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3:30PM EDT (UTC-4). Note that the calls are now two hours in duration.  



Rob McClure is unable to make the call today.

Agenda Topics and Notes

  1. Roll call and Agenda check (Chair)
    Call began at 3:35PM EDT with quorum reached.

  2. Announcements (all)
    • We WILL begin time boxing discussions as we have been unable to complete our decisions or our agenda for two months or more now.
    • We do need to stay on top of the outcome of the HL7 elections.

  3. Action Items Check  (Chair)
    1. We acknowledge that we need to take care of the items on this list. Rob asks that co-chairs especially review their action items and resolve or update
    2. Attendees and especially chairs are again urged to finish and check off their action items.

  4. Baltimore/September WGM Planning (Carol Macumber)
    Plammed schedule for the WGM can be found here.

  5. Vocabulary Policy Items Needing Decisions (Ted Klein)
    1. Policy around 'breaking changes'.   Big questions currently on code system URIs and Naming System identifiers.   Chairs call is focussed on this topic exclusively right now until we have a policy to bring forward to the main call here for approval.   Table to next call; must be discussed on chairs call next Tuesday and ALL chairs MUST review the policy statement around this.

  6. Documentation Page for MED-RT (Jessica Bota/Carol/Rob Hausam)

    The page of information for using MED-RT in FHIR was updated and HTA and the updaters want a quick review on today's call.   It can be found at: 
    Following review, Rob H or Jess (as VA rep) will post an announcement and call for comment on the Zulip implemented and Terminology channels.    This page represents the resolution of the FHIR ticket for Med-RT.  

    1. Last call it was determined that more information about MED-RT would be needed since only portions can be represented by FHIR. Suggested addition:

      “The MED-RT Code System includes relationships between MED-RT concepts and concepts in external Code Systems, as well as relationships between concepts only in the external Code Systems. The external Code Systems that MED-RT references include RxNorm, MeSH, and SNOMED CT US Edition. 

      The contents of this page are intended to represent concepts defined as existing solely in MED-RT and does not include relationships that reference concepts in the external Code Systems. For more information on MED-RT, see”

      Robust discussion of the wording of this second sentence, with much disagreement.  Rob Hausam is encouraged to write up an improvement of the description to be more helpful and more clear.   Will review it on the next call.  8/6 call: not done, table to next call 8/20,

  7. Guidance for NDC11 for the implementers and IG writers (Rob/Carol/Rob)
    Finish the guidance for NDC11 for the implementers and IG writers, it was NOT completed on the 5/28 call (2020-05-28 Vocab WG Call Agenda/Minutes)   We need to complete the discussion on today's call.
    Do we need to revisit the HTA decisions on this and reopen the issue?  Or put it to bed?   We will have an explicit decision on the implementation of the HTA/Vocab policy decision from May 28 on the next call where we will review documentation of it.  This is all about HOW to implement the policy of the support for multiple identifiers in NDC for a concept.  Rob Hausam believes that there is an easy way to implant the decision.   Suggestion:
    We create duplicate concepts in the code system and use the ConceptMap resource to declare the equivalence between them.
    A robust discussion of what is needed and how to implement this ensued.    We have used the synonym property for UTG, but this gets us only halfway there.  Carol asks who will do the work of creating all these synonym codes?
    Rob Hausam will mock up the suggested solution for this to illustrate how it is represented and how it works through services etc for the August 6 call.  We also need to see how this works in the FHIR build server as a reference implementation.    Progress has been made but not ready for discussion today, we will bring it back on the 8/20 call.

  8. From active email discussion:  "Occupational Data for Health (ODH) Code system contents" (Rob McClure)   Table to next call.
    The HL7/HIT community has continuing difficulty finding the source of truth for various commonly used code systems, such as the ODH systems.   What should be the HL7/UTG/HTA policy around these?   HTA has engaged with the discussion on these, and the Mitre folks and some others are engaged in moving forward.   We will get some update on the next call.   Ginny Lundsman has been of help and we should persue deep engagement.  Perhaps we can see if ONC can help in some way?  HTA would be happy to engage, but we do not currently know exactly what the needs are.   To be continued on the next call, may be discussed on the chairs call.  Rob M to on today's call, table to the call on 8/20.

  9. Issues around 'extensible' and 'unknown' (Carol/ Ioana Singureanu /  Jay Lyle).    Table.  Change name.  Note Rob M has a fast answer to close this.
    1. There has been some feedback, and progress today.   Many email commentaries 
    2. The project team is working through the comments and changers to address the criticisms
    3. The specific instance of the issue was around the use of a SNOMED code in a coded data element that is extensible (this is not about the value set binding).
    4. It is noted that folks are taking liberties with the encoded of stuff just to get their work done.
    5. This original point is now closed. 
    6. Rob M notes that we still need to discuss issues around the use of extensible in the CARIN project
      1. see comment from 2020-05-28 Vocab WG Call Agenda/Minutes where NDC codes are added to an extensible binding of RxNorm.
    7. We need to find out from Rob M exactly what the issue is and what needs to be done.   
    8. The original request was resolved between Jay and Ioana, and although statements have been made that there are still issues around extensible, we have not clue what exactly it is we need to figure out and decide.
    9. Remove this from call agendas.  It will be brought back if necessary.

  10. UTG Update (Carol/Jess/Ted)
    1. Status
      1. All information is posted on the  UTG confluence pages and immediate priorities are on UTG Project Tasks broken down by milestone (i.e. publish Release 1 of content)
      2. Release v2.0.0 of UTG content schedule plan (content is published and essentially live, but not yet doing Jira workflow process for approved semi-automatic processing)
        1. Tentative release 2 week of August 10
        2. Will make decision if ready on Friday August 7 with Grahame
        3. If not ready, will push back one week to decision August 14 go live plan August 17
        4. Goal is to have a completely clean build with no errors, and to have a good coremif (all active immediate content issues below done)
        5. Working on cleaning up the NUCC codes disaster.
      3. Completed second Educational Session, remaining in progress
        1. Second session geared towards the HL7 community is complete and available in the following locations:
          1. HL7 Education on Demand (free access):

          2. HL7 YouTube:

          3. Also linked through Vocabulary Maintenance at HL7 (landing page)
      4. Continued to work on Documentation updates and organization
        1. Documentation is being added to Confluence from a Word Document 
        2. In process of updating the landing page so that it is more helpful for pointing interested parties to the right information: Vocabulary Maintenance at HL7
      5. Open Content Issues
        1. Due to a timing issue, the FHIR resources for the R5 preview site were updated with their versions after the R4.0.1 versions were imported
          1. Work is underway with Grahame to fix this in UTG
        2. The V3 coremif being generated by the UTG build pages is not valid
          1. Ted and Lloyd have determined the issues and work is underway to address them.  Turns out it is a bit more involved than hoped and will take 2-3 weeks more to get corrected.
          2. Work is underway to fix the import deficiency around the deprecation information in v3 (Ted)
        3. In progress of fixing NUCC bad enumerated codes ("N" instead of "X") in the HIPAA value sets (Ted/Jess)
          1. Bad codes have been fixed but some issues with NUCC Value Sets remain
        4. NamingSystem.title URI corrections for remaining systems
      6. Workflow Tasks
        1. Need to finalize process for implementing approved proposals in master source of truth
          1. Issues were found with the current approach that must be addressed prior to Go Live
    2. Pilot underway
      1. We need more folks to go to Jira and look at it and comment on the proposals and/or vote on those in Consensus Review.
      2. Any problems or issues we need to know about as the system has not yet had enough testing and we can only fix the problems we are told about.
      3. Feedback and issues from the Pilot are logged on Participating in UTG Pilot Testing
    3. Discussion/Decision items 
      1. The plan is STILL to:
        1. Complete the pilot (need to have proposals approved in order to fully test build/publication tooling)
        2. Get the voting stuff settled with SGB and TSC
        3. Go over where we are with TSC and CTO, and seek Go-Live decision in August
        4. Announce Go-Live to membership and "turn it on" sometime in September - things are running 3-4 weeks behind where we wanted to be
    4. Immediate Priorities
      1. Fix content issues (see Open Content Issues section above)
      2. Work out the final process for implementing vocabulary changes
      3. Work on resolution of the new errors introduced by version 1.1.2 of the Publisher
      4. Get educational materials ready 
      5. Publish Release 2.0.0 of the UTG content

  11. FHIR Tracker Items (Rob Hausam/Carmela).  We had the one block vote in item e through g below.out of time for further ones.    Continue next call.
    1. ConceptMap changes are in the current build.
    2. All folks are requested to join the every other Thursday calls on this topic because without attendees no decisions can be made.  The calls alternative with these main Vocab calls.
    3. There are a few issues currently marked 'ready to vote'; please look these over as we hope to vote on them on the call next. (same time slot as this call next week). The JIRA query for this is: The JIRA query is named Vocab: ReadyForVote.  There are a number of items in this ReadyForVote state.   We will work through some now:
    4. Rob H will work on getting another block vote ready on next week's tracker call and bring it for decision on the August 20 Vocab call.
    5. We are examining the two items 27848 and 23785. pulled from the last the vote.    
    6. 23785 updated text for the trusted expansion extension:    Tabled for further work; Carmela recommends that someone summarize all of the scattered discussions, and Michael wants to see an example.  Note that 27848 is related and these two go together.
    7. 28120 motion to accept the updated text for this ticket by Carmela, Carol seconds.  Vote:   7/0/0, motion carries.       Action for post coordination see below.
    8. 27056 to add a boolean element for naming system uniqueID to note Authoritative for the uniqueID.   Reuben moves that this change be accepted and implemented in FHIR, second by Rob Hausam.   Friendly amendment fix the "ie" in the descriptions to "is".    Vote: 6/0/1, motion carries.    

  12. Gender Harmony Project Update (Carol/Rob M)   
    Project is progressing.   Today there was another presentation at NCQA DQS.   Project has decided it will be balloting a logical model in STU→Normative track target January 2021.    There is a survey open on this and can be found at Gender Identity All participants still just plugging away on it.  Mary Kay has requested that some folks from X12 and NCPDP come in and monitor what is gong on and to help.  Such involvement is strongly encouaged, the more viewpoints that can be coordinated the better.

  13. Liaison Reports     
    1. ISO (Ted) - Fall 2020 meeting is virtual only.  Details will be forthcoming.  

    2. LOINC (Ted/Rob H) - New LOINC release: LOINC 2.68 and RELMA 7.1 are now available for download from the website.   LOINC has now been accepted as a member of the JIC.  Sarah at Rengenstrief has taken a new position, a number of open positions have been posted for LOINC.   New copyright statements that LOINC is mandating be used have been received.   We need to put in some effort to get the notices placed in al the mandated spots in UTG.

    3. HTA (Carol/Reuben) -  HTA call yesterday finalizing external code systen policy, 3 new code systems from Canada now registered, copyright information around LOINC discussed.   Recommendations made to HQ for GOM changes.    See the HTA minutes for details.    HTA nominations are open.   It is noted that some of the members are being asked to renew so that they don't all expire at the same time next year.   Carol and Reuben are on HTA, Rob M is liaison.

    4. SNOMED (Rob H/Reuben/Peter) - The next meeting is confirmed to be virtual and no charge.   It will be held October 8-9.   Registration at Work still moving ahead with SNOMED on FHIR and to bring an IG forward.   Work moving ahead with the Sushi and related tooling. Question on how we should represent a standalone extension in FHIR and UTG.   Recommend using a Fragment.   It is noted that a fragment cannot add new concepts or other structures, but a 'release' of core plus a national extension is considered a complete code system and not a fragment. 

  14. New Business
    1. Additionally related HTA item:
 zulip chat.  Active discussion.   We need to make a Vocab WG policy about the precise workflow and decision and sequencing of steps for the changes in canonical URLs.    Critically important item to be agreed, decided, and documented!  This will be on top of the cochairs call agenda next week, then the following week circle back to HTA and Vocab so that Wayne and Grahame can both join for the finalization of the policy.   Julie is invited to next week's cochairs call.  Still outstanding is finalized policy on the changes with URIs.  

    2. Rob McClue asked to be added:   We need to discuss our best practice approach wrt where a group like EBMobFHIR should host code systems and value sets. By that I mean, when should they use UTG and what configurability would we allow them (external to HL7 reviewers?) EBMF has a unique problem in that it's crafting content for a base resource, not just in an IG. They seem to be following a basic process that must be auto-creating code systems for every new value set with made up content because they have never created a code system resource.   Tabled as Rob M not on the 8/6 call.

    3. Mary Kay has gotten additional information for us and HTA for things like DRGs, etc from X12 and NUBC..  Rob H asks if we can get a full list of all ICD10CM codes so we can put the enumerated set into FHIR services.  It is noted that we do have an obligation  CMS has supplied the information for DRGs, Place of Service, and RARCs (Remittance Advice Remark Codes).   All information is in hand.   Template work to enable this has been worked out with Lloyd and Grahame to enable such value sets and code systems where the content is fully IP protected to be included in a build.  

  15. Next call items
    1. See items above.

The call was ended and adjourned at 5:33PM EDT.  Next call scheduled for Thursday August 20, 2020 at 3:30PM Eastern US Time for two full hours.   

Action  items

  • Carmela A. Couderc will put in a new FHIR ticket for improvement in text describing post coordination and composition in code systems to cover the questions around whether fragments can contain post-coordinated code expressions.    FHIR-28233 - Getting issue details... STATUS