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HL7 Terminology Authority Call



Password: hl7termauth

Date: 2018-01-04
Time: 4pm

Timezone, USA, New York


Heather Grain

Note taker(s)

Heather Grain


Attendee type H - HTA Member

O - observer

L - liaison



P - present

A - Apologies

N - not present without apologies





Heather Grain

Global eHealth Collaborative



Rob McClure

MD Partners



Sandy Stuart

Kaiser Permanente



Jean Narcisi

American Dental Association



Julie James




Ted Klein

KCI Inc.



Roel Barelds

CSC Scandihealth A/S



Jim Case

National Library of Medicine/IHTSDO



Wayne Kubick




Robert Hausam

Vocabulary Co-chair



Jane Millar

SNOMED International






Quorum Requirements Met:      Yes

1          Opening

1.1         Agenda Confirmation

1.2         Minutes of Previous Meeting

Minutes of meeting 2017 12 08 Jean Moved and Sandy seconded that the minutes be accepted.

2          Membership

2.1         GOM review

-           International membership -

-           Number of members – minimum of 6

Review GOM extract for HTA (see Terminology Authority – Documents folder ?

Update to the GOM is needed to:

  • Have at least one member whose first language is not English
  • Have a minimum of 3 members who are not primarily resident or working in the USA which is represented by them being a member of an HL7 Affiliate (non USA).


TSC is considering whether additions similar to those for health metrics be included.

2.2         SNOMED International

Review message from SNOMED International at  

Action:  Message to International Council – that though we wish you to use SNOMED CT – a license is needed (see updated copy of HTA Policies and Guidance Licensing V1.1.

  • Previous documents are on HTA document page - specifically Policy on Licensing Terminology and Policy on currency of value set content.  What if anything, needs to be updated.
  • Reference the release from SNOMED International – indicate that this message confirms the acceptability of receipt, storage and mapping of SNOMED CT to local codes but that you cannot create new data and assign new codes as a non licensed organisation.


  • HTA need to provide guidance to the community based upon the current position of SNOMED International regarding use and receipt of SNOMED CT concepts.
  • New Orleans – schedule time to update and produce simple guidance from an HL7 user perspective.

    Content Requests

No current requests in hand.

2.2.1         Tutorial on Requests for SNOMED content requests

Develop and deliver a short tutorial (and webinar) on

SNOMED Content, requests, international release use, license requirements, etc

See Tutorial Outline – for consideration.  Updates made to the tutorial outline.  The course content will be developed based upon this outline.

HG to send outline to SNOMED International for their approval.  Add this item to the agenda for New Orleans – with the intent of reviewing content and preparing for webinar development prior to the Cologne meeting and presentation of a 1 hour session at Cologne to test the process.

2.3         Publishing

2.3.1         External Terminology Web Page

Review Content Document and next stages   - see details below.

ACTION: The current outline of content is considered appropriate as a starting point.  Need to request page establishment.  Establish a draft in confluence to get the content sorted before we go with a page.  This will need a confluence account for this – HG to request project area for board committees, and put HTA in there.

Objective:  Need to have HTA ongoing process to review and maintain content.  Need to ensure that Harmonization process will provide the information required in the future.

Issue:  how do we plan to manage external terminologies used by Affiliates?

There was support for a registry to all terminology product references.  This assists unique identification and supports both international and national use cases and cross boarder information exchange.   That where possible the use case should be clear.  This acknowledges that information will initially be incomplete but that we move forward to improve information available.

Another HL7 function is the creation of unique identifiers for each code system.  Ted suggested that is not an HTA function to maintain those identifiers but HTA should provide oversite on the metadata associated with code systems used in HL7 standards.  We will need to coordinate with V2, V3, CDA and FHIR approaches.  

HTA need to establish a process to be conformed with going forward and that each different approach must comply with this approach.

ACTION:  include in HTA agenda activity on metadata specification for ALL code systems and discussion on process governance.  This will be part of the UTG process.

2.3.2         Version 2

Need HTA to sign off on harmonization proposals – to make it easier to clarify process.

Action:   HTA as a committee -  be included in Harmonization process – Ted to make contact to see this happens.

Universal disclaimer needed in all publications - we need to confirm this with Publishing and agree on the words to be used.

Action:   craft words relevant for inclusion in publishing.  Draft to be prepared based upon existing web details.  Consider use of words from the External Terminology Web Site content.

When statement available -   Request statement on external code systems (such as SNOMED, ICD, LOINC) use be included in the publishing process. 


2.4         Harmonization

2.5         Process Guidance to FHIR

For anything that is not a structural code FHIR has agreed to be part of harmonization so will be folded into the existing process for V3, V2, CDA.   The maturity model does not necessarily include the maturity of the value set content.  This activity is ongoing in Vocabulary and HTA will be notified if there is a need for further consideration.


2.6         Other Business

2.6.1         Watch List procedure

Watch list reviewed.

2.6.2         New Orleans Meeting

Julie apologies but would join with teleconference if possible. 

Meeting closed at 5pm.


3          Appendix: Known issues and Watch Items

3.1         SNOMED CT HL7 International namespace use

HTA to determine method of operation

Decision:  until the UTG project determines the method of handling new content there will be no use of the namespace. 

3.2         Publishing

  • LOINC survey instrument attribution – attribution information included in web and publishing guidance (listed above).
  • Policy for publishing value set definitions referencing external terminologies (current and future)
    • When a value set definition refers to external terminologies without listing the content we need to:
      • Ensure licensing requirements for use is appropriately attributed and defined
      • When value set definitions are published there is a need to automatically reference the page of external terminologies and licensing links for use.
      • Every published document will include that information.
      • Include in this policy and process in the external terminology web page.

ACTION:  move to active discussion


  • Additional issues associated with publishing for HTA. 
    • The way value set definitions are persisted in the families do not have populated content about the source/owner.  This field is often not populated at the moment. 

7/12/17 steward is included – but need to consider the owner (who is responsible for the value set).  There is a need to indicate the purpose or scope of the value set content.   This is a Vocabulary issue rather than HTA.

Additionally, tooling in the MIF does not permit publication of the steward of the value set.  It is held in the database, but the tooling is not captured for V3 value sets.  This is being addressed in the UTG.  V2 has the steward and owner is algorithmic according to the chapter the content is used in, but where tables are used in multiple chapters.  Not for further discussion in HTA as Vocabulary will work on these issues

  • Inclusion of maps in publications.

3.3         Value Set Specification Projects

3.4         Tooling

3.5         FHIR content request updates

Awaiting information from Grahame G about how FHIR will update terminology resources to match the international release.

3.6         policy statement on SCT allowed binding strengths in FHIR for clarification (Ted)

On hold at the moment until other processes are determined more clearly.

Ted suggested this be moved to the watch list.  We need to determine semantic implications of binding strength of expansions which are subject to profiles.    This issue is not restricted to FHIR.


4          External Web Page Content

Reference to HTA – link

Link to the document on external vocabularies (policy document)

List of terminology products and organizations with whom we have agreements:


SNOMED International

American Dental Association SNODENT

List of known external terminology products and organizations used in HL7 products:

  • ICD (WHO)
  • Others….., including content from V2 tables 396 (external code systems used in V2 standards), link to V3/CDA and FHIR external terminology pages.  These are known terminologies and this information is known to be incomplete and less than what is required. 


External content should be brought through Harmonization.  The Harmonization and balloting process will be the trigger updates to the information provided on this page.  If these requests, go through harmonization the HTA can be informed and take on the liaison and organization of licensing agreements.  Working Groups are not empowered to make such arrangements. 

The tooling below aims to provide a quick reference to find tooling and information about external terminologies used in HL7 standards.   This provides a traceable process to assist standards users.

Develop a table of information about each code system including:

  • Formal name of the code system
  • Short name or abbreviation of the code system
  • Owner of the code system
  • Technical identifier/s of the code system
  • Link to information about the code system – this should contain information about how to obtain the content.
  • IP information and Licensing - link
  • HL7 users of this information – e.g. HL7 product use link?
  • Information current as at



This is a code system with regularly released editions, an international edition, and national editions.  HL7 international realm specifications shall only use the SNOMED CT international release.  Realm specific specifications shall use either the international or the edition of that Realm.  Use of a Realm specification outside that Realm will require specific additional licensing from SNOMED International or the National Release Centre/s of that Realm. 

Full title: SNOMED Clinical Terms

Owner: SNOMED International

Scope of content (semantic space)  all content relevant to healthcare

Technical Identifiers:  note:  this terminology requires identification of the code system and the version of the code system being used.   The identifiers shown here are for the code system (and do not indicate the version)

Link to information about the code system:  www.snomed.ord

Licensing information

  • HL7 users of this information – V2.x, V3, CDA, FHIR
  • Information current as at: 2017 September 15




Full title: Logical Observation Identifiers, Names and Codes

Owner: Regenstrief Institute

Scope of content (semantic space) LOINC is a common language (a set of identifiers, names, and codes) for identifying health measurements, observations, and documents.

Technical Identifiers:  note:  this terminology requires identification of the code system and the version of the code system being used.   The identifiers shown here are for the code system (and do not indicate the version)

  • OID - 2.16.840.1.113883.6.1
  • URL -

Link to information about the code system:

Licensing information

  • HL7 users of this information – V2.x, V3, CDA, FHIR
  • Information current as at:  2017 September 15


Note:  addition of emerging code systems.  Any material that we don’t curate ourselves we should reference on this page.  This list will extend over time and we need a mechanism to identify these beyond those with specific agreements.

Information on source of truth and updates