From: Robert McClure MD <email@example.com>
Sent: Wednesday, April 29, 2020 12:23 PM
To: Brett Marquard <firstname.lastname@example.org>; Davera Gabriel <email@example.com>
Cc: Austin Kreisler <firstname.lastname@example.org>; Calvin E. Beebe <email@example.com>; Eric Haas DVM, MS <firstname.lastname@example.org>; email@example.com; firstname.lastname@example.org; Gay Dolin MSN RN <gdolin@NamasteInformatics.com>; email@example.com; Julie James <firstname.lastname@example.org>; Jean Duteau <email@example.com>; Floyd Eisenberg MD, MPH, FACP <FEisenberg@iparsimony.com>
Subject: Re: Utilization of ISO codes for Preferred Language: BCP 47 in USCDI FHIR IG
Nope, still not sorted out. I will note that the language codes and use of the syntax and process defined in BCP 47 (RFC 5646) has open access IP (I’d have to track down the reference for that) meaning we don’t need to get ISO permission to use it. I don’t know what Davera means by “nested reference” but I’ll pick up the “syntax” reference because this (and UCUM) are two of the code systems that are problem children in that they are not a typical code system and instead are a set of grammatical elements plus the syntax (process) to be used to construct valid codes. As such we can certainly define specific code sets (value sets) when a restricted known set is needed. But we have a problem when we simply want an element bound to any valid code. FHIR accomplishes this in a backhand way via the implicit ValueSet that leaves implementation unclear. C-CDA and all other HL7 standards can do essentially the same thing by doing an “all codes” CDL. Problem is actually implementing this using the standard approach of having a “current static list” creates an incomplete solution that is known to break.
I’m not sure this is an HTA issue, but I’d like to see us formally clarify that for code systems that function like this, when a value set that is “all codes” is bound to an element, the best-practice implementation would be to not create a static value set member list but instead should be implemented as validation operation, presumably with a known common set of valid codes for selection and display. I’m not sure if that means we don’t bind to a value set, or (perhaps better) somehow we clarify that implementing that “all codes” CLD is done differently in these situations.
. . .
All content represents my view only
Robert McClure MD : President, MD Partners, Inc.
303.926.6771 : firstname.lastname@example.org
On Apr 29, 2020, at 5:39 AM, Brett Marquard <email@example.com> wrote:
Good morning Davera,
Thanks for reaching out.
A few quick items:
- The US FHIR Core supports USCDI, but isn’t restricted to USCDI. There is no HL7 IG named USCDI FHIR IG.
- US FHIR core is now ‘owned’ by the cross projects work group (co-chair Jean/Floyd added to cc), although emailing Structured Documents leadership is never a bad idea since they were involved in much of the original development
- This value set is in use in both C-CDA and US Core
- Preferred Language Request for Comment (RFC) 5646, “Tags for Identifying Languages”, September 2009 (http://www.rfc-editor.org/info/rfc5646) Seehttps://tools.ietf.org/html/bcp47
When you dig into this you end up at ISO. This has always been a bit of a mess, I have added Rob to see if he had ever untangled this during his efforts to load into VSAC.
Not ideal, but always reference this site when looking for language codes. https://www.loc.gov/standards/iso639-2/php/code_list.php
From: Davera Gabriel <firstname.lastname@example.org>
Sent: Tuesday, April 28, 2020 2:05 PM
To: email@example.com; firstname.lastname@example.org; email@example.com; Brett Marquard <firstname.lastname@example.org>; email@example.com; firstname.lastname@example.org; gdolin@NamasteInformatics.com; email@example.com
Subject: Utilization of ISO codes for Preferred Language: BCP 47 in USCDI FHIR IG
As a representative of the HL7 Terminology Authority, I am sending this message to members of the Structured Documents Leadership team (Austin Kreisler, Calvin E. Beebe, Sean McIlvenna, Benjamin Flessner, Gay Dolin, Andrew Statler) as well as the Argonaut SMEs (Eric Haas, Brett Marquard) per information available on the HL7.org and confluence sites regarding the groups with ‘ownership” of the USCDI FHIR IG. If this message was sent to you inappropriately, if you could please let us know who can address our question, that would be most appreciated.
In reviewing the utilization of code systems within HL7 specifications, we are taking a look at those terminologies, vocabularies, and value sets that require a license for use. Among these are the ISO standards. In the HL7 FHIR® US Core Implementation Guide STU3 Release 3.1.0, Preferred Language utilizes an ISO standard <https://www.hl7.org/fhir/us/core/ValueSet-simple-language.html> . This is a reflection of the current USCDI for Preferred Language <https://www.healthit.gov/isa/representing-patient-preferred-language-presently> which links to BCP 47 <https://tools.ietf.org/html/rfc5646> . Our questions is whether this is actually a "nested reference" and if the IG is actually a syntax using ISO codes.
Can you help us make that determination?
Many thanks in advance for your time and or direction in resolving this issue.
Davera Gabriel, RN
Senior Research Terminologist
Johns Hopkins University
Institute for Clinical and Translational Research
2024 E Monument St, Suite I-200
Baltimore, MD 21287
+1 (530) 723-8356 firstname.lastname@example.org