Date: Tuesday 22 September 2020

Quarter/Slot: 19.00-21:00 BST (14.00-16.00 EST)

All Participants: Make sure you are registered with WHOVA and join the session through that.

Attendee type:

H - HTA Member

O - observer

L - liaison


P - present

A - Apologies



HPJulie JamesBlue Wave Informatics LLP

Roel Barelds


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

Wayne Kubick


Suzy RoySNOMED International
LPSwapna AbhyankarLOINC
Rob McClureMD Partners
OPAndrea MacLeanInfoway
OPJoan HarperInfoway
OPJessica BotaApelon
OPMarc DuteauMD Partners
OPJohn Vaillancourt
OPGenny Luensman
OPAnn Phillips
OPBruce Bray
OPLenel JamesBlue Cross Blue Shield Association

Minutes Approved as Presented 

Minutes of the last WGM Meeting were approved on the HTA Teleconference.  Minutes of the HTA TC of 21-Jan-20 are Proposed SM, RB - carried unanimously.

Discussion items

Please note: order of items may change due to availability/practicality

ManagementMinutes approvalJulie
TopicUCUMReubenSee comments on external terminology page
ManagementPrep for joint with VocabJulie
  • Review of Policy of Maintenance on  External Codesytem URIs and Review of related Vocab Vocabulary Co-Chair Chair talking points on proposed external terminology policy meeting – 26 August 2020 (updated 1 Sept)
    • CM Background was provided on the discussion which occured at the Vocab WGM session on 9/21/2020. Notes can be found here 
    • TK: Commented that we need clarity on the conceptual underpinings of the canonical identifier for use in FHIR standards for code systems.
    • RD: Trust and cooperation is being missed and needed at a global level for us, HL7, to collectively meet our goals. If a CS owners provides us an identifier. and we say No, it breaks down trust and cooperation...making things more difficult going forward.
      • Mary Kay's use cases around the use of proprietary content in IG's, in contradiction of the agreements with the terminology owners, is an example of how those relationships with external terminolgoy owners and HL7 may be at risk in the future.
    • JJ: HTA has made a general request to respect code system owners via both Zulip and HTA Confluence. 
    • WK: Similar episodes between HTA and FHIR have occured. A couple general things need to happen with regards to both communities (HTA/Vocab and FHIR) listening to each other, Fundamental issue is that HTA can't set policy, it has to go through TSC for implementation. 
    • CM: HTA attempts to represent and respect the wishes of our external terminology owners as partners and contributors to HL7 standards.
    • AM: As and owner of code systems (pCLOCD) and as an org who works with other owners (CIHI and Health Canada), we have heard loud and clear that they beleive that the identifiers, and information associated with their content should be represented consistently per their definition. Now, the legality of it has not been purposely investigated as part of the process, as we are here in the spirit of cooperation and openess.
    • WK: Agreed. However there has to be a process by which change is implemented. 
    • CM: To that end, we should go ahead and look at Vocab's attempt to do so (define a process) here
    • WK: Thank you, encourages the continued work. Noted that more than one of the outlined use cases/scenarios my apply and make the sitauation more complicated. Some quality checks may be necessary to prevent additional issues from continuing to present themselves going forward....minimizing that would be ideal.
    • TK: Every IG writer, when they want to talk about a CS not owned by HL7, go first to HTA. If it is not there, they need to engage HTA and follow the path of establishing. However, that repository is not extensive and some of the pages are complete. 
    • RD: We have done a recent review, and applying quality control and moving forward to reconcile. The bigger point that not everyone knows where to go is a big problem. Thus, the proposal for a single repository and discussion with FHIR (Grahame), Vocab, HTA, and UTG. The quicker we can move to that, where peope have single source of truth, the better.
    • WK: I'll talk to TSC/Austin as we need to get alignment in an open and respectful way
    • LJ: Represent the payer stake holders, and the community that you have spoken about making sure information is provided. I appreciate your challenge, as we have our related regulatory timelines and challenges. Just wanted to note that one of the major stakeholders of UTG is in the room and appreciating the challenge
    • RB: We have to find a way to deal with these two groups

  • Copyright and Third Party Copyright considerations
    • Per Minutes on 09-02-2020 minutes - Consider adding verbiage on the HTA page with regards to the acceptance of copyright statement and the larger license, which includes any additional Notice of Third Party Content and Copyright Terms
    • Commentary from Regenstrief (Swapna Abhyankar) - "In the meantime, I feel it prudent that you ask third party copyright holders for permission to use their intellectual property in FHIR-enabled apps, and that you include the text in the EXTERNAL_COPYRIGHT_NOTICE field in any FHIR implementation guides or other products that include LOINC terms representing concepts that are owned by third parties. We do not believe the LOINC copyright statement extends to subsequent use or administration of these materials."
    • SA: LOINC has negotiated permissions to include codes from third parties (such as assessments). When they are used in any products, that external copyright notice must be included. Also, LOINC having permission doesn't give users the permission to use those assessments. In some cases the data includes LOINC codes for both the question and answer. In other cases, LOINC may have only one or the other.  Examples include the Abbreviated Injury Scale (AIS), noting that users are told they need a license via the AAAM (see Reading the codes does not require a license, but utilizing the scale would require a license.
      • SM: SEEK and Pain assessment material, amongst others, has been included in FHIR Profiles. We reach out to the scale developers and get the permission.
        • We need to have a copyright acrosse HL7 products to use this third party content. I need to be able to tell them that it's going into LOINC so that it can be shared, and have a copyright statement that the content developers can review and agree to when we approach them.
      • LJ: The owner of the copyright may not agree or provide that information (e.g., AMA etc). There is no free lunch and third party apps have to get their own permission. We need to also remember that the content may also go to the patient, not the physician.
    • RB: HL7 has an agreement to use the LOINC codes. LOINC has decided to use codes from a third party. Who is responsibe for ensuring that the copyright for the third party is noted?
    • LJ: It's HL7's responsibility to note and make it electronically known that another license is required to operationalize
    • SA: HL7 use case is covered as long as you include the external copyright notice wherever the codes are included. Providers would need to get separate permission.
    • LJ: Technical leads from Da Vinci(Viet N) and Gravity (Bob D) are in discussion with FHIR (GG) and UTG, to make the electronic notification possible. 
    • JJ: We need to pull this all together as a cohesive whole. 
    • LJ: The stage has been set, and we will know more in approximately 6 weeks. We need Swapna/LOINC and HTA as the "tip of the spear" to declare the need, which you're doing here. We are working with as many of the stakeholders as possible and will bring back progress to Vocab/UTG/HTA. 
    • RB: Doesn't FHIR need business requirements from HTA/LOINC on what needs to be implemented? As this is the first time Swapna has heard of the work
    • JJ: Swapna, is there anything you'd like HTA to do in the meantime?
      • SA: From the LOINC perspective, we are doing what we need to do to abide by copyright law, and include and distribute the content. Not sure where our(LOINCs) responibility ends...
      • JJ: HTA will include the third party/external copyright consideration on the LOINC page
  • HTA policy on pre-release codes in FHIR
    • It has been proposed that they can be represented as a code system fragment, however this declares the pre-release codes as members of the code system - which may be in violation of the code system authorities intent.
      • JJ: A technical solution has to be found for this...HTA's intent is to ensure that the code system owner's intent is not violated
      • SA: Consensus from Connectathon - implement a provisional version that could expand with pre-release codes. This would not be the whole code system, only pre release codes relevant to that version (e.g, 2.68 vs 2.68-prerelease). This did raise questions about the current definition a code system "Fragment". 
      • CM: There is agreement that the authoring of these codes are restricted to the code system owner.
      • Group agreed that there is no risk to violation with the cConnetathon solution.
TopicHTA Content Pages ReviewReuben
  • Action items from Reuben's quality assessment of HTA external terminology information
    • RD: next steps
      • Strategic direction on handling external terminolgoies - specifically, moving to a single repository at
        • With that direction, we would consider fixing the issues identified as part of that transistion. Thus a new UTG governance process (and implemented via JIRA) is put in place and HTA is the sole party responsible for approving and maintaining. 
      • It the absence of that direction
        • Allocate existing pages to HTA members for review and resolution
    • Endorsement of the approach (single repository) will be taken to TSC by Reuben for formal endorsement and work can start
      • The largest part of work will be working out the UTG process as HTA will be the maintainer and it will not undergo the existing consensus review process
TopicHL7 Terminology Single RepositoryJulie

See above

  • Formal vote of endorsement will occur at joint with vocab

JJ: Email from Jean Narcisi regarding ensuring that the payer provider information exchange has the information they need, including some SNODENT value sets. In the process, SNODENT found some mismatches in the codes and concepts. SNODENT has a rolling SOU and has put their content into UTG. Jean is just letting us know and we thank her for leading the contribution. 

RD: Once the content is in UTG, it will emerge as a FHIR Codesystem, not a stub and not a NameSystem.  Making UTG a Terminology Service for this content.  Should be noted that this is the first instance of a full-fledged FHIR code system representation of an external code system.

ManagementPlans for the futureJulieHanding over the leadership of HTA...

Action items

  • HTA to include verbiage on the LOINC External Terminology page for users to note the limitation on third party content Julie James