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Chair: Caroline Macumber 

Scribe: Davera Gabriel 


Monday, July 25, 1:00-2:30AM UTC

Monday, July 25,  9:00-10:30AM USA ET

Monday, July 25, 11:00-12:30AM (next day) AEST

Tuesday, July 26, 2:00-3:30AM NZDT   


Attendee type:

M - TSMG Member

O -Observer / Guest


P - present

A - Apologies

X - (Apologies with Proxy)



M (Co-Chair)PClinical Architecture
M (Co-Chair)PThe Johns Hopkins University
M (Co-Chair)PSaludax
HL7 International
M (TSMG Rep to the TSC)PMD Partners, Inc.

MPApelon, Inc.
MPNational Institute of Standards and Technology (NIST)
MX - proxy to ReubenHL7 New Zealand
MPPrecipius b.v.
MPHL7 Germany
OPHealth Intersections
OPCanada Health Infoway
OPNational Library of Medicine
OPHausam Consulting LLC
SNOMED International
Joe FlackJohns Hopkins BIDS
Office of the National Coordinator for Health Information Technology (ONC)
OPJohn SnyderNational Library of Medicine (US)
Ted KleinTK Consulting
Lloyd MackenzieAccenture
Ravi KafleWashington State Department of Health
Doug DeShazoLexisNexis
MaryKay McDanielFM/Markam
Corey SpearsMITRE
John SpinosaLantana
Hope GrayHL7 Intern
Joe AmlungReginstrief
OPMartha JonesHL7 Intern
Riki MerrickVernetzt, LLC
OPGaurav Vaidya
Emily PfaffUNC
OPEric PrudhommeauxJaneiro Digital
Joe AmlungReginstrief Instutute
OPDavid BoothYosemite Project
Jim BalhoffUNC

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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."

Agenda Topics 

Meeting was recorded

Agenda Outline

Time allocationLead

Agenda Item

  • Note that meetings are recorded
  • Welcome to members and observers


  • Announcements
    • January 2023 Ballot Cycle Deadlines
      • August 21st, 2022: TSC Approval of PSS
      • November 1st, 2022: NIB Deadline (6 weeks prior to ballot opening)
    • Contract work announcement for web-based terminology resource editor for FHIR
    • Working group meeting registration has started - please register
  • TSMG appointments for 2023 - eMail to Dan V on 23June22
    • AI:  Davera will follow-up with Dan V - done, no response
      • Response from Dan remains outstanding
      • Rob M will follow-up?
TSMG Standing Subcommittee Updates

  HL7 Terminology / Unified Terminology Governance (THO/UTG)10RD/JB
  • Scheduling next THO release
    • Gender Harmony does not need a release right now
    • Need to confirm what FMG needs
  • Many CodeSystems use urls when they should be FHIR-37440 - Getting issue details... STATUS
    • Rob Hausam was able to determine that Grahame changed the uris back in July 2018
    • Should remove these from R5 prior to the FHIR content deadline?
    • Note that THO code systems reference value sets anchored in as well as the value set in THO
    • A comparison from this commit must be performed.  Per Rob H:  this is ~1600 files, thus this cannot be a manual process to inventory / check the possible changes.
    • Must be done before R5 - a high priority task
      • Can we escalate this other technical resources? 
      • This doesn't require a terminology SME.  A comparison need to be established: can be a scripted process
      • Rob H: Version differences, but there may not be content differences.  we have not established that.  Perhaps only duplicates.
      • Content that exists in both THO and R5 with the same canonical URL
        1. Exact match on content - remove resource from R5
          1. Grahame modified version so that it referenced THO or FHIR based on the version, not sure logic for validation though
          2. If minor version is 1, it was migrated as part of 4.0 cleanup and 4.1 prep. If 3, it was part of prep for R4B, Ted saw some with minor version a 6
          3. All have a major version of 0 in THO due to some build hack to pull out the right thing and not give duplicate resource errors
        2. Versions are different - look to see if the content is different & determine which content is correct - a manual review
        3. Content is different, do manual review to determine which is the most up to date - another manual process
      • Content anchored in THO that only exists in R5
        1. Move to THO and remove from R5
      • Determine handling of value sets that reference THO anchored code systems
    • JB: Info about THO release schedule (starting for Jan 2023 ballot cycle): HL7 Terminology (THO) Publication Schedule
    • If there is terminology content (not just metadata) in the R5 ballot, then there is an outstanding issue about how to get that content into THO.  JB:  there are tickets (HTA) updates but these are metadata and not content
    • Gender Harmony content that is in the CI build will have "THO" in their base (and not when balloted. 
      • 4 Value Set / 2 Codsystems with THO base... the content is in the FHIR R5 build
        • included in snapshot for R5 ballot
      • GH IG & V2 IG will be balloted at the same time
      • Once all are closed
      • these will be removed from R5 the Ballot and will go into THO
      • Before the R5 ballot is published 
      • The above content needs review per the closed caption / recording)
      • Issue:  consensus versus proforma content into THO 
  • E-vote for review of terminology expectations for IG developers
  • Versioning policy for UTG/THO
    • Reuben sent out doodle poll last week for new task force to define versioning policies for:
      • External code system metadata records
      • Value sets
      • Naming systems
      • Concept maps
    • Postponed this week - will start next week
  • Subcommittee work in progress
    • Deprecation Policy and Implementation
    • Filling slots for UTG OSG Voters
      • Management Groups for Product Family OSGs 
        • FMG: John Moerke, Bryn Rhodes, Rob Hausam? 
        • CMG: Lisa Nelson, Alexander Henket, Marc Duteau
        • V2: Michael Faughn, Frank Oemig, Rob Snelick
    • Vocab WG follow-up: Policy Requiring Identification of Stewards for HL7 (Internal) Code Systems
IRIs in FHIR & UTG contentup to 40 minsGaurav Vaidya

RDF subgroup of the HL7 Implementable Technology Standards (ITS) working group presented a proposal on supporting concept IRIs in FHIR by incorporating IRI stems into the UTG repository to the HL7 Vocab WG last Thursday (item 4 on the agenda  Apart from some great feedback, the Vocab WG suggested that we present our proposal at the Monday TSMG meeting so that we could get feedback from a wider group of HL7 members, in particular the HL7 Terminology Authority and UTG/THO.

  • Vocab WG presentation sides are here (took about 20 minutes)
    • This generated 10-20 minutes of discussion and feedback, 
  • The full proposal as it currently stands is here
    • Group would like to get feedback from TSMG.
  • Proposal and questions from Vocab WG is in the slides / presentation:
    • Who gets to pick IRI stems and with what criteria?
    • How do we deal with versioning?
    • How do we deal with characters that aren’t ASCII?
    • Should FHIR ValueSets be changed to better support concept IRIs?
      • Per RM:  this entire proposal is  not a "should" as much is this is a "how" per the resource constraints
    • RM: HL7 doesn't need as much input re: developing stems
  • LM (in chat): Would we need to ask the same question for CodeSystems?  Should FHIR CodeSystems be changed to better support concept IRIs? and NamingSystems would need to be changed to better support IRI stems too, right?
  • Follow-up discussion from last week 25Jul22: What is the actionable task for TSMG? 
    • How are these inserted into THO, who maintains them?
    • Has this proposal been discussed with FMG?
    • DBooth: the issue is there is not a direct correspondence between the coding.systm and an IRI stem 
      • GG (in chat): for all code systems published through the FHIR publication tooling, the IRI stem is the canonical URL, and the syntax for the full IRI is {canonical}#{code}, and this resolves correctly
        • RD (in chat): does that apply to the IG Publisher too? GG: that's part of the FHIR publication tooling, yes
      • GG:  the base IRI is established, but the syntax of how to achieve this (to display) would need to be discussed.  
        • For external coding systems there is a maintenance burden to represent the external coding systems. there are 3 issues:
          • HL7 authored code systems have an established IRI (by default) and this can be exposed. syntax could be discussed
          • In THO there's additionally a lot of info about external that would need to be accommodated
          • If referencing external IRI's:  how would that be referenced in FHIR?
      • DB:  why put these into the HL7 site?  these are used outside of HL7 and so these should be used within HL7
      • CM:  does this mean the HTA / TSMG would have to create / maintain this
        • DG: in every external terminology,. does this mean that the HTA would have to create an IR for each of these?
          • GG / CM:  this cold be handled by request... for those instances where someone explicitly needs an IRI then HTA would establish that 
      • EP: adoption of this approach supports the utilization of queries that support both FHIR content and other datasets outside of FHIR
      • RD:  what about versioning - each different version requires a differing IRI stem.. What is suggested re: this need?
        • DB: this proposal doesn't deal with versions becuase we think there should not be a change with a version change. 
          • EP:  some terminologies with concept persistence: SNOMED / LOINC there is on need for change of IRI with versions
  • Request from group
      • Need a way to map from coding systems to IRI stem when these are not the same.  For HL7 terminologies there is a simple rule, for terminologies external to HL7 this is not simple.  Implicit in these requests is asking HL7  (the TSMG) developing and maintaining the maps between these identifiers
      • Designate an Identifier system value for IRI Stems in CodeSystems
      • Designate "urn:ietf:rfc:3987" as an Coding.system value or IRIS in the FHIR identifier build registry where the coding.code is already an IRI
      • Add an "IRIstem" to the NaminfSyetemIdentiferType, so it can be used in the NamingSystem.uniqueId.type_field in Naming Systems
    • RM: before going to Vocab, the TSMG must approve the request for how to express the external terminologies.  The remainder of the technical specifications falls to the Vocabulary WG. 
      • TSMG will discuss & vote in next week's TSMG meeting
      • Then, this goes to Vocab WG next week (August 4)
      • Re: urgency / timeline - this proposal doesn't need to go to ballot, so this may not have the time constraints assumed and discussed in the las Vocab WG meeting
        • does not require a structural change - so does not require resolution for R5
        • can be aligned with the next release of THO - in time for the January ballot
 Technical Steering Committee (TSC) matters10RM
  • eVoting
  • Requirement for web-based authoring environment - will be a feature of editing tool out for contract
  • Leadership elections in process for TSC - please vote of you are able to
Terminology Server (Implementation Requirement)

  • Follow-up from WGM - next steps re: terminology server (service) requirements (1-page description)

Supporting Documents

Outline Reference

Supporting Document