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National E-Health Transition Authority

nehta IHTSDO Conference Report October 2013 Meeting

2 December 2013

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IHTSDO Conference Report October 2013 Meeting

2 December 2013 Approved for external information 3 of 21

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Contact for enquiries NEHTA Help Centre t: 1300 901 001 e: [email protected]

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dv # Reviewer(s) Type of review Purpose

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003 Technical writer Editorial To confirm that the document meets NEHTA’s editorial standards.

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4 of 21 Approved for external information 2 December 2013

Table of contents 1 Introduction ....................................................................................................... 5

1.1 Purpose ........................................................................................................ 5 1.2 Intended audience ......................................................................................... 5 1.3 Scope ........................................................................................................... 5 1.4 Acknowledgements ........................................................................................ 5

2 Executive summary ............................................................................................ 6 2.1 General Assembly .......................................................................................... 6 2.2 Member Forum .............................................................................................. 6 2.3 Content Committee ........................................................................................ 6 2.4 Implementation & Innovation Committee .......................................................... 6 2.5 Quality Assurance Committee .......................................................................... 7 2.6 Technical Committee ...................................................................................... 7 2.7 Substance Hierarchy Redesign SIG .................................................................. 7

3 General Assembly ............................................................................................... 8 3.1 Summary of meeting...................................................................................... 8

4 Member Forum ................................................................................................... 9 4.1 Summary of meeting...................................................................................... 9

5 Content Committee ........................................................................................... 10 5.1 Summary of meeting.................................................................................... 10

6 Implementation & Innovation Committee ........................................................ 13 6.1 Summary of meeting.................................................................................... 13

7 Quality Assurance Committee ........................................................................... 14 7.1 Summary of meeting.................................................................................... 14

8 Technical Committee ........................................................................................ 15 8.1 Summary of meeting.................................................................................... 15

8.1.1 Work item review ............................................................................. 15 8.1.2 Joint Technical and Implementation and Innovation Committee session .. 17 8.1.3 Presentations and working session ..................................................... 18

9 Substance hierarchy redesign project............................................................... 20 9.1 Summary of meeting.................................................................................... 20

Acronyms ................................................................................................................. 21



1 Introduction 1.1 Purpose

This report provides a summary update on the activities occurring at an international level in the International Health Terminology Standards Development Organisation (IHTSDO)1.

1.2 Intended audience This document is intended for the Australian terminology community of practice.

1.3 Scope The report provides information on IHTSDO items and areas of work discussed at the IHTSDO October 2013 Working Meeting held in Washington DC, United States of America.

1.4 Acknowledgements The NCTIS wishes to acknowledge the contributions of Matthew Cordell, Kate Ebrill, Kylynn Loi, Dion McMurtrie, Michael Osborne, and Cathy Richardson in providing content for this report.

1 IHTSDO®, SNOMED® and SNOMED CT® are registered trademarks of the International Health Terminology Standards Development Organisation.

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2 Executive summary 2.1 General Assembly

• IHTSDO has established a Customer Relations and Marketing function.

• The agreement between IHTSDO/Regenstrief regarding LOINC and SNOMED CT has been finalised and published.

• A Quality Management System is being introduced to ensure the quality of IHTSDO’s products and processes.

2.2 Member Forum • The IHTSDO is working towards better supporting stakeholder needs. Initial

activity includes a survey and one-to-one discussion with each member country.

• Collaboration to improve the technical quality assurance of RF2 releases is underway with a Member Forum subgroup set up. Dion McMurtrie from Australia will be participating.

• An IHTSDO Open Tooling Framework is in development with the goal of meeting members’ terminology tool needs. Reference set and mapping modules are planned for delivery in April 2014.

2.3 Content Committee • Work has progressed on the IHTSDO/Regenstrief cooperative agreement:

new staff are being hired to take on the work of mapping the LOINC parts to SNOMED CT.

• Work to improve SNOMED CT progresses in a number of critical areas including Anatomy, Allergies, Substances, Observables and Organisms.

• The proposed inclusion in International SNOMED CT of content from National Release Centres that does not meet editorial guidelines will be investigated.

2.4 Implementation & Innovation Committee • IHTSDO will be releasing documentation which will be useful for both

implementations and users in Australia. These documents will begin to appear starting January 2014.

• IHTSDO has reviewed the Affiliate license agreement with changes currently out for feedback from National Release Centres.

• The SNOMED CT Implementation Advisor scheme is still continuing, with a new intake to begin February 2014.

• The Challenge test and Competency Guidelines (Education SIG) continue to be worked on.



2.5 Quality Assurance Committee • As the IHTSDO matures, KPIs based around quality are starting to be

developed. This also includes regular reporting of appropriate metrics.

• The importance of a Critical Incident Policy has been recognised by the management board, and an appropriate policy is currently being developed.

• It has been identified that specifically contracting external parties to review certain content deliverables (like the anatomy redesign work) reduces dependency on expecting the community of practice to provide feedback.

2.6 Technical Committee • The Diagramming Guidelines are close to approval.

• The concrete domain specification has been unblocked and formal work is due to restart soon.

• There is a renewed focus on the URI specification, particularly for standardising code system versioning representation.

• RF1 deprecation is likely to require considerably more time and discussion.

• Query language and information model binding work items are to be worked on in conjunction with the Implementation Advisor Scheme work on terminology constraint and binding.

• The new RF2 subgroup of the Member Forum is to work on RF2/release ambiguities. This group is a good candidate to progress the packaging standards/guidelines work item.

• A replacement for complex map patterns has been proposed. More work is required to fully specify it and determine if it can replace all current map patterns or allow a simpler pattern to coexist for simple maps.

• LOINC agreement:

o There are concerns over representation, versioning and impact on the distribution form of the expressions used for mapping as part of the agreement.

o There are concerns over restrictions to content additions to SNOMED CT where requests overlap with LOINC codes.

• The Open Tooling Framework (OTF) was presented and discussed by the committee. There was considerable discussion and much interest in the planned future for the OTF.

2.7 Substance Hierarchy Redesign SIG • To see quick deliverables on this project, the initial focus of development is

exclusively substances that are drug ingredients. Initially, a candidate list of “ingredient substances” will be made available for these projects to leverage, while the full redesign is being implemented.

• IHTSDO now have two new terminologists on staff who are available to specifically progress this (Substance) work and pharmacy.

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3 General Assembly 3.1 Summary of meeting

• New initiatives are under way in areas such as tooling, customer relationship management, SNOMED CT benefits, the work plan and the budget.

• A Quality Management System is being introduced to ensure the quality of IHTSDO’s products and processes. This system will enable users to easily understand the function of the different governance bodies and find documentation such as templates.

• Achievements for 2013 include:

o First fully in-house SNOMED CT release successfully delivered in July 2013.

o The IHTSDO/Regenstrief Institute agreement regarding LOINC and SNOMED CT was finalised and published.

o The Open Tooling Framework is nearing completion of the proof of concept phase to provide an open, community driven framework for terminology tooling.

o Customer Relations and Marketing functions have been established.

o Baseline release for SNOMED CT to ICD-10 mapping was released in July 2013.

• The following areas are the main focus for 2014:

o Customer Release and Marketing.

o Product Release Management.

o Technical Architecture and Applications.

o Terminology Development.

o Content Product Development.

o Derivatives Development.

o Implementation and Education.

o Collaboration emphasised, rather than harmonisation.

o The Quality Management System.

• During the meeting, the General Assembly voted and approved the following:

o Changes to the Management Board Election Policy.

o 2014 Work Plan and Budget.

o 2014 Annual fees.

o Amendment to the Articles of Association to allow electronic voting.

• Standing Committee members were elected including Philip Wilford (I&IC), David Evans (QAC), Arjuna Vijayanayagam, (QAC) and Dion McMurtrie (TC) from Australia.



4 Member Forum 4.1 Summary of meeting

The content committee met for two half-day sessions on 8-9th October 2013. The sessions were largely informational covering working group updates, IHTSDO/Regenstrief Institute work plan, plus a review of “Procedures and Interventions” and a discussion on the value of adding concepts from national extensions that do not meet editorial principles as primitive leaf concepts. For more information, please see the details below.

• The IHTSDO is working on strategies to develop better relationships with its stakeholders e.g. vendors and members. A survey will be distributed and member countries will have the opportunity of one-to-one discussions to explore support that is required. Work in this area is planned to be an ongoing activity.

• Member Forum input was sought on a proposal for content which does not meet International editorial guidelines but is currently present within more than one national extension with the potential for it to be considered for inclusion in the core. Australia along with the US and Canada were the proposers. Considerable discussion occurred which raised some concerns, however approval to further explore was provided.

• The delays in progression on the Pharmacy Boundary and Scope document were discussed with questions on IHTSDO plans to progress the work. The recent hiring of new terminologists with Pharmacy expertise was raised as the planned action.

• An RF2 subgroup for collaboration on technical QA of releases has been formed with Dion McMurtrie as the Australian representative. IHTSDO support for this project will be provided.

• The Open Tooling framework (OTF) which is currently close to the end of proof of concept stage is being developed with the goal of meeting member’s terminology tooling needs. It is planned to be a set of defined service modules, browser based with standardised API’s. Reference set and mapping modules are planned for delivery in April 2014. The workbench and OTF will run in parallel while the workbench is still being used. Further information is located at: http://ihtsdo.github.io/.

• Countries provided updates on their activities. If you require information on another country’s activities please contact [email protected].

http://ihtsdo.github.io/

mailto:[email protected]

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5 Content Committee 5.1 Summary of meeting

Content Development

• Editing is under way for the January 2014 release with 1273 new concepts and 11,443 descriptions added so far. About 1,400 concepts from bulk requests will be added as unmodelled leaf nodes prior to the January 2014 release. About 700 requests will be held up, pending the LOINC development work.

• The IHTSDO mapping service continues to map SNOMED CT to ICD-10 and ICD-9. Field testing of the SNOMED CT to ICPC2 map will continue to the end of November.

• There is now a TRELLO board for tracking small changes that do not require an artefact in Collabnet.

LOINC cooperative work

• The work plan to integrate LOINC into SNOMED CT is being formulated and governed by an Executive Policy Group, consisting of three members from IHTSDO, and three from the Regenstrief Institute.

• Two additional terminologists will be employed by IHTSDO to work on adding the LOINC parts to SNOMED CT and mapping the SNOMED CT expressions. IHTSDO is looking to hire an additional contracted resource to work on implementation guidance documentation.

• Initial mapping of LOINC parts is underway – scoped to top 5000 lab LOINC terms, plus microbiology and chemistry.

Substance hierarchy redesign

• The Boundary and scope document has been completed, including a draft concept model.

• The Substance project is supported by two IHTSDO terminologists – Toni Morrison and Romin Khazai

• The plan is to finalise the Alpha release by January 2014, including use cases focused on a limited set of pharmaceutical ingredients.

Anatomy Redesign

• Many of the critiques of SNOMED CT stem from incorrectly modelled anatomy – Kent Spackman showed an OWL preview of the revised Anatomy model.

• The Anatomy redesign requires changes to the SNOMED CT model – addition of new logic: Sufficient definitions, General Concept Inclusions, role chaining and anonymous class axioms (e.g. any part of something that is lateral is also itself lateral).

• Other additions include surfaces, “skin of”, “subcutaneous tissue of”, “part of lateral half of”, and “bone tissue of”.



Nursing SIG

• Judy Warren presented on the International Classification of Nursing Practice. A map has been made to SNOMED CT. There are 57 observables with 12 missing concepts.

Event Condition Episode

• The new model for Allergy/Pseudo-allergy was released in July 2013. The model uses a “hypersensitivity condition” concept as a parent of allergies and pseudo-allergies.

• Four combination disorder patterns have been identified. A model for testing is expected by April 2014.

Observables and Investigation model redesign

• A test of the observables model was performed in August 2013 using 50 randomly-selected items from the Sample observable and Vital signs hierarchies.

• The plan is to have an Alpha release of some model content for clinical observables by December.

• Clinical Observables testing has shown that the model requires General Concept Inclusions or it becomes very difficult to get consistent modelling.

Organism redesign

• Work has progressed documenting patterns for microorganisms – see the Wiki for details: https://csfe.aceworkspace.net/sf/wiki/do/viewPage/projects.organism_infectious_disease_mode/wiki/HomePage

• The design patterns will be formally provided to the content committee in the near future for approval.

• Editorial resources will be required to proceed with remodelling SNOMED CT content.

Procedure and Interventions

A number of use-cases were presented for expanding the content with respect to procedures, plans and interventions in SNOMED CT. Use cases included intervention report, billing, “History of”, Discharge summary continuity of care document, benchmarking, medical registers and quality management.

• It was suggested that due to the high degree of post-coordination required that a navigational reference set to aggregate SNOMED CT in a certain way to represent the intervention or goal. We need to make the tools better for aggregational logic. Preference is not to add content.

• Kent Spackman suggested that IHTSDO could build a Procedure hierarchy that would be the foundation of an international classification and hand it to ICD for publication in ICD-11.

• IHTSDO is not ready for a working group on this as yet.

https://csfe.aceworkspace.net/sf/wiki/do/viewPage/projects.organism_infectious_disease_mode/wiki/HomePage

https://csfe.aceworkspace.net/sf/wiki/do/viewPage/projects.organism_infectious_disease_mode/wiki/HomePage

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Request for Consideration – Addition of National Release Centre content not meeting editorial rules.

• A proposition was tabled by Beverly Knight with support from the USA and Australian National Release Centres on inclusion of content from multiple National Release Centres in the international edition, even if the content does not meet editorial guidelines.

• Kent suggested that the IHTSDO editorial guidelines should be reviewed in light of examples that are useful, reproducible and understandable.

• There is a consensus to flesh out the project, but no action items yet.



6 Implementation & Innovation Committee

6.1 Summary of meeting Note: These notes were taken from the meeting minutes as there was no

Australian representative available to attend the meeting.

The main working agenda items for the Implementation & Innovation committee were:

• Work Plan 2013 progress report:

o The SNOMED CT Implementation Advisor scheme is progressing well with plans to start a new scheme in Feb 2014.

o Draft Guidance on Practical use of Reference sets is in development.

o SNOMED CT and LOINC Guide has been held back pending completion of the agreement.

o Glossary review to begin towards the end of the year.

• Education SIG report:

o Discussion on Competency guidelines and standards for standards.

o Version 0.2 of a guideline for the methodology for developing competencies has been produced.

• LOINC:

o Joint session with Technical committee (see Section 8.1.2).

• Expression constraints and reference set queries:


• Open Tooling Framework (OTF):


• Implementation SIG report.

• 2014 work plan.

• Affiliate licensing changes.

• Discussion of new documents, with the following documents currently out for review:

o SNOMED CT Starter Guide

(In draft – expected release January 2014)

o Search and Data Entry Guide

(In draft – expected release January 2014)

o Expression Constraint and Terminology Binding

(In draft)

o Mapping document

(Expected to be released soon)

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7 Quality Assurance Committee 7.1 Summary of meeting

• The Quality Framework is being used by the SNOMED CT to ICD-10 mapping project.

• The absence (and necessity) of a critical incident policy has been recognised by the organisation and an appropriate policy is currently under development.

• A subgroup is being formed to progress the metrics identified through Bob Dolin’s report.

• Quality Review of Anatomy redesign work. As this item becomes available for public comment before being finalised, it is being considered that a formal independent review should be organised. This ensures that there is a focused critique of the model, and does not rely solely on the community of use.

• The QAC’s role in content development was discussed. Should it be a general overview group or actively involved in assurance activities, or both? The reporting expectations from the group were also discussed, and ideally reporting would be made public where possible and available regularly, however it was recognised that some reports on partially-developed work can cause confusion, so some selectivity will be required.



8 Technical Committee 8.1 Summary of meeting

The main working agenda items for the Technical Committee were:

• Work item review.

• Joint session with the Implementation and Innovation Committee focussed on:

o Information on the LOINC Agreement.

o Representation of terminology constraints and terminology binding to information models.

o Facilitating open source development in relation to SNOMED CT implementation.

• Presentations and a working session including:

o Open Tooling Framework development and progress report (Rory Davidson).

o RF2 mapping draft (James Campbell).

o Deprecation of the RF1 release (Robert Turnbull).

o Identifying coding systems and versioning of coding systems in clinical documents (Dion McMurtrie).

o Member Forum RF2 sub-group to discuss/resolve ambiguities in the RF2 specification pertaining to extension releases (Dion McMurtrie).

o Ongoing work to improve the Standing Committee and Member Forum contributions (David Bunker).

8.1.1 Work item review

The Technical Committee work items were walked through to resolve and update:

• Status and position in the standards process.

• How each piece of work fits into the IHTSDO plan or member/user requirements.

• What is outstanding, the priorities of these items, and the path forward.

The main items discussed are detailed in the table below.

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Work item Status

Diagramming Guidelines

The Diagramming Guidelines have undergone final changes earlier in the year and are awaiting review by Kent Spackman and David Markwell prior to being sent to the Management Board for approval as a guideline.

Concrete Domains This work item was paused pending a resolution to planning/funding for implementation in the IHTSDO Workbench and IHTSDO Classifier. Since this time the VA, in collaboration with Apelon and CSIRO, have implemented these features in the VA’s branch of the IHTSDO Workbench. Due to demand from other member nations and the need for the Medicines model, this item is to be restarted. Its status and work remaining to completion are documented on the Technical Committee wiki2.

URI specification The URI specification’s status was discussed and considered to be particularly important as it underpins other initiatives such as the CTS2 SNOMED CT implementation guide and other initiatives requiring a solution to versioning SNOMED CT. The current specification has been through review cycles and requires limited changes to progress in the standards process.

Deprecation of RF1 See the discussion in Section 8.1.3.

Definition of a query language syntax for SNOMED CT

This item is believed to align with the Implementation Advisor Scheme work on terminology constraints and binding. This item will be connected to the Implementation Advisor Scheme work item.

Information model binding

As above, this is believed to be connected to the Implementation Advisor Scheme work item being managed by the Implementation and Innovation Committee.

Packaging guidelines and tools

This work item is believed to be important as it is a source of divergence in national extension releases at present. This item will be put to the new Member Forum RF2 subgroup to be progressed.

Classification tools This item is a review of classifiers available in the market and academia and their relevance to SNOMED CT. This was discussed, but it is not as important in the short or medium term as some other committee work. As such this item has been removed from the Technical Committee work plan.

File naming review The file naming convention is overdue for review, however this item is felt to be better progressed after the packaging guidelines have been worked through.

Compositional Grammar review

The compositional grammar is due for review, and due to a number of well-known issues with the grammar the committee is keen to progress this work item.

2 https://csfe.aceworkspace.net/sf/wiki/do/viewPage/projects.technical_committee/wiki/DefinitionOfAMechanismToRepresentNumbersInRF2

https://csfe.aceworkspace.net/sf/wiki/do/viewPage/projects.technical_committee/wiki/DefinitionOfAMechanismToRepresentNumbersInRF2





Work item Status

RF2 complex map pattern

A proposed specification of a new map pattern has been produced and discussed. There are some issues with the specification to be resolved, particularly its use of a “NULL” value in RF2 which currently doesn’t exist. The proposal is also to replace all map patterns with this single map pattern, which adds many nullable/default columns for simple maps which do not require the complexity. It was noted that some of the changes expressed in earlier versions of the proposal made their way into the published version of the IHTSDO’s Technical Implementation Guide, highlighting an IHTSDO change control issue. This item is to be worked on for a resolution in the near term.

Universal restrictions This issue has been deferred until the Pharmacy Concept model group and Content Committee determine if universal restriction semantics are required, and if so how to best resolve the issue.

8.1.2 Joint Technical and Implementation and Innovation Committee session

The main topic for discussion during the joint session was the agreement with LOINC, and the technical and operational implications of the agreement that can be found at http://www.ihtsdo.org/loinc/agreement.pdf.

One of the major concerns with the agreement is the practicality of the content restrictions. Designed to protect the IHTSDO and Regenstrief from each other, these restrictions:

• Require that SNOMED CT content not be created when a gap is discovered in SNOMED CT mapping LOINC codes.

• Require that these gaps in SNOMED CT content be filled using SNOMED CT expressions in the mapping between SNOMED CT and LOINC.

• Allow LOINC to create new codes where SNOMED CT concepts exist with no counterpart in LOINC.

Concerns were expressed with regard to the practicality of this arrangement, particularly member nation extensions and where more than one member requests content from the IHTSDO aligning to the LOINC content. David Markwell made it clear that any such request will be denied, however it is unclear how control can be exerted over the member nation’s extensions.

Concern was also raised over how the expressions involved in the map would be released. David Markwell had suggested that these expressions would be classified with the SNOMED CT distribution, potentially affecting both the expressions and the distribution requiring others that classify the release to also classify with these expressions present. However these expressions (as part of the agreement) are not to have descriptions or be modelled as SNOMED CT concepts. It is yet to be determined how these release mechanisms may work.

http://www.ihtsdo.org/loinc/agreement.pdf

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The representations of terminology constraints and binding were briefly discussed. The Technical Committee discussed how to best collaborate, given the keen interest and overlap in this area. One of the major points of discussion was versioning SNOMED CT (required as part of terminology constraints and binding) and the need to standardise the representation of SNOMED CT versions. Considerable time was dedicated to discussions of the use cases and needs as well as the solution offered in the current URI specification, which is to be pursued.

Finally, the open source development supporting SNOMED CT implementation was discussed. The Open Tooling Framework was introduced, and while this may form a good resource in future, it is clear that this will not deliver the required implementation needs in the short term – the OTF is focussed on internal needs first. Some discussion was held on the Member’s requirements for a SNOMED CT browser – a call was made for comments on the draft requirements.

8.1.3 Presentations and working session

Rory Davidson (IHTSDO) reported on the Open Tooling Framework’s development and progress - see http://ihtsdo.github.io. The OTF is currently focussed on IHTSDO tooling needs, with an eye to wider community needs. Rory has made a call for collaboration, and is keen to make this a much more open and inclusive process than the IHTSDO Workbench development has been so far. It was stressed that this is not necessarily a replacement for the IHTSDO Workbench, and many pieces of the IHTSDO Workbench may be reused. It was also stressed that the OTF itself is and will be an evolving set of software interfaces, not software itself. The IHTSDO will have an OTF implementation which will be open source, however it is envisaged that others may implement some or all of the OTF interfaces as well.

James Campbell presented a draft revision of the Mapping reference set pattern for RF2. This proposal has been put together to simplify the “Complex Mapping Pattern” in RF2 to one reference set from two reference sets, and also aims to replace all other mapping reference set patterns. There are some issues with the current documentation of the proposal, including the ability to support the null columns required in RF2. Concern was also expressed in relation to forcing “simple” maps to use this new multi-use case file format containing many redundant columns for simple maps. These issues still remain to be worked through, however the committee supported the idea of revising the “Complex Mapping Pattern”.

Robert Turnbull (IHTSDO) raised the deprecation of the RF1 form of the SNOMED CT International release. The main driver from the IHTSDO is that the cost and effort to create the RF1 version of the release is quite high and is not automatable, reducing capacity to perform other enhancements. Pushback was once more felt from some representatives of member nations, particularly the UK. However discussion broadened to consider what “deprecation of RF1” actually means, and whether this means the standard would ever be withdrawn or if the IHTSDO would simply stop producing RF1 format artefacts and no longer maintain the RF1 specification itself.

http://ihtsdo.github.io/



Dion McMurtrie (NEHTA) presented on identifying coding systems and versioning of the coding system in clinical documents. This topic had been raised previously with respect to HL7 messages and never reached resolution at the IHTSDO, with the IHTSDO deferring the issue to HL7. However the committee recognised that the IHTSDO should have a position on versioning SNOMED CT, particularly in relation to extensions, given that they are core to SNOMED CT. Work is to progress to define a draft versioning scheme for SNOMED CT for comment out of the URI specification work.

Dion McMurtrie updated the Technical Committee on the Member Forum’s decision to create an RF2 subgroup to discuss/resolve ambiguities in the RF2 specification. The issues to be discussed particularly pertain to extension releases. The group is to consist of those who produce extension releases of SNOMED CT with an aim to reducing or removing inconsistencies between these extension releases by tightening the documentation of the SNOMED CT specifications (particularly RF2). The group will collate and discuss issues, formulate options and recommend solutions, which will be forwarded to the other IHTSDO standing groups including the Technical Committee. Terms of reference are being drafted for the subgroup to be completed by the end of 2013.

David Bunker (IHTSDO Management Board) led a discussion on the ongoing work to improve the Standing Committee and Member Forum contributions. This discussion revolved around the role of the Technical Committee in the organisation and the type and style of work it should perform. This item was particularly driven by an initiative to include a short description of each standing group at the IHTSDO in an introductory briefing document for new or potential members. David agreed to draft initial text based on the discussion and circulate for further comment.

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9 Substance hierarchy redesign project

9.1 Summary of meeting • It was recognised that while a lot of analysis has been done, there are

dependencies from other projects (internal and external) waiting on this to be resolved. The priority dependency was agreed to be the Pharmacy model. Through discussion it was determined that the initial focus of development will be those substances that act as the targets for ingredient relationships. Initial redesign will focus on aligning the chemical substances with a structure similar to that of the Chemical Entities of Biological Interest (ChEBI) ontology. Additional properties will be introduced later.

• Concerns about the ambiguity of many of the existing concepts were raised. As the Substance hierarchy doesn’t have a model at the moment, this ambiguity is a result of a mixture of poorly-chosen legacy terms and lack of standardised nomenclature for many substances. Completely replacing all concepts would have a large impact on both the modelling of other hierarchies and implementers. A pragmatic approach is required.

• To all dependent projects such as the IHTSDO Pharmacy redesign, and national drug extensions to being integrated with the Substance hierarchy, but not inheriting the existing defects, the relevant target concepts of the redesign will first be made available as a flat list of disjoint concepts. These projects can then progress as required, and more comprehensive modelling of substances can be introduced later.

• The IHTSDO have now recruited two new terminology analysts. The analysts are to be available to assist with progressing this project, and helping to implement the required changes. Regular project meetings will also recommence with their assistance.



Acronyms Acronym Description

ChEBI Chemical Entities of Biological Interest

CSIRO Commonwealth Scientific and Industrial Research Organisation

CTS2 Common Terminology Services 2

I&IC Implementation & Innovation Committee

ICD-9, ICD-10, ICD-11

International Classification of Diseases 9th revision, International Classification of Diseases 10th revision, International Classification of Diseases 11th revision

ICPC2 International Classification of Primary Care- 2nd Edition

IHTSDO International Health Terminology Standards Development Organisation

ISO International Standards Organisation

KPI Key Performance Indicator

LOINC Logical Observation Identifier names and codes

NEHTA National E-Health Transition Authority

OTF Open Tooling Framework

QAC Quality Assurance Committee

RF1, RF2 Release Format 1, Release Format 2

SIG Special Interest Group

SNOMED CT Systemised Nomenclature of Medicine-Clinical Terms

TC Technical Committee

URI Uniform Resource Identifier

VA US Department of Veterans Affairs

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