Vocabulary TC Meeting Minutes – San Diego WG

Sunday Jan 7, 2007

Attendees:

Name Company Email

SundayQ1

Q2

Q3

Q4

Cecil Lynch UC Davis clynch@surewest.net X X X XChris Chute Mayo chute@mayo.edu X X X XJim Case AAVLD jtcase@ucdavis.edu XJune Rosploch KP june.rosploch@kp.orgRuss Hamm Mayo Hamm.Russell@mayo.edu X X X XSandy Stuart KP sandra.stuart@kp.orgSarah Ryan HL7 sarah@hl7.org X XTed Klein KCI ted@tklein.com X X X XHarry Solomon GE Harry.Solomon@med .ge.com X XLloyd McKenzie HL7 Canada Lloyd@lmckenzie.com

Richard Thorenson

Behavioral Health Treatment and Disease

Richard.thorenson@samhsa .hhs. gov

Francine Kitchen GE Healthcare Francine.kitchen@ge .com Rita Altamore WA DOH Rita.Altamore@doh .wa.gov

Paul KnappContinovation Services Inc pknapp@continovation.com

Stan Huff IHC/Univ of Utah stan.huff@ihc .com

Carol Mulder InfowayCmulder.infoaccess@on .aibn.co m

Vivian Auld NLM auld@nlm.nih.gov X X X XDrayton Rodrigues IHC Drayton.rodrigues@ihc .com X X X XDale Nelson Zed-Logic dale@zed-logic.com X X XScott Hollington KCI hollington@email.com X X X XTom Johnson Mayo Johnson.thomas@mayo .edu X X X XDeb Belcher GE Healthcare Deborah.belcher@ge .com X X X XAyman Fadel RUG Tools ayman@rugtools.com X X X XCraig Parker IHC craigparkermd@gmail.com XRobert Hausam Theradoc robert.hausam@theradoc .com X X

Jane Curryjanecurry@healthinfostrategies.com X

Masaharu Obayashi Kaurikogaku Ltd. obayashi@kthvee.co.jp XGrahame Grieve JIVA grahameg@gmail.com X

Sunday Q1Co chair WG meeting prep timeChair: Chris ChuteScribe: Ted Klein

- Review of week’s agenda

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- Possibly MnM can accommodate us for Q1 Wednesday after all- Need to contact INM chairs to get a list of the discussion topics for our

joint meetings- Contact Bob Bishop to ascertain his attendance to begin early on the

glossary discussion Q2 on Tuesday

As part of figuring out what the US Realm quarter on Thursday should focus on, the discussion of the coordination (or lack thereof) between ONC, AHIC, HISTB, and HL7 for US Realm-type definitions for HL7 communications seem that it is producing a significant problem.- Chris asserts that VTC must raise this issue to the HL7 Board: the

dysfunction of the US Realm process and its place and coordination in the federal processes underway

- This question will be pursued informally and in parallel through ONC channels.

Adjourn for morning break.

Sunday Q2

Co chair WG meeting prep time Chair: Cecil LynchScribe: Ted Klein

We need to put together some kind of framework for the cleanup of Vocabulary content and documentation. MnM and INM have stated that they would prefer more vocabulary work to be done by the vocabulary committee rather than just left to harmonization. How does the vocabulary technical committee participate in the process of the definition and final approval of value sets for use in the different balloted documents? - For conformance to Good Vocabulary Practices - For consistency across HL7 for the same things- It is not the job of the VTC to define value sets, but it is our job to ensure

the infrastructure of different areas (eg SPL) have good vocabulary usage consistency

It was noted that there is a naming inconsistency of substantial elements between CTS and LexGrid implementation (eg ValueDomain vs ValueSet). This came about some years ago, and is only really being recognized as an issue now. Note that the current LexGrid specification, once the master naming issues have been modified to be consistent with HL7 balloted conventions, can serve as the bulk of the CTS2 specification going forward.

** break for lunch **

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Sunday Q3

Demonstrations

Chair: Ted KleinScribe: Chris Chute

IntroductionsOverview of NLM project and context given by the chair

Review of Harmonization tool:

Eclipse tool to author and manage harmonization proposals. Demonstrated adding codes to a value set associate with a domain.

Comment made to add Authoring committee in addition to Sponsoring committee to manage the SIG workflow question.

Question raised about “approval” flags with associated dates to document workflow.

Comments about additions:

Check the database to see if a “similar” concept already exists, semantically or lexically.

When will it be ready: version 1 for March harmonizationThose that want to try it: a pointer to the GForge site will be on the wiki

Review/Preview of the Klein Consulting contract deliverables:

Ted overviewed the nature and functions of the NLM contract to Klein, anticipating the demonstration. This is to map HL7 content to CHI contents, and make this available for TC review.

Question: how much difficulty is evident distinguishing a domain from a value set.The data in the RIM repository is not consistent or complete. Domains without value sets, retired domains, referential integrity issues.

Are you mapping the “abstract concepts?” Value sets may have title that is abstract.Yes, but these are not always clear, and they must be done manually.

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Tool that portrays the mappings that are created for TC review has many questions. First effort directly reuses the tools created for harmonization proposal (first half of this quarter) but adopted to show CHI mappings.

Question of matching semantic types and the available vocabularies. How does the TC recognize these dependencies? Vocab has been tasked to steward this process, and should review harmonization proposals.

Vocab should review for semantic types consistency. Domain TC should review for domain appropriateness. Not enough working group meetings between now and Sept, harmonization is a convenient forum for this work.

Addition to tool will be some selection, review annotation, that can directly create the XML change document.

Direct linkage to message specific value sets anticipated.

Sunday Q4

16 pt documentChair: Ted KleinScribe: Chris Chute

A key insight was that much of the existing 16 point document will be superseded or functionally replaced by the Harmonization tooling set being built by Russ Hamm.

Clarification on the nature of structural codes, and why they are “special.”

Review of an actual harmonization proposal, to ground 16 point document in current practice.

A decision was made not to spend time on 16pt elements that are covered by the tooling. Instead, Registering a Terminology was selected for enhancement.

Monday January 8, 2007

Attendees:

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Name Company Email

MondayQ1

Q2

Q3

Q4

Bob Bishop VHA Robert.Bishop2@med.va.gov X X XCecil Lynch UC Davis clynch@surewest.net XChris Chute Mayo chute@mayo.edu x

Christine Bester GPIchristine.bester@gpinformatics.com

Ganesh Singh Oracle ganesh.singh@oracle.comHarold Solbrig Mayo Solbrig.Harold@mayo.eduJim Case AAVLD jtcase@ucdavis.eduJune Rosploch KP june.rosploch@kp.orgKathleen Connor Fox Systems kathleen.connor@foxsys.comLee Coller Oracle Lee.Coller@oracle.comLen Gallagher NIST lgallagher@nist.govMead Walker dmead@comcast.netPavla Frazier NCI/MSD frazierp@mail.nih.govRobert Grant robert.b.grant@gov.bc.caRuss Hamm Mayo Hamm.Russell@mayo.edu X XSandy Stuart KP sandra.stuart@kp.orgSarah Glamm Epic sglamm@epicsystems.comSarah Ryan HL7 sarah@hl7.orgTed Klein KCI ted@tklein.com XPeter MacIsaac peter@macisaacinformatics.orgRobert Hausam Theradoc 5 ausam.hausam@theradoc .com Harry Solomon GE Harry.Solomon@med .ge.com

Jane Curryjanecurry@healthinfostrategies.com X X x

Lloyd McKenzie HL7 Canada Lloyd@lmckenzie.com X

Richard Thorenson

Behavioral Health Treatment and Disease

Richard.thorenson@samhsa .hhs. gov

Francine Kitchen GE Healthcare Francine.kitchen@ge .com Rita Altamore WA DOH Rita.Altamore@doh .wa.gov

Paul KnappContinovation Services Inc pknapp@continovation.com

Stan Huff IHC/Univ of Utah stan.huff@ihc .com X X X

Carol Mulder InfowayCmulder.infoaccess@on .aibn.co m

Rob McClure Apelon mcclure@apelon.com X X x

Andrew PerryClinical Information Consultancy andrew@clininfo.co.uk

Davera Gabriel davera@ucdavis.eduIan Townend Ian.townend@cfh.nhs.ukGeraldine Wade gwade@pol.netJohn Kilbourne kilbourj@mail.nih.govTim Williams twillia@cap.org XMike Lincoln Michael.lincoln@va.govDan Russler Dan.russler@oracle .com Bob Davis NAHDO rdavis@nahdo.org X XMark Schaffarman

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Carmela Couderc Siemens carmela.couderc@siemens.com X X XKathy Giannangelo AHIMA Kathy.giannangelo@ahima.org X X XTom Johnson Mayo Johnson.thomas@mayo .edu XVivian Auld NLM auld@nlm.nih.gov X X X

GB KesarinathCDC/Northrup Grumman Gfk0@cdc.gov X

Sarah Ryan HL7 sarah@hl7.org X X XScott Hollington KCI hollington@email.com X X XMike Newman VA Michael.newman@va .gov X X XHeather Grain STAND Australia h.grain@latrobe .edu.au XBeverly Knight Beverly.knight@procurement .ca XRoss Martin Pfizer Ross.martin@pfizer.com X X

Monday Q2Chair: Stan HuffScribe: Chris Chute

Monday Q3

Chair: Stan HuffScribe: Chris Chute

Continue discussion of value set document.

Delete reference to abstract and specializeable value sets, an historical artifact from the times when all items in the HL7 database were concepts.

Add introduction of definitional terms and their relationships (value set, coded attributes, domains, etc).

Clarification of nested and sub-value sets

Motion: Vocabulary domain names should be managed and maintained as a coded vocabulary system.Chute - McClure0 negative; 3 abstain; Motion carries

Move on to discussion of Value Set Binding in Implementation Guides

Refinement of versioning of value sets using date-times.

Monday Q4 Designating what's NOT in a prescribed medication - Ross MartinChair: Ted Klein

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Scribe: Stan Huff

1. Differentiating features of medications – Ross Martina. Use cases

i. Compliance packaging – Z-Pakii. Gluten free, sugar free, no trans-fats, all naturaliii. Flavors

b. In branded products databasei. Include the differentiating features in the database

c. In pharmacy orders using RxNorm or generic clinical drugsi. Do not pre-coordinate differentiating features as part of

RxNormii. Collect differentiating features as post coordinated attribute

or attributes in the orderiii. Choice:

1. A growing list of additional attributes (flavor, package, “free”, etc.)

2. One differentiating attribute that allows repeats (preferred approach; Vote: Yea – 8, Nay – 0, Abstain - 4 )

a. Need a controlled vocabulary for flavorsb. Need a new controlled vocabulary for “generic”

compliance packagingc. Need pre-coordinated concepts for “gluten

free”, “all natural”, “No trans fats”, etc.d. In SPL

i. Could handle “gluten free” as a “warning and precaution” if the needed concepts are all available as pre-coordinated concepts

ii. Can capture flavors as inactive ingredientsiii. Packaging is already handled – may need new terms for

compliance packaging

Tuesday January 9, 2007

Name Company Email

TuesdayQ1

Q2

Q3

Q4

Bob Bishop VHA Robert.Bishop2@med.va.gov X X X XCecil Lynch UC Davis clynch@surewest.net X X X XChris Chute Mayo chute@mayo.edu

Christine Bester GPIchristine.bester@gpinformatics.com

Ganesh Singh Oracle ganesh.singh@oracle.com

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Harold Solbrig Mayo Solbrig.Harold@mayo.eduJim Case AAVLD jtcase@ucdavis.eduJune Rosploch KP june.rosploch@kp.orgKathleen Connor Fox Systems kathleen.connor@foxsys.comLee Coller Oracle Lee.Coller@oracle.comLen Gallagher NIST lgallagher@nist.govMead Walker dmead@comcast.netPavla Frazier NCI/MSD frazierp@mail.nih.govRobert Grant robert.b.grant@gov.bc.caRuss Hamm Mayo Hamm.Russell@mayo.edu X X XSandy Stuart KP sandra.stuart@kp.orgSarah Glamm Epic sglamm@epicsystems.comSarah Ryan HL7 sarah@hl7.orgTed Klein KCI ted@tklein.comPeter MacIsaac peter@macisaacinformatics.orgRobert Hausam Theradoc robert.hausam@theradoc .com Harry Solomon GE Harry.Solomon@med .ge.com

Jane Curryjanecurry@healthinfostrategies.com X X

Lloyd McKenzie HL7 Canada Lloyd@lmckenzie.com

Richard Thorenson SAMHSARichard.thorenson@samhsa .hhs. gov X

Francine Kitchen GE Healthcare Francine.kitchen@ge .com Rita Altamore WA DOH Rita.Altamore@doh .wa.gov

Paul KnappContinovation Services Inc pknapp@continovation.com

Stan Huff IHC/Univ of Utah stan.huff@ihc .com X X X X

Carol Mulder InfowayCmulder.infoaccess@on .aibn.co m

Rob McClure Apelon mcclure@apelon.com X X X X

Andrew PerryClinical Information Consultancy andrew@clininfo.co.uk X

Davera Gabriel davera@ucdavis.eduIan Townend Ian.townend@cfh.nhs.ukGeraldine Wade gwade@pol.netJohn Kilbourne kilbourj@mail.nih.govTim Williams SNOMED twillia@cap.org XMike Lincoln Michael.lincoln@va.govDan Russler Dan.russler@oracle .com Bob Davis NCHS/NAHDO rdavis@nahdo.org X X XMark SchaffarmanEd HammondHeather Grain Australia h.grain@latrobe.edu.au X X X XJim Campbell Campbell@unmc.eduGaby JewellSkirmantas Kligys Skirmantas.kligys@oracle .com Tom OnikiRichard Franck IBMMax Walker Max.walker@dhs.vic.gov.auCrystal Kallem AHIMA Crystal.kallem@ahima.org XPenni Hernandez Thomson Healthcare Penni.hernandez@thomson.com X X

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Scott Hollington KCI hollington@email.com X X XBeverly Knight Beverly.knight@procurement .ca X XMike Newman VA Michael.newman@va .gov X X X XCarmela Couderc Siemens carmela.couderc@siemens.com X X X X

Tom WhiteNY Office of Mental Health tomwhite@omh.state.ny.us X

Vivian Auld NLM auld@nlm.nih.gov X XTom Oniki IHC Tom.oniki@intermountainmail.org XDavid Markwell CIC david@clininfo.co.uk XMary Kennedy SNOMED mkenned@cap.org X X X XBhavana Patel InfoWay bpatel@infoway-inforoute.ca XKathy Giannangelo AHIMA Kathy.giannangelo@ahima.org X X X

Tuesday Q1Chair: Cecil LynchScribe: Ted Klein

We decided that the binding document is the most critical piece to be completed, so we will usurp this quarter to continue work on that document. We will check the Wiki at Mayo for the open items on Datatypes to be ready for Q4 tomorrow with INM.

We continued to work through the binding document.

Lots of discussion on reuse of value sets and whether or not adding new codes means that you must define a new value set or not. Also discussion on ownership for maintenance of value sets, and versioning information around value sets.

The implications of the versioning decisions from Boca Raton must be brought forward for incorporation in the MIF – this is an action for joint vocab/MnM.

** break **

Tuesday Q2

Fixes to current Vocabulary ballot contentChair: Jane Curry Scribe: Stan Huff

1. Motion: That public facing documents (ballot reference materials, in the HDF, etc.) and in tutorial information we change the name of “vocabulary domain” to “concept domain”. This name will also be changed in CTS II. In current or new documents we will include a statement to indicate that “concept domain” was formerly known as “vocabulary domain” as an aid in

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interpreting previous versions of documents.3 Abstain, 9 in favor, 0 opposed.

2. Action item: Jane will update ballot reference information in the next ballot cycle based on a final version of the Value set binding document.

** break **

Tuesday Q3

Glossary and Assessment InstrumentsChair: Stan HuffScribe: Cecil Lynch

Tom White

Assessment Instruments

Tom presented a slide set (attached below) to prompt discussion and inform the vocab regarding the development and current status of assessment instruments and the standards gaps that exist.

Tom went over the current and planned future representation for questions of the assessment tool and the answers in LOINC. The answers would not be LOINC codes, but would have internal identifiers (Part No.) that could then be mapped to SNOMED. Tom also represented his analysis of the questions from MDS against UMLS concepts. He also showed the representation of an MDS question and answer in a 2.5 HL7 message and a version 3 (CCD) message. This approach has been approved by HHS.

Tom made a proposal that this should be an HL7 project proposal in order to facilitate the capture of domain expertise across a wide range of stakeholders. He outlined the areas that he felt should be addressed in such a proposal.

Stan stated that he supports the promotion of this as a project and felt that this would also be a good way to test the application for a project through the newly reorganized HL7 process.

MOTION: Tom White Proposed that vocabulary support a formal project to facilitate the creation of a balloted document that describes the HL 7 process for defining a survey instrument.

Jane offered a friendly amendment that it be the creation of an implementation guide instead of a balloted item.

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Jane second

Discussion: Should this be first discussed among the additional affected TCs and Sigs first

Vote For 12 Against 0 Abstain 4

Glossary Discussion: Bob Bishop presented the work he has been doing on the HL7 Glossary. The glossary is attached. There were discussions that the term definitions need to be specific to HL7 rather than a more general term. Heather stated that ISO world has a database that looks at definitions of these common terms and their definitions within specific contexts and that it would be helpful to have the HL7 glossary definitions include in that database as well.

Action: Stan will set up a separate conference call to further refine the glossary with Bob and others who respond to the list

Tuesday Q4 Chair: StanScribe: Cecil

2006-12-06 Vocab Call minutes.doc document was referenced to discuss the issue of post-coordination in value set definition. David discussed the issue of the fact that it was not a simple issue in that the representation may take multiple forms. There was then a discussion of whether so that it may be better to have a pointer to the terminology service that can compose the concept.

Motion Cecil: That there is a requirement for a method to specify a post-coordinated expression as a member within an enumerated value set.Second TedVote Abstain 5 Against 0 For 14

Discussion regarding the need to also have the ability to support the use case of providing a way to point to a “method” of defining a post-coordinated expression by rules and returning the expression as a member of an intentional value set.

Motion: Ted:Second: DavidWe have a requirement that we allow intensional definitions that specify the components of post-coordinated expressions. These definitions may be used to specify the membership of a value set.

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In other words, we want to be able to create rules that specify how components can be combined to create valid post-coordinated members of the value set.

An example would be a first component of “has laterality” and a second component would be all those body parts that can be lateralized and the third component is the laterality options (left, right).

Discussion:

There was an animated discussion of “what is a value set” and at least two view points.

Vote abstain 7 opposed 0 in favor 13 motion passes

Action item: We need to take up a discussion of the current value set definition.

Adjourn for the day at 5:20PM.

Wednesday January 10, 2007

Name Company Email

WednesdayQ1

Q2

Q3

Q4

Cecil Lynch UC Davis clynch@surewest.netLen Gallagher NIST lgallagher@nist.govRuss Hamm Mayo Hamm.Russell@mayo.eduTed Klein KCI ted@tklein.com

Jane Curryjanecurry@healthinfostrategies.com

Stan Huff IHC/Univ of Utah stan.huff@ihc .com

Carol Mulder InfowayCmulder.infoaccess@on .aibn.co m

Rob McClure Apelon mcclure@apelon.comIan Townend Ian.townend@cfh.nhs.ukGeraldine Wade gwade@pol.netJohn Kilbourne kilbourj@mail.nih.govTim Williams twillia@cap.orgMike Lincoln Michael.lincoln@va.govDan Russler Dan.russler@oracle .com Heather Grain h.grain@latrobe .edu.au Tom OnikiRichard Franck IBMLee Min Lau 3M leeminlau@mmm.comJaqui Parker Jaqui.parker@thomson .com Kasey Poon 3M kpoon@mmm.com

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Shaun Shakib 3M scshakib@mmm.comBetsy Smith FDA Elizabeth.smith@fda.hhs.gov Rob Hallowell Robert.hallowell@siemens.com John Hatem Oracle John.hatem@oracle.comKathy Giannangelo AHIMA Kathy.giannangelo@ahima.orgBhavana Patel InfoWay bpatel@infoway-inforoute.caDoris McGinness SNOMED dmcginn@cap.org Garry Cruickshank InfoWay g.cruickshanck@sympatico.ca Ani Vallabuanem Epic ani@epicsystems.comHugh Glover Blue Wave Hugh-glover@bluewave.com

Tom OnikiIntermountain Healthcare Tom.oniki@intermountainmail.org

Chenjian Che 3M cche@mmm.com

Brian Levy Health LanguageBrian.levy@brian.levy@healthlangage.com

Nancy Orvis DODStefan Baumann Novartis Stefan.baumann@novartis.com

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Q1 Wednesday No Meeting

Q2 Wednesday Joint with EHR

See EHR minutes

Q3 Wednesday Joint with MnM

See MnM minutes

Q4 Wednesday Joint with MnM

See MnM minutes

Thursday January 11, 2007

Name Company Email

ThursdayQ1

Q2

Q3

Q4

Cecil Lynch UC Davis clynch@surewest.net X X X XLen Gallagher NIST lgallagher@nist.gov XRuss Hamm Mayo Hamm.Russell@mayo.edu X XTed Klein KCI ted@tklein.com X X X X

Jane Curry Infowayjanecurry@healthinfostrategies.com X X

Stan Huff IHC/Univ of Utah stan.huff@ihc .com X X X XRob McClure Apelon mcclure@apelon.com X X XJohn Kilbourne NLM kilbourj@mail.nih.gov XTim Williams SNOMED twillia@cap.org X X XMike Lincoln VA Michael.lincoln@va.gov X X X XLee Min Lau 3M leeminlau@mmm.com X X X XJaqui Parker Thomson Healthcare Jaqui.parker@thomson .com XShaun Shakib 3M scshakib@mmm.com X X X XBetsy Smith FDA Elizabeth.smith@fda.hhs.gov X XRob Hallowell Siemens Robert.hallowell@siemens.com XJohn Hatem Oracle John.hatem@oracle.com XKathy Giannangelo AHIMA Kathy.giannangelo@ahima.org X X X XBhavana Patel InfoWay bpatel@infoway-inforoute.ca X XGarry Cruickshank TVHC g.cruickshanck@sympatico.ca XAni Vallabuanem Epic ani@epicsystems.com X

Hugh Glover Blue WaveHugh_glover@bluewaveinformatics.co.uk X

Nancy Orvis DOD nancy.orvis@tma.osd.mil XMary Kennedy SNOMED mkenned@cap.org XEd Cheetham NHS Ed.cheetham@nhs .net X X X XHeather Grain Standards Australia h.grain@latrobe .edu.au X X X

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Bob Bishop VHA Robert.Bishop2@med.va.gov X XBob Davis NCHS/NAHDO rdavis@nahdo.org XPenni Hernandez Thomson Healthcare Penni.hernandez@thomson .com X XCarmela Couderc Siemens carmela .couderc@ siemens .com X X X XVivian Auld NLM auld@nlm.nih.gov XTom Oniki IHC Tom.oniki@intermountainmail .org X XSukhyang Lee HL7 Korea slee@sdic.sookmyung.ac.kr X

Julie James Blue WaveJulie_james@bluewaveinformatics.co.uk X

Michael van Kampen GPIMichael.vankampen@gpinformatics.com X

Gina Dube First data Bank Gina_dube@firstdatabank.com XJoseph Baptist NICTIZ Baptist@nictiz.nl XTodd Cooper Dev Sig t.cooper@ieee.org XSusan Varghese Booz Allen Hamilton Varghese_susan@bah.com X XCraig Parker IHC craigparkermd@gmail.com XScott Hollington KCI hollington@email.com X XAnn Wrightson CSW Group Ann.wrightson@csw.co.uk XSteve Hufnagel MHS Stephen.hufnagel.ctr@tma.osd.m

il XSven Tiffe AGFA Healthcare Sven.tiffe@agfa.com XPratik Parikh Pratik Parikh Pratik.p.parikh@gmail.com XRavi Natarajan NHS Ravi.Natarajan@nhs.net XDiane Oliver Cerner dianeeoliver@comcast.net X XGB Kesarinath Northrup/CDC Gfk0@cdc.gov XJohn Koisch VA John.koisch@va.gov XKevin Kelly IBM Kevin.kelly@us.ibm.com XBarbara Eckman IBM baeckman@us.ibm.com XGalen Mulrooney VA Galen.mulrooney@va.gov XGregory Marinkovich DOD Gregory.marinkovich@tma.osd.m

il XKen Rubin EDS Ken.rubin@eds.com XGaby Jewell Cerner gjewell@cerner.com X X

Thursday Q1 Joint with Pharmacy Vocab HostingChair: Stan HuffScribe: Cecil Lynch

John Kilbourne discussion of FDA Delivery Device representation in RxNorm. Each device has a semantic type of “Drug Delivery Device”. No way at present to name devices that are coupled or prefilled with a drug such as Epi-pen. Gave examples of these types included in the attached slides.

5 major questions

1. What characterizes a DDD? They may all be vastly different.2. When is something really different and deserve a unique thing?The example was 21 day and 28 day pill packs where 7 are placebo or iron.

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3. Can we reliably distinguish the device by the name (fully specified, incompletely specified or not a DDD at all)?4. What are the parts of the normalized name for the DDD to represent it in RxNorm?5. What do we do about nested DDD where a kit contains another kit?

There was a discussion of how RxNorm works now. Works similarly to the UMLS Meta-thesaurus for concepts. See slides for further details.

DDDs all characterized by “containment” or “association”. Essentially defines whether the device stands alone or is a container for another device. John discussed a new way to name these various flavors of DDD, specifically acronyms like BDA for Branded Drug Delivery Device type A which describes a Type A of a DDD that contains another Device.

Time was short so the discussion was stopped at this point and there is a great deal more in the attached slides. (click on the icon below to open the presentation)

Representing ‘Drug Delivery Device’ concepts in RxNorm

January 2007

John Kilbourne MDNational Library of Medicinekilbourj@mail.nih.nlm.gov

Rob McClure presented the Working Group results on routes. He presented findings that there are some inconsistencies with RIM and Pharmacy messages. Current Route is actually a complex idea that contains several different ideas such as site method etc (see slides attached).(click on the icon below to open the presentation)

Developed a new Concept Domain called “Administrations for Medicinal Substances”.

Implications:Need a terminology model to support the more complex relations and identify a terminology. No identified existing terminology works so requires an HL7 developed terminology. This needs to then be harmonized with RIM requirements. AfMS terminology needs to be maintained and Pharmacy is asked to be the Steward for this terminology. Pharmacy has agreed to do this (act as Steward, and develop the model and terminology) and have support from FDA, NCI, SNOMED and others to aid in the process including future alignment.

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Pharmacy Action items

Create an HL7 Project

Vocab action Items

Asking for approval and participation and Rob suggested we use LexGrid for tooling. Will need volunteers to work on this. Stan volunteered.

Motion: RobSecond: Ted

The vocab TC approves and supports the decision by the Pharmacy sig to create a project that will develop and maintain a terminology for the administrations for medicinal substances to replace the current Route of administration table that has been found to be deficient.

Vote For: 23 abstain 5 opposed 0

Discussion: There was discussion that this effort should be coordinated with ISO 215 Group 6 so that the efforts are harmonized. It was pointed out that this is difficult due to lack of overlap in membership and access to ISO committees. Nancy Orvis recommended that we seek out the HL7 members that are in both ISO and HL7 so that this is directly communicated. Gary Cruickshank also stated that he follows the ISO meetings and will bring this up at the Montreal ISO meeting.

Next Item was whether there is a need for a joint meeting in Cologne. It was agreed that the need is there and will be Q1 on Thursday.

Next item discussed was that Ross Martin had brought forward to vocab the issues that there is a need to be able to add differentiating attributes to SPL.

Gary Cruickshank felt this could be added as an annotation. Stan pointed out this requires a coded terminology to meet the SPL use case that Ross brought forward. Stan pointed out that this was meant to be an introduction and not any finalized.

Meeting adjourned

Thursday Q2

Chairing: Cecil LynchScribing: Ted Klein

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Todd Cooper asked how an OID that exists in the registry can be superceded by different ones that the committee feels are more appropriate to be used by their constituency. Ted explained that they need to make a decision in their committee (devSIG) and send a notice to Ted and Cecil and we will flag, retire, and mark as superceded the entries appropriately in the OID registry.

Cecil presented the Marital Status codes project for Bob Davis. (Attached below)

Cecil presented the current state of the proposed marital status vocabulary list. One of the problematical items is ‘estranged’. Bob has a list of comprehensive definitions and will distribute it to the vocab list. For those things that appear to not really belong in a list, should there be some kind of mechanisms for modifiers for existing elements? It seems that it is clear that there are multiple hierarchies, and it might be best to have a basic ontology of a flat list, and avoid the hierarchies that seem to cause disagreement.

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Bob Bishop asked how this is referenced and we discussed the Realm binding to this value set, and the different procedures to bind to the Universal Realm or an affiliate Realm.

Ed suggested that he submit some of the UK concepts that he does not see any equivalents on the list, and Stan agreed that would be nice to do. Betsy would like to see better symmetry in the naming, and we agreed to send it out to the list for comment.

Motion by Stan: Tell Bob Davis that we support him developing this common list. Ted seconds. Vote on first motion: 11/0/1Second motion from Stan: we separate out the approval of individual items in the list from the hierarchical relationships of the items. Betsy seconds. Stan wants to withdraw this motion and change it to a general vocabulary committee policy. New motion: For all new proposed HL7-maintained code systems, we separate out the adoption of hierarchies from the adoption of the members of the code system. Betsy seconds. Vote: 13/0/0 revote after wording correction post policy adoption: 12/0/0

There was a discussion of whether or not HL7 should be defining and maintaining hierarchies in the HL7 defined and maintained code systems. There was general agreement for a policy to avoid troublesome hierarchy adoption.

We embarked on a discussion of a policy for relationships and their use and maintenance within the HL7 tooling and processes.

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Proposed policy wording:When considering creation of relationships between members of HL7-maintained code systems, HL7 should identify whether the relationships are universal in nature for HL7’s purposes, or whether the relationships are Realm or Use Case specific. HL7 should only create and maintain those that are deemed Universal and useful to the HL7 community. Other relationships should be maintained in other places, such as external terminologies.

Stan moves that we adopt this as Vocabulary Committee policy. Shaun seconds. During discussion Bob identified that we need a better way of publishing and accessing policy documents. Vote: 12/0/0

As a consequence, we need to revisit the previous motion.

Thursday Q3

Chair – Ted KleinScribe – Stan Huff

1. Conference calls: We will continue with every two week schedule. Begin on Wednesday January 24 at 3:00 pm Eastern time. April 18th would be the last call before the WGM in Cologne.

2. CDC announcement – Thursday Jan 18th Webinar demonstration of the CDC Vocabulary Maintenance and Distribution systems

3. Co-chair elections: Chris Chute’s term is up and he has decided not to run for re-election. Candidates: Russ Hamm, Heather Grain (write-in candidate). Russ Hamm was elected as the new co-chair for a two year term.

4. HSSP – Healthcare Services Specification Projecta. HL7 Service Oriented Architecture SIGb. OMG Domain Task Forcec. See slides from Ken Rubin (link below)

5. CTS – Russ Hamma. HL7 will produce Functional Specificationb. OMG – will produce the API, one and only one API per platform.c. Originally, CTS II was to be an extension of CTS. Now we are

making a functional specification that should cover CTS I, but the exact API will be determined by the OMG RFP process. Insuring

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that the CTS II API is backwards compatible with can happen by 4 mechanisms:

i. Mandatory requirements, interfaces that are backwards compatible,

ii. Vendors MAY support backwards compatibilityiii. Evaluation criteria that stipulates higher evaluation for

backwards compatibilityiv. Issues for discussion that would address how the interface

would relate to backwards compatibility.d. Proposal is to use LexBIG model as a springboard to get a head

start on use cases and requirementse. Motion: The Vocabulary TC will follow SOA SIG - HSSP process

as proposed for developing CTS II. Moved: Stan/Galen. Vote: 28 in favor, 0 opposed, 2 abstain.

f. Motion: The Vocabulary TC will adopt the LexGrid resources as a starting set of use cases and requirement as the basis for CTS II. There is no requirement that LexGrid APIs or functionality must be preserved. Stan/Galen. 12 in favor, 5 opposed, 13 abstain.

Thursday Q3

Chair – Stan HuffScribe – Ted Klein

Topic: This was originally booked to be joint with Conformance, but they do not have anything to discuss so we have the time back.

Some discussion has continued from the previous quarter on the final vote to use LexGrid as a starting point for the CTS2 work. It was pointed out that LexGrid is actually in use currently, and also some concern that this may limit what CTS2 covers. Stan asserts that there is no desire to limit the work that the committee does, just to get further along by starting with LexGrid functionality.It was asked that if CTS2 ends up being very different from OMG machinations, will this be an issue is ISO is expected to endorse CTS1 as an ISO standard. This is definitely something to worry about.

Continuing topic: value set binding document continued work. We got through the rest of the part one of the document except for the examples. We still need to go through part 2 of the document.

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