MnM Minutes WGM 201301 Phoenix

From HL7Wiki
Jump to navigation Jump to search

Return to MnM Minutes for 2013

Sunday Jan 13 Q3


Woody Beeler, Doug Fridsma, Hugh Glover, Grahame Grieve, David Hay, Alexander Henket, Austin Kreisler, Virginia Lorenzi, Lloyd McKenzie, Zoran Milosevic, Brian Pech, Vin Sekar, Mead Walker, Jean Duteau


Establish Agenda for WGM from Hot Topics and FHIR Methodology Needs


  • Selected "Identifiers related to Social Media" and "Uncertainties around Procedure" for discussion in session on Q2 Thursday.
  • Discussed Need for M&M Co-chairs to address the question of MnMs directions with regards to "new" Methodology Responsibilities. Will address at Lunch on Wednesday
  • Verified Needs of FHIR for Methodology Sessions and Ballot Reconciliation Sessions and assigned these through the schedule.

Final Agenda was posted on Gforge and circulated by e-mail Sunday evening

Monday 1/14 Q1


  • Andy Bond (
  • Nat Wong (
  • Woody Beeler (
  • Rik Smithies (
  • Alexander Henket (
  • Ewout Kramer (
  • Grahame Grieve (
  • Dave Shaver (
  • Yukinori Konishi (
  • Sakamu Takasaka (
  • Andrew Liu (
  • John Moehrkhe (
  • Paolo Russian (
  • Saul Kravitz (
  • Alex Zupan (

FHIR - Define Principles and Methodology Implications of:

Must Understand

After a discussion of the way mustUnderstand works, the following recommendations were made:

1. “mustUnderstand” should only be declared on an element whose meaning would reasonably affect the meanings of parent or peer elements. 2. It does *not* indicate any expectation that mustSupport is true for the element, nor should it be used a general purpose importance flag

The name "mustUnderstand" was discussed, and the subject was tabled on the basis that the name, definition and implications of mustUnderstand will be revisited subsequently (along with mustSupport).

Adopted: Grahame/Rik 15-0-0

Interversion Compatibility

  • Let people know that we are trialing inter-version compatibility during the DSTU process
  • No guarantee of consistency between DSTU versions while we work this out
  • expectation of breaking changes between DSTU and Normative edition
  • we will clarify the methodology implications through the DSTU process
  • FHIR project team will draft working guidelines to test through that process

Adopted Grahame/Ewout 15-0-0

Default Values

  • Default values are to not supported by the FHIR methodology
  • if an element is labeled mustUnderstand, and the value is not explicit in the instance, or known by the context, the resource cannot be understood
  • implementation guidance may need to discuss appropriate behavior in the context of absent values

Adopted: Grahame / Zoran 15-0-0

Element Naming Policies

Meeting adjourned at 10:30 with no time to consider element naming policies

Monday 1/14 Q2


  • Andy Bond (
  • Woody Beeler (
  • Zoran Milosevic (
  • Rik Smithies (
  • Alexander Henket (
  • Grahame Grieve (
  • Dave Shaver (
  • Yukinori Konishi (
  • Sakamu Takasaka (
  • Andrew Liu (
  • John Moehrkhe (
  • Paolo Russian (
  • Saul Kravitz (
  • Alex Zupan (

IHE-related issues

Motion: 1. That a number of resources that are part of FHIR and owned by HL7 be identified as subject to shared management by IHE and HL7 2. These resources must enable the implementation of designated IHE profiles 3. Ballot disposition actions are not able to take actions inconsistent with this agreement 4. HL7 will publish a FHIR profile along with the resource that describes their use to implement IHE profiles 5. The resources will be balloted by HL7 using the standard process, though IHE menbers have the right to vote on these resources

This motion was referred to the FHIR management group for consideration.

In addition, a number of FHIR ballot comments were resolved: 661-664, and 670

Tuesday 1/15 Q1


Alexander Henket, Lloyd McKenzie, Rik Smithies, Jean Duteau (chair), Jackie Mulroney, JP Systems

FHIR Ballot Issues

Ballot Reconciliation of FHIR Methodology issues

Tuesday 1/14 Q4

SAIF Artifact Definition Project

Deferred to SAIF Project Meeting Wednesday Q4. Session Cancelled

Wednesday 1/16 Q1


Achilles, Tanya
Beeler Jr, George (Woody) (Beeler Consulting LLC)
Besho, Ornela (American Dental Association)
Cannady, Patrick (American Dental Association)
Case, James (National Library of Medicine)
Couderc, Carmela (Siemens Healthcare)
Grain, Heather (Standards Australia, eHealth Education)
Hamm, Russell
Hausam, Robert (Hausam Consulting)
Huang, Wendy (Canada Health Infoway Inc.)
Klein, William Ted (Klein Consulting, Inc.)
Liu, Andrew (HL7 Canada)
Macumber, Caroline (Apelon, Inc.)
Scichilone, Rita (American Health Information Management Association)
Smith, Daniel (Apelon, Inc.)

Host Joint with Vocabulary - Agenda

  • Harmonization
  • IHTSDO Terminology Authority
  • Core Principles Binding IDs for Code Systems & Value Sets (Discussion deferred for lack of time)

Agenda Approved, Klein/Huang Unanimous



Practice of simplified proposals acceptance with subsequent (to the harmonization Meeting) clean-up really posed problems for one set of proposals. (All from single source and included complex hierarchies and concept content.)

The Technical Review might have been used to set this aside. Attempted after the review to help, but this was not possible.

Related question could be raised in Technical Review. Such as, where/how should proposals be split? Might the structure be reviewed first? Should the scope be reduced?


  • Provide the Technical Review earlier in order to have advance time to respond
  • If Technical Review finds significant problems, add a way to authorize M&M and/or Vocab Co-chairs individually to declare the final submissions "Not ready for Review". (Could be appealed at the Harmonization Meeting.)
  • Allow Technical Review to require splitting of proposals along lines that Technical Review determines.
  • From recent ANSI audit, need to better document approvals and administrative data that document actions of proponents, Technical Review, and the Harmonization Meeting.
  • Authorize M&M and Vocabulary Co-chairs (at least three co-chairs and at least one from each Work Group) to approve and undertake "Technical Corrections". (A "Technical Correction" is undertaken to assure that the final representation is the same as that which was originally approved.)

Motion from Klein to have the recommendations above documented and implemented in Harmonization. Second: Hamm. 13-0-0

Discussion - Might we improve this by providing support to the Work Group in advance? Response: Has been done, and can be done, but constraints include availability of time to assist and communications. Discussion of process and check lists.

IHTSDO Terminology Authority

Revised the draft ITA. Case moved, Klein to approve those changes. 13-0-0

Wednesday 1/16 Q2


Beeler Jr, George (Woody) (Beeler Consulting LLC)
Besho, Ornela (American Dental Association)
Cannady, Patrick (American Dental Association)
Case, James (National Library of Medicine)
Couderc, Carmela (Siemens Healthcare)
Coyle, Joey
Glover, Hugh (Blue Wave Informatics)
Grain, Heather (Standards Australia, eHealth Education)
Hamm, Russell
Hausam, Robert (Hausam Consulting)
Henderson, Mike (Eastern Informatics, Inc.)
Henket, Alexander (HL7 Netherlands)
Huang, Wendy (Canada Health Infoway Inc.)
James, Julie (Blue Wave Informatics)
Klein, William Ted (Klein Consulting, Inc.)
Langford, Patrick
Liu, Andrew (HL7 Canada)
McKenzie, Lloyd (HL7 Canada)
Milosevic, Zoran (Deontik Pty Ltd)
Peytchev, Vasil (Epic)
Stechishin, Andy (CANA Software & Services Ltd.)
Wang, Lijun

Host Joint with FHIR and Vocabulary

Methodology Issue

When is it appropriate for FHIR to assert "UV" bindings to terminologies? In FHIR coding can be done three ways:

  • Code (CS)
  • Coding (CV constrained)
  • Codable Concept (CD).

For these, can bind to either

  • Code list - flat list implicit definition of code system and concepts
  • Concept Domain -
  • Value Set

Binding may be a binding to UV bindings, and Code list is implicitly a UV binding. Thus may wish to constrain use of CodeList and binding to a specific ValueSet.


  1. The “code” data type (equivalent to CS) should only be used when the data element forms an essential part of interpreting the meaning of the resource, such that safe processing would be impossible without it. I.e. the element must be “mustUnderstand” or the element is a part of the FHIR infrastructure and has no clinical or business meaning
  2. Value set bindings will not be marked as “required” for CodableConcept elements at the Resource level unless a context binding in the universal realm already exists in v3 terminology
    1. We can’t make implementers non-conformant just because for jurisdictional policy or legacy reasons they’re unable to express data in a particular code system
    2. Profiles are the solution to tighter terminology
  3. If a Concept Domain is context bound in the universal realm at HL7, the equivalently RIM-mapped FHIR elements should be bound to the same value set (within the constraints of backward compatibility rules, approval cycles, etc.)

Motion: Vocabulary and MnM endorse this as part of FHIR Methodology: McKenzie/Henderson 14/0/3

Ballot Reconciliation

FHIR Item 152 - Klein/McKenzie 17-0-0
FHIR Item 491 - Couderc/Milosovic 18-0-0
FHIR Item 506 - Addressed first portion with following motion; second portion found Persuasive with Mod; third portion asked & answered; fourth portion answered with a rationale. Couderc/Stuart 18-0-0
FHIR Item 477 - Couderc/McKenzie 18-0-0

Discussion on allowing to use URI

as an identifier for Code Systems and Value Sets.

Rambled a bit but...

Motion: Begin another ballot process to update Core Principles to identify URIs as an allowed mechanism to identify Code Systems and Value Sets

Klein/McKenzie 18/0/0

Wednesday 1/16 Q3


David Hay, Alexander Henket, Lloyd McKenzie, Zoran Milosevic, Grahame Grieve, Nandan Shanbhag, Nat Wong, Rob Hausam, Andrew Liu, Mike Henderson, Richard Kavanagh, Ewout Kramer

FHIR Methodology

Default Values


Thursday 1/17 Q1


Lloyd McKenzie, John Harvey, Ewout Kramer, Leslie Sistla

FHIR Ballot Reconciliation

Thursday 1/17 Q2


  • Zoran Milosevic (
  • Grahame Grieve (
  • Tom De Jong (
  • Alexander Henket (
  • Leslie Sistla (
  • Lloyd Mackenzie (

V3 Hot Topics

Identifiers related to Social Media

Discussion about Social Media

RIM Modelling

  • Sharing of information from one to another is an inform act
  • Speaker is the performer
  • who they are communicating to is the receiver of the act
  • the author might be someone else or the performer
  • the conversation is wrapped in an Encounter
  • Lloyd repudiates his previous comments with "I am not convincing to me at this time"
  • Tom will draw a model snippet & consult Clinical Statement


  • If you want to use an URI as an identifier in an II data type:
<id root="2.16.840.1.113883.4.583" extension=""/>

Uncertainties around Procedure

  • within the constraints of CDA, you should use the approach used in C-CDA
  • The preferred solution is to fix actionNegationIndicator so it's not immutable the default value is false not null
  • this will require a RIM harmonization proposal - this was referred to Kai by Alexander
  • Tom takes an action time to find out whether the difference between "I did not prescribe X" and "I asked for X not to be used"

FHIR ballot Reconciliation

ballot reconciliation was performed

Thursday 1/17 Q5


Woody Beeler (MnM), Dale Nelson (ITS), Ted Klein (Vocab), Rob Hausam (SD), Andy Stechishin (Tooling), Hugh Glover (Pharm), Julie Glover (Pharm), Wendy Huang (PA), Alexander Henket (PA), Lloyd McKenzie (MnM), Ewout Kramer (FHIR), Grahame Grieve (MnM), Lorraine Constable (OO), Joginder Madra (PHER), Mead Walker (PatSafety/RCRIM), Jean Duteau (MnM), Abdul-Malik Shakir (CIC)

Facilitators Round Table

Harmonization Dates for 2013

It will be some set of dates between March 7-15 due to HIMMS and Ed Summits.

  • ACTION: Woody will come back with a definitive set of dates

Round the Table

  • Dale(ITS):R2B Ballot Reconciliation is complete. Will be publishing next.
    • ACTION: Woody will follow up with ITS on the R2B Implications to the Generator.
  • Ted(Vocab):Cleaned up some projects. Cleaned up some OID issues - still have some left. Discussed the TSC comments on the Terminology Authority. Two projects working with Tooling - evaluation of the IHTSDO Workbench as a tool to apply the harmonization approvals to the repository; evaluation of the content request mechanism from the NLM. Version 2 Tables Cleanup is making great progress - issues are being brought back to the relevant committee and should be reflected in v2.9. ANSI Audit was held and the Harmonization 2010 cycle was reviewed and there were some major concerns raised. FHIR and CTS2 are using URIs to identify vocabulary, so there will be a reballot of Core Principles to allow URIs to be a valid means of identifying vocabulary objects. Use of MAY, SHOULD, SHALL in Structured Documents Templates was discussed. Use of Negation in vocabulary versus explicit modelling. Discussions around CTS2 - Mayo Clinic and PHAST are building implementations of CTS2. SD has been using TermInfo rules for validating value sets.
  • Rob(SD):Harmonization Proposals: HQMF - one or two, CDA R3 - many proposals.
  • Wendy(PA): Harmonization Proposals: two to support existing HL7 V3 registry topics. Reviewing all of the currently balloted topics.
  • Lorraine(OO): Harmonization Proposals: 20 proposals for Nutrition Order. FHIR Work, Nutrition Order, Lab Specimen Model
  • Joginder(PHER): v2 work, OASIS project mapping to v2/v3. Harmonization Proposal: one proposal
  • AMS(CIC): CV Imaging DAM, Trauma DAM will be balloted. Questions about the DAM Style Guide they produced. Issue about additional diagrams for DAMs and how we would present those. Data Element relationships with FHIR.
  • AMS(Education): Question about methodology training project - it is still in the planning stages.
  • Ted(Security on behalf of Kathleen): There is a list of things that were not completed in the last round that will be bringing them forward.
  • Woody(MnM): Core Principles R2 will complete reconciliation shortly. R3 might be considered but not for the May ballot cycle.
    • MOTION: Ballot RIM Release 6 in May ballot cycle (Woody/Grahame) 15-0-0
  • Lloyd(MnM): Provided an overview of the MnM meetings that were held. See presentation.
  • Grahame(FHIR): FHIR has transitioned to where the committees are now producing resources. Balloting Schedule - will be balloting DSTU in September 2013 with a second DSTU ballot if needed. Committees will need to get complete resources into the specification within the published deadlines. Committees should expect to get comments back from the Connectathons. There will be a means to publish resources that are not DSTU. Person has been removed as a resource.

Friday 1/18 Q2


Tentative List - Use or Delete: Woody Beeler, Doug Fridsma, Hugh Glover, Grahame Grieve, David Hay, Alexander Henket, Austin Kreisler, Virginia Lorenzi, Lloyd McKenzie, Zoran Milosevic, Brian Pech, Vin Sekar, Mead Walker

Agenda Planning for May 2013 WGM in Atlanta