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Discussion items


Work Group Health

2021May Interim Reports

SWOT is close to 5 years old, which is the limit. 

Conference Call Schedules

Work Group Conference Calls ending

Tuesday 3:30 pm  (UTG)  Ted will reschedule the series. Reuben and Ted might be the only attendees, but they will be able to get some UI work done.

Terminology binding single call scheduled for tomorrow (uncertain, negation, etc.). There is a slight overlap with the UTG call, not allowed with the HL7 Calendar tool.  Rob is having a hard time getting this scheduled. 

Monday 4:00 pm (Gender Harmony), just one of the series. Carol will reschedule the series if necessary.

Remember to include this text when scheduling meetings (even though notes might not end up on the calendar invite): 

Meeting Attendance: For all Vocab Zoom meetings, please see contact information for project/meeting leaders as we request that you email one of the contacts prior to attending a meeting for the first time. Doing so allows us to better moderate the admittance to our conference calls.  All attendees must be admitted by the host.

Ticket notification

FHIR-31936   this ticket was entered while reviewing VSDP guidance text, upon review it seems unlikely to ever happen - suggest setting status to defer, or closing ticket.  We noted that we are ok with the extension as is - this will be voted on in one of the first block votes.

3 R4B Concept Map tickets: FHIR-28284, FHIR-22129, FHIR-31386   still resolved - change required. The first and third will be verified by Robert Hausamthe second ticket FHIR-22129 doesn't have a note about any code changes being made. 

  • Rob H will check these tickets. 

FHIR-29947   - tooling issue with ConceptMap relationshipType rendering - Robert Hausam  to invite GG to the May 13 main call to discuss. 

Co-chair nominations

Ted, Rob M., Rob H.

Ted = no

Rob H = yes

Rob M = unknown

Recruiting? Ted will nominate Jess.

R5 Priorities

Should we add more FHIR tracker calls? RD is in strong support of this. We would need at least 2 co-chairs (or proxy) and 1 other person for quorum. RD will help figure out a time for the call. 

Progress made for ConceptMap tickets this past Thursday 

R5 dashboard showing applied tickets so far:  

R5 ConceptMap Dashboard:     (10 remaining tickets)

R5 NamingSystem Dashboard:    (2 remaining tickets)

R5 CodeSystem Dashboard:        (17 remaining tickets)

R5 ValueSet Dashboard:    (at least 58 remaining tickets - they have all been triaged) 

Vocab - no resource:    (85 remaining tickets)

Transparency of documentation

Publish code system update schedule?

There is some question as to the source of the CodeSystem list. Rob H. will follow up with Marc.

 Marc D. obtained a list of all CodeSystems on We need to be able to generate this list on demand and relate it to CodeSystem update schedules?  We have to be careful because there isn't much funding to keep CodeSystems up to date here. 

Rob H: we could publish general expectations about major CodeSystem updates. Others are updated on request - its not well known that this is the process. Rob H. will write this information. 

Reuben D: it comes down to transparency, and openness to the community. At some point HL7 will have to get a proper SLA to maintain this server. Ted notes there will be financial impacts. 

Ted mentioned that the publisher gets terminology from 3 or so places to create an IG. is one source, but it is the last source. A patch has been put in to look in first for CVX (patch)

ConceptMap - normative track?

Recent FMG email listed ConceptMap as a potential for normative track in R5. 

RD: suggests that we respond to the email with information that it will not be normative in R5, and if they would like to discuss, please contact Ted to join the agenda on one of the main WG calls. Robert Hausam will initiate contact with FMG, if we cannot get this discussed prior to the WGM, this should be put on the WG agenda.  Any FMG member should be able to attend and address the question.

May 13 co-chair webinar - reminder

Conflict with Vocab Main WG call

We will meet for 30 minutes, attend the co-chair call for 60, and come back to the Vocab call for 90 minutes. Ted Kleinwill send a message on the listserv.

CodeSystem Identifier Task Force

Not discussed on this call

Status:  diagram in a good state. Next steps to bring start communicating and putting decisions into action.

  1. Team has suggested a separate, focused webinar
  2. Edge cases identified, 
  3. See notes here:  2021-04-26 Vocab Special Topic Agenda/Minutes


Not discussed on this call

To do: consider new JIRA tickets for other instances of WorkflowStatusDescription (see last week's minutes)

New JIRA project 

Kind of covered on this call

Rob M.

Clarify how to set up the JIRA project for existing standards

We need to get this settled. We will continue to collect on Confluence (low volume). Rob M. has asked Marc to look into this. There is probably a series of tasks to do, and then we won't have to do them again. Gender Harmony and VSD. 

O&O lab short term suggestions on how to exchange SOGI

Not discussed on this call

Sexual Orientation, Gender Identity, Administrative Sex, Birth Sex etc

Scheduled for Q1 Tuesday at WGM - confirm

We need to integrate Gender Harmony specifications into the product families - this has started due to California request to get SOGI data through labs. Integrating moderately detailed information into the spec to answer questions. By the end of the WGM there should be a publishable version. The existing Gender Harmony project will be adjusted. PC and O&O will meet with Vocab to move forward - V2 and FHIR. SD joint session might cover this as well.

Identifier Systems

Not discussed on this call

Zulip chat:  started specifically about transport addresses, more general discussion about how to support making identifier system identifiers available to the implementer community.

Project status? 

4/26/2021 status:

We have a recommendation that the NamingSystem.title is equal to CodeSystem.title when there is a CodeSystem. Same for and

Ted is waiting for work underway by Reuben. Once this is ready, they will work together to make the changes in THO. 

IdentifierSystem support tickets added as part of action items from 2 weeks ago.

HSCR-138 - Getting issue details... STATUS     Add support for Identifier Systems in THO  - details on text for descriptions and tab names included here. 

HSCR-135 - Getting issue details... STATUS      Evaluate Identifier System support in THO - this ticket should be closed or deferred 

HSCR-139 - Getting issue details... STATUS      Add Identifier Systems to UTG in bulk

FHIR-31706 - Getting issue details... STATUS    Add NamingSystem extension to support Identifier System sub-type

Remaining action items:

Vocab will be responsible to nudge people to get this done.

  1. As part of prep work required for HSCR-139, Rob M. volunteers Marc D. to work with Rob H to create the artifact for bulk update into THO and to create the UTG ticket.  CC sent an email to co-chairs and Marc to remind them of this effort. 
  2. Remove the identifier systems from the FHIR page (GG)
  3. HTA stuff (Carol)
  4. Identify V2 and V3 identifier systems that have been defined as CodeSystems need to be addressed  
    1. Some of these exist  CodeSystem resources without a NamingSystem but some do have NamingSystems
    2. This is a mess, and someone will have to figure out 
    3. Vote on and apply FHIR-31706 added to address this: V2 identifier systems are sub-typed that will most likely require an extension
      1. This sub-type is important information for implementers (the FHIR identifier datatype has a system, value, and type. The type is the "subtype" mentioned above. ) 

Extensible Binding and upcoming recommendation to change CodeableConcept binding strength to preferred. 

not discussed on this call

Rob M. report from the M&M meeting. 

FHIR-29968 - Getting issue details... STATUS

In what circumstances should there be extensible binding strength in FHIR Core? What are the criteria that define when extensible binding strength is allowed in FHIR Core. More of these have been popping up. The M&M meeting is on Wednesday 3-4 EDT. Rob M. will attend the meeting.

This is not the same as the issue we've discussed in the past about implementer expectations in general with extensible binding strength.


not discussed on this call

Where do we represent the published code system version in THO? HSLOC.  Internal THO version, but not external code system version.

Provenance and AuditEvent

not discussed on this call

Problems related to the fact that Provenance and AuditEvent are a collaborative effort that has common lineage to DICOM, HL7, ISO and W3C. ValueSests exist with overlapping concepts - not helpful. 

Action plan? 

John M. started this Zulip thread - related to security. He is asking for Vocab's help to fix the problem. 

Ted: we use Provenance in THO - to track changes applied to THO content.

John is bringing up issues that are surfacing and causing problems with other implementation. Suggest that he prepare his material and get on a main WG call agenda. Rob M. sending this message. 

Submitter permissions

Submitters to UTG must be HL7 members. There is a person who is working on some submissions and he is not able to submit because he is not an HL7 member.

There was a decision made some time ago, never documented that a person must be an HL7 voting member to be able to submit a UTG proposals. Submitter and reviewer permissions are separate in UTG.

 Ted gave this person permission to submit UTG content submissions even though he is not an HL7 member.

The UTG task force needs to take this issue on. We will ask Rob McClure to bring this issue to the UTG Task Force.

Using Codes / Selecting a Code System Identifier Text Review

did not discuss

Co-chair review of this text:

Updated text for Using Codes / Selecting a Code System Identifier

Confirm so ticket can be applied.  Ticket was applied for R5 draft. 

Decided to talk about this at the 6 pm meeting. 

3/1/2021 update: The identifier meeting attendees clarified the target audience for the materials we are creating. 

Decided to focus first on getting the diagram up to date - which is for an IG author audience.  

  1. implementers
    1. implementers should just use what is in the spec
    2. Rob H. contends that the FHIR spec should only have information for implementers, even though it has information for IG authors now. 
    3. If thats the case, then any information about how to obtain a code system URL might not belong in the spec
  2. IG authors
    1. responsible for making sure the spec has the right code system and value set identifiers

Note: the Monday 6 pm ET discussions have been specific to the URL - for use in FHIR. There are other identifiers for the other HL7 product families. This should be managed through UTG. Not only identifiers, but different metadata across the product families. Example? 

Once the HTA material is in HTA, the problem will be less.  TOOLING REQUIREMENTS - create OIDs for every FHIR terminology 

Code System Identifier Deprecation 

not covered on this call

Discussion from 2/08.  3/15 note: this is now a "to do" item on the policy page

  1. Code System Identifier Deprecation  
    1. See notes here: 2021-01-18 Vocab Chair Agenda/Minutes
    2. See notes here where the group was reaching consensus:  Jan 2021 - HL7 WGM - Thursday Q3 Minutes
    3. FHIR-30319 - Getting issue details... STATUS  voted to move out of R4B to R5, define a policy related to deprecated 
    4. FHIR-31028 - Getting issue details... STATUS   create a new concept in Publication Status value set = Deprecated  
      2. Add a new concept to the CodeSystem, change the existing definition to be the existing enumerated list. Make a new ValueSet that is enumerated list + deprecated 
      3. 4/5/2021 update: Rob M will bring this issue to a FHIR-I call
  2. Deprecation applies to
    1. CodeSystem Identifier
    2. CodeSystem resource
    3. ValueSet identifier
    4. ValueSet resource
    5. Concept Map resource
    6. Status:
      1. V3 and V2 ValueSets support deprecation in the work flow, FHIR does not as a status
      2. V3 and V2 ValueSets do not support Draft, whereas FHIR does 
        1.  Candidate for unification/harmonization
    7. FHIR inconsistently defines workflow status (e.g. review, approve) - sometimes in the Resource, other times depending on Provenance

2/15/2021 Update: Vocab needs to define a deprecated identifier policy - the addition of a new publication status code is great, but doesn't solve everything. There is an immediate need to document how to work with the R4 definition before we get to R5. Based on last discussions, implementations can't distinguish between inactive and deprecated by looking at the effective period. TK will update the ticket with his thoughts on this issue. Unfortunately we are time limited. This was pushed to R5.  

FHIR-30319 - Getting issue details... STATUS

Discussion 2/22/2021:

Governance: (still need a policy)

Deprecated status takes precedence over the validity period.

How to detect deprecated identifiers 

  1. Deprecated = true
  2. Validity period end = past date

Chance for mis-interpretation? Adding deprecated to the status value set does not help the NamingSystem identifier deprecated issue. 

Ran out of time. 

External code systems - Canada

Extensible definition

not covered on this call

Rob M.

Discussion from 2/15: Note from 3/15 - this is now on the policy page as a "to do" 

Rob H: get the proposed text integrated into the FHIR specification (in the CI build), and review in context. 

We reviewed FHIR-29968  and did not get to the point where we have a text block to propose for the R5 build.

Rob M:

  • Example value set expansion: Red, Blue, Green, Yellow
    • Someone wants to communicate Magenta. Is this a type of Red, or is it something different? In SNOMED, magenta would be a sub-type of red.
    • Extensible is intended to be guidance for implementers for what to support.
      • It is allowed to send a code that is in a more recent expansion/version of the bound value set.
      • See #4 in the comment of the JIRA.  This is problematic. 
      • It is acceptable to have a new value set version or a new value set that is claiming conformance to the original extensibly bound value, where an expansion has a concept that is a descendant of the original extensibly bound value set expansion
        • Want to explicitly add magenta to the expansion - either a new version of the original value set or a new value set and claim conformance. 
        • #4 as written doesn't allow this.
    • An implementer might decide to add magenta to their value set because their use case needs it. Conceptually, there is a new IG that has a new ValueSet.  
      • This is really obvious when a different CodeSystem is in play
  • Ted: Extensible could be viewed as ideally you would make the value set required, but you know there are use cases that you can't possibly know about, and want to allow implementers to send something not in the value set when necessary. 

.   FHIR-29968 - Getting issue details... STATUS

Policy on the use of extensible value set bindings

This was discussed at length during Q5 Tuesday during the WGM. Jan 2021 - HL7 WGM - Tuesday Q5 Minutes

See discussion notes from previous co-chair call: 2021-01-18 Vocab Chair Agenda/Minutes

Should we also review the definition of preferred binding strength? 

How to distinguish between extensible and preferred?

CPT4 Syntax

not covered on this call

This is encapsulated in one of the policy statements yet to be defined - in the lower priority section.

Vocabulary Work Group Policy Statements

Supporting C-CDA FHIR IG

not covered on this call

From WGM. How does C-CDA address terminology quality now that Term Info cannot be referenced?  

Action items

  •  Ted KleinReschedule the UTG series - Tuesdays at 3:30 EDT