1. 1 CTS 2 Status Harmonization Update Oxford Harmonization Meeting OMG Technical Meeting HL7 Working Group Meeting CTS 2 Submission Team March 17, 2011

2. Agenda Harmonization Meeting Updates Oxford Harmonization Meeting OMG Technical Meeting HL7 Working Group Meeting Current Status OMG Submission Timeline Resources

3. Oxford Harmonization Meeting Held in Oxford, UK from November 29 to December 3, 2010 Attendees: Harold Solbrig, Russ Hamm Representatives from: Apelon, Inc. Codicies IHTSDO Oxford University Mayo Clinic UK National Health Service (NHS) 3

4. Oxford Harmonization Meeting Monday-Tuesday Met with Jim Davies and Charles Crichton and reviewed various aspects of the model, including the representation of cardinality, the designation and use of optional parameters in method calls and the aggregation of methods into services. Dr. Davies indicated that the underlying approach was valid and requested that Oxford be included as a supporter on the final document. Wednesday Met with Fernando Gallo (Codicies), Ann Wrightson (NHS Wales), Russ Hamm and John Carter (Apelon), Jim Davies and Charles Crichton (Oxford) and Sarah Ryan (Ockam). The meeting focused on the update and authoring portions of the model and we received a lot of input on how the information needs to be modeled and presented for the final document. 4

5. Oxford Harmonization Meeting Thursday Discussion on the current state of the CTS 2 specification with respect to SNOMED-CT and IHTSDO The structure, philosophy and approach being taken Met with John Guttai, David Markwell and Ann Wrightson (NHS Wales), Fernando Gallo (Codicies) Russ Hamm, Jim Davies, Charles Crichton (Oxford) and Sarah Ryan (Ockam). Discussed IHTSDO's take on authoring (they were of the opinion that it was not well enough understood to standardize) and the IHTSDO Release Format 2 model. 5

6. Oxford Harmonization Meeting Thursday (continued) Discussed work that David Markwell has been doing regarding post- coordinated value sets, agreeing that that portion of the project was not sufficiently mature to include in CTS2. Received guidance about restructuring the submission and what it needed to do in order to receive IHTSDO approval. Discussions: Representation, selection and application of constraints including: Search constraints by reference sets Extension and intensional Static and dynamic (i.e. pre-declared and on-the-fly) Post-coordinated expressions constraints Semantic expression constraints Literal expression constraints 6

7. Oxford Harmonization Meeting Thursday (continued) Discussions: Classifier integration and related functionality CTS 2 support for SNOMED Release Format 2 (RF2) Significant discussion surrounding the update model for CTS 2 Need to ensure that workflow and business process pertaining to terminology management is not mandated by CTS 2 Need to demonstrate RF2 support Contents of RF2 is the complete content of SNOMED since 2002, managed via active/inactive flags Received a IHTSDO commitment to endorse all sections of the specification except authoring conditional on the discussed changes being met. On December 15, 2010 the IHTSDO Workbench voted to formally support CTS 2, with the exception of the update model. 7

8. Object Management Group Meeting Held in Santa Clara, CA from December 6 – 10, 2010 Attendees: Harold Solbrig, Craig Stancl Met with the Healthcare group to present an outline of the submission. Met with the Ontology PSIG to review what we were doing on the model and presented the issues we were facing. Fed CTS2 requirements into the API4KB project, which is attempting to standardize the RDF/OWL API, which currently has multiple implementations (Jena, Protégé 3, Manchester API and others). CTS2 requirements dovetailed well with other groups and also provided possible solutions to some of the issues. 8

9. Object Management Group Meeting Discussed Ontology identity vs. reasoning engines - whether the identity of an ontology changes after a particular reasoner has been applied. Feedback was incorporated into CTS2 specification. Both of these meetings (Healthcare and Ontology) provided significant feedback that led to a wholesale restructuring of the submission document as well as significant changes in how it was represented. 9

10. Object Management Group Meeting Deliverables: Presentation to the Healthcare Domain Task Force on Wednesday, December 8, 2010 https://cabig-kc.nci.nih.gov/Vocab/uploaded_files/2/2f/OMG_CTS2.pptx Presentation to the Ontology PSIG on Thursday, December 9, 2010 https://cabig-kc.nci.nih.gov/Vocab/uploaded_files/e/ed/OMG_OPSIG.pptx 10

11. HL7 Working Group Meeting Held in Sydney, Australia from January 9 – 14, 2011 Attendees: Harold Solbrig, Russ Hamm, Craig Stancl Presented outline of submission to Vocabulary working group and participated in a series of related discussions. Met with Lloyd McKenzie to begin education and harmonization alignment steps for MIF and other HL7 models. Met with the HL7 SOA working group and presented the work being done and got advice on how to organize and structure the submission. Presented to the "SOA in Healthcare Day" on CTS2 and its content and got significant buy-in from the community. 11

12. HL7 Working Group Meeting Met with ONC where it was agreed that a one cycle submission delay would be acceptable and committed to having the ONC developers look at and work with the specification prior to submission. This decision partially resulted in a request to move the OMG submission deadline to move from February 21, 2011 to May 23, 2011. 12

13. HL7 Working Group Meeting Deliverables Presentation to the HL7 Vocabulary Working Group on Jan 11, 2011. https://cabig-kc.nci.nih.gov/Vocab/uploaded_files/8/82/HL7_CTS2.pptx 13

14. Current Status “Status Report” (current draft submission) submitted to OMG ADTF on Feb 21, 2011 in place of original final submission (anticipated May 23). https://cabig-kc.nci.nih.gov/Vocab/uploaded_files/b/bb/OMG_20110221_CTS_2_Submission.pdf UML model is approaching a steady state Fundamental Model and Functionality remains consistent with first submission(s) Work continues on: Refactoring and refinement: each community has its own needs and “non- negotiables” Naming: each community has its own names Formal semantics: a precise specification is a lot of work Exception handling Scheduled for submission to OMG on May 23, 2011 for June meeting. 14

15. CTS 2 Timeline Event or ActivityDatePurpose OMG Technical Meeting (Arlington, VA) March 21- 25, 2011 Update Healthcare DTF and Ontology PSIG and request submission extension. Update Healthcare DTF Provide updates to the working group. Review specification and solicit feedback. Update Ontology PSIG Attend ADTF present current status and request change of date for revised submission March 23, 2011 Make a motion to request change for revised submission date. CTS 2 Community Support Session (Rockville, MD)March 28- 29, 2011 Review CTS 2 spec with interested groups. CTS 2 Peer Review Sessions (NCI, VKC, HL7, IHTSDO, Codices, etc) April 2011Review CTS 2 spec with community groups. On-going CTS 2 specification updates based on accepted feedback from community. current - May 2011 Finalize submission content. HL7 Working Group Meeting (Lake Buena Vista, FL) May 15-20, 2011 Vocab and SOA Work Group meetings for PIM finalization. Update Vocabulary Working Group Update SOA Working Group Revised Submissions Due (new)May 23, 2011 New date if approved by the ADTF. Submit final submission.

16. CTS 2 Timeline (Continued) Event or ActivityDatePurpose OMG Technical Meeting (Salt Lake City, UT)June 20-24, 2011 To present final revised submission to OMG and numerous votes. Revised Submission Presentation June 20-24, 2011Present CTS 2 final submission. Final evaluation and selection by TF / Recommendation to AB and TC June 20 and 23, 2011OMG Process TC Vote to recommend specification June 20, 2011OMG Process [Anticipated] Approval of recommendation by Architecture Board / Review by TC June 23, 2011OMG Process Platform Technical Committee Adoption Vote June 24, 2011 OMG Process Charter Finalization Task Force Following the passing of the spec, a finalization task force is chartered (FTF) to address technical issues that arise from implementation feedback based upon the publicly available spec. Publication of Beta Specification to OMG websiteJuly 2011Specification available for implementers. OMG Technical Meeting (Cambridge, MA)June 18-22, 2012FTF Report. Finalization Task Force Report to ABJune 18-22, 2012The FTF produces a report and a set of deltas to the specification that are defended to the AB. Following a successful AB vote, an implementation questionnaire must be completed by two business entities indicating that the spec has been implemented. That is the precondition to the BoD vote. OMG Technical Meeting (Jacksonville, FL)September 10-14, 2012 Attend Healthcare DTF and Ontology PSIG meetings. Attend final vote. BoD Vote to adopt specificationSeptember 10-14, 2012 Vote to adopt specification.

17. Resources CTS 2 Submission Wiki http://informatics.mayo.edu/cts2/index.php/Main_Page HL7 CTS 2 SFM (DSTU) http://www.hl7.org/documentcenter/ballots/2009may/downloads/V3_CTS_R2_DST U_2009OCT.pdfhttp://www.hl7.org/documentcenter/ballots/2009may/downloads/V3_CTS_R2_DST U_2009OCT.pdf OMG RFP for CTS 2 http://www.omg.org/cgi-bin/doc?ad/2009-9-17 CTS 2 Submission Team Harold Solbrig (solbrig.harold@mayo.edu)solbrig.harold@mayo.edu Russ Hamm (rhamm@apelon.com)rhamm@apelon.com Rick Kiefer (Kiefer.Richard@mayo.edu)Kiefer.Richard@mayo.edu Craig Stancl (stancl.craig@mayo.edu)stancl.craig@mayo.edu 17

18. Questions? 18