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2018-04-14 Learning Health Systems Call

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Facilitator Russell Leftwich Note taker(s) Emma Jones
Attendee Name Affiliation

X Russell Leftwich InterSystems
John Roberts Tennessee Department of Health
X Stephen Chu Individual
Evelyn Gallego ONC
X Kathy Walsh LabCorp
Asim Muhammad Philips Research Europe
Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
Jeff Brown Cancerlinq
X Lisa Nelson Individual
Dave Carlson VA
X Chris Melo Phillips Healthcare
X Michelle Miller Cerner
Benjamin Kummer Columbia University
Matt Rhan
X Michael Padula
Joseph Quinn
Thomson Kuhn
Rob Hausum
Serafina Versaggi VA
Ann Whiz
Kathleen Conner
X Bridget McCabe
Lisa Gonzalez
Bridget Burke
X Claude Nanjo


  • Chair: Russell Leftwich
  • Scribe: Emma Jones
  • Motion to approve Feb 28 call minutes: Stephen moved ,Emma second

Agenda SNOMED codes for starter value set

  • Care Team Member SNOMED codes we did not find - report out
  • Russ met with Rob McClure
    • Dead line in July for SNOMED International. US deadline is April 5th
      • Will have to go through HTA (HL7 Terminology Authority)
      • Submitting to the US will go quickly with draw back of not being available internationally
        • Go thru with the US SNOMED submission then elevate it to the international
        • Use the NUCC codes and create an HL7 value set for the codes that are not available in SNOMED. Suggestion to not use NUCC because the codes are different
        • Create an entire value set in SNOMED. Ultimately, HL7 need to stop having value sets where one set for CDA and one set for FHIR. If creating an HL7 value set, we have agreed that there will be onesingle value set

for both FHIR and CDA.

      • How does FHIR handle value set QA guidelines section 4 - only use FHIR defined codes when no external code system exists. Code elements (that are not codeable concents) terminology should be HL7 controlled.
      • Based on Michelle's explanation will be best to have the SNOMED started set. Value set being created is for the function on the care team - like the quarterback, halfback. CareTeam participant role is

bound to participant role.

      • tracker 12509 already exists - will update it with the new values for participant.role
      • Started value set have concepts like treating physician and admitting physician, etc.
      • Extensible - may need to add to the change request. But note the binding to SNOMED as preferred but not too tightly by making it required because other countries may not have SNOMED license.

CIMI Modeling discussion followup - Claude Nanjo

  • CIMI will do a recording the introductions he provided last week.
  • Sart today's follow up by reviewing one of the story boards that will be used to start the modeling. Claude will select a storyboard and send the select one to the group
  • Continue presentation from "Composition enables reuse" - this renders how all the pieces come together and makes it look similar to FHIR.
    • CIMI defines the re-usable components and re-usable structure when the component get re-used
    • CIMI core informational unit is a clinical statement. Clinical statement has topic and context. topic aligns with things in SNOMED. Context is bioligical - like moodcode and negation representation in V3
    • Knowledge entry can represent context. Composition reuse enable consistency across content representation.
    • CIMI tries to distinguish the differences between the thing itself, the topic (the ordering of the prociedure) and the context.
    • wanted to avoid negationInd because it's too easy to miss it. Does a commection of absence attributes.
    • Stopped at Binding semantics to clinical patterns. CIMI does not have a notion of a care team - need to model that.
    • Important for CIMI to define the high level classes as the core level and leave the lower level to later.