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

2. 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

3. 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

4. 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

5. 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

6. Crowd-Sourced Architecture

7. 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

8. 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

9. 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

10. 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

11. 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!

12. Questions?
W. Ted Klein MS, FHL7, General Manager, Klein Consulting Informatics LLC
Vocabulary Technical Committee Co-chair, Health Level Seven (HL7)
HL7 Representative to ISO TC215, Member Clinical LOINC Committee, Member ISO TC249