Welcome and introductions

5

@Peter Williams

@Rob Hausam

Recording + Notes.

Summary of previous week (TS) and previous TB

5

@Peter Williams

@Rob Hausam

• 2019-11-12 - SNOMED on FHIR Meeting (TS)

• 2019-11-05 - SNOMED on FHIR Meeting (TB)

Future meetings

5

@Jane Millar

FHIR DevDays Amsterdam, November 20 – 22, 2019

HL7 Sydney, February

Christmas Break: Skip 24 + 31 Dec great idea, seconded, carried.

URI Standard update

10

@Peter Williams

The SPLG workgroup discussed this

http://snomed.info/valueSet/GPS

Update this causes a problem in the tooling as it demands a capital V in ValueSet.

http://snomed.info/fhirStructureDefinition/example

Free Set Response

5

@Jim Case

2019-11-05:

The five bullet points from the Sunday morning meeting were discussed. In summary:

• This group is at this stage not going further with the "red mappings". The group does currently not see value in this work.

  • A SNOMED CT code for an adjective provides little benefit, beyond in a pure technical sense. Bridging between alternative representations where overlap exists and diverging modeling patterns have been applied on each side, is thought by the group to be prohibitively difficult. The problems identified previously by TermInfo and other pieces of work have yet again proven to be a barrier.

• Anyone including the VA may progress the issue further by doing research, depending on the outcome, which might or might not lead to a change of this groups work plan.

• The group thinks that the work was an interesting exercise, but any future similar work should focus on areas where the use of SNOMED CT provides real benefit.

Implementation Guide

@Peter Williams

Did we conclude on the best approach(es) for semantic overlap between fields as discussed in Terminology Binding

Update: Option 4 seems the most elegant - "BodySite must always be a specialization or self of finding site" although BodySite is an easy example since the mapping to the SNOMED concept model (finding site) is well understood. It would not work for Condition.Status where resolved/remission is not represented in attribute values.

Update 17 Sept: If we were to express ValueSets for profiles using Refsets (which this group would have to curate and publish) then National Centres could add to those refsets using their own module.

Update 15 Oct >2 issues:

1. We're still seeing only the differential in the profiles, no option to view the snapshot

2. The link from profile to a ValueSet uses a slash (eg http://build.fhir.org/ig/IHTSDO/snomed-ig/ValueSet/bodyheight.html - does not exist) and navigating from the ValueSet itself uses a dash (eg http://build.fhir.org/ig/IHTSDO/snomed-ig/ValueSet-bodyheight.html )

3. Only the first element in the differential is being displayed. The page appears to cut off early. See http://build.fhir.org/ig/IHTSDO/snomed-ig/StructureDefinition-AllergyIntolerance-SubstanceFocused.html

@Rob Hausam Check with Lloyd McKenzie and Eric Haas if their two frameworks have been fully

Free SNOMED CT Set for FHIR

@Jane Millar

@Jeremy Rogers

@Daniel Karlsson

Free SNOMED CT set for FHIR

25 June. Grahame keen to see work done on both sides to bring us closer together in the ValueSets concerned with clinical safety:

-          AdverseEvent.outcome (red)

-          Condition.clinicalStatus & AllergyIntolerance.clinicalStatus (amber) These are the same items although in separate Valuesets. HL7 could discuss making them a single ValueSet.

Observation resource

@Jeremy Rogers

See updates here: Observation binding

Cancer Disease Status

Carmela Couderc

http://hl7.org/fhir/us/mcode/2019Sep/StructureDefinition-onco-core-CancerDiseaseStatus.html

http://hl7.org/fhir/us/mcode/2019Sep/ValueSet-obf-datatype-ConditionStatusTrendVS.html

Query about qualifier values used. Would it be better to use < 418138009 |Patient condition finding (finding)| ? (JR suggested immediate children ie "<!" rather than descendants)

See also 373117000 |Pathology examination findings indeterminate (finding)| (child of 250537006 |Histopathology finding (finding)|)

Exemplar Profile

@Daniel Karlsson

@Jeremy Rogers

Publishing Profiles

• Wrapped by implementation guide - in this case https://github.com/IHTSDO/snomed-ig

• Value set publish to a live SI hosted Snowstorm instance. Alternatively @michael lawley has offered to host.

• Additional hosting on Simplifier (STU3, not yet R4 - January?)

• Suggestion to review work already done to ensure R4 compatibility

• Would value sets also be published as reference sets? Maintain via Refset tool and published in MLDS. Note: UK experienced substantial 'getting off the ground' effort in this area. Sweden have worked through ~10 (will request promotion of content to International Edition where appropriate).

• HL7 FHIR Registry?

• Option to have multiple profiles available at the same time using slicing.

• Chance to do some technical work at HL7 San Antonio

Options for Profile discussion:

Notes 26 Feb: UK working on pathology reporting - diagnostic / observation.

Suggestion that we try out two types of profile, both of which avoid issues of conflict between fields within the information model:

1. Where we only use the code field for clinical content (plus the administrative fields)

2. Where we restrict the code field to atomic values and all other resource fields should also be populated. Note that this does not solve the role group problem.

28 May: Plan to publish profile for the October conference (8 sessions + working between meetings. Completion for review Tues 14 October (or earlier since we'll need time to complete the IG?)

• Build implementation guide

• Setup FHIR server with relevant valusets

Tooling for profiles: Forge (.NET) is now R4

RH: Suggestion that "published" valuesets would be read-only.

Allergies

@Daniel Karlsson

Revisit any outstanding questions on Allergies.

External publication of v0.1 of the AllergyIntolerance resource

Vital Signs

10

@Daniel Karlsson

Vital Signs Profile of Observation Resource

Jeremy's work to compare Vital signs profile and SNOMED Subhierarchy - issues with eg blood pressure. Complex expression constraints available which cover the use of observables by the NHS(UK). Mapping to LOINC codes.

See Spreadsheet attached to: SNOMED on FHIR Meeting (TB) - Tuesday 21 August 2018

Issues / Discussion :

• Normative vs. descriptive purpose - 1, 2, or 3 profiles?

• Unresolved modeling issues

2019-08-20:

Update of the Vital Signs panel binding page.

Discussion about the Vital Signs FHIR profiles and how to profile those to SNOMED profiles. We are going to create SNOMED profiles on the specific FHIR Vital Signs profile (e.g. Heart rate) and declare conformance with a generic SNOMED Vital Signs profile.

v3.0.1

ProcedureRequest

ReferralRequest

v3.4.0 (publication Aug 19?)

ServiceRequest

X

@Daniel Karlsson

These two separate resources existed in the FHIR 3.0.1 Spec. @Rob Hausambut have been removed in 4.0 and replaced with ServiceRequest

http://build.fhir.org/servicerequest.html → ServiceRequest

Questions:

• What determines which FHIR resource to use: the location of the data item in the sending system’s information model, or the semantics of the particular code regardless of where it was found? Some hybrid of both?

• If the resource to be used is determined at least partly by the location in the sending information model, how does a requesting system cope with the fact that different implementations (or different users of the same implementation) both can and do secrete essentially the same clinical info in very different parts of the host information model?

Need to revisit the original questions raised in this group wrt the two separate resources of yore, and consider whether the same issues persists wrt the new single ServiceRequest resource.

Next meeting

5

3 December

Procedure followed by Care Plan