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Chair:  Rob McClure If Internet is working

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Web Meeting Info:

5-6:30pm USA ET

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NOTE: This attendance applies if you are present at the related meeting/call, regardless if you have signed a different attendance for your WG. 


Attendee type:

M - TSMG Member

O -Observer / Guest


P - present

A - Apologies



M (Interim Chair)PSaludax
M (Interim Chair)PMD Partners, Inc.
MPClinical Architecture
MPThe Johns Hopkins University
MPApelon, Inc.
M-National Institute of Standards and Technology (NIST)
MPHL7 New Zealand
MPHL7 International
OPCanada Health Infoway
OPNational Library of Medicine
OPHausam Consulting LLC
OPThe Johns Hopkins University

Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)
Management Minutes Approval

Admin 45min

Decision Making Practices (DMP) 30min

Review CMG approach

Mission and charter

Lisa to present

Someone needs to take on the task of crafting our DMP for review

Alignment with M&C

Review Scope and Activities

Using time that is remaining

HL7/OHDSI Terminologies Workshops / WG kickoff last week

  • elicited use cases / problems, much / many the resolution of which falls within the TSMG scope of work
  • next steps: establish meetings, communication channels
  • comments / guidance from TSMG appreciated


 Next agenda

  • Review HTA situation, perhaps co-chair vote
    • TSC rep, 1 year selections
  • THO publication
  • Update on DMP work
  • Scope and activities

 Adjourned at

Meeting recording

Minutes Approved as Presented 



This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."




  • Membership
    • Member resignation.
      • RM:
        • Uma Gowder has resigned.
        • Her personal situation was such that she was not able to devote the time and, therefore, she has resigned.
        • Accordingly we now have 10 members including WK.
        • There is a willingness from the TSC to fill this seat.

    • HL7 Terminology Authority (HTA)
      • RM:
        • The HTA is considering how it might "join forces" with the TSMG.
        • One of the approaches would be that they are folded into TSMG. This does not mean that the HTA will go away.
        • I think will have to decide what HTA is in the context of TSMG, but I certainly would imagine it to be one of our standing committees and it will continue to function in much the same way as it does now.
      • CM:
        • The HTA will be meeting tomorrow (Wednesday, 6 October 2021) to discuss and bring back recommendations to the next TSMG meeting.
        •  I don't anticipate that that HTA members will have any issues if we are in agreement that we can ensure that the functions that the HTA is currently fulfilling can continue to be done by its membership as part of the TSMG.
      • RM:
        • Three of the current HTA members are also members of the TSMG (RM, DG and RD)
        • Of the other three, one nominated to be a member of the TSMG but was not appointed and indicated that was glad she didn't wasn't because she has some other family commitments.
      • PJ:
        • It would be nice of all three of the HTA members (who are not currently TSMG members) joined.
        • In particular, if at least two of them joined that would cover a gap that we may have here: we do not have any non native English speakers.
        • In terms of terminology — as we are constantly reminded in SNOMED-on-FHIR meeting by Daniel carlson and others — that it's very important to consider that capability.
      • CM:
        • Absolutely PJ.
      • RM:
        • Yeah and you also get representation from Europe.
        • The idea of the HTA becoming part of the TSMG was discussed by the TSC and there was no concerns raised.
      • RD:
        • (To RM): Was Uma Gowder's resignation confirmed?
      • RM:
        • Yes, confirmed.
      • RD:
        • (To RM): Did the TSC note whether the HTA members becoming members of the TSMG would be able to choose 1 or 2 year terms?
      • RM:
        • TSC did not make any formal statements.
        • I am confident that they would let the TSMG make these decisions noting that half the members need to be 1-year and the other half 2-year terms.
      • RD:
        • If this comes to pass, it is not as if they would be a different kind of TSMG member.
        • They would be able to do what they are doing now in the HTA if that becomes a function of TSMG, as well as anything else.
      • RM:
        • Yes, they would like be pushed to do more.
        • (To all): Does anyone have a strong opinion about this man that's The interviewer you've got your hand up.
      • DG:
        •  If the HTA decides to become part of the TSMG, I'm a strong proponent that that would be a good thing.
        • I agree with PJ that having non English first language members would be good and also their international and terminology experience would be good to have if TSMG takes on those functions.
        • So i'm emphatically interested in seeing the smooth transition and including those folks you know within the TSMG if it all works out that way.
      • RM:
        • I request that members attending the HTA meeting to please carry my strong endorsement for the HTA to become part of the TSMG.
        • If for some reason the HTA says no and wants to remain separate, Then we will come back to this next week, because I think we will want to seek another member.
        • We did have some that were in the original nomination pool so it will be for the TSC to go back and think about that.

  • Co-chair number
    • RM:
      • I've listed the folks who have openly expressed interest.
      • This is yet another thing complicated by 
        • the HTA approach might bring a co-chair here with it.
        • three of those who have expressed an interest are also Vocabulary WG co-chairs.
      •  I have certainly gotten a strong sense from the TSC that this expectation of separation of concerns with regards to the management group and the methodology group (Vocabulary WG), while important, is something that could be waived for some initial period.
      • So, I don't know that everyone who is a Vocabulary WG co-chair has to resign if they end up being a TSMG co-chair.
      • There is interest in having 3 co-chairs.
      • I think that's defensible because:
        • We have a lot to do.
        • If the HTA function and its members becomes part of the TSMG that places additional burden on two co-chairs.
        • Those folks particularly myself and RD who've been so actively involved in the past (I don't know it could be a year in putting together TSMG and have some kind of runway with regards to what we want to try and accomplish, I think it would be problematic to lose that.
      • So so there's some advantages there with having 3 co-chairs.
      • I don't think we've gotten responses from all TSMG members yet on their positions regarding leadership positions including BR who is still on holiday.
      • I am pretty sure that BR is not interested in standing for TSMG co-chair.
      • TSC is not averse to TSMG having three co-chairs even though the norm is two.
      • TSC is also not averse to at least one of the Vocabulary WG co-chairs remaining a Vocabulary WG co-chair if he or she becomes as TSMG co-chair.
      • So, with that, let's wait and see what the HTA does and hopefully then we will have some clarity and we can move forward with voting for co-chairs.

  • TSC rep
    • RM:
      • We have some members who have expressed an interest and I'm sure we will find a rep.

  • Term lengths
    •  RM:
      • Once we know what half is we can decide term lengths.
      • (To CM): Do you have a preference or will you hold off?
    • CM:
      • I do not have a preference.

  • Infrastructure
    • RD:
      • Listserv is setup, just working out some kinks.
      • I expect by the end of the week the listserv and conference call system would be setup and working.
      • We have also approached Dave Hamill regarding a dedicated Zoom account.
      • Zulip streams and the TSMG Confluence site are all up and running.

  • Decision Making Practices (DMP)
    • LN:
    • RM:

  • TSMG infrastructure
    • RD summarises:

Decision Making Practices (DMP)

  • CDA Management Group (CMG) organisation
    • LN presents organisation of CMG (see video record from 00:29:15)
    • RM:
      • (To LN): Did CMG get formed in the same way the TSMG in that the TSC appointed members? 
    • LN:
      • Each of the current CMG members has a particular role that they are focused on.
      • Sort of a stakeholder spot that they hold and so, for example, we recently lost Rick Geimer who has a tooling sort of perspective, and so we had to replace him with someone else who came with that kind of perspective: CDA tooling.
    • RM:
      • (To LN): Is that something that you guys came up with on your own with regards to how the roles or did the TSC dictate that?
    • LN:
      • TSC gave it to us initially when they formed CMG just like they did for the TSMG.
      • They know what we want at least one person with this perspective at least one person with that perspective.
      • We tried to keep that slate of members consistent with those original stakeholders spots.
    • RM:
      • (To LN): But then when when you needed to fill a slot (e.g. if someone's term is up) is it CMG's responsibility to find someone else or does the TSC do that?
    • LN:
      • It is CMG's responsibility.
    • RM:
      • (To LN): So you find someone and propose that person to the TSC?
    • LN:
      • Yes.
      • We consider this a part of our ongoing sustainability charter: to be seeking out replacement members to come in from the right spaces.
    • RM:
      • (To LN): Is this documented?
    • LN:
      • Yes.
    • RM:
      • This is exactly aligned with the sort of stuff we're trying to do and I would definitely like to document it so that when you need to replace members, you know what you're doing.
    • LN presents CMG dashboard (see video record from 00:39:38)
    • RM:
      • This looks awesome.
    • LN presents CMG quality plan (see video record from 00:43:43)
    • RM:
      • There's a lot of alignments with everything you've been saying I think in terms of what we might need to do with terminology.

    • LN presents CMG roadmap (see video record from 00:46:06)
    • LN presents CMG project dashboard (see video record from 00:48:50)
    • RM:
      • Wow, looks awesome.
    • RD:
      • Thanks LN - that truly is fantastic.  I really want to thank you for for telling us, it took you a year to set this up because last week I look at this and I was like okay we've got a lot of stuff to do, and probably not a lot of time.
      • (To LN): Can you speak to how when you started establishing CMG how you worked out what structured documents as the methodology groups turf is and what CMG's turf is is and how that was kind of agreed and how well that's worked?
    • LN:
      • In the beginning, we just had these two main words that we focused on 'methodology' and 'management'.
      • And from there, it was a lot of debate to figure out "what's management" and "what's methodology" and every year we provide a CMG report in the structured documents meetings so on a weekly basis they're getting two cents from us what we're talking about what we're doing.
      • And every once in a while they'll push back and ask "Oh, why are you doing that?"
      • There's been a pushing back and forth, all the way since the beginning.
      • The first time we did a roadmap we we got whacked seriously.
      • Structured Documents went: "What are you doing telling us what to do with certain IGs? That's not your job. You don't make a roadmap for Consolidated CDA – that belongs to Structured Documents. You don't set up quality criteria, that's something that structured docs does. You could make a checklist about the management process of how you would use that but that's not your job."
      • And we've just gone back and forth, most of the time it's been turfy feeling like like we're trying to do stuff and they go stay off our turf.
      • But a couple of times we've had situations where the management group started worrying about a roadmap for example for Consolidated CDA and and we ended up going a different approach as a management team to say: "You guys are responsible for one of the most significant IGs for CDA in the whole community, and you have no roadmap that's not a quality thing. You know you need to take charge of that."
      • And so I guess that's again that's their role as Structured Docs is not so much methodology.
      • I think the, the only piece of work that you know that we really pressed on them for has been the quality criteria or the IG and a couple of setup things around, how will we manage these new GitHub repos to track content.
      • I would say it's a it's a very friendly collaborative kind of relationship/
      • We have no members overlapping so when when we go and discuss thing jointly then nobody's having to listen with both perspectives in mind.
      • They can just be like the mindset of the Management Group or the mindset of the Methodology Group and we can easily debate if it's certain work seems to belong in one place or the other. 
      • When both groups want to do something, and you just have to decide whose job it really is that's an easier conversation than when neither group is doing it and they both think that the other group should be. That's harder.
    • RD:
      • (To LN): Do you guys have formal meetings between the two groups and how frequently those occur?
    • LN:
      • One joint one formal meeting at each working group meeting.
      • Lots of informal regular updates from the management group into the methodology group every week.
      • And we have ad hoc meetings when necessary to speed up decision making.
      • If a decision is needed by both management and methodology, whoever has the next meeting, we invite representatives from the other one to form quorum and we can get some stuff done more quickly that way when we need both groups.
    • RN:
      • Thanks LN.
    • RM:
      • I am tempted to ask every member what they think about this.
    • LN:
      • There's the notion of 'a round' whereby everyone on a meeting gets a quick little chance to say yeah i'm for it i'm against it, this is interesting, whatever.
      • It's a great way to make sure that everybody has a chance to have input.
    • RM:
      • Yeah well and that's that's kind of where we're going with this so.
      • I'll just start because i'm going to call on each member to give their comments with regards to their thoughts on this, so in my list it's Carol its first so Carol your thoughts.
    • CM:
      • I don't know how much pushback we're going to get with regards to who does what.
      • That being said, Vocabulary WG has punted on many important decisions and worked to execute it.
      • Based upon the promise of TSMG being the body that will make those decisions and, in some cases, do the work.
      • LN in your description it sounds as if it was a semi collaborative process between CMG and Structured Documents by which the lines between management methodology were dropped
      • TSMG and its inception was somewhat different.
      • Part of what Vocabulary WG and the HTA wanted higher level governance capabilities and we haven't really talked about that either RM right in terms of our bill of ability to make decisions, independent of always going back to the TSC when another work group or Vocabulary WG has a different opinion.
      • And so, as we start defining these things, I think that's going to be also very important in terms of what we are and are not required to go to TSC for when a decision has to be made in terms of setting policy.
    • RM:
      • True.
      • I think obviously, the proof will be in the individual puddings that we end up kind of walking into.
      • I'm also interested, though in in the overview that Lisa gave with regards to the structure of the Confluence site, the approach with regards to setting up a dashboard, comments with regards to how many people you think should be required as a part of quorum i.e. chair and how many?
    • CM:
      • For Vocabulary WG it is at least one chair and three Members from different organizations.
      • So at a management level, you think the bar would be a little bit higher — you would say at least three members, one of which is a chair.
      • And, and then the open question is whether or not we also want to make sure there is outside perspective, I mean to date we've had a lot of interest in people joining or non members.
      •  I like that Vocabulary WG does that, because then it's not such an insular process, but there always has to be others in the community participating.
    • RM:
      • Everything's up for conversation and I want to get other thoughts.
      • Quorum really is about membership and not about people who aren't members.
      • I don't know that you can establish a quorum that includes people who aren't members.
    • CM:
      • I'm pretty sure that's what quorum for Vocabulary WG meetings it's three, it has to be a chair and at least three people all which cannot be from the same organization.
    • RM:
      • That's right, but there is no membership in Vocabulary WG.
      • We're talking about kind of different kinds of fruit.
    •  DG:
      • Awesome presentation and well done.
      • With regards to the organising, particularly the roadmap, I like this a lot.
      • The short interactions i've had already are kind of roadmap-ish so I like the idea that of adopting a roadmap.
      • The follow-ups that I hope to do, and we can do it in this meeting or in a future meeting, about the workshops last week and other kinds of activities like the Connectathon.
      • I'm in kind of a different spot in in doing outreach in that what i'm seeking to do is to get validation for the plan work and then find alignment.
      • So there aren't 100 things to do, but rather there are 10 well-aligned things for which we have 10 stakeholders right?
      • So, having a roadmap and working on what the things are, and setting them down in a structured sort of way including what the goals are down to some specifics and then you know yeah participating.
      • And you know what the policy decisions are, and you know where you know where the work goes.
      • it's fine but that's the kind of thing that I would be interested in that I can really I think then bring benefit both to the community and to the TSMG.
      • So that's where things are kind of with me right now.
      • For example in the workshops with the Odyssey workshops last week, there were a lot of things that were talked about in the end. The purpose was to talk amongst the community to gather use cases and ideas and some of those things are aligned with our work. 
      • I would be interested in engaging in creation of a disciplined kind of process and roadmap similar to CMG as soon as possible.
      • With regards to the decision making process, I think you're coming up with something that makes sense, you know the co-chair and a certain number for quorum.
      • And then, with regards to the the Vocabulary WG, i've actually been thinking because i've been thinking about how these projects line up because i'm active doing things in Vulcan and i'm active, with the Odyssey community, you know as well.
      • I'm not really clear where the division is between the kind of work that TSMG is going to do moving forward versus the the kind of work that will happen in the Vocabulary WG.
      • We will just have to see I guess.
      • I'll have an opinion when we when we get there, but what I am really clear on is, for example, I feel a need sometime soon to make to reach out to this new Implementation Division.
      • That would be kind of another group to kind of get a read on to find out what's going on with them to again bring that information back.
      • I really want the group to hear that there's a lot of outreach going on.
      • I really see the benefit in finding alignment.
      • Doing fewer things and doing them strategically, making strategic decisions about fewer things that is informed by how we know where the community is coming from, rather than what it may appear to be where you're gathering lots of information from interacting groups.
    • RM:
      • (To DG): You know as you and CM and others think about the specific things that you think we should be involved in, you need to put those someplace and I would suggest figuring out how to add to the Scope and Activities Confluence page off the main page.
      • I think should be the starting point to start information that will eventually end up filling up a dashboard.
      • We need to think about targeting our management activities towards things that need to get done.
      • So, let's start by documenting that what you think we need to be responsible for and active in and and we'll kind of come back to that and get people engaged.
    • LN:
      • I thought I would send a note to Austin and Wayne and Jean Duteau to see if there's any documentation about answering this question sort of definitionally what's the difference between management and methodology.
      • Then you know you'd have some other guiding principles or some other documentation to point our finger at.
    • WK:
      • There is a document.
      • The document is the BAM — it's a 180 page document that was written some 12 years ago that I think three people in the organization have actually read — the same three who wrote it.
      • I think HL7 in general over-obsesses on these three things and the separation of concerns but that predates me that obsession.
      • You know, within a normal business environment, you know governance is performed by a board, which also has senior executives, who are management.
      • Management is responsible for day to day operations and methodology provides a technical expertise in order to accomplish those operations
      • But at HL7 you know, usually these things have the same people involved in all three of those things, in many cases, you know.
      • Usually we don't break that down to each individual department level, as we do in HL7  and the work group. Some people are more committed to it than others.
      • I said, I think we may I think we over-obsess about divisions when we should be working together as a team to get stuff done and not worry so much about whose responsibility is if you're doing good stuff.
      • The barriers and separation of concerns can be more harmful to me than the objectives of trying to get things done.
    • RM:
      • (Agreeing with WK): In the end the definitions of management/methodology and separation of concerns really won't matter because there's only so many people working on things and we just need to get stuff done.
      • So I think you know I don't want to presuppose how to do this, other than to say that we should you know focus on the things that that this group cares about and then work with Vocabulary WG to make sure that we're not stepping on their toes.
      • I suspect that there won't be big issues there.
      • I think, where there will be bigger issues actually is in FHIR and CDA
      • So I think that needs to be figured out.
      • We need to be responsive to dancing with partners where we step on their toes, we need to back off sometimes that's just going to be a part of what what we do.
    • JB:
      • My first thought is that the more we can pull from what the CDA Management Group did here, I think the quicker, we can get going, and so this is awesome.
      • Even if we don't have the organization down completely, we need to start documenting some of the things that we believe fall into scope.
      • I know I have a ton of things for UTG and THO that I would love to get on a page somewhere and i'd be more than happy to help with some of this organization of our pages as well.
      • I also wanted to agree with CM as far as Vocabulary WG punting some tasks. I think it's something that we're going to need to be on top of.
      • I know, from my perspective, just not even having a having a versioning and policy for value sets in THO.
      • To me, I was surprised that was not a methodology thing, but you know if we have to kind of enforce that then so be it
    • LN:
      • We need to think about at least one regular meeting, where the product teams are coming together and we might jointly propose agenda items to help have conversations that cross cut across all the products families, because of common vocabulary needs.
      • There used to be a meeting that happened on day three Q0 but it hasn't happened since COVID.
      • WK you might be able to help reinstate this, but Linda Michaelson and I we're going to start asking for it to be a standing meeting organized again during our virtual working group.
    • WK:
      • (To LN): Are you talking about the product management council?
      • We're supposed to be working on trying to set one of those up before the end of the year.
    • RM:
      • That is a good idea.
      • We do we do need to make sure that we have a representative that is engaged from each of the product families as a member of the TSMG.
      • I think that it does make sense that we have regular regular meetings between the management groups.
    • WK:
      • What CMG has done is extraordinary.
      • However, I do want to caution TSMG is a little different than a product family management group.
      • Some thing did strike me as being more or less applicable than others but certainly from a general framework it's a really good model to build from I think that I think some things have to be handled differently in those groups, since it is cross product really.
      • But yeah sure I mean that's that's great work it's great model built in that, but keep an open mind for other directions that might also work.
    • RM:
      • I need someone who's a member who can take on the task of putting together the first pass of the DMPs.
      • Then it would be wonderful if we began to kind of take some of what LN's figured out so that we don't stay in year zero for a year, if we can avoid it.
      • (To LN): If you are willing, would you like to help RD and I pull this together?
    • LN:
      • Yes.
    • ACTION: LN to work with RD and RM to draft the DMPs.
    • WK:
      • (To RM): You know the TSC is in the process of updating the templates — I think we were pretty close to that so maybe hold off a week or two.
      • The issues were how do you deal with closed member groups like this that Melva was working on but I think it's very close.
      • I suggest holding off for a week or two till this gets done.
    • LN:
      • We could have a the attendance filled out very easily so that if you need to vote on something in the coming four weeks or something like that that you would at least know how to make quorum.
    • RM:
      • I think that the number that you picked — which is the standard one — is the one that we should pick which is a xo chair and three members.
      • One of the things that we have to really pay attention to — which WK kind of pointed at this too — and that is: We are a cross entity management group and we really need to make sure our membership is broad and is representing a number of different entities so.
      • If we just say that we need three members and a co-chair to make quorum, hopefully that will always mean we have some broad participation, because we are created in that way.
    • WK:
      • Firstly, you've got a pretty large group here you've got what 10 or 11 members and so that's that's that's not a majority of members.
    • CM:
      • We have four (co-chair + three members)
    • RM:
      • We would have four out of 10 right now but probably will be 11 or 12 if we do add more.
      • Based on the HTA being added we could certainly make that number five (co-chair + four members).
      • But, with that many,  I just worry. For example, US Realm Steering Committee has seven members and we didn't hit quorum today, and I think that's not the first time we've had quorum problems that's a lot of people.
    • WK:
      • Five five feels a little better to me as being half the membership, including the Chair.
    • RM:
      • We are going to have to eVote – no question.
      • I encourage members to look at the Mission and Charter to check if anything needs further refinement.
      • I want to note that HL7 Terminology (THO) has been circling for quite some time with regards to its next publication.
      • It is a TSMG activity to review and agree and publish.
      • There are some errors still and that are based on things that i've been assured by Ted are issues in the publisher that are there really bugs in a publisher that are not really errors in the content.
      • Ted has asked Grahame once again to try and fix those which Graham had promised and i've asked him to ask, and I know that he did.
      • Grahame and Ted will be here next week so we can vote on publishing it.
      • Other than that, I don't think we have any things that are like absolutely pressing, but I do encourage folks, as I say, to go to that scope and activities to try and say, these are things that are important.
      • For example I did stir the hornet's nest with regards to
      • Again no one's interested in and kicking the box over. We just want to try and figure out what's really going on there and there's going to be some pushback on that so that's an example which is fine to put on our list — we'll figure out how we're going to deal with it.
    • RD:
      • HL7 co-chairs on the co-chair listserv received an email from Carol on behalf of the HTA regarding external terminology metadata records in THO which are not managed by the HTA.
      • This is the email CM sent: [cochairs] Non-HTA Managed code system metadata records and technical identifiers.eml
      • If any members wish to ensure that any of these are not retired and brought properly under the HTA's management, a request needs to be made to the HTA through Jira.

Supporting Documents

Outline Reference

Supporting Document

Minute Approval