Page tree
Skip to end of metadata
Go to start of metadata

Chair: Caroline Macumber 

Scribe: Davera Gabriel 


Tuesday, October 26 5:00-6:30PM USA ET

Tuesday, October 26 9:00-10:30PM UTC

Wednesday, October 27 7:00-8:30AM (AEST)   

Zoom link -

Find your local number:


Attendee type:

M - TSMG Member

O -Observer / Guest


P - present

A - Apologies



M (Co-Chair)PClinical Architecture
M (Co-Chair)PThe Johns Hopkins University
M (Co-Chair)PSaludax
M (CTO)PHL7 International
M (TSMG Rep to the TSC)PMD Partners, Inc.
MPApelon, Inc.
National Institute of Standards and Technology (NIST)
MPHL7 New Zealand
Precipius b.v.
MPIntermountain Health
HL7 Germany
OPHealth Intersections
OPCanada Health Infoway
National Library of Medicine
Hausam Consulting LLC
SNOMED International
OPCanada Health Inforway

Antitrust statement: Professional Associations, such as HL7, which bring together competing entities are subject to strict scrutiny under applicable antitrust laws. HL7 recognizes that the antitrust laws were enacted to promote fairness in competition and, as such, supports laws against monopoly and restraints of trade and their enforcement. Each individual participating in HL7 meetings and conferences, regardless of venue, is responsible for knowing the contents of and adhering to the HL7 Antitrust Policy as stated in §05.01 of the Governance and Operations Manual (GOM)

Minutes Approved as Presented 

2021-10-19 TSMG Agenda and Minutes

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."

Agenda Topics

Agenda Outline


Agenda Item


 Minutes Approved, no dissent

Rob: Need to add the text per the TSC / Cochairs meeting


  • HL7 Terminology Authority
    • Welcome to Susan, Sylvia and Roel as new members of the TSMG.
    • Outcomes of 25-Oct-2021 TSC meeting 2021-10-25 TSC Agenda/Minutes 
      • The three new members are appointed for 1-year terms.
      • TSMG must return at the end of 2022 and petition with justification for continuance of 12 appointed (13 total with CTO) members, otherwise the number of membership slots will reduce back to the original 10 + CTO.
      • TSMG must provide TSC with a list of all the members, including the new ones, indicating what product family or international role each of us fills. This may mean some members picking up a task they are not currently familiar with.


None of the three additions from the HTA is present, to be discussed in next agenda item.   New members of the HTA are welcomed to the group.

Rob M:  need to meet expectations as presented by the Product Families.  Perhaps original wording perhaps was too restrictive - diversity of membership was emphasized.  There may be roles to be filled that are not family product family specific.  Everyone doesn't have to fill a product family role per se... but all of the product families must be filled.  CTO, Vocab HTA, UTG/ THO ae the four required members.. and additionally there is the expectation that all of standards product families,.  Implementation roles...  the expectation is that there should be representation for all of these interests per the TSMG charter

Reuben:  this list needs to be updated to reflect HTA-focused concerns, such as : external terminology representation.  Need to assign roles to present members

Rob M:  This was intended as a guideline and not immutable, this can be adjusted

  • Change to weekly main call meeting time
    • Noting the imminent DST changes and also that we have new members in Europe who may find our current time slot challenging we should discuss a new time slot.
    • Proposal:
Wednesday, 3 November 20218-9:30PM2-3:30PM4-5:30PM9-10:30PMThurs: 6-7:30AMThurs: 9-10:30AM
Wednesday, 10 November 2021 and ongoing till mid-March 20228-9:30PM1-2:30PM3-4:30PM9-10:30PMThurs: 6-7:30AMThurs: 9-10:30AM


Jess: UTG call would need to be rescheduled, 

Tuesdays Carol has a conflict, SNOMED on FHIR conflict every other week

Wednesdays:  conflict with FHIR tracker call - smaller group than the TSMG, looks like the best meeting to move

     Bryn has a conflict on 1st and 3rd Wednesdays, Also a conflict with FMG during that time

     later in the spring, the Wednesday spot will conflict with the standing HTA call

Mondays:  conflict with Gender Harmony

Thursday:  conflict with Vocabulary Main call

Members agreed to the change to Wednesday after discussing the options and the conflicts.

Reuben will follow-up with Carmella to change the FHIR Tracker call to the Tuesday slot the TSMG call occurs in now, and make accommodation for rescheduling the HTA call in the spring

This will additionally be changed / added to the call calendar

Update on Decision Making Principles (DMP) work


Draft interim DMP

2. The Terminology Services Management Group (TSMG) is a closed committee. Unless in executive or declared in-camera session, anyone may be present and listen to the discussion without voice. They must identify themselves and if attending for a specific agenda item, identify that area of interest. When that agenda item is presented, they may at the discretion of the presiding Chair, be called on to provide additional information.

5.1  Defining Quorum

Quorum for the TSMG requires at least 50% of the TSMG membership including the chair such that the chair has a casting vote.

7.    Electronic Voting

a) At the discretion of the TSMG members, decisions “considered outside of scheduled meetings that meet quorum” may be resolved by eVote.

b) eVote may be requested for input on decision topics and for the approval of documents including Project Scope Statements (PSS), Publication Requests, and other documents as
determined by the TSMG and the TSMG co-chairs.

c) A list of routine decisions may be distributed to the TSMG membership with options to vote affirmative, negative, abstain, or refer to telecon. A comment is required for a negative or refer to telecon vote.

d) The typical voting period “72 hours after the eVote is announced” TSMG co-chairs may choose to extend the voting period. Negative or Referred items will be on the agenda for the next TSMG meeting.

e) Quorum for electronic voting will as for in person TSMG meetings (section 5.1). Refer to Section 5 for WGM quorum requirements.

f) If quorum has not been achieved after 72 hours, the vote will be taken at the next TSMG meeting.

g) All TSMG subcommittee votes must be eVotes


Reuben: Any discussion except the red text?

RobM:  DMP re:  eVote.. folks have to request this.  There has to be a motion and a second in the committees its up to the chair as to what goes into the eVote, so the membership doesn't have any say as to what goes into the eVote group. 

Carol:  are you restricting this to the 3x WGMs? discussed differences between eVoting and electronic voting 

Reuben:  days for limiting the eVoting discussion

RobM:  the situation the voting can occur is the issue... the DMP is too restrictive, and this emulated that

Carol motions to accept these terms, RobM seconds this motion.  7 voting members present.  no abstentions, no negative votes Motion passes 7-0-0

  • Establishment the following three standing subcommittees and their leads
    • HL7 Terminology Authority (HTA)
      • Led by CM and RD in their current roles as HTA Chair and Vice-Char respectively
    • THO / UTG (name to be decided)
      • Led by JB with RD as supporting TSMG Co-Chair
    • Outreach
      • Led by DG
  • Discussion on any other initially required subcommittees
  • All TSMG members must join at least one subcommittee 


Rob:  these are standing groups as contrasted from task forces.  Rob moves to accept, Reuben seconds.  Motions passes 7-0-0

Rob: comment:  we discussed proxies last week. 

Reuben: We put that into the DMP, but need to discuss this at the next meeting

Publishing terminology to the FHIR Ecosystem



GG: Requests have been for terminology service(s) fro IG publisher / validator.  There are requirements to make this work.  Grahame doesn't want to maintain terminologies other than what is required by the validator.  Validator is gaining a lot of interest with the community.  Not all content must be loaded on if folks have viable terminology servers, then they should be allowed / supported to use these.  example:  VSAC - have used some of that content in the past, but not all of that content.  TermServer could provide content to the publisher validator, without being responsible for publishing ALL terminology.  Grahame developed tools to permit utilization of outside terminology resources via (three) modalities.   Service would need to be registered to access this "ecosystem"  to make a term service "authoritative" to be available to this purpose.  

Reuben:  would these registered TermServices "own" & be responsible for their content

Grahame;  not sure... in some cases, like VSAC, the registree may not "own" anything

RobM: restated... and authoritative distribution point,  an entity

Peter:  demonstrable conformant implementation, rather than "owner"  focus on what the term server can do, capability not ownership

Grahame:  no an owner of the content is desired

Peter:  this is will limit participation

Reuben: agree with Grahame

Davera:  could there be more than one criteria to participation?

Graham:  need to have appropriate certification that the code system content is authoritative sufficiently to preform as needed

Carol: this criteria would open you up to some liability re:  the content

Graham:  needs to "authoritative" 

RobM:  needs to have some statement / measurement of having authoritative content that isn't the role of "owner" of the terminology

Grahame: TermServices doesn't have to be free / open.  Must have a way for folks to register for its use, the restrictions need to be documented, and the path to access to the content would work.  Grahame will have an Authenticated header that could be configured for the toolsmith.  Accordingly, there needs to be an agreed-to path to configure and maintain registration and said header, token etc.

Reuben:  Identification for code system... is the workflow tx, first?

Grahame:  workflow:, then to term server, the  complexity with many code systems utilization

Reuben: what happens with versions (ie:  SCT)  the header will handle a range of versions in the header.

RobM:  "conformant" is a description that may work for this case.  in some cases, the content is not available for the authoritative source, ie:  CVX.  in VSAC CVX is available as a conformant content set, and not from its owner.   Sometimes use the term "convenience copy."

Grahame: is the authoritative source for now, will revisit this later.  The FHIR tooling is what is intended to be supported for the time being.  There are some unusual circumstances that occur from mixing content from many standards.  Validation becomes difficult & complicated. Some issues cannot be aligned efficiently.  if is the primary point of validation for toolsmiths, this lowers the complexity of having to check many sources of reference content.

RobM:.  This is a good example of the value of a collaboration between the TSMG and publishing vis tx.fhir.doc.  This proposal is a good first step to bring transparency to the alignment processes required to support FHIR publishing. 

Grahame:  agree - this has been needed for quite some time, and this is a good step toward providing solutions re: terminology validation.  This document sections represent what the tooling folks have been asking for awhile.  There is additional content / details that will be needed to fill-out this proposal document.  In some cases not quite sure what is technically feasible.  Some of this is to document what exists.  Will follow pattern registration used in the SMART code - file will contain everything the tools need to know to process the content needed.

RobM:  this is a solid stab at what might be conducted as a part of the terminology Services tasks for the Connectathon

Grahame: We did this at the last Connectathon - validation issues with performance. (these are now tickets)

RobM:  is would be great to get a list of code systems & begin to start listing what kinds of things that we want to do at list a number of attributes / requirements that would be needed to support this, as a punch-list for the TSMG to work as a way to initiate interactions with the terminology server providers.  This would be a good way to start to interact with  This document is a start at improving / broadening the use of terminology by

Grahame: partly...

RobM:  where is there information about content that is not in not THO - but its just a package?  where is that built into the publisher

Grahame:  have been asked about human readable & implicit value sets - where is this?  There is no proper place for this at the moment.  This (...) is the "master place"  for content that are "packages"

Peter:  need to discuss this use case... instance / specific artifact 

Grahame:  I get bug tickets because the terminology servers are not validating the same way the validator on does.  the trouble is with the terminology severs

Reuben: there are tasks re: maintain the content of the proposal.  Does this propose that the TSMG would be responsible for this?

Grahame: asking TSMG to comment of the proposal, and the methods employed.  Longer term bigger question:  how do we maintain the burden of maintain publishing for other organizations.  This is a part of the bigger picture therein that's true for all of HL7.  This implies there is a dedicated resource that's not Grahame to do that.

RobM:  Highlight that statement... that statement applies. Bigger picture: should be  cloneable resource to be used by others.  It doesn't make sense to have one version that's used for standards and a different approach that others use to do validation.  This is thematic re:  the resources to maintain this approach. 

Reuben:  Wayne comments

Wayne:  Grahame stated we do not know what to do.. will keep us posted. 

Reuben: all members and attendees should look at the proposal and be presperd to discuss in an upcoming meeting

Not covered, ran out of time: Statically Bound Value Sets


Supporting Documents

Outline Reference

Supporting Document

Minute Approval


  •  TSMG Members should read through Grahame's proposal, provide feedback, be ready to discuss at the next meeting

  • Agreed-upon definition of proxy voting should be discussed at the next meeting
  • Reuben Daniels will update the TSMG calendar transactions, zoom registration re: updated time for this call & send notification to the list etc.