MINUTES OF VOCABULARY TECHNICAL COMMITTEE
SEPTEMBER 29, 1999
Attendees: See Attendence999.xls
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Introductions
Approval of Agenda
Next meeting date: Thursday, January 27, 2000
Stan announced that we need facilitators for other groups.
In an election conducted by John Quinn, Stan Huff was elected co-chair
for a second term.
6. Jim Cimino made a presentation on Drug Forms. See
DrugForms999.ppt.
7. Tim McNamara made a presentation on Dose Form Analysis. See
DoseFormAnalysis999.ppt.
8. Discussion, including what are the next steps followed these
presentations. Points made were:
a. We need to review the editorial rules of the Drug Knowledge Base
(DKB) vendors.
b. Stan Huff: We need to get a list of clinical drugs so that they can be
used in ordering. We need to define a set of drugs that can be
ordered by a provider and sent to a pharmacy where the drug will
be dispensed. We also need to use this terminology to trigger
decision rules to detect allergies and drug/drug interactions and to
detect whether doses are appropriate or not. Goals – fill
prescription, allergy checking and dosage checking.
c. We need to use the clinical drug model. We need to get
participation from DKB vendors and do inversions of drug database
to create a list of clinical drugs.
d. Keith suggested we first focus on route and drug forms.
e. Clem states problem is what providers order. How do you map from
orders to DKB lists?
ACTION ITEM: Jim Cimino
Get a list of drug forms from each participating DKB vendor. Get
description of editorial policy relating to form. Get list of all NDCs and their
vendor assigned dose form. Produce a straw man hierarchy for HL7
standard forms. Get data by end of October. Produce draft by end of year.
ACTION ITEM: Ed Hammond
Get a list of routes. Clem suggested that Chapter 4 of HL7
Standard has a rather complete list. Produce straw man list for HL7
standard routes. Get data by end of October. Produce draft by end of
year.
ACTION ITEM: Sue Bakken
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Investigate getting funding for drug vocabulary work.
9. Proposed model for clinical drugs:
Active ingredients
Chemical
Strength amount
Strength units
Volume amount
Volume units
Form
The decision was to focus on the properties of the manufacturer – focus
on the clinical properties. For now we will only deal with the active
ingredients based on the therapeutic intent of the drug. We need to
decide what names we will use for chemicals. We need to say ml or cc or
teaspoons. We need to distinguish between salt and no salt (an animal
source).
MOTION: Moved we accept the above model of a clinical drug by Jim
Cimino.
Vote: For – 14; opposed – 2; abstain – 6. Motion carries.
10. MOTION: Moved that we consider a formal definition of the drug
model (document) at the next meeting by Keith Campbell.
Vote: For – 22; opposed – 0; abstain – 0. Motion carries.
11. Further discussion of clinical model questioned what do we want to use for
the names of the chemicals. Suggestion included looking at the following
sources:
 SNOMED
 USAN
 Read
 NHS
 DKBV
 Drug companies
 Chem Abstracts
Keith notes that synonyms create problems. Is there a FDA approved list?
Keith expressed concerns of scooping.
12. ACTION ITEM: Tim McNamara
Draft a statement of what a drug ingredient might be. Define also
what is an active ingredient.
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Julia Kim will assist in this project (volunteered by Keith Campbell).
She will look at CUIs, etc. Jim Cimino will work with her and provide
guidance.
13. ACTION ITEM: Jim Cimino and Stan Huff
Look at FDA approved list of drugs. Look at synonymy among all the lists
in 11 above. Focus is assessment of existing options based on
requirements. Requirements are:
 List be able to represent ingredients to prescribe things
 Scientifically valid
 Represent distinctions that are clinically useful
 Include “things you tell people to take”
 If two forms of ingredient have different therapeutic actions, the
names must be distinguishable (salts, animal of source, raceme)
14. How do we want to represent strength, volume amount and units? Do we
use scalar vs nonscalar dose? What units to use may fall out of dose form
analysis.
15. Question: how do you describe versus how do you populate the clinical
drug list? Consensus was that we state rules clearly for doing
strength/volume. We do this for each active ingredient. We say “this
amount in this XXX.” We say per 1 tablet or per one thing; per each for
expressing strength.
16. Keith Campbell made a presentation on Centralized Terminology
Services. See CTS999.ppt. He suggested a single point of managing
terminology. Do it at one place and use server to handles uses. Keith
noted that centralized vs distributed is an issue. After discussion, the
following Motion was made.
17. MOTION: Form a subgroup, headed by Keith Campbell, to look at a
standardized API for centralized terminology services and
incorporate first CorbaMed group that developed LQS into the
process.
Vote: For – 25; opposed – 0; abstained – 0; Motion carries.
18. ACTION ITEM: Keith Campbell
Form a centralized technology services subgroup to create a standard
API. Do as a joint project with CorbaMed. Include the group that
developed the original LQS of CorbaMed.
Signup list passed around table. Volunteers are listed in CTSGroup.xls.
19. Jim Cimino made a presentation on Good Terminology Practices. See
GTP999.ppt.
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20. Sue Bakken suggested that we do an educational training session for
vocabulary facilitators for the next few meetings. We should use
Vocabulary domain specifications to avoid confusion with RIM domain
specification.
21. Keith discussed issue of unique identifier across HL7 interests areas.
Should the same identifier be use globally? We need to decide formally
what we really want to say. HL7 tables collectively are a coding system.
We need to go to a true coding system – global unique identifiers. We
need more content specific specification of data. We can put a prefix on
codes that identify the source of the code. We need uniqueness across
tables.
22. Sue Bakken suggested a formalization of the registration process. She
suggested we publish an information sheet on the process.
ACTION ITEM: Sue Bakken
Develop a document that explains the registration process.
ACTION ITEM: Stan Huff
Write up a formal application for the registration process for LOINC. This
document will be used as an example.
ACTION ITEM: Kent Spackman
Write up a formal application for the registration process for SNOMED. This
document will be used as an example.
Some discussion on versioning. ICD 9 and ICD 10 are different systems, not
simply version changes. Versioning is appropriate if codes keep same
meaning across versions. Example is : SNOMED international, SNOMED
RT, and SNOMED Version 3.4.
It was noted that registration was not meant to be a barrier to registration. It is
a process of cataloging, not approving.
Wednesday Sept 29 1999 p.m.
23. Stan Huff presented a proposal for putting the HL7 tables on the HL7 Web
site. See VocTab999.ppt. Larry Stotz will do the work and expects to be
finished by the end of this year. Stan stated that we need to create tables
for all the domains to be used in the HIMSS 2000 demo. We need
facilitators for each TC or SIG participating in the demo.
24. ASSIGNMENTS: Vocabulary Facilitators
 Patient Care
o Sue Bakken
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o Carmela Courderc
PAFM
o Nancy Orvis
o Ed Hammond
Orders, Results
o Stan Huff
o Kent Spackman
o TBN from GCPR
o Wayne Tracy (Orders, Results)
o Helen Stevens (Orders, Results)
Scheduling
o Ed Hammond
o Anita Benson (Scheduling)
Medical Records (Document Types)
o Mike Lincoln
Other table assignments
 Degrees
o TBN from GCPR (Jim McCain)
o Robin Zimmerman
 Religion
o Ed Hammond
o Nancy Orvis
o Gunther Schadow (he doesn’t know it yet)
 Race and Ethnicity
o Dan Pollock
 Vaccine and Vaccine Manufacturers
o Susan Abernathy
The time line for all of these items is to get the data to Larry Stotz within the
next 6 weeks. Larry will implement. By the end of the year, we will have
vocabulary domain names and rows defined in the tables.
25. ACTION ITEM: Chip Masarie
Produce a document defining the rules for case in the domain names for
the HL7 tables. We need this document quickly to be used for the creation
of HL7 tables.
26. ACTION ITEM: Stan Huff
Create spreadsheets with headers for use by individuals creating the HL7
tables.
27. ACTION ITEM: Sue Bakken and Keith Campbell
Identify the guidelines by which we identify the HL7 maintained or
externally defined table maintained.
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28. Some general rules for tables were suggested. Use object style naming –
capitalize the first letter, all else in lower case unless appropriately
capitals. Spell names out; do not abbreviate.
29. Steve Brown made a presentation on the GCPR Vocabulary project. See
Gcpr-hl7.ppt. VA and DOD have a requirement to share information. Key
to the GCPR project is vocabulary. They are looking for NLM, standards
organizations, and industry collaborations for solutions that are affordable
to both GCPR and the rest of the community as well. They want
something everyone will adopt. Affordability is important.
30. Sheila Frank reported on the HCFA metadata project.
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