Presiding Co-chair:  Heather Grain

Minutes Author:       Heather Grain

Meeting Coordinates   Baltimore Room, WGM Venu

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



Julie James




Ted Klein

KCI Inc.


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
OPRichard Zhu
OPTodd Cooper


Quorum Requirements Met (3):  Yes

Agenda  Q2 - Q3

Agenda Confirmation

Clarification:  Vocab is considering how we maintain HL7 owned and maintained content.  This will be discussed in Vocab (legacy V2 and V3 discussion) joint with MnM on Wednesday Q2 (hosted by Vocab).    HTA indicated that this topic is appropriate for Vocabulary (as it does not concern external terminologies) but that the process should be consistent with the HTA management processes.

Minutes of Previous Meeting

Minutes of conference call on 2019 Aug 16th.  Sandy Moved and Ted Seconded that the minutes be accepted.  All in favour.

SCT Content Request process review status (HG)

The content request documents are now published on the confluence site and available to all WGs.  

Ted will ensure that the UTG process links to this information page.

Where does content request process fit with UTG (TK)

Ted will develop information on the process for review by HTA (as a straw man).  

Ted suggested tthat for code systems which do not have externally maintained web pages and documentation that we can use as a URI as the canonical identifier URIs are assigned for these terminologies published at    There are some Terminologies not in FHIR which do not have URIs but are in the MIF.  

In assigning canonical URLs to code systems we don't know (we have not received one from the authority responsible for the code system) we cannot be sure that we are representing the code system accurately.   The OID based systems have been dealt with.   Unfortunately we will have to make a decision on this before we know the size of the problem.

It was agreed that this needs to be done, but the solution will need to be maintainable.  

Ted Moved that, in order to instantiate the V3 core MIF entries for external code systems, in the absense of canonical URLs from the authority code system, UTG development will create URLs for these under

Seconded Rob M

Though we know this is not desirable, we have no other option.  HTA acknowledge that this is a problem and will monitor issues as they arise.

UTG Requirements

Ted asked that all HTA members review and provide feedback on the UTG requirements documentation.  This has been added to the next call.

Ted Klein to provide a link or copy of these requiremetns to HTA members.

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.  

Rob moved that the updated document be forwarded to the TSC for their consideration and inclusion in the GOM.  Seconded Jean.

Vote:  6 in favour, 0 abstain 0 against

motion passes


Report from Harmonisation - Ted

Nothing specific for HTA came through at the recent harmonisation.  


Clarification of Legal situation

See document from Christof and following communication from Jane.

The information below is to be:

a) shared and confirmed with Vocabulary WG Heather Grain

b) forwarded to the Board for their approval Heather Grain 

c) forwarded to the TSC after Board approval for inclusion in the updated GOM

The recent questions posed has raised a question regarding the scope of HTA.

1) A German translation (of HL7 Vocabulary display values) is produced by a third party "X" for HL7 Germany, according to 6.8.2 Affiliate Agreement.

2) The German translation is uploaded by "X" to a secured terminology server (CTS) located in Brussels, i. e. outside of German territory

3a) The German translation is downloaded from the CTS by an authorized party "Y", located _in_ Germany and used by "Y" under HL7 International rules and HL7 Germany Affiliate Agreement.
3b) The German translation is downloaded from the CTS by an authorized party "Z", located _outside_ of Germany and used by "Z" under HL7 International rules and HL7 Germany Affiliate Agreement.

This issue is: who owns, validates and distributes translations.  This will involve external code systems but also internal code systems.  

HTA is responsible for strategic issues associated with the use of HL7 vocabularies particularly as this impacts international use implementation and governance of HL7 Vocabulary content. This use case is not an external terminology but does impact international use and terminology governance, which is inside the responsibility of the HTA.    This has bought to light the need to update the GOM to more accurately reflect the scope required for HTA.

Moved:  Rob M seconded Julie that this proposal be forwarded to the Board for their consideration.  

Vote:  6 yes, 0 abstain, 0 against.

Answers to the questions raised

Legal situation regarding cross boarder change.

Situation regarding SNOMED CT

  • the international release includes English and Spanish - we may use these directly.
  • If the terminology is a licensed terminology - the Affiliate would require a license to undertake this process (e.g. SNOMED CT)

HL7 terminology  - There are governance issues 

  • there is a need to ensure that the quality of the translation is safe for use
  • that the process of translation is appropriate
  • what is the approved authenticated official canonical translation for these value sets and where do people go to get them.  Should we be the distribution centre as an approved translation of HL7.  We seek to avoid multiple translations of a value set for a given language.
  • Where does responsibility lie for translation and for quality assurance

Affiliate licensing regarding publication needs to be further investigated.

For further discussion on next call. Heather Grain include in next agenda.

Free Subset  

This was unexpected and the HTA and Wayne were not aware of this activity.

There are a series of concepts in FHIR infrastructure that cover ideas that are similar to snomed concepts.  

It is odd that these discussions are happening without invovlement of the HTA - we have asked to be informed  - we need to be involved at the earliest stage.   we are trying to establish a functional working mechanism.

Heather Grain to follow up with Rob Hausam

Heather Grain to discuss with SNOMED International to confirm the process requires HTA intervention

Other Business

Call Schedule:  .  Heather to schedule the calls fortnightly continuing the current schedule on the alternative week to the regular Vocabulary WG call at 4pm New York time.  due to ISO meetings which will preclude members from joining the call the first call will be Nov 1st.

Move Sunday meeting to Q1 and Q2

Adjourn Meeting -  3:03pm


Not planned for discussion this call


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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