FHIR Terminology Services and Resources
FHIR Profiles & Terminology Binding
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Meeting Recordings
https://drive.google.com/drive/folders/1puHQHB-KM9fYK9tymCjWpY0T9Z39iHOX
Description | Mins | Owner | Notes & Actions | |
---|---|---|---|---|
1 | Welcome and introductions | 2 | @Peter Williams @Rob Hausam | Recording, notes & attendance. Check questions in Zulip and SNOMED International #snomed-hl7-fhir |
2 | Previous Meetings | 2 | @Peter Williams @Rob Hausam | |
3 | Atlassian Migration | 5 | @Peter Williams | New Confluence Space: SNOMED on FHIR Discussion moved to forums: https://forums.snomed.org/c/groups/snomed-fhir/40 |
4 | Other Meetings | 10 | @Peter Williams @Rob Hausam | Recent Events: MedInfo Tai Pei 9 - 13 Aug See https://medinfo2025.org/ HL7 Working Group Meeting and HL7 FHIR Connectathon Sep 13 - 19 Pittsburgh, PA Future Events: Hospitals on FHIR 9 - 10 October see LinkedIn SI SNOMED Business Meetings & Expo October 19 - 24 Antwerp (Update 2025-06-10 Discussion on LLM Abstract submission. KK : https://github.com/IHTSDO/llm-chain-entity-extraction ). See Business Meeting Schedule and Expo Schedule Other Regular Meetings: HL7 Group TSMG (meeting Wed PM ET every other week) - Terminology Service Management Group (HTA Thursday AM is now a subgroup of the TSMG). 2022-05-17 RH Joint session with Vocab at last business meeting. 2022-06-14 Group has approved minimum capabilities for terminology servers. Now looking at bigger/better HL7 Terminology Server HL7 Cross group projects : CDA & FHIR Translation Meetings (weekly): @Jay Lyle Going well, there is an implementation guide and the group is doing connectathons. May in Dallas and Minneapolis. See https://confluence.hl7.org/display/CGP/C-CDA+to+FHIR+and+from+US+Core+Mapping |
5 | European Health Data Space EHDS | 10 | Daniel Karlsson Marie-Alexandra | Feedback on Laboratory by October 13. Imaging deadline 11 Nov. KH See list of deadlines for feedback here: https://ehtel.eu/media-room/open-calls-consultations/open-consultations.html |
6 | Terminology Server Procurement | 10 | Daniel Karlsson | Looking for list of requirements for Terminology Servers (suggestions to speak to Jeremy Rogers (UK) and Rutt Lindstrom (EE)). Also list of servers including ECL version supported MAL - https://darrendevitt.com/the-6-open-source-fhir-servers/ Older link (R4) https://www.antvaset.com/list-of-fhir-terminology-servers |
7 | Explicit syntax for properties |
| Russ Ott
| 2025-08-27 See email thread KKE See bottom of Ontoserver CodeSystem response for SNOMED-CT https://r4.ontoserver.csiro.au/fhir/CodeSystem/32506021000036107-20210204?_format=json |
8 | Round Table Introductions & Updates |
| All | Austria - EHR Coding mandated. Attempting to map ICD-10 to SNOMED CT and also translation Australia - Sparked FHIR Accelerator Programme - https://confluence.csiro.au/x/39Fqa
@Reuben Daniels NB National Extensions of SNOMED need to transition to be self hosted rather than Tx.fhir.org end of 2024. CSIRO @michael lawley now representing the NRC. Terminology Registry - Ontoserver registered as authoritative. Increasing interest from affiliates. Interest in LLM for mapping and matching/ranking in VS. 2025 particular focus on VCL (similar to ECL, for FHIR) especially for R6. 2025-04-06 Interest in LOINC. API usage outside of FHIR ecosystem eg OpenEHR Austria / Germany - Annotating clinical narratives. GemTex - annotated corpus (annotation using SNOMED CT) relations mapped to SNOMED patterns. Looking for more support for mapping FHIR ValueSets to SNOMED concepts - particularly when involving negation, would like to collaborate on common solution. 2024-10-20 @stefan.schulz Focus on translation and indexing (interfacing terminology), analysis of clinical narratives AIDVA - Guide for Annotating Clinical Narratives (SCT + FHIR) B2i @Márk Czotter SnowOwl Terminology Server supporting multiple versions of FHIR at same time. Belgium - National architecture level work being done, to consolidate regional structures. Datasets for Allergies and Vaccinations, Care Plan. Now working on Medication Resources well in progress, Obs and Conditions followed by Procedures. 2025-04-06 E-Prescriptions moving to FHIR. Considering moving Drug Database to SNOMED. Canada - @Linda Bird working with Medicines. Ontoserver installation. Interest in Parameterized ValueSets (See https://build.fhir.org/ig/FHIR/fhir-tools-ig/parameterized-valuesets.html also https://build.fhir.org/ig/FHIR/fhir-tools-ig/parameterized-valuesets.html ). Also interest in access the MRCM. Mapping from Observable Entities to ValueSets, taking dependencies as what was previously entered. Estonia - Medication schema nearly complete. 2024-10-20 Ministry of Social Affairs, switching from CDI3 to FHIR. Issues with document signing on a per Resource basis (possibly enough to prove use of secure gateway), plus issues with data access & permissions. Europe - Laboratory Guide published 2024-10-20 (@Daniel Karlsson ) Ballot to make Lab work a global standard, some issues representing panels. IG for European Patient Summary. Group working on VS for Lab. HL7 Europe projects. "My Health EU" supporting cross border and lab result sharing for 2025 using HL7 Europe IG. "Extended EHR" - logical models to support prioritised areas eg lab, patient summary and IGs based on same. 2025-04-06 Legislation passed that (in 4 years time) will mandate communication in a standardized manner (FHIR + SNOMED most likely) 2025-07-30 Update from @Marie-Alexandra Lambot on the Xia project. See also . Looking at specifying course modules using SNOMED CT concepts in a new extension. Survey on SKILLS: https://ec.europa.eu/eusurvey/runner/XiAWP3survey1, Survey on RESOURCES: https://ec.europa.eu/eusurvey/runner/XiAWP3survey3, Survey on CURRICULA: https://ec.europa.eu/eusurvey/runner/XiAWP3survey4 France - @François Macary Hong Kong - HL7 May Ballot for comment India - Netherlands - Looking for dissemination of patient friendly descriptions + longer explanations. Using FHIR Supplement. May look at converting more code systems to FHIR eg IDMP (see @Rutt Lindström) 2024-10-20 National Terminology Server (Ontoserver) Patient friendly synonyms and explanations. New Zealand - Cancer control agency building FHIR / SNOMED platform for sharing cancer data (multiple domains) with query based FHIR Valuesets. Interested in hearing about: standardizing language reference sets, access to MRCM (see item 20 "MRCM in FHIR" demo being progressed), Concept Maps - logic for dependsOn (see Concept Map in R5) & how to select ValueSets based on context, Syndication (see https://github.com/IHTSDO/termserver-syndication but this is not FHIR. FHIR uses more of an NPM approach), Query Specification (Query based reference sets their expansion). @Peter Jordan Affiliate Engagement Group. Notes that 30% of (personal) primary health record codes did not pass validation. Recommends LinkedIn FHIR group, see https://www.linkedin.com/in/darrendevitt/ Notes that Tx.fhir.org never supported ECL hence need for National TS to come into play. See also HealthPoint use of SNOMED CT presentation. CCA @Linda Bird 2024-10-20 NZHTS National TS (Ontoserver) using CanShare language reference set for patient friendly terms. Norway - Sweden - Swedish national FHIR profile 2024-10-20 HL7 Sweden discussing TS for building Swedish IGs. Existing TS is MVP so procurement underway with growing requirements. Alerting work collaborating with Norway eg question of what is alert worthy. 2025-04-06 Swedish eHealth (not the NRC). Working with HL7 Sweden to set up national terminology server. Implementing FHIR for national services. Switzerland - SNOMED International - internal work to reduce configuration using archive hierarchy with cached metadata. Request for MLDS badges. 2025 Work scheduled to bring Snowstorm into line with IG Tooling requirements. See also implementation demos, growing in number, here: https://ihtsdo.github.io/sct-implementation-demonstrator/#/ Spain - (SS update) RESQ+ Harmonizing data acquisition forms for stroke, looking to standardize form across several languages. Difficult to work with clinicians directly in SCT, more success using SCT in FHIR context United Kingdom - UK Core based on R4, developing IGs and Profiles. Medicines, GP Connect Profile, National Terminology Service used for mappings and ECL expansions (looking to use for primary publication point). Pathology team developed IGs, challenge moving from legacy arrangements. OpenEHR being revisited. Interested in SNOMED Extended maps in FHIR (see Concept Map in R5 ) and making it more automatically executable. 2024-10-20 @Stuart Abbott Improved dose syntax. 2025-04-06 progress made particularly on pathology. Daedelus support services for multiple countries using Ontoserver. Running "Learnathons" with InterOpen. United States - US CDI draft of v5. Cancer on FHIR - connectathon at HIMMS Regenstrief @Robert McClure Gravity - Social determinants of care. Interest in how the MRCM is being applied. |
9 | Surfacing Annotation values |
| @Peter Williams | How will we make concept annotations available via CodeSystem$lookup? 5.2.4.8 Component Annotation String Value Reference Set TODO: Produce a list of codes that are used as properties in $lookup responses |
10 | Parameterized ValueSets |
| @Linda Bird @michael lawley | Parameterized ValueSets (See https://build.fhir.org/ig/FHIR/fhir-tools-ig/parameterized-valuesets.html also https://build.fhir.org/ig/FHIR/fhir-tools-ig/parameterized-valuesets.html ) This extension allows one or more parameters to be passed into a valueset definition such that the underlying code system can be interrogated using the value of parameter to filter the full list down to some subset. |
11 | Tx Ecosystem |
| @Daniel Karlsson | ML Owner of extension gets to say what the authoratative source for that extension is. Registration (after proving conformance) is done via a json file - pull request to a GitHub repository |
12 | Snowstorm FHIR API Workplan |
| @Peter Williams @Kai Kewley | The following Snowstorm FHIR API work is planned for May/June
@Kai Kewley would like to see this work completed in Snowstorm-X first, so it can be released and tested prior to being included in Snowstorm. |
13 | Concept Maps |
| All |
|
14 | LOINC Ontology |
| @Peter Williams | http://loincsnomed.org version 1.0 released 2025-03-21 See Surfacing Alternate Identifier Values in FHIR URI will use the LOINC module http://snomed.info/module/11010000107 RMcL makes distinction between the identifier and the code See Zulip discussion https://chat.fhir.org/#narrow/channel/179202-terminology/topic/Alternate.20Codes ECL 2.2 specifies support for Alternate Identifiers see 6.1 Simple Expression Constraints eg LOINC#54486-6 (which would be expanded inline before any further processing is done). DK wondered if this could be used more widely, eg for lookups ML Suggests that alternate codes in a different CodeSystem should not be surfaced as an alternate code via a CodeableConcept Shrimp exposes "Identifier" as a Coding type, so specifies both that it's the LOINC URI and the code See also https://chat.fhir.org/#narrow/channel/179166-implementers/topic/Conditional.20additional.20bindings RMcL Particular interest in the Document Ontology |
15 | European Projects |
| @Marie-Alexandra Lambot | Xia (eXpanding Innovation Alliance) European Project - 11 February, starting with review of existing teaching material (to level of BSc) - SNOMED, LOINC & FHIR. Working in English. Looking for review, identification of gaps. 2025-04-06 See https://be.linkedin.com/company/csct-be Looking at educating both implementers and Healthcare Professionals. Looking to take existing materials and transform into micro-courses. https://www.linkedin.com/company/xia-eu-project MAL To join for an interview of your needs https://forms.office.com/Pages/ResponsePage.aspx?id=gExd0B7a10yDpg0glLIEGC7IDn-Y609HruE58vzlKb9UNUE2MzBZT1oxTlc5NEFBVks0VTBHREZQQy4u This quick survey of needs that can be shared with users: https://forms.office.com/Pages/ResponsePage.aspx?id=zVoFSJuyw0aY70P78H6TDibonnaXyVZPpjGQQFEwQpxUMkRaUTAwWkpYTEE5RFQxSjhBSFhMSkQ0SC4u Many thanks for those who will take the time to answer it and you're welcome to join our CSCT pages and the XiA page on LinkedIn to follow the evolution of the project SS AIDAVA - project in 3rd year, free text annotation. Simple Ontology Co-creation workshop December 2 2025. |
16 | Magic Codes Zulip Discussion |
| @Peter Williams @Daniel Karlsson @Rob Hausam | Magic Codes and Observable Entities as Questions and Clinical Findings as Answers |
17 | Support for Clinicians in using Information Models |
| @Kusal Wijayaweera | Suggested resources: Introduction - Clinical Reference Groups https://confluence.ihtsdotools.org/display/CP SNOMED CT Clinical Implementation Guide for Allergy, Hypersensitivity and Intolerance |
18 | FHIR Observation Observation VS for Vital Signs |
| @Rob Hausam | HL7 Orders and Observations Workgroup looking at Observation profiles for Vital Signs and Value Sets for what is considered to be a vital sign and need to consider SNOMED CT (possibly also NPU) for analogous value sets, started with LOINC. DK We have looked at this - suggests using the superset of this material and allowing users to work with a cut down set. Concerns that this might need to be context specific. SA, UK has also looked at this. SH Could take forever to agree a set of vital signs, better to specify archetypes of data required. |
19 | Post Coordination |
| @Feikje Hielkema (Unlicensed) | Information models as expression of post coordination → classifying to determine equivalence with pre-coordinated content. Would like to associate a FHIR Resource with a SNOMED Template @Linda Bird noted (from previous work done) that the solution involves first defining the template and then working out the transformation to comply with the concept model. DK notes that this equivalence with the SCT model does not always correspond. SS notes problem with representing (specifically in modeling/classifying) negation in SCT. FHR Lack of documentation that explains 'this is how to approach the problem' |
20 | Question on de-labelling allergies |
| @Kusal Wijayaweera | PWI Suggested Verification Status = Refuted here: https://build.fhir.org/allergyintolerance.html (DK See previous work done mapping to SCT Free SNOMED CT set for FHIR eg 723511001 | Refuted (qualifier value) | / 410594000 |Definitely NOT present (qualifier value)|) See also SNOMED CT Clinical Implementation Guide for Allergy, Hypersensitivity and Intolerance And https://ihtsdo.github.io/sct-implementation-demonstrator/#/allergies |
21 | HL7 and OpenEHR |
| @Maryam Razavi @Alejandro Lopez Osornio | |
22 | Use of Codeable Concept to transmit multiple codes |
| @Kath Priest @Daniel Karlsson | EU requirements for transmitting closest SNOMED International codes along with relevant local code systems is a great use case for the new ECL Top and Bottom operators. Having this requirement come from the Member Forum would assist in ensuring that the implementation of this feature into Snowstorm is prioritised. @Daniel Karlsson Note that Top and Bottom operators simplify access, which can be replicated in earlier implementations of ECL with a more complex query: 6.12 Top and Bottom ALO See also Interoperability Demo (last tab) at https://ihtsdo.github.io/iid-ips/ which offers the closest concept in the IPS Set, along with the ECL used to obtain it. |
23 | Translation in Code System Supplements |
| @Daniel Karlsson | Translation in Code System Supplements. See Zulip discussion https://chat.fhir.org/#narrow/stream/179202-terminology/topic/CodeSystem.20supplement.20use.20cases See also https://build.fhir.org/ig/FHIR/ig-guidance/languages.html#creating-a-language-pack |
24 | Terminology Binding in the Condition FHIR resource |
| @Katrien Scheerlinck (Unlicensed) | There is currently a discussion going on in Belgium regarding the desirable terminology binding in the Condition FHIR resource. We are working together with a group of clinicians/domain experts who almost all indicate that there are a whole series of finding concepts in SNOMED CT, which are required in the use case of diagnosis registration in the patient. As well, the information website (https://build.fhir.org/condition.html) on this FHIR resource indicates that, in case of persistent symptoms or in case there is no official diagnosis yet, only symptom identification as a preliminary diagnosis, concepts from the finding hierarchy may be used: “…alt hough in some cases a persistent symptom, e.g. fever, headache may be captured as a condition before a definitive diagnosis can be discerned by a clinician.” What would be your opinion on this? Hoping this helps to give a direction to the discussion including good, substantiated arguments. ML See https://build.fhir.org/ig/hl7au/au-fhir-core/StructureDefinition-au-core-condition.html LB Has anyone looked at the alignment of the verification status and explicit context concepts? PWI This group looked at this as part of the proposed "Free Set" in 2019 - see FHIR SNOMED CT Free Set - Questions for HL7 (Amber mappings). Consider the likes of << 41769001 |Disease suspected (situation)| and << 373573001 |Clinical finding present (situation)| ML Existing issues: “probably not present” is a child of “Known absent” where the term “probably not” indicates that it is NOT a child of “Known absent” |
25 | Resources for Allergy Intolerance / Adverse Events |
| @Kusal Wijayaweera | Question on Allergy Intolerance resources. Group responded with: SNOMED CT Clinical Implementation Guide for Allergy, Hypersensitivity and Intolerance https://build.fhir.org/ig/HL7/fhir-ips/ValueSet-allergy-intolerance-snomed-ct-ips-free-set.html https://ihtsdo.github.io/sct-implementation-demonstrator/#/allergies March 1, 2024 Allergy CRG meeting agenda Previous discussions listed in : https://snomed.atlassian.net/wiki/display/FHIR/Discussions Allergy Intolerance vs Adverse Events TODO: Archive |
26 | How to handle ad-hoc post coordination in medical records |
| @Kusal Wijayaweera | Question about EHRs containing unconnected concepts - like post coordination but not using SNOMED Compositional Grammar. Like 12345005, 5678004 (which is syntactically invalid according to SCG) or 185324002 |Failed encounter| + 281399006 |Did not attend (finding)| (UK) + 275694009 |Patient defaulted from follow-up (finding)| (this would actually be valid syntax as these are considered to be parents, but would need to come from same hierarchy). See also 410543007 |Did not attend (qualifier value)| ML Well expressed post coordinated expressions are allowed in FHIR, but the challenge is what might this mean to some client system. AP Suppliers are particularly resistant to receiving even the simplest post-coordination and would prefer to have atomic concepts split out to make use of the information model (might even get stored as free text if supplied but unexpected). PWI Specific example allows for general rules to be determined eg Failed Encounter is redundant due to more specific concept in list, or that we could particularly flag up concepts which come from separate hierarchies as needing intervention. |
27 | IPS ValueSet Question raised | 15 | @Alejandro Lopez Osornio | https://jira.hl7.org/browse/FHIR-44904. "Resolve SNOMED Version challenge with value set" Canada specify version details for each filter in a valueset specification, which then trips validation when the version being expanded against does not match. DK: If you use extension content then you need to specify the version to know where the concept exists. Although the lookup will work across multiple versions. ML: Note that compose/include/filter descendent of that specifies the core edition, and so it would not include Canadian concepts. Also, a version - if included - should include the effective time. Discussion about sending both the local code plus the IPS / International Code using a Codeable Concept (in that case the version element of each code would indicate which one is International. Or a test could be made for subsumption) which could be determined using (ML supplied) ECL: !<< (>> my_local_code AND ^ IPS_refset) See also https://ihtsdo.github.io/iid-ips/ and be aware of new ECL top and bottom operators which could be used to simplify this. |
28 | MRCM in FHIR |
| @Linda Bird
| Exposing the MRCM in FHIR KK Exposing it directly would be difficult because we can return lists of concepts, but we cannot return a string eg ECL ML Thought it could be exposed via the CodeSystem as another property - metadata about each domain's range. LB Use case is driving an expression or ECL editor (KK Remember content type). KK choice between (simple) server statement vs (more work) implicit expansions. |
29 | General Discussion |
| All | Misc Discussion Internal discussion on languages in general and specifically latin words. MAL suggested looking at https://iate.europa.eu/home which includes latin. See Latin Terms - Discussion Snowstorm-lite revisited (see 2024-01-09 - SNOMED on FHIR Meeting (TS & TB) ) URIs and Identifying Modules - "Edition identifier" - this is the full URI, not just that module. "Most dependant module" - yes but fails in the International Edition. "Identifying Module". "Root module" - Not always the top/bottom of the hierarchy. |
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