the GPS - discuss with Suzy.  FMG is requiring that anything that requires use of SNOMED is balloted as US Realm; HTA needs to challenge this.  Susan will investigate this further and come back to the HTA.

Reuben talked to Grahame - the FMG rule does not apply if using the free set, only applies if outside of the freely available reference set. the rule is NOT formally documented anywhere. Grahame has stated that the rule exists because they do not want to require implementers to be required to go through any additional licensing requirements.

Susan - will be requesting additional concepts via SNOMED Int into the free set. To do this, Susan sent concepts to Grahame for submission to SNOMED "free set" (what is this??? the GPS is a conglomeration of a number of free sets, concepts are not added to it directly) 

Julie and Carol met with Suzy and Monica from SNOMED Int and drafted a policy with regards to concept requests (which can be extended to determine how state HL7 realms apply to the use of SNOMED) that will be communicated in San Antonio, stating the following:

Universal Realm

Requests for new or changed content within SNOMED CT should be internationally appropriate and should be made to the HTA using the content request form present in https://confluence.hl7.org/display/TA/Request+content+in+external+terminologies, respecting the deadlines that the HTA have published for the upcoming SNOMED release cycle.  The HTA will then manage this according to the process documented at https://confluence.hl7.org/display/TA/SNOMED+CT+New+Concept+request+process

US Realm or HL7 Affiliate with a SNOMED NRC

Requests for new or changed content within SNOMED CT for inclusion in the national extension or requests for content (to be promoted to) the international release should be made directly to the Affiliate’s NRC.

HL7 Affiliate without a SNOMED NRC

To use the process above for the Universal Realm, dealing directly with the HTA.


HTA members agree with the above, however raise a question (especially the new members) about who/how the HTA submits those requests to SNOMED. By the rules above, Susan can submit the request for new concepts via the process above. So Susan is going to:

Value sets are in the IG hardcoded - no OID - they have SNOMED CT SOLOR extension IDs, we were waiting for a process from Rory to compare extensions to promote to international version. However, this development item has not yet been completed. Thus, all SOLOR content needs to be submitted as new content however, their codes will be retained. Susan is going to submit a request for all the Vital SIgns and Wound related concepts (ballot in Sept). Pain will be submitted later (ballot in Jan).

Note: Cutoff for July SNOMED Int release inclusion is May 1st  The IPS Freeset (which goes through Rob H) is March 15th.


ManagementNext CallN/ACarolNext call, scheduled 1st April

AdjournmentMeeting adjournedN/ACarol


Action Items


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