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MnM Minutes WGM 201501 SanAntonio

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Sunday Jan 18 Q3 - Finalize Agenda/Review Hot Topics


Jean Duteau, Chair/Scribe
Lloyd McKenzie
Austin Kreisler
Kevin Coonan
Katherine Duteau


  • Agenda Finalization
Tuesday Q1/Q2 will be cancelled
Friday Q2 will be cancelled
  • M&M Business
Brief discussion of FHIR and its relationship to RIM (in context of Care Plan resources)
MOTION: Josh Mandel and Ewout Kramer are appointed acting co-chairs for M&M for purposes of handling M&M FHIR business (Austin/Kevin) 4-0-0-

Monday Jan 19 Q2 - FHIR Methodology Topics


Lloyd McKenzie (chair), Gevity,
Jevery Ting, Systems Made Simple,
Il Kon Kim, KNU,
Pu Yun Lee, KNE,
Joon Hyun Song ZHIS,
Mike Henderson, OSEHRA,
Peter Antunn, Interfaceware,
Prashant Trivedi, NHS,
Bill deBeaubier, Systems Made Simple,
Isaac Vetter, epic,
Cecil Lynch, Accenture,
Craig Parker, IHC,
Kevin Harbauer, Healthwise,
Cosmo Difazaro, Systems Made Simple,
Gaby Jewell, Cerner,
Brad Arndt, Cerner,
Puneet Nagpal, Web MD,


Reviewed the following tracker items:

Wednesday Jan 21 Q1 - M&M FHIR Vocabulary Joint Session


Jos Baptist, Nictiz,
Jim Case, NLM/NIH,
Heather Grain (scribe), eHealth Education,
Peter Hendler, Kaiser Permanente,
Wendy Huang, CHI,
Ted Klein, KCI,
Lloyd McKenzie (chair), gevity,
Rob McClure, NLM/ONC,
Bill deBeaubier, Systems Made Simple,
Frank McKinney, independent consultant,
Bertil Reppen, HL7 Norway,
Paula Frazier, ONC,
Michael Donnelly, Epic,


How FHIR uses vocabulary – FHIR defined vs….externally-defined vs structural codes

Does HL7 want to have a single terminology name space across all of our content or not? The answer is yes, though we know that this might be challenging. FHIR can support this but needs to reach the normative stage. It won’t happen immediately. Vocabulary need to think about what it means to maintain a single namespace for code systems and value sets for all HL7 products.

The benefit of terminological naming across the organisation is there appearance of having our act together for those who don’t know better. Having the names the same with different value set content is often an issue. The ability to reduce the number of artifacts we maintain and increase consistency where this is viable. There is a need to be consistent and identify clearly where there are variations. What we are asking for is to have a closer alignment with FHIR, though the cat is already out of the bag.

FHIR have flexibility until they go normative. Lloyd didn’t think that it was essential that we use the same codes from the same code system and from a technology perjspetive it will be very difficulty to achieve that due to the differences in methodology between V2, V3 and FHIR. However we can come to a place of formal relationship between concepts between the products where there is a need to be different.

The multiple product space presents a lot of choices. FHIR is able to put some energy into this. IN DSTU2 nothting with change but we can use the time while in DSTU to consider tools and processes to manage the terminology harmonization more effectively.

When a code system or value set are needed by FHIR the following hierarchy of preference for code systems is used:

  1. external international code systems
    external code systems available internationally
    hl7 defined code systems, specified by example
    FHIR defined codes – take it up to the HTA – is there one of these within SNOMED CT, LOINC etc.

Profiles are provided and referenced from Resources tab, in the infrastructure the conformance area provides access to value set, naming system and concept maps. When Start at FHIRE and choose continuous integration build ( – sends you to from this point choose resources, scroll down to find value set, naming system and concept

For terminology services select resource and select terminology server from under the terminology heading.

Every resource page – propose a change (at the bottom of the page – you need a gforge tracker and you need to login.

Formal view of profile content example is at: [1]

FHIR Terminology Service

FHIR is a terminology service is described at The terminology service includes concept map and value set information including instructions for value set expansions, Concept lookup and validation are also included. Instructions for subsumption testing is also included.

FHIR Core WG relationship – artifacts (resources, data types), value sets

MnM provides guidance to WGs on modelling best practice including FHIR. The FHIR Core Work Group could be designed similarly to the way MnM functions within HL7. The difference is that MnM doesn’t own any components of V3. From a governance perspectives you don’t want a group defining the rules for what an artifact looks like being responsible for defining an artifact. FHIR Core Work Group defines methodology group, management group which is responsible for coordination of work activities and content, and ballot timing and resource creation management and responsibilities. Governance group sets objectives and high level precepts upon which everything else is based. None of the governance level structures do the work. The purpose of the core work group is to produce artifacts, particularly core infrastructure artifacts such as definition of what is a resource, value sets, conformance, what is a bundle etc. This group functions under FHIR Management Group, MnM etc in the same way as other content development groups. This is similar to Vocabulary, where the methodology is defined, rules and policies and practices are defined by Vocabulary. Vocabulary also has stewardship of common components and publishing considerations to manage.

In V3 you have all artefacts, RMIM’s etc and the MIF is in another corner. In V2 you have published pdf pages with tables and codes. The method of sharing data in V2 is not the format in which it is distributed. In FHIR the publishing, distribution, value set resource etc are balloted in the same manner as all other artifacts.


Wednesday Jan 21 Q2 - M&M FHIR Vocabulary Joint Session


Jos Baptist, Nictiz,
Nicolas Canu, L'atelier du Soft,
Jim Case, NLM/NIH,
Heather Grain (scribe), eHealth Education,
Rob Hausam, Hausam Consulting,
Peter Hendler, Kaiser Permanente,
Ted Klein, KCI,
Lloyd McKenzie (chair), gevity,
Rob McClure, NLM/ONC,
Sandra Stuart, Kaiser,
Frank McKinney, independent consultant,
Bertil Reppen, HL7 Norway,
Paula Frazier, ONC,
Michael Donnelly, Epic,


Revisit harmonization and V3 maintenance

How do we do QA on FHIR Vocabulary

Grahame and Lloyd have talked about a process of open review, rather than harmonization. The basis is to achieve collaboration and consistency where relevant. The band width to progress this is an inhibitor. There is a strong opinion on FHIR side that v3 harmonization process doesn’t make sense for FHIR and Vocabulary are in general agreement.

There is some motion to look at a single source of truth for persistence and publishing of all HL7 vocabulary. The CTO wants this to happen and some of the preparatory work has been done, including clean up and migration work has occurred. FHIR will be expected to join this process at some point.

FHIR already makes available the FHIR terminology, selected subsets of version 3 value sets and V2 content. Technically it would be feasible to expose the full V3 vocabulary in that process. As far as CDA gets captured in Trifolia exposing that would be a low bar to achieve as well. From a technical perspective using the FHIR terminology service which is more than half build and populated could be a short cut to get projects associated with vocabulary clean up and single source. The functionality includes voting capacity components.


  • From a read only perspective – here’s our stuff, some of it sucks to bad for you – this could be easily done. Exposing this material may make it clearer that there are difficulties with the content. A single place with a computable interface would make it easier for those with time and bandwidth to discover and recommend modifications. The expectation would be that this would be a read only repository with write access from the source of truth through publications.
  • It could move to be the source of truth
  • VSAC is also producing similar tooling. FHIR could have an interface in VSAC which could provide information to that tooling. We need a place where we can expose, warts and all, all that we have and encourage more eyes and resources to manage the curation of the content.

Lloyd would be comfortable with curation in VSAC if it was clearly international rather than US-centric. NLM would like to see VSAC used broadly, with the proviso of licensing requirements. Would UMLS host the Australian, Japanese, Chinese etc. content requirements?

There are structural codes which all people have to use, there are also common value sets to which you should map. There are also issues that VSAC cannot currently support group based entries but this is being considered.

The option for a Project Scope Statement is needed for definition of the process for quality management of FHIR resources such as code systems, value sets and namespaces was discussed.

New Project

Vocab co-sponsored by structure doc and MnM – definition of the management of value sets across HL7 products. This project has a technical component including: FHIR already have a project for the registries. Collaboration – how do you want to access it, query, subscribe.

Action: Rob McClure to bring this to Vocab discussions tomorrow.

Vocab own and Mnm co-sponsor

FHIR already have a project associated with set of FHIR registries are in development which include value set content. This experience through terminology connectathons will inform the project defined above.

Clean-up of ActRelationship – RIM as an ontology?

It is difficult to know which structural vocabulary has been used in a given situation. The absence of required realm specific models means that we don’t know if the model is broken or not when these are used.

This could be simply a theoretical problem as if we make changes to the terminologies now we could break things, but you might find problems so late that it is not possible to roll back and fix the problem. There was a serious redesign of ActRelationship type which has improved it but it is known not to be perfect but is functional. We should touch the structural components when a major inhibiting outcome occurs. As there is no current central repository to identify who has implemented our content so we can’t notify people of potential impacts to them.

FHIR impact – if the RIM was a strong and robust ontology it would assist FHIR functionality but it would probably require a complete new version of the RIM. This need is not strong. The tools are not yet able to cope with significant change. This is not urgent at the moment. Lloyd suggested leave the RIM largely as it is. When people come who have identified change this request will be reviewed considering the business case.

Moved Ted Klein, Seconded Rob McClure that the Structural Vocabulary content of V3 should only be changed if there is a strong and compelling business case to do so (blocking functionality, or causing significant impact to implementations). When a change is agreed upon a communication strategy must be prepared in association with any such changes.

Vote: For 14, Abstain 1, Opposed 0 Motion Passed

Vocabulary FHIR change proposals

The meeting went through the current project tracker system to identify vocabulary positions on FHIR related work items. The items discussed include: Ensure that all FHIR value sets meet VSD minimum requirements (approved by Vocab) Add batch mode for translate functions (ability to batch process translation requests – note: translation is used or mean map or translate. This is currently one code in and one code out (simple map without individual map equivalence specification). Equivalence is able to be specified but was not shown in the output – it was requested that it be included. Need to be able to indicate more than one target which is now handle by being able to use codeable concepts rather than code values. (Vocabulary agree – moved HG seconded SS)Make change to translation operation to change the cardinality of the code system version, and coding and codeable concept and outcome parameters to be 0..* instead of 0..1.and update documentation to reflect requirements. Changing data type on the outcome because in some cases there might be more than one translation for a given source code. The documentation needs to also indicate that this process includes concept translations such as maps rather than language translations. – Moved Jos and seconded Sandy S.

Vote: In Favor: 14, Abstain 1, Opposed

Any string may have a designation which is in a different language.

Thursday Jan 22 Q1 - FHIR Methodology


Rik Smithies, HL7 UK,
Paul Knapp, Knap Consulting Inc,
Peter Bernhardt, Relay Health
Ilkon Kim, KNU,
Gaby Jewell, Cerner,
Jason Mathews, Mitre,
Daniel Loewenstein, Epic,
Joon Hyun Song ZHIS,
Isaac Vetter, epic,
Dave Shaver, Corepoint,
Lloyd McKenzie (Chair), Gevity,


Reviewed the following change proposals:

Thursday Sep 18 Q5 - Facilitators Roundtable - Joint with Vocab, FHIR


Jean Duteau, M&M, Chair/Scribe
Kevin Coonan, EC
Ted Klein, Vocab
Sandy Stuart, INM
Paul Knapp, ITS
Brian Postlewhaite, PA
Alexander Henket, PA
Pat Van Dyke, EHR
Mark Roche, StructDocs
Andy Stechishin, Publishing
Ewout Kramer, FGB
Kathleen Connor. Security/CBCC/FM
Hugh Glover, Pharmacy
Lloyd McKenzie, M&M/FMG
Joginder Madra, PHER
Wendy Huang, PA
Rob Hausam, O&O
Calvin Beebe, StructDocs
Katherine Duteau, PHER


  • Harmonization Schedule Report
Initial Harmonization Deadline - February 1, 2015
Technical Review will be Feb 2-5, 2015
Final Proposal Deadline - February 22, 2015
Harmonization Meetings - March 3-5, 2015
Motion: Accept the harmonization dates as written above. Andy/Kevin 18/0/0
  • Committee Reports
BRIDG - Balloting v4 of the model in May 2015. They are also reshaping and determining what features/mappings it needs to relate to the rest of HL7, eg. RIM, FHIR
PC - With a DAM being completed, determining what next. In the past, a DMIM and RMIMs would be created, but unsure in the new environment how to move forward. Further discussion was deferred to the M&M List. Patient Care was told that they "cultivate" a resource and need to know what that means. A new term will be chosen and the FMG will clarify the difference between owning and "cultivating".
Vocab - CTS2 and TermInfo passed ballot and will be published. ValueSet Definition project passed ballot and are reconciling. Dealt with issues with external vocabularies (eg. SNOMED) and the IP issues. A lot f work on a common set of vocabulary across all artifacts.
Security - Proposals: One set of codes for Trust vocabulary. One for ParticipationFunction (out of CBCC).
O&O - Two harmonization proposals: cleanup on interpretation code system, NullFlavour codes.
StructDocs - One discussion proposal for Harmonization - use one version of the RIM and a different version of the RIM vocabulary. Will bring the item to M&M and Vocabulary before the Harmonization meetings.
FMG - Lots of reconciliation was done by the committees! There were issues with GForge and FMG will reach out to EST about these issues. Workgroups have indicated that they are comfortable with the stated deadlines. O&O had some concerns and FMG will be working with O&O on priority and assistance.
  • M&M Wrap up - Did FHIR reconciliation of methodology and datatype issues. With the recent trend of M&M meetings at WGM and the apparent lack of v3 modelling, M&M will be refocusing on its methodology work.