Ted Klein Klein Consulting Informatics LLC Unified Terminology Governance Project Overview for TSC Health Level Seven International (HL7) May 6, 2017 Madrid, Spain Ted Klein Klein Consulting Informatics LLC

HL7 Terminology Governance HL7 Terminology Governance now is Disjointed V2, V3, CDA, FHIR, and CIMI mostly independent The vast majority of work is in Value Sets and Concept Domains There is no single source of truth We cannot tell anyone where “the HL7 terminology” is Value Sets, Concept Domains, Code Systems, Concept Maps all published independently in each product family Tooling Issues Current tooling for V3 does not work properly Quality and Updating Issues and Problems High degree of duplicative work, many items not maintained or curated Limited expertise High Cost for limited benefit Harmonization has a high cost in time and money and covers only V3, which is nearing the end of its lifecycle We want to reduce (or at least NOT increase) HL7 required resources for this

New Process is Needed QA and Tooling Projects bogged down using current processes HL7 has been working on these for years with little progress to show Vocabulary, EST, Publishing, INM – all involved Decreasing ability to respond to WG and Community queries FHIR is rapidly developing in their own direction inconsistent with older project lines Ballot updates in V2 and V3 in ballots are coordinated with FHIR completely manually FHIR has begun to participate in Harmonization, but the processes and data formats are not integrated well as of yet Links on the HL7 website bad Links published in CDA IGs are broken Links found with search are often obsolete No web accessibility for V2 terminology

UTG Project 2 years ago Lloyd and I started the UTG Project Vocabulary WG is the putative steward of HL7 vocabulary in all of the HL7 product lines Current difficulty coordinating with WG efforts in this space Current processes do not work well with FHIR Project was approved last year and is very active Increasing urgency to complete it Harmonization for V3 and V2 nearing end of usefulness FHIR needs a more formal process for terminology governance and ongoing curation now that it is more mature V3 ballot and NE edition tooling is broken The community is becoming impatient with HL7s inability to publish its vocabulary in a user-friendly way Primary Scope is curating Value Sets and Concept Domains But HL7 Code Systems (done for decades) also need curation

UTG In Brief 24 Major Objectives It will replace current Harmonization Broad and consensus-based, fit into current balloting, asynchronous and open process, align work with benefits, minimize ongoing support resource requirements, continuous operation, cross all product lines, integrate QA, utilize advanced tooling, fit into all product families, use expertise properly, etc. It will replace current Harmonization New ways to incorporate governed shared vocabulary into published Standards New ways to publish the HL7 Terminology Increase shared review of shared terminology objects It will support HL7s evolving standards development process Must support FHIR rapid development model

Crowd-Sourced Architecture

Envisioned Process Flow Two parallel activity tracks: 1. HL7-driven processing and maintenance 2. Continuous community-driven updates and consensus The two tracks are coordinated by access and publishing, plus queued approved requests for updates

Current State Design document up to version 10 But moving more slowly than hoped due to competition for resources Not far from the point where HL7 will be asked to begin to invest in the implementation We plant to make use of JIRA and Confluence and other not yet determined collaboration tools We will leverage usable and appropriate FHIR tools and techniques Terminology Services, Value Set Editor, Zulip Forums, Web enabled, etc. But it is also clear that some new tooling must be developed This is a “heads-up” for coming requests

Detailed Process Flows The project has developed detailed process and work flow diagrams Active input from Vocabulary, FHIR, Conformance, and Publishing We would like more Tooling input Putting it into place will involve significant changes to how balloted artifacts are created and published Will affect every WorkGroup Will likely required GOM changes Will need coordination with SGB

Current State Working through intricacies of consensus process At point where we need to evaluate existing tooling 3rd party: JIRA and Confluence, Zulip, XDIFF, Google Docs, etc. FHIR tools: Terminology Services, Repository Value Set Editor, … Other HL7 tools: OID Registry, Trifolia, Publishing, … Now at the point where we are assessing which terminologies will be subject to UTG It is clear that much of the HL7 Terminology is tightly coupled to ballot artifacts We call this ‘structural’ Not subject to consensus modifications as it is dependent upon the ballot artifacts; consensus change is through ballot processes only Working through intricacies of consensus process Must be consistent with GOM and HL7 principles

Immediate Goals Increase socialization It would be a bad idea to suddenly inflict this on the entire organization without warning It will be helpful to have more input and points of view Begin evaluation of 3rd party tooling Also assess which HL7 tools can be used (esp. FHIR) Increase Tooling and Publishing Groups Involvement and Input Agree on documentation from which RFPs can be put together by HL7 Get this done this summer at the latest!

Questions? W. Ted Klein MS, FHL7, General Manager, Klein Consulting Informatics LLC Vocabulary Technical Committee Co-chair, Health Level Seven (HL7) http://www.hl7.org HL7 Representative to ISO TC215, Member Clinical LOINC Committee, Member ISO TC249 email: kci@tklein.com