Welcome and introductions

5

@Rob Hausam

@Peter Williams

Recording + Notes.

Summary of previous week (TS) and previous TB

5

@Rob Hausam

@Peter Williams

• 2020-04-07 - SNOMED on FHIR Meeting (TS)

• 2020-03-31 - SNOMED on FHIR Meeting (TB)

Future meetings

5

@Rob Hausam

@Peter Williams

Upcoming events: 

SNOMED International Business Meeting April 5 - 8 SNOMED on FHIR meeting Sunday 5 April - CANCELLED

San Antonio HL7 Meetings + Connectathon May 16 -17 Cancelled. Virtual connectathon being discussed, potential charge for admission being discussed.

FHIR DevDays - June 16-18, 2020 Cleveland, OH (Update 10 March: RD: Go/No Go decision 10 May. DK: US expected to peak late April)

HL7 Baltimore September 18 - 25

SI Business + Expo October

April 14: HL7 FHIR Connectathon is going to run May 13-14-15, a 24 h event.

https://confluence.hl7.org/display/FHIR/2020-05+Connectathon+24

FHIR Dev Days also an online event.

COVID-19

A COVID-19 Guide is in development.

Use of Observation et al. resources for identifying laboratory, PoC and/or home tests plus combinations like patient specimen collection for lab test. A combination of Observation, Specimen, Device, and DeviceDefinition resources could meet such needs. Also, new Observation.code values will likely be created to allow this differentiation as well.

Revisit Immunization

45

Immunization

April 14:

A generic SNOMED CT concept for "key worker" (or just "target population") is needed to state an immunization reason, or a reason for an immunization recommendation.

Follow up on Blood Pressure.

10

@Daniel Karlsson

@Andrew Perry

Is the "vital signs" scope too limited?

Distinction being made between "Vital Signs" blood pressure and general blood pressures.

No conclusion reached on "panel codes". Compromise to use whatever is recorded on the system and where none available use a high level concept.

Update 17 March: DK - NHS Limiting Scope, any update? Answer: No. Decided to transmit all blood pressures and other < 248326004 |Body measure (observable entity)| (blood pressure is not a body measure!), but only those that met the FHIR binding would have the LOINC code and relevant category.

Specimen

30

@Riki Merrick

Specimen binding. Update from HL7 Specimen Project Group by @Riki Merrick (and offer to review this group's work!)

DK Both FHIR and SNOMED have reasonably elaborate models for dealing with these which creates "interesting" opportunities for binding discussions.

Discussion on why Specimen (which - as an industry - has been around forever) is only at maturity level 2. Perhaps there's a lack of production implementations. DK: Specimen is a potential candidate for a SOF Published Profile.

Implementation Guide

31

@Peter Williams

The Implementation Guide is now building fine. Please everyone have a look and share comments. http://build.fhir.org/ig/IHTSDO/snomed-ig/index.html

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)|)

Update 31 March 2020 - PWI: links above no longer work. I was unable to find obvious alternative via http://hl7.org/fhir/us/mcode/

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

14 Jan 2020: Update from Rob on his progress with a new FHIR Template infrastructure. Required migrating/juggling what we had already built on older infrastructure. Sits under our implementation guide materials at build.fhir.org/ig/IHTSDO/snomed-ig/branches/new-template/ as Option 6: SNOMED Specific Profiles

Differential Table view shows the difference between the parent resource and our SNOMED-specific further profiling of it.

Discussion around practicalities of handling bindings where the ECL isn't very pretty, but the enumerated membership list could change very frequently e.g. a list of codes for vaccine preparations (or procedures) that are specifically relevant to some national childhood immunisation programme, and which can therefore change monthly as new vaccine preparations become available. Preferred implementation solution would be for suppliers to be able to consume ECL, however complex.

Discussion about what kind of separation should exist between the Implementation Guide (which should list things we think everybody should be doing in some certain way) and any more discursive musings that have have not reached that level of consensus or experience.

Thoughts on whether the IG should be balloted, and how to assess the maturity of any of it? Should each SNOMEDonFHIR published profile have its own (1-5) maturity metric stated?

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

Next meeting

5

28 April 2020